Indian Journal of Orthopaedics最新文献

{"title":"Fragility Fracture: 10 Commandments.","authors":"S S Jha","doi":"10.1007/s43465-025-01356-y","DOIUrl":"10.1007/s43465-025-01356-y","url":null,"abstract":"<p><strong>Background: </strong>Fragility fractures are a major health concern. It is a fracture that occurs from a low-impact event, such as a fall from standing height or less typically due to weakened bones. These fractures are most commonly associated with conditions like osteoporosis, where the bone density is reduced, making the bones more susceptible to get fractured. Fragility fractures often occur in older adults including post-menopausal women and commonly affect areas, such as the hip, spine, and wrist. These fractures reflect the underlying bone fragility, and following first fragility fracture, there is increased risk of getting further fractures. Apart from osteoporosis, the contributing factors have also to be considered like age, gender, nutritional deficiencies, physical activities, and medical conditions like chronic kidney disease. The other risk factors like smoking, and excessive alcohol consumption, and certain medications such as corticosteroids and anti-convulsants like sodium valproate, can overtime result into osteoporosis.</p><p><strong>Methods: </strong>Fragility fractures basically revolve around the terminal management of osteoporosis and many issues have not been over emphasized. Hence, these 10 commandments have been crafted to focus on the areas which can help prevent fragility fractures or combat those cases who come with a history of fragility fractures.</p><p><strong>Results: </strong>The ten commandments have crystallized into various headings, including fragility fracture-the risk factors & DEXA, subnormal turnover bone diseases, microbiota & microbiome, inflammaging including obesity, parathyroid, thyroid & testosterone, dilemmas in the management of osteoporosis in younger adults, vitamin D, calcium & albumin, pharmacologic treatment options, associated medications & alternative therapies, and monitoring. High and low turnover bone disease, dysbiosis in gut, and inflammaging are the highlights including therapy and monitoring.</p><p><strong>Conclusion: </strong>Fragility fracture also known as osteoporotic fracture has significant morbidity and mortality. Management of osteoporosis has been emboldened with the existing basket of both anti-resorptive and anabolic drugs. Safety concerns on long-term use of these drugs are emerging. These ten commandments will help management strategies to concentrate on targeting therapy to persons most \"at risk\" of getting these fractures.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"244-255"},"PeriodicalIF":1.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occurrence of Malformations of the Upper Extremity in Tibial Hemimelia: Correlation with the Jones Classification.","authors":"Lisa-Marie Seeor, Albert Fujak, Chakravarthy U Dussa","doi":"10.1007/s43465-025-01359-9","DOIUrl":"https://doi.org/10.1007/s43465-025-01359-9","url":null,"abstract":"<p><strong>Background: </strong>Tibial hemimelia is a rare malformation with a wide clinical spectrum of presentation. The severity of this condition can be typed using different classification systems. It can exist as an independent entity or can be associated with upper limb or visceral malformations. The aims of our study are therefore, a. to report the incidence of upper limb deformities in relation to the severity of tibial hemimelia classified by the Jones classification, b. incidence of tibial hemimelia as a part of a syndrome c. to report the overall incidence of the associated upper limb and visceral deformities.</p><p><strong>Methods: </strong>A retrospective study was done using radiographs and clinical notes. The severity of the tibia deformity was assessed using the Jones classification. The clinical notes were reviewed to report the additional findings in the upper limbs and the visceral organs.</p><p><strong>Results: </strong>The study included 69 patients with tibial hemimelia aged from 10 months to 34 years. Twenty of them (28.9%) had bilateral involvement. Additional malformations were observed in 56 patients (81%) involving the upper and lower limb and visceral organs. In 11 patients (16%), tibial hemimelia occurred as part of a syndrome, most often being Gollop-Wolfgang complex. The incidence of malformations of the upper extremities was 15 (21.7%), four of which (26.6%) involved bilateral upper extremity malformation. The cleft hand was the most frequent malformation of the upper extremities, followed by hypoplasia or aplasia of the thumb and fingers.</p><p><strong>Conclusion: </strong>Jones type I tibial hemimelia is often associated with visceral and upper limb malformations. visceral anomalies are associated with syndromal forms of Tibiail hemimelia. Several forms of upper limb malformations with varying severity were associated with the disorder. Therefore, a holistic approach to the patient should be initiated soon after birth involving a paediatric, hand and visceral surgeon, to provide the best possible care.