目的：观察 3D 打印膝踝足矫形器（knee ankle foot orthosis，KAFO）对脑卒中后 2 周～ 3个月偏瘫患者步行功能的影响。

方法：纳入 2018 年 1 月 1 日—2020 年 7 月 31 日符合病例选择标准的脑卒中后偏瘫患者30例，按照随机数字表法将其随机分为对照组 1，对照组 2 及观察组，每组各 10例。在常规原发病治疗以及康复治疗基础上，3 组患者均在站立及步行训练时全程佩戴矫形器。对照组 1 佩戴传统踝足矫形器（ankle foot orthosis，AFO），对照组 2 佩戴传统 KAFO，观察组佩戴 3D 打印 KAFO。3 组患者均接受 4 周的康复治疗，治疗前后采用10 m 步行测试（10-meter walk test，10-MWT）、6 min 步行测试（6-minute walk test，6-MWT）、下肢 Fugl-Meyer 运动能力评估量表、Berg 平衡量表进行评估，并测量治疗前后的足间隙数值。

结果：3 组患者治疗前 10-MWT、6-MWT、Fugl-Meyer 运动能力评分、Berg 平衡量表评分、足间隙数值的差异均无统计学意义（P ＞ 0.05）。治疗 4 周后，与治疗前相比，3 组患者的 10-MWT 较前缩短（P ＜ 0.01），6-MWT 较前增加（P ＜ 0.01），Fugl-Meyer 运动功能评分较前增加（P ＜ 0.05），Berg 平衡量表评分较前增加（P ＜ 0.05），足间隙较前增加（P ＜ 0.05）。组间比较，观察组上述指标均优于 2 个对照组（P ＜ 0.05）。

结论：3D 打印 KAFO 可以增强下肢运动能力，改善平衡功能，降低患者的跌倒风险，进而提高步行速度及耐力，优化康复治疗。

Objective: To observe the effect of three-dimensional (3D) printing knee ankle foot orthosis (KAFO) on walking function of hemiplegic patients 2 weeks to 3 months after stroke.

Methods: Patients with post-stroke hemiplegia who met the case selection criteria from January 1, 2018 to July 31, 2020 were randomly divided into control group 1, control group 2 and observation group, with 10 cases in each group. On the basis of routine primary disease treatment and rehabilitation treatment, all patients in the three groups wore orthosis during standing and walking training. The control group 1 wore traditional ankle foot orthosis (AFO), the control group 2 wore traditional KAFO, and the observation group wore 3D printing KAFO. All patients received 4-week rehabilitation treatment. The 10-meter walk test (10-MWT), 6-minute walk test (6-MWT), Fugl-Meyer Motor Ability Assessment Scale, Berg Balance Scale, and the minimum distance between the foot and the ground (foot space) were measured before and after treatment.

Results: There were no significant differences in the 10-MWT, 6-MWT, Fugl-Meyer Motor Ability Assessment Scale score, Berg Balance Scale score and foot space among the three groups before treatment (P > 0.05). After 4 weeks of treatment, the 10-MWT was shortened (P < 0.01), the 6-MWT was increased (P < 0.01), the Fugl-Meyer Motor Ability Assessment Scale score was increased (P < 0.05), the Berg Balance Scale score was increased (P < 0.05), and the foot space was increased (P < 0.05). Pairwise comparison between groups showed that the indexes of the observation group were better than those of the two control groups (P < 0.05).

Conclusion: 3D printing KAFO can enhance the lower limb movement ability, improve the balance function, reduce the ability loss of patients, and then improve the walking speed and endurance, optimize the rehabilitation treatment.