臺灣博碩士論文加值系統

背景：拇趾外翻是下肢常見的足部變形疾病，且時常發生於女性以及老年人身上。通常會伴隨著足部疼痛、步態異常以及平衡不良增加老年人跌倒的風險。近年來，市場上出現許多針對拇趾外翻所設計的商品，但存在著一些缺點，例如：產品價格、拇趾外翻矯正效果以及影響行走時足部推進。3D列印技術是一項加法製造技術，已經運用在許多的醫學領域。因此本研究目的在於透過3D列印技術開發拇趾外翻矯具，並且評估穿戴矯具之運動學表現。
方法：本研究招募了17位擁有拇趾外翻的個案，並請每一位受試者分別在裸足以及穿著3D列印矯具情況下各行走5次。使用動作分析來量測靜態站立以及動態行走下拇趾外翻角度變化。
結果：結果顯示穿著3D列印矯具靜態站立以及動態行走中拇趾外翻角度分別下降了14度以及6度。而在穿著矯具動態行走中和裸足相比，第一蹠趾關節背屈角度被限制了14度。
結論：本研究顯示穿著3D列印矯具無論是靜態站立或是動態行走，可以有效地矯正拇趾外翻角度。

Background：Hallux valgus (HV) is a foot deformity and common found in female and elderly. It often accompanied by foot pain, impaired gait patterns, poor balance, and falls in elderly. In recent years, many commercial orthoses for HV in the market are developed, but they have some disadvantages, such as the expensive, correction effect of HV and influence on gait. The three-dimensions (3D) printing technique, also known as additive manufacturing, has been used in various medical fields. This study aimed to develop a new 3D printing orthosis for HV and evaluate the kinematics of wearing HV orthosis using the motion analysis.
Method：This study recruited 17 subjects with HV and asked to walk 5 times in two different conditions including with and without orthosis. The subjects were measured in terms of HV angle in static standing and dynamic walking using Motion Analysis System.
Results：The results showed that the HV angle in static and dynamic were respectively reduced about 14 and 6 degrees for the patients with 3D printing orthoses. In dynamic walking the extension of 1st metatarsophalangeal joint (1st MTP) was restricted about 14 degree while wearing 3D printing orthosis.
Conclusion：The 3D printing orthosis effectively corrected the HV angle in static standing and dynamic walking.

目錄
第一章 緒論 1
1-1 前言 1
1-2 足部解剖構造 2
1-2-1 骨骼構造 2
1-2-2 肌肉構造 3
1-3 拇趾外翻介紹 4
1-3-1 拇趾外翻流行病學及評估方式 4
1-3-2 拇趾外翻臨床症狀與生物力學研究 6
1-4 拇趾外翻介入方式 16
1-4-1 手術治療 16
1-4-2 物理治療 17
1-4-3 輔具介入 18
1-5 3D列印相關研究 23
1-6 研究動機及目的 27
第二章 材料與方法 28
2-1 3D列印拇趾外翻矯具開發設計與製造階段 29
2-1-1 設計理念及開發流程 29
2-1-2 足部模型以及矯具設計建立 30
2-1-3 3D列印機製造 31
2-2 臨床實驗階段 34
2-2-1 研究對象 34
2-2-2 實驗流程 35
2-2-3 測試方法與資料收集 36
2-3 統計分析 42
第三章 結果 43
3-1 靜態站立拇趾外翻矯正效果 43
3-2 動態行走拇趾外翻矯正效果 44
3-3 地面反作用力結果 47
3-4 舒適度結果 48
第四章 討論 49
4-1 靜態站立拇趾外翻矯正效果之探討 49
4-2 動態站立拇趾外翻矯正效果之探討 51
4-3 地面反作用力之探討 55
4-4 舒適度之探討 56
4-5 關節型3D列印拇趾外翻矯具成本之探討 57
4-6 產品開發及臨床實驗階段之研究限制 59
4-7 未來研究方向 61
第五章 結論 64
附錄 68

圖目錄
圖1-1足部骨骼解剖圖1 2
圖1-2足部肌肉解剖圖1 3
圖1-3拇趾外翻 5
圖1-4(a)X光影像診斷(b)量角器量測5 5
圖1-5拇趾外翻好發疼痛常見位置 12
圖1-6大拇趾足底壓力比較 12
圖1-7足部區域以及壓力分佈 13
圖1-8步態行走時拇趾外翻組和健康組比較，實線為健康組虛線為拇趾外翻組 15
圖1-9(a)正常人與拇趾外翻足底壓力(b)正常人與拇趾外翻者von Mises分佈 15
圖1-10手術治療圖 16
圖1-11肌內效貼扎 17
圖1-12腳趾分離運動 17
圖1-13客製化鞋墊結合拇趾分離器 19
圖1-14客製化鞋墊 19
圖1-15三種不同長度鞋墊 19
圖1-16矽膠型拇趾外翻矯具 21
圖1-17關節型拇趾外翻矯具常見斷裂處 21
圖1-18硬材型拇趾外翻矯具 22
圖1-19襪套式拇趾外翻矯具 22
圖1-20拇趾分離器矯具設計 25
圖1-21拇趾外翻矯具設計 25
圖1-22足底筋膜炎矯具設計 26
圖1-23 3D列印足踝矯具製造(a)取得人體模型(b)在修模軟體進型編修(c)模擬編修後成品(d)匯入切片軟體以3D列印機造之成品 26
圖2-1 實驗流程圖 28
圖2-2 槓桿力學示意圖 29
圖2-3掃瞄器掃瞄足部模型 30
圖2-4 (a)大拇趾分成三等份，中間設計趾套(b)編修後矯具 31
圖2-5列印參數設定 32
圖2-6切片匯出的*gx檔以及預估時間 33
圖2-7 3D列印機「Finder」 33
圖2-8列印後成品 33
圖2-9腳長量測範圍 35
圖2-10 靜態量測方式 (a)裸足下量測(b)穿著3D列印矯具下量測 36
圖2-11 下肢貼上反光球進行動態行走 38
圖2-12光球貼點 38
圖2-13動態行走下外展及內收角度β計算方式 39
圖2-14動態行走下背屈以及蹠屈角度α計算方式 39
圖2-15 測力板X定義為前後方向，Y定義為左右方向 40
圖2-16 地面反作用力之Fz1及Fz2示意圖 40
圖2-17 舒適度量表 41
圖3-1靜態站立矯正效果 43
圖3-2動態行走下角度變化(-外展/+內收) 45
圖3-3動態行走下最大外展角度 45
圖3-4動態行走下角度變化(-蹠曲/+背屈) 46
圖3-5動態行走下最大背屈角度 46
圖3-6矯具不適處 48
圖4-1陳學者等人之研究動態角度最大值之外展角度變化 53
圖4-2矯具差異(a)無關節矯具(b)關節型矯具 53
圖4-3行走時蹠屈與背屈角度差異(a)無關節矯具(b)關節型矯具 54
圖4-4腳掌推進期第一蹠骨背側以及第一二趾間摩擦 56
圖4-5矯具加入泡棉減少異物感提升整體舒適性 56
圖4-6改良式關節設計 62
圖4-7合併足弓支撐關節型拇趾外翻矯具 63

表目錄
表1-1無拇趾外翻組與拇趾外翻組退化性膝關節比例 12
表1-2動態行走中角度變化 13
表1-3術後角度差異 13
表1-4術後足壓差異 14
表1-5步態行走時角度變化 14
表2-1受試者基本資料 34
表4-1過去文獻比較 50
表4-2拇趾外翻組和健康組運動學比較 53
表4-3本研究開發之矯具與現有產品之比較 58

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