《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (4): 416-422.doi: 10.3969/j.issn.1006-9771.2023.04.007
黄承兰1, 侯俞彤1, 杨云霄1, 曾红2a, 张子砚3, 赵文宽4, 王赞博5, 单春雷6, 戴尅戎2b, 蔡斌2a, 王金武2b()
收稿日期:
2022-08-20
修回日期:
2023-03-21
出版日期:
2023-04-25
发布日期:
2023-05-19
通讯作者:
王金武(1971-),男,汉族,上海市人,博士,教授、主任医师,主要研究方向:骨科、康复工程。E-mail: 作者简介:
黄承兰(1997-),女,彝族,贵州毕节市人,硕士研究生,主要研究方向:肌肉骨骼康复、康复工程。
基金资助:
HUANG Chenglan1, HOU Yutong1, YANG Yunxiao1, ZENG Hong2a, ZHANG Ziyan3, ZHAO Wenkuan4, WANG Zanbo5, SHAN Chunlei6, DAI Kerong2b, CAI Bin2a, WANG Jinwu2b()
Received:
2022-08-20
Revised:
2023-03-21
Published:
2023-04-25
Online:
2023-05-19
Contact:
WANG Jinwu, E-mail: Supported by:
摘要:
目的 了解矫形鞋垫的分类,3D打印矫形鞋垫常用技术、常用材料及其在扁平足中的应用。
方法 检索PubMed、Web of Science、中国知网和万方数据库2012年至2022年发表的相关文献,总结相关内容。
结果 最终纳入文献10篇,来自5个国家,涉及290例参与者,发表时间主要集中于2019年至2022年。矫形鞋垫可分为预制型、半定制型和定制型,其中定制型可分为传统定制型和3D打印定制型。3D打印制作矫形鞋垫时常选择的打印技术为选择性激光烧结、熔融沉积成型(FDM)和PolyJet打印,材料包括乙烯醋酸乙烯酯(EVA)、聚乳酸、热塑性聚氨酯、聚酰胺、聚丙烯。3D打印矫形鞋垫应用于扁平足,改善足底压力,缓解足部疼痛,联合使用鞋垫张贴能有效控制后足外翻。
结论 3D打印定制鞋垫的制作效率和精确度优于传统定制鞋垫;常选择的打印技术和材料主要为FDM和EVA。3D打印矫形鞋垫可对扁平足足底压力、舒适度和足部运动功能产生积极影响。
中图分类号:
黄承兰, 侯俞彤, 杨云霄, 曾红, 张子砚, 赵文宽, 王赞博, 单春雷, 戴尅戎, 蔡斌, 王金武. 3D打印矫形鞋垫在扁平足中应用的系统综述[J]. 《中国康复理论与实践》, 2023, 29(4): 416-422.
HUANG Chenglan, HOU Yutong, YANG Yunxiao, ZENG Hong, ZHANG Ziyan, ZHAO Wenkuan, WANG Zanbo, SHAN Chunlei, DAI Kerong, CAI Bin, WANG Jinwu. 3D printed orthopedic insoles for flatfoot: a systematic review[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(4): 416-422.
表1
纳入文献的基本特征"
文献 | 国家 | 样本特征 | 鞋垫类型 | 鞋垫材料 | 打印 技术 | 干预方案 | 评估 | 结论 |
---|---|---|---|---|---|---|---|---|
Jandova等[ | 捷克 | 正常足(n = 26) 扁平足(n = 18) 高弓足(n = 7) | 原始鞋垫; 定制鞋垫; 3D打印解剖鞋垫 | EVA | PolyJet | 佩戴鞋垫站立和行走 | 测量使用3种鞋垫行走时的足底压力分布 | 定制鞋垫和3D打印解剖鞋垫可改善扁平足足底压力 |
Xu等[ | 中国 | 扁平足(n = 80) | 3D打印定制鞋垫; 预制鞋垫 | EVA | 未提及 | 每天穿戴6~8 h,持续8周 | 测量足底压力;VAS | 3D打印定制鞋垫可改善足底压力分布,并提高舒适度 |
