3D打印矫形鞋垫在扁平足中应用的系统综述

doi:10.3969/j.issn.1006-9771.2023.04.007

Abstract

Abstract:

Objective To review the classification of orthopedic insoles, common techniques of 3D printing orthopedic insoles, common materials and their application for flatfoot.
Methods Literatures were retrieved from PubMed, Web of Science, CNKI and Wanfang Data from 2012 to 2022, and the relevant contents were summarized.
Results A total of ten studies were finally included, from 5 countries, involving 290 participants, which published from 2019 to 2022. Orthotic insoles were classified as prefabricated, semi-custom, and custom, while custom ones were classified as traditional custom and 3D printed custom. 3D printed orthotic insoles were often made with selective laser sintering, fused deposition modeling (FDM) and PolyJet printing technologies, and commonly used materials included ethylene-vinyl acetate (EVA), polylactic acid, thermoplastic polyurethane, polyamide, and polypropylene. For flatfoot, 3D printed orthotic insoles could improve plantar pressure, relieve foot pain and the combined use of insole posting could control rearfoot valgus.
Conclusion 3D printed custom insoles can be made more efficiently and accurately than traditional custom insoles. The printing technologies and materials often chosen for 3D printed orthotic insoles are mainly FDM and EVA. 3D printed orthotic insoles is effective on plantar pressure, comfort and foot movement function of flatfoot.

Key words: arch, flatfoot, 3D printing, personalization, orthopedic insole, systematic review

CLC Number:

R496

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.

Figures/Tables 6

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^[14](2022)	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^[15](2019)	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^[16](2022)	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^[17](2022)	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 ^[18](2021)	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^[19](2022)	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^[20](2021)	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^[21](2022)	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^[22](2019)	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^[23](2019)	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

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类型	特点
定制型	满足不同个体的生物力学需求。需要专业医生或矫形师检查下肢生物力学，获得足部印模，并开具鞋垫处方^[24]。
半定制型	对预制鞋垫进行修改，使其匹配足部畸形^[16]。
预制型	批量生产，根据足部尺寸进行选择，对足部畸形矫正较差^[25]。

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^[23]。	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^[26]。
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^[27]。	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^[28]。

3D printed orthopedic insoles for flatfoot: a systematic review

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技术	特点
FDM	商业化技术。通过加热和挤压热塑性细丝，从底部到顶部层层堆积。原材料利用率较高，成型原理简单^[33]。
SLS	通过反射引导激光束局部加热熔化粉末材料，可应用于多种材料，精度高，效率较高^[31]。
PolyJet	化学树脂通过紫外线曝光后打印固化。通常采用蜡支撑，印刷后通过融化去除。最大优点是允许产品中包含多种材料^[31]。

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^[36]。
PLA	易于印刷，机械性能高于大多数塑料^[37]。
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^[38]。
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^[39]。
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^[40]。

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