| Background:Chinese medicine Bone-setting manipulation with "no surgery, faster recovery, less money" features is welcome by the majority of patients to treat fracture, dislocation and other bone diseases. However, doctors in the vast majority of Chinese medicine hospital has largely abandoned this therapy, TCM bonesetting therapy is in danger of extinction.One of the reasons leading to this situation, is the traditional bone setting teaching method of one to one. The manual operation for practice direct in fracture can increase the pain of patients, and a new injury will occurred because of the incorrect operation. At the same time, the limited practice case and the tension and panic of trainees in operation affect the learning effect, leading to the technical learning cycle is long, effect is poor.If the operating parts, operation steps, operation parameters of the TCM Bone-setting manipulation are validated and combined with the virtual simulation technology, we can construct an open, extensible, automatic appreciable training system, which will greatly improve the training efficiency and quality, completely change the traditional teaching mode of the bone setting manipulation, get serious, intense manipulation teaching become a3D interactive games, edutainment.In the succession of traditional practices and Li Guanghai bonesetting eight method based on, Foshan Hospital of traditional Chinese medicine combined with the characteristics of human anatomy and physiology and mechanics principle, established with the characteristics of South of the Five Ridges,"the fourteen manipulations of bone setting". The technique has the advantages of simple operation, strong repeatability, less pain of patient. Reduction rate is high, not only for fresh fracture of limbs of good curative effect, but also for the old fracture and some intra-articular fracture. Thus,"the fourteen manipulations of bone setting" is listed as "eleven five" key specialty of the main project, the promotion of the project of the State Administration of traditional Chinese medicine.My tutor, Professor Chen Zhiwei is the fourth generation descendant of Lee orthopedics and proficient in manipulations of bone setting. He presided over the project "the development of the Virtual teaching system of the fourteen manipulations of bone setting" which will open up a precedent of Chinese Bone-setting manipulation teaching digitalization and standardization, have the sense of milepost type.Chinese medicine Bone-setting manipulation belongs to the category of intangible culture. The database system can be the most close to the actual way to preserve the key information of famous doctor's manipulation, which is of great significance to the inheritance of the famous schools of bonesetting manipulation, to the protection of traditional Chinese non material culture.The Chinese medicine Bone-setting manipulation digital research will enrich the study content of digital medicine and make beneficial exploration for the modernization of traditional Chinese medicine research method.This study by the Colles fracture reduction techniques "lift-press manipulation" to carry on quantitative analysis, establish the way sports biomechanical parameters of the mathematical model and the3D visualization of virtual and real model, for" virtual teaching system of the fourteen manipulations of bone setting " construction to provide quantitative basis, as a means of teaching digital lays a foundation.Objective1. To obtain the force value of the operators'each fingers on the fracture limb by applicating of force measuring collecting system, summary to the mechanical characteristics of manipulation, discuss the possible influencing factors, compare the mechanical characteristics of different operator.2. To obtain the motion trajectory of the key points of the operator and assistant's hands by applicating of position tracking system, summary to t the kinematic characteristics of he manipulation.3. To establish the mechanical model and evaluation model of the operator's manipulation; To establish the movement trajectory model and evaluation model of the operator's manipulation. 