Cherni等[ | 加拿大 | 扁平足(n = 19) | 3D打印柔性矫形鞋垫; 带张贴的3D打印柔性矫形鞋垫; 3D打印刚性鞋垫 | 未提及 | 未提及 | 穿戴不同鞋垫持续步行3 min | 测量穿戴不同鞋垫下足底压力;肌电图 | 刚性鞋垫可改善足底压力,压力中心向中外侧方向位移减少,步行时姿势稳定性提高 |
赵碎浪等[ | 中国 | 扁平足(n = 9) | 3D打印全负重鞋垫; 3D打印半负重鞋垫; 3D打印非负重鞋垫 | PLA | FDM | 步行8 m | 测量足底压力;VAS | 带足弓支撑的半负重3D打印鞋垫支撑期总触地时间降低,压力中心向内侧移动,与足弓支撑高度正相关 |
Cheng等 [ | 中国 | 扁平足(n = 10) | 足弓加固支撑鞋垫; 足弓支撑鞋垫; 无足弓支撑鞋垫 | TPU | FDM | 步行 | 测量足部运动学参数和足底压力 | 鞋垫降低后足区峰值压力,控制后足外翻和前足外展 |
Ho等[ | 澳大利亚 | 扁平足(n = 13) | 3D打印定制鞋垫; 传统定制鞋垫 | PP | 未提及 | 步行5 m | 测量足和足踝生物力学变量 | 3D打印鞋垫降低踝关节跖屈力矩和力量 |
Desmyttere等[ | 加拿大 | 扁平足(n = 19) | 3D打印定制柔性矫形鞋垫; 带有张贴的3D打印定制柔性矫形鞋垫; 3D打印定制刚性矫形鞋垫 | PA | SLS | 步行3 min | 测量运动学和动力学参数 | 刚性鞋垫可减少中足外翻和前足外展;带有张贴的3D打印定制柔性矫形鞋垫可有效减少后足外翻角度和踝关节内翻力矩,增加膝外展力矩,控制足内旋 |
Hsu等[ | 中国 | 扁平足(n = 10) | 3D打印自动扫描鞋垫; 3D打印全接触鞋垫; 3D打印内侧楔形鞋垫 | TPU; EVA | FDM | 行走 | 运动分析系统;舒适度 | 3种鞋垫可以有效改善踝关节运动学和动力学以及主观舒适度 |
Lin等[ | 中国 | 扁平足(n = 12) | 3D打印定制矫形鞋垫 | PLA | FDM | 行走 | 测量运动学和动力学参数 | 降低踝关节外翻和外旋力矩,纠正足部异常,提供足够的机械强度承受步行中的重量 |
Yurt等[ | 土耳其 | 扁平足(n = 67) | 3D打印鞋垫; 传统定制鞋垫; 平面鞋垫 | EVA | 未提及 | 佩戴8周 | VAS;国际体力活动量表 | 3D打印鞋垫和传统定制鞋垫比平面鞋垫能更有效减轻扁平足疼痛 |
表3
定制矫形鞋垫的分类"
类型 | 制作过程 | 特点 |
---|---|---|
传统 | 手工制作。通过石膏获得足部模型,选择合适材料,对足部阳模进行加热,修剪多余材料,并打磨成型[ | 鞋垫无微孔,需进行微调或对准等操作,高度依赖矫形师的经验和工艺,制作较为复杂、费力、耗时,且存在一定误差[ |
3D打印 | 足部距下关节中立位时使用足部扫描仪获取足部参数,导出数据并处理成3D文件格式或立体平版印刷数据文件,选择合适的3D打印机、打印材料和打印技术,制造表面具有光滑小孔的鞋垫[ | 提高鞋垫适配性,减轻质量,增加通风,促进定制形状的创新和几何形状的产生;制作过程无接触,环境较为干净整洁,精密度较高,效率较快,穿戴体验改善[ |
表5
3D打印矫形鞋垫常用材料"
材料 | 特点 |
---|---|
EVA | 由乙烯和醋酸乙烯酯(vinyl acetate, VA)形成的热塑性共聚物,其性能与VA比例有关,VA比例大增加极性、粘合性、抗冲击性、柔韧性和相容性,降低结晶度、刚度、软化和熔点[ |
PLA | 易于印刷,机械性能高于大多数塑料[ |
TPU | 具有多功能的热塑性、弹性体性能和优异的机械性能,可分成硬段和软段,硬段能增加TPU强度,软段有助于提高柔韧性和伸长率,被广泛应用于工业、医疗、体育领域[ |
PA | 机械强度高,软化点高,耐热,耐磨损,具有一定的吸震性,品种多、产量大、应用较为广泛[ |
PP | 成本较低,有较高的耐化学性、防潮性,优异的机械性能,广泛应用于医疗设备[ |
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doi: 10.1186/s12891-022-06044-8 |
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