3D打印定制鞋垫结合康复治疗对青少年脊髓性肌萎缩症的疗效研究

研究目的:本研究旨在探讨3D打印定制鞋垫结合康复治疗对青少年脊髓性肌萎缩症(SMA)患者的治疗效果和临床意义。方法:回顾性研究对象为2022年11月至2024年5月在青海省康复医院接受治疗的2型和3型青少年脊髓性肌萎缩症住院患者。根据功能状态,我们选择83例患者,分为不可独坐者、可独坐者和可行走者。患者随机分为实验组(接受3D打印定制鞋垫结合康复治疗)和对照组(赤足结合康复治疗)。在相同的康复治疗方法下,我们比较两组患者在为期12个月的治疗周期内的“起立–行走”计时测试(TUGT)、6分钟步行测试(6MWT)、关节活动范围(ROM)以及科莱瑞迪2D足底压力分析仪和步态分析仪的测试数据。结果:实验组在下肢生物力学功能、运动功能及生活质量等方面均明显优于对照组,特别是在步态稳定性和行走能力的提升上表现显著。结论:3D打印定制鞋垫结合康复治疗能够显著改善青少年脊髓性肌萎缩症患者的下肢生物力学功能,提高运动能力和生活质量,因此该治疗方案具备广阔的临床应用前景。Objective: This study aims to explore the therapeutic effects and clinical significance of 3D printed custom insoles combined with rehabilitation therapy for adolescent patients with spinal muscular atrophy (SMA). Methods: This retrospective study involved hospitalized adolescent patients with type 2 and type 3 spinal muscular atrophy who received treatment from November 2022 to May 2024 at the Qinghai Rehabilitation Hospital. Based on functional status, we selected 83 patients and categorized them into groups of those unable to sit independently, those able to sit independently, and those able to walk. Patients were randomly divided into an experimental group (receiving 3D printed custom insoles combined with rehabilitation therapy) and a control group (barefoot combined with rehabilitation therapy). Under the same rehabilitation treatment methods, we compared the two groups over a 12-month treatment period using the “Timed Up and Go Test” (TUGT), the 6-Minute Walk Test (6MWT), Range of Motion (ROM), as well as data from the Footscan 2D foot pressure analyzer and gait analyzer. Results: The experimental group showed significantly better lower limb biomechanical function, motor function, and quality of life compared to the control group, with notable improvements in gait stability and walking ability. Conclusion: The combination of 3D printed custom insoles and rehabilitation therapy can significantly enhance the lower limb biomechanical function and improve motor ability, and quality of life in adolescents with spinal muscular atrophy, indicating that this treatment approach has broad clinical application potential.

可变刚度缓冲鞋垫结构设计及优化

目的设计X型结构变刚度缓冲鞋垫,探究其对糖尿病截趾患者足底表面压力和内部应力的影响。方法基于CT影像建立糖尿病截趾患者足部-小腿有限元模型,根据足底压力分布特征进行鞋垫区域划分。设计X型结构3D打印缓冲鞋垫,通过改变结构面板厚度改变结构的模量,对划分区域填充不同模量的X型结构方案进行仿真分析。结果糖尿病截趾患者足底峰值压力在跟骨区,足趾区选用面板厚度1.2 mm结构、跖骨区选用面板厚度1.4 mm、足弓区选用面板厚度2.0 mm和足跟区选用面板厚度1.6 mm组合后的鞋垫减压效果最好。与赤足相比,此方案鞋垫分别降低足跟区峰值压力、趾骨区峰值压力和足底软组织内部应力40.18%、31.7%和50.45%。结论变刚度下3D打印鞋垫可有效降低足底表面压力、内部应力,减小二次截趾概率。

三维步态分析踝足疾病应用矫形鞋垫后的效果研究

目的运用三维步态分析技术对踝足疾病应用3D打印矫形鞋垫后的效果进行分析,从而判断鞋垫适合度。方法对2018年1-8月在该中心住院的14例踝足疾病患者和职工应用矫形鞋垫前后,即刻利用三维步态捕捉分析系统进行运动学[踝关节背伸/跖屈、内翻/外翻、内旋/外旋活动范围(ROM)]和动力学参数(膝关节内收力矩峰值,踝关节屈曲、内翻/外翻、内旋/外旋力矩峰值)分析,采用统计学分析应用鞋垫前后参数差异。结果应用鞋垫后即刻,受试者踝关节矢状面ROM比应用鞋垫前增大,踝屈曲、外旋力矩峰值较前减小,内收、内旋力矩峰值较前增大,但差异均无统计学意义(P>0.05);踝关节冠状面、水平面活动角度较应用鞋垫前减小,膝内收力矩峰值较应用鞋垫前增大,踝外展力矩峰值较应用鞋垫前减小,差异均有统计学意义(P<0.05)。结论不同踝足疾病患者使用矫形鞋垫的效果不一样,应选择性应用。

3D打印矫形鞋垫联合正骨推拿手法治疗脑瘫足外翻患儿30例临床观察

目的:观察3D打印矫形鞋垫联合正骨推拿手法治疗脑瘫足外翻患儿的疗效。方法:将脑瘫足外翻患儿60例随机分为治疗组和对照组,每组各30例。治疗组采用3D打印矫形鞋垫联合正骨推拿手法治疗。对照组采用传统矫形鞋垫联合正骨推拿手法治疗。观察2组的录像步态、足印图、足底压力、足部支撑情况。结果:2组录像步态疗效总有效率分别为93.33%(28/30)、70.00%(21/33),2组比较,差异有统计学意义(P<0.01)。2组治疗前后足底压力各区域面积占比组内比较(除对照组足前掌内侧缘外),差异均有统计学意义(P<0.01);治疗后足跟压力组间比较,差异有统计学意义(P<0.05)。治疗组治疗后在离地时相、整足接触时相方面均有改善,差异具有统计学意义(P<0.05)。结论:中医正骨推拿手法联合精准造模的3D打印矫形鞋垫,对于脑瘫足外翻患儿有显著疗效,值得应用于临床。