4. To establish the3D virtual model and the physical model of the fracture arm, the3D virtual model of the operator, to realize the3D visualization of virtual reduction.Methods1. Measurements of One operator and operating characteristics and influencing.Acquire the patient factors that may influence of manipulation, including: patient's age, weight, body mass index, height, health, suffering from carpal wist circumference circumferential, suffering from carpal swelling (health limb circumference difference), the time of injury. Measure the mechanical parameters of an expert on30cases of Colles fracture which were treated by lift-press manipulation, including each finger force peak, mean, action time. Analyse the relationship between the influencing factors and the mechanical parameters. Study on influential factors in patients with lift-press manipulation.2. Establishment of the mathematical model of the operator time-force curve.Each finger force was integrated for the lifting force and pressing force. Analyse the data of the time, lifting force and pressing force, draw the time force curve. To calculate the mean time-force curve, the curve of similarity between the mean time-force curve and each curve with the average algorithm and similarity algorithm, build time-force curve evaluation model.To calculate the mean curve fitting equation of the curve by Curve fitting the curve data, build mathematical model.3. Comparison of the mechanical parameters by different operatorOperation were carried out by an biginner to15cases of Colles fracture patients Measure the mechanical parameters of the biginner including each finger force peak, mean, action time, compare the biginner mechanical characteristics with that of the expert and the beginner.4,Measurements of One operator's motion trajectory and the establishment of its mathematical model.Measure the motion trajectory of the operator and an assistant on30cases of Colles fracture which were treated by lift-press manipulation, including operator's double thumb and dorsal hands of assistant. Trajectory data is decomposed into three groups of two dimensional data. To calculate the3mean motion trajectory curve, the curve of similarity between the mean motion trajectory curve and each curve with the average algorithm and similarity algorithm, build motion trajectory curve evaluation model.To curve fitting three dimension curve data, calculate the average's three equation of curve fitting, establish the mathematical model curve fitting of trajectory curve.5,Establish the3D virtual model and the physical model of the fracture armlpatients with fracture of the right Colles was scanned with CT, two dimensional image was got and introducted into mimics (beta) for image segmentation, three-dimensional digital reconstruction and saved with STL format. Then the files was introducted into Maya (beta) and the the affected arm bone and soft tissue of the visualization of three-dimensional virtual model were established.To print a limbl:1solid model by application of computer aided laser sintering rapid forming technology. To the model as a template produce fracture arm solid silicone model using silica gel mold technology.6,To realize the3D visualization of virtual reduction of the lift-press manipulation.The soft tissue model of the3D reconstruction of fracture arm part is saved as STL format, into Maya re-forming grid, adjust the morphology, establish operator and assistant hand3D model.In Virtools, hand motion tracking system was constructed by the hand model, data glove and position tracker. Using data glove gets operator's hand shape data, position tracker for trajectory data, dynamic link the virtual hand, achieves the three-dimensional visualization of virtual reduction manipulation.ResultsAll the fractures are anatomic reduction or function reduction, no negative damage occured.1,Pressing force is double thumb force and lift force is both2-4fingers force.The minimum value of pressing force is37.65N, the maximum value is106.76N, mean76.09±21.11N. The minimum value of lifting force is127.59N, the maximum value is372.39N, mean226.10±64.10N.2,The Comparation of mechanical parameters of the same manipulator with Pearson correlation analysis. There are significant correlation between lifting force peak and mean, pressing force peak and mean (P=0.000).There is some correlation between lifting force peak and pressing force peak (P=0.052);There is no significant correlation between lifting force mean and pressing force mean (P=0.096); There is no significant correlation between time and lifting force peak, pressing force peak, lifting force mean, pressing force mean (P>0.05)3,According to multivariate linear regression analysis, there are significant correlation between pressing force peak and the patient's age, and body mass index. Age was negatively correlated with pressing force peak, which was positively related