</p><p><strong>Level of evidence: </strong>Level IV study, retrospective review of 69 patients with tibial hemimelia.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 5","pages":"650-658"},"PeriodicalIF":1.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Hanging Drop Sign\" in pelvis X-ray.","authors":"C Rex, A Kesavram, M Harishkumar, S Amudha Ganesh, G Kalaivani, C Premanand","doi":"10.1007/s43465-025-01360-2","DOIUrl":"https://doi.org/10.1007/s43465-025-01360-2","url":null,"abstract":"<p><strong>Background: </strong>Diagnosis of Seronegative Rheumatoid Arthritis (SNRA) is based on clinical, radiological, and MRI findings with set criteria. High specificity is provided by plain X-rays in the differential diagnosis of rheumatic disorders Blum A et al. in Journal de Radiologie 90(12):1789-17811, 2009, https://doi.org/10.1016/s0221-0363(09)73586-3. In our study of pelvis X-rays, we found that ischiopubic ramus enthesopathy was more common than sacroiliitis and we have coined that enthesopathy finding as \"hanging drop sign\" because of its characteristic appearance.</p><p><strong>Methods: </strong>A total of 152 proven (92 Females, 60 Males) SNRA cases (based on ACR*/EULAR**criteria and ASAS***criteria) were studied for enthesopathy features in their plain X-ray of pelvis. In addition to sacroiliitis, calcification/ossification of attachment of pelvic muscle and ligaments was documented. Hanging drop enthesopathy was noted in ischiopubic ramus in most of the cases. A cadaveric study was done on 10 specimens just to understand the corresponding anatomical origin of this enthesopathy.</p><p><strong>Results: </strong>Of the 152 pelvic radiographs studied, 110 revealed radiological evidence of SNRA. Among them, 64 patients had hanging drop sign (58.18%), 25 patients had sacroiliitis (22.72%), and 21 patients had other features like hip arthritis, calcifications around greater trochanter, iliac crest, and acetabular region. The cadaveric study revealed that the hanging drop sign corresponds to the adductor part of adductor magnus muscle and gracilis muscle origin in the ischiopubic ramus.</p><p><strong>Conclusion: </strong>In pelvic radiology, hanging drop sign is a common radiological finding in patients with seronegative rheumatism. It is along the origin of adductor part of adductor magnus and gracilis. It is more common than sacroiliitis and this radiological feature can be a useful tool to diagnose SNRA.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 5","pages":"644-649"},"PeriodicalIF":1.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Outcome of Intraarticular Osteotomy and Osteosynthesis for Calcaneal Malunion with Salvageable Subtalar Joint: A Retrospective Case Series.","authors":"John Mukhopadhaya, Janki Sharan Bhadani, Raju Kumar, Jaswinder Singh, Raju Vaishya","doi":"10.1007/s43465-025-01367-9","DOIUrl":"https://doi.org/10.1007/s43465-025-01367-9","url":null,"abstract":"<p><strong>Background and objective: </strong>Calcaneal malunion, a frequent complication of calcaneal fractures, disrupts hindfoot anatomy, causing pain, deformity, stiffness, and gait abnormalities. While conservative management can be effective in selected cases, surgical intervention is often required. This study evaluates the efficacy of intraarticular osteotomy and osteosynthesis as a joint-preserving procedure to manage calcaneal malunion and prevent subtalar arthrodesis.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on ten male patients (aged 23-52 years) with symptomatic calcaneal malunion who underwent intraarticular osteotomy and osteosynthesis between March 2015 and March 2023. Functional outcomes were assessed using the Maryland Foot Score (MFS) and the American Orthopaedic Foot & Ankle Society (AOFAS) score. Clinical, radiological, and procedural parameters were analyzed.</p><p><strong>Results: </strong>The average follow-up duration was 42.9 months (range 15-108 months). Type II malunion (60%) was the most common. Postoperative functional outcomes showed improvement, with a mean MFS of 92.4 and an AOFAS score of 84. Wound breakdown primarily in diabetic patients, was managed successfully with negative pressure wound therapy. Significant enhancements in radiological alignment and functional parameters were observed in all patients.</p><p><strong>Conclusion: </strong>Intraarticular osteotomy and osteosynthesis are effective surgical options for managing calcaneal malunion, facilitating subtalar joint preservation and obviating the need for subtalar arthrodesis. This procedure optimizes functional recovery and preserves joint mobility in carefully selected patients.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 5","pages":"591-601"},"PeriodicalIF":1.