糖尿病患者步态周期不同时刻的足底压力及中底结构设计  

Plantar pressure at different phases during gait cycle in diabetic patients and midsole structure design

作　　者：曹子君 王芳[1,2] 李雪梅 李明新[4] 何耀广[1,2] 张宇 杨涛 刘国庆 张建国 Cao Zijun;Wang Fang;Li Xuemei;Li Mingxin;He Yaoguang;Zhang Yu;Yang Tao;Liu Guoqing;Zhang Jianguo(College of Mechanical Engineering,Tianjin University of Science and Technology,Tianjin 300222,China;Tianjin Key Laboratory of Light Industry and Food Engineering Machinery Equipment Integrated Design and Online Monitoring,Tianjin 300222,China;Metabolic Disease Hospital,Tianjin Medical University,Tianjin 300070,China;Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津科技大学机械工程学院,天津市300222 [2]天津市轻工与食品工程机械装备集成设计与在线监控重点实验室,天津市300222 [3]天津医科大学代谢病医院,天津市300070 [4]天津医院,天津市300211

出　　处：《中国组织工程研究》2023年第13期2005-2010,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金项目(12102301),项目负责人:王芳。

摘　　要：背景:足底压力过高是导致糖尿病足溃疡的因素之一,研究糖尿病患者步态周期内不同时刻的足底压力有助于设计防护鞋具。目的:分析糖尿病患者足跟撞击和前掌推离时刻的足底压力,设计中底结构,优化减压效果。方法:开展足底压力试验,分析糖尿病神经病变患者、无神经病变的糖尿病患者与健康人在足跟撞击和前掌推离时刻的足底压力差异。构建足部有限元模型,设计乙烯-醋酸乙烯酯共聚物中底和不同模量的热塑性聚氨酯菱形晶格中底,分析神经病变患者使用不同中底时足跟撞击和前掌推离时刻的足底压力及软组织应力变化,优化糖尿病防护鞋结构尺寸。结果与结论:①神经病变组前掌推离时刻的足底压力峰值比健康对照组高22.2%,差异有显著性意义(P<0.05);②乙烯-醋酸乙烯酯共聚物中底使神经病变患者足跟撞击和前掌推离时刻的足底压力峰值分别降低13.0%和12.9%,使软组织应力峰值分别降低18.2%和11.1%;③优化的菱形晶格结构将患者2个时刻的足底压力峰值分别降低41.6%和48.4%,将软组织应力峰值分别降低41.4%和49.8%;④提示开发糖尿病防护鞋具应重视对前掌推离时刻的减压,菱形晶格结构能实现比传统乙烯-醋酸乙烯酯共聚物中底更好的效果。BACKGROUND:High plantar pressure is one of the critical factors causing diabetic foot ulcers.Studying the plantar pressure in multi-phase during gait cycle of diabetic patients contributes to ofoading footwear development.OBJECTIVE:To analyze the plantar pressure distribution in diabetic patients at heel strike and push off,and design midsole to optimize ofoading effect.METHODS:Plantar pressure was tested to analyze the difference in plantar pressure at heel strike and push off between diabetics patients with diabetic peripheral neuropathy and without diabetic peripheral neuropathy and healthy subjects.Finite element model of foot was constructed.Ethylene vinyl acetate copolymer midsole and thermoplastic polyurethane diamond lattice structure midsole with different modulus were designed.Changes in plantar pressure and stress of soft ssue at heel strike and push off in diabetic peripheral neuropathy patient were analyzed to optimize the structure size of diabetes footwear.RESULTS AND CONCLUSION:(1)The peak plantar pressure at push off in diabetic peripheral neuropathy group(22.2%)was higher than healthy control group(P<0.05).(2)Ethylene vinyl acetate copolymer midsole reduced the peak plantar pressure at heel strike and push off by 13.0%and 12.9%,reduced the peak stress of soft ssue at two phases by 18.2%and 11.1%.(3)The optimized diamond lattice structure reduced the peak plantar pressure at two phases by 41.6%and 48.4%,reduced the peak stress of soft ssue at two phases by 41.4%and 49.8%.(4)In conclusion,ofoading at push off should be noticed in development of diabetic footwear.The diamond lattice structure midsole could archive better effect than ethylene vinyl acetate copolymer midsole.

关 键 词：糖尿病 足底压力 步态 生物力学 有限元分析 鞋具 中底 晶格结构 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R587.1