to body mass index.Regression equation as:①pressing force peak=97.094-0.502*age②pressing force peak=52.684-0.437*age±1.892*Body mass index.Standardized regression equation as:①pressing force peak=-0.543*age②pressing force peak=-0.472*age+0.350*Body mass index.There is significant correlation between lifting force peak and the patient's age which is negatively correlated with lifting force peak.Regression equation as:lifting force peak=150.139-0.830*age.Standardized regression equation as:lifting force peak=-0.677*age.There were no significant differences of time, peak stress, peak stress between gender groups after rank sum test.4,To derive the lifting force, pressing force curve data using the average algorithm and similarity algorithm, respectively, the curve fitting of a respective equation.The average curve equation of pressing force as: n=(2.058052647670905-1.0)/(1.772090609144278+2.058052647670905-2.0); m=(1.772090609144278-1.0)/(1.772090609144278+2.058052647670905-2.0); y=38.87667475608392*pow((x-2.555382299093445+5.285326911086262*m)/5.285326911086262,1.772090609144278-1.0)*pow(1.0-(x-2.555382299093445+5.285326911086262*m)/5.285326911086262,2.058052647670905-1.0)/(pow(m,1.772090609144278-1.0)*pow(n,2.058052647670905-1.0));The average curve equation of lifting force as:y=0.25*130.8523843466957*(1.0+erf((x-3.586683019982423+3.093930183060448/2.0)/(1.4142135623730950488*1.065996735910002)))*(1.0-erf((x-3.586683019982423-3.093930183060448/2.0)/(1.4142135623730950488*0.7327274926659335))Pressing force curve similarity range as:0.65664～0.95267.Lifting force curve similarity range as:0.88598～0.97525. 5,There is significant statistical differences between expert and novice at pressing force peak, lifting force peak and time of operation after comparing the data (P<0.05). The lifting force peak of expert is smaller, the pressing force peak of expert is larger, the operation time of expert is shorter.6,Trajectory data is decomposed into three groups of two dimensional data. To calculate the3mean motion trajectory curve, the curve of similarity between the mean motion trajectory curve and each curve with the average algorithm and similarity algorithm.The left thumb (S1) locus equation:(1) Left fracture①X axis locus curve equation: y=a+bx^(0.5)+cx+dx^(1.5)+ex^2+fx^(2.5)+gxv3r2=0.9671934915808159r2adj=0.9663584168210549StdErr=0.04186406096931441Fstat=1356.160797249026a=-0.07762311443610218b=0.1353448042055287c=-0.04243399476984195d=0.002664427066777493e=0.0001615771547219304f=-2.54225903859872E-05g=7.904472752836059E-07②Y axis locus curve equation: y=a+bx^(0.5)+cx+dx^(1.5)+ex^2+fx^(2.5)+gx^3+hx^(3.5)+ix^4r2=0.9911397157312829r2adj=0.9908476184476988StdErr=0.02264832517888956Fstat=3831.31446286108a=0.0286316201475236b=-0.4999758304325031c=0.6155299936302018d=-0.2872136495973893e=0.06563597363370239f=-0.008000625620561614 g=0.000532845234580611h=-1.83214448566935E-05i=2.546590757046606E-07③Z axis locus curve equation: y=a+bx(?)(0.5)+cx+dx(?)(1.5)+ex(?)2+fx(?)(2.5)+gx(?)3+hx(?)(3.5)+ix(?)4r2=0.9670708539138131r2adj=0.9659852776692136StdErr=0.06712512937983962Fstat=1005.862000182331a=0.01435159849081429b=-0.2885498008690854c=0.3353082667436838d=-0.1530455334991204e=0.03304521077122846f=-0.003947087191012418g=0.0002685465799534986h=-9.707898705717631E-06i=1.442362851471318E-07④The left thumb (S1) three-dimensional trajectory surface fittingequation: z=a+bx(?)2+ce(?)(-x) r2=0.5938685734256063r2adj=0.5895015688387848StdErr=0.2331978088556317Fstat=204.7159979242712a=3.092703281759233b=7.093854276579674c=-3.264260812793225(2) Right fracture①X axis locus curve equation: y=a+bx(?)(0.5)+cx+dx(?)(1.5)+ex(?)2+fx(?)(2.5)+gx(?)3+hx(?)(3.5)+ix(?)4+jx(?)(4.5) r2=0.8426717348628718r2adj=0.831513701874423StdErr=0.03702954319108692Fstat=84.50793861288972a=-8.495241056627773E-05b=-0.4735363817818375c=1.018849798491283 d=-0.7911841713942608e=0.3107545918706676f=-0.06920536035568158g=0.009117537541338358h=-0.0007034798405219569i=2.936467759521229E-05j=-5.118760631073097E-07(2) Y axis locus curve equation:y=a+bx(?)(0.5)+cx+dx(?)(1.5)+ex(?)2+fx(?)(2.5)+gx(?)3+hx(?)(3.5)+ix(?)4+jx(?)(4.5) r2=0.981890015983476r2adj=0.9806056199539353StdErr=0.05725388385218863Fstat=855.4420843370495a=-0.001999784501583893b=0.7008122334498449c=-1.365011840069585d=1.043917969642899e=-0.4062793020693362f=0.08957517960956156g=-0.01168842960609188h=0.0008954698599060319i=-3.727874088277785E-05j=6.517512039359243E-07③Z axis locus curve equation: y=a+bx(?)(0.5)+cx+dx(?)(1.5)+ex(?)2+fx(?)(2.5)+gx(?)3+hx(?)