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Viability and Clinical Outcomes of Non-vascularized Fibular Strut Grafts: a 50-Year Experience of 621 Cases.","authors":"Surender Singh Yadav","doi":"10.1007/s43465-024-01313-1","DOIUrl":"https://doi.org/10.1007/s43465-024-01313-1","url":null,"abstract":"<p><strong>Aims: </strong>Non-vascularised fibular grafts have been used for over a century as means of reconstruction the skeletal defects. The aim of this study was to evaluate the viability and clinical outcomes of non-vascularized fibular strut grafts using an immediate fixation technique. This enables them to retain their viability for early incorporation with the host-bone.</p><p><strong>Materials and methods: </strong>During the last 5 decades, 621 cases of bone gaps have been managed with non-vascularised fibular struts in various clinical situations. Out of these 498 cases were after excision of bone tumours, 90 post-infective gaps and 33 post-traumatic. According to the site of the defect, single fibular struts were used in 115 cases, twin grafts in 493 and triple struts in 13 cases. The size of the graft measured from 5 to 25 cms.</p><p><strong>Results: </strong>Functional results have been evaluated according to the Clinical and Radiological score. The biological activity resulting in union and hypertrophy of the twin and triple struts demonstrated the viability of the grafts in 91% cases. Evidence of radiological non-union at one of the host-graft junctions resulted in 39 cases. Stress fractures had been observed in 22 cases only in single grafts and none in twin or triple grafts.</p><p><strong>Conclusion: </strong>The technique of immediate fixation of non-vascularized fibular grafts at the host site appears to have changed the age-old concept regarding the non-vascularised grafts. The results have revealed that such struts retain their osteogenic cells and remain viable resulting in 'lateral-union' and unite with the host bone without undergoing the classical degenerative changes.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 5","pages":"581-590"},"PeriodicalIF":1.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Sagittal Stress Fracture of Distal Femur Secondary to Osteoarthritis Knee: A Report on Unusual Case.","authors":"Anil Regmi, Jhapindra Pokharel, Pradeep Kafle, Rabindra Regmi","doi":"10.1007/s43465-025-01366-w","DOIUrl":"https://doi.org/10.1007/s43465-025-01366-w","url":null,"abstract":"<p><strong>Introduction: </strong>Stress fractures in the sagittal plane of the distal femur are rarely observed in clinical practice, particularly when occurring as a consequence of advanced knee osteoarthritis. This case report aims to highlight a rare presentation of sagittal plane stress fractures in the distal femur resulting from advanced knee osteoarthritis. It discusses the implications of this condition for both diagnosis and treatment, underscoring the need for heightened clinical awareness in patients with severe degenerative joint disease.</p><p><strong>Case presentation: </strong>A 74-year-old female presented with bilateral osteoarthritis of knee Kellgren and Lawrence (KL) grade IV with a linear sagittal stress fracture of the distal femur. Unusual type of stress fracture was suspected on plane radiograph and confirmed on Magnetic Resonance Imaging (MRI). Bilateral total knee replacement was performed and screw augmentation was done for stress fracture. On one-year follow-up, patient was symptom-free, with no pain complaints. Knee range of motion was possible up to 0-100 degrees on the bilateral knee joint with no extensor lag.</p><p><strong>Discussion and conclusion: </strong>Bilateral sagittal stress fractures of the distal femur secondary to osteoarthritis of the knee represent a rare but clinically significant pathology. Surgical intervention, by total knee replacement with adjunctive measures to stabilize the fractures, can effectively alleviate pain and improve functional outcomes in these patients.</p><p><strong>Level of evidence: </strong>V.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 5","pages":"694-701"},"PeriodicalIF":1.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of Metals and Alloys in Orthopedics with Their Relevance in Osteoporosis.","authors":"Nirmal Ch Mohapatra, Rajesh Rana, Sisir Kumar Sahoo","doi":"10.1007/s43465-025-01344-2","DOIUrl":"10.1007/s43465-025-01344-2","url":null,"abstract":"<p><strong>Background: </strong>The evolution of metals and alloys in orthopedics has significantly improved the management of bone-related disorders, particularly osteoporosis, where decreased bone density and fragility complicate implant stability and healing. Traditional materials such as stainless steel and cobalt-chromium alloys provided strength and wear resistance but were associated with challenges like stress shielding and implant loosening.