(3.5)+ix(?)4r2=0.9943519069227967r2adj=0.9939939291925514StdErr=0.04629265975673771Fstat=3146.909955854675a=-0.01193721751520225b=0.5793461169296306c=-0.8498294571256936d=0.505990697648167e=-0.149818440106772f=0.02487474942439187 g=-0.002348333563413301h=0.0001175754731735221i=-2.420282168783593E-06④The right thumb (S1) three-dimensional trajectory surface fittingequation: z=a+bx+cy r2=0.9305612742301761r2adj=0.9293430509710564StdErr=0.1845737220911371Fstat=1152.501989294469a=0.03008771334856491b=1.682929748507088c=-0.82556415211897637,Assistant right back (S3) relative to the operator's left thumb (S1) locusequation(1) Left fracture①X axis locus curve equation: y=a+bx(?)(0.5)+cx+dx(?)(1.5)+ex(?)2+fx(?)(2.5)+gx(?)3+hx(?)(3.5) r2=0.06388967381077861r2adj=0.03655798545488893StdErr=O.1980558595739665Fstat=2.681256045273429a=0.03134237452999182b=0.2643025901123284c=-0.1373992512588724d=0.03041028350749511e=-0.003295221439362416f=0.00018596552305517g=-5.272822564128425E-06h=5.99164213185788E-08②Y axis locus curve equation: y=a+bx(?0.5)+cx+dx(?)(1.5)+ex(?)2+fx(?)(2.5)+gx(?)3+hx(?)(3.5)+ix(?)4r2=0.8957483573827327r2adj=0.8923114900437019StdErr=0.1093215979526616 Fstat=294.2819937426782a=0.0007275800970030686b=-0.04609259881283027c=0.1030714736527294d=-0.06236271163932799e=0.01590610908493899f^-0.002015263799117551g=0.000134978155774958h=-4.575273741618609E-06i=6.171592254338378E-08(3) Z axis locus curve equation: y=a+bx(?)(0.5)+cx+dx(?)(1.5)+ex(?)2+fx(?)(2.5)+gx(?)3+hx(?)(3.5)+ix(?)4r2=0.9035952250703065r2adj=0.9004170456770199StdErr=0.1792069866018487Fstat=321.0228588908379a=-0.005610188247828707b=0.5927321477850638c=-0.5109186397143521d=0.1853365780214895e=-0.03327853441733689f=0.003284599971474132g=-0.0001794025318022814h=5.023682687296648E-06i=-5.539698435446068E-08(1) Right fracture①X axis locus curve equation: y=a+bx(?)(0.5)+cx+dx(?)(1.5)+ex(?)2+fx(?)(2.5)+gx(?)3+hx(?)(3.5)+ix(?)4+jx(?)(4.5) r2=0.8426717348628718r2adj=0.831513701874423StdErr=0.03702954319108692Fstat=84.50793861288972a=-8.495241056627773E-05b=-0.4735363817818375c=1.018849798491283 d=-0.7911841713942608e=0.3107545918706676f=-0.06920536035568158g=0.009117537541338358h=-0.0007034798405219569i=2.936467759521229E一05②Y axis locus curve equation: y=a+bx^(0.5)+cx+dx^(1.5)+ex^2+fx^(2.5)+gx^3+hx^(3.5)+ix^4+jx^(4.5) r2=0.981890015983476r2adj=0.9806056199539353StdErr=0.05725388385218863Fstat=855.4420843370495a=-0.001999784501583893b=0.7008122334498449c=-1.365011840069585d=1.043917969642899e=-0.4062793020693362f=0.08957517960956156g=-0.01168842960609188h=0.0008954698599060319i=-3.727874088277785E-05j=6.517512039359243E-07③Z axis locus curve equation: y=a+bx^(0.5)+cx+dx^(1.5)+ex^2+fx^(2.5)+gx^3+hx^(3.5)+ix^4r2=0.9943519069227967r2adj=0.9939939291925514StdErr=0.04629265975673771Fstat=3146.909955854675a=-0.01193721751520225b=0.5793461169296306c=-0.8498294571256936d=0.505990697648167e=-0.149818440106772f=0.02487474942439187g=-0.002348333563413301 h=0.0001175754731735221i=-2.420282168783593E-068,Establishment of the fracture arm of the3D virtual model and solid silicone model.9,Realized to the3D visualization of virtual reduction method.Conclusion1. The lifting force peak is greater, the greater the pressing force peak.2. The older, smaller pressing force and lifting force. Body mass index is greater, more by pressing force.3. The lifting force peak of expert is smaller, the pressing force peak of expert is larger, the operation time of expert is shorter. Experts relieve the lifting force by adding pressing force to avoid the reset force concentrated in one place, in addition to its short time of reset, then the damage is smaller.4. The time-force average curve of manipulation operator was established by average algorithm. Curve fluctuation interval of operator's manipulation is obtained by similarity algorithm. The the mathematical evaluation model of the curve is established by curve fitting. The mean curve and equation of movement trajectory relative and absolute motion locus of the key points on the three dimensions were obtained using the average algorithm after decomposing the trajectory data, the evaluation model of motion locus were established, which made the manipulation strength and the trajectory of key point evaluable.5. Based on computer graphics,3D animation technology, sensor technology, reverse engineering and silicone mold technology, the3D virtual model and solid silicone model of the fracture arm is established, the3D visualization of virtual reduction method is realized to.
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