</p><p><strong>Materials and methods: </strong>To address these limitations, titanium alloys emerged as a superior alternative due to their biocompatibility, lightweight nature, and bone-like elasticity, making them suitable for osteoporotic patients. Recent advancements have led to the development of magnesium-based biodegradable implants and nitinol (shape-memory alloy), which enable minimally invasive procedures and provide dynamic support. Additionally, porous and bioactive coatings, such as hydroxyapatite (HA), have been introduced to enhance osseointegration and implant fixation in compromised bone.</p><p><strong>Results: </strong>The integration of pharmacological strategies, such as bisphosphonates and sclerostin antibodies, with advanced implant surfaces has further enhanced bone regeneration. Emerging innovations, including 3D-printed personalized implants and smart alloys capable of adapting to physiological changes, show promise for improved long-term stability and faster recovery in osteoporotic patients.</p><p><strong>Conclusion: </strong>The continuous development of orthopedic materials has paved the way for more effective treatments for osteoporosis, addressing key challenges such as implant stability, stress shielding, and bone regeneration. Innovations in bioactive coatings, biodegradable metals, and personalized implants represent the future of orthopedic care, offering improved outcomes for patients with compromised bone health. However, continuous research is essential to optimize these technologies for broader clinical applications.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"271-279"},"PeriodicalIF":1.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peroneus Longus to Peroneus Brevis Tenodesis Does Not Improve Ankle Functional Outcomes: A Prospective Cohort Study.","authors":"Manit Arora, Sachin Tapasvi, Tapish Shukla, Sahil Garg, Jay Shah","doi":"10.1007/s43465-025-01361-1","DOIUrl":"https://doi.org/10.1007/s43465-025-01361-1","url":null,"abstract":"<p><strong>Purpose: </strong>Peroneus longus (PL) graft harvest has recently gained popularity for various ligament reconstruction surgeries. A recent systematic review shows it is a safe and reproducible technique with low morbidity of donor sites (1). The method for PL harvest routinely involves tenodesis of the PL stump to the peroneus brevis (PB). To the authors' best knowledge, no study exists in the literature that has compared the outcomes of tenodesis versus no tenodesis on post-operative ankle functional outcome scores. The purpose of the present study is to assess the importance of tenodesis on post-operative ankle scores.</p><p><strong>Methods: </strong>A total of 200 consecutive patients from July 2022 to November 2022 were included in the study: 72 in the no tenodesis group and 128 in the tenodesis group. Institutional ethics approval was obtained from the institutional ethics review committee before the initiation of the study. Demographic variables (age, gender and level of play) were recorded. Pre-operative American Orthopaedic Foot and Ankle Society Score (AOFAS) and Functional Ankle Disability Index (FADI) scores were calculated for both groups and compared with post-operative scores at six weeks, three months, six months and one-year follow-up.</p><p><strong>Results: </strong>For the entire study population (<i>n</i> = 200), we found that AOFAS and FADI scores showed no significant difference at any interval except for lower scores at six weeks of follow-up for both groups compared to baseline. We found that the no tenodesis group had slightly better AOFAS and FADI scores at the six-week follow-up, which were statistically significant (<i>p</i> < 0.05). However, the magnitude of variance (0.13 and 0.20, respectively) was too small to be clinically significant. Age, gender and level of play had no impact on ankle functional outcomes.</p><p><strong>Conclusion: </strong>Tenodesis of the PL to the PB has been the standard norm in PL graft harvest for various ligament surgeries. The present high-powered prospective cohort study shows that tenodesis.does not improve ankle functional outcome scores compared to no tenodesis. Further work is needed to assess the impact of tenodesis or no tenodesis on ankle biomechanics (eversion, plantarflexion and gait).</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 4","pages":"558-565"},"PeriodicalIF":1.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Kunal et al. Single/Multiple Dose Percutaneously Injected LR PRP Enhances Union Rate in Fracture Delayed Unions: A Prospective Case Series.","authors":"Madhan Jeyaraman, Swaminathan Ramasubramanian, Naveen Jeyaraman","doi":"10.1007/s43465-025-01368-8","DOIUrl":"https://doi.org/10.1007/s43465-025-01368-8","url":null,"abstract":"","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 4","pages":"566-567"},"PeriodicalIF":1.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial.","authors":"S S Jha","doi":"10.1007/s43465-025-01353-1","DOIUrl":"https://doi.org/10.1007/s43465-025-01353-1","url":null,"abstract":"","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"243"},"PeriodicalIF":1.1,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}