International Orthopaedics最新文献

{"title":"Non-vascularized coracoid process autograft for glenoid reconstruction in revision shoulder arthroplasty.","authors":"Jean-Gabriel Delvaque, Mohamad K Moussa, Efi Kazum, Carlos Murillo, Philippe Valenti","doi":"10.1007/s00264-024-06296-0","DOIUrl":"10.1007/s00264-024-06296-0","url":null,"abstract":"<p><strong>Purpose: </strong>To report the radiological and clinical outcomes of non-vascularized coracoid process autografts used for glenoid reconstruction during revision shoulder arthroplasty.</p><p><strong>Material and method: </strong>This is a retrospective, monocentric study from January 2016 to October 2022 targeting patients treated with a coracoid bone graft for glenoid reconstruction during revision of shoulder arthroplasty. The primary outcome measures were coracoid graft union rate and graft-implant osseointegration. Secondary outcome measures included clinical and CT-scan identified radiological complications and functional outcomes as measured by the Visual Analog Scale (VAS), Range of Motion (ROM), Subjective Shoulder Value (SSV), Constant score (absolute and ponderate), and ASES score.</p><p><strong>Results: </strong>Fifteen patients (9 males, 6 females; mean age 66.9 years, range 38-85) were included. At a mean follow-up of 20.9 months (range 12-56 months), 93.3% achieved complete graft integration. One case of partial lysis without baseplate loosening was noted. Regarding range of motion, the mean forward elevation was 130° (range 90°-170°), external rotation at the side 25° (range 10°-40°), external rotation in 90° of abduction 45° (range 10°-80°), and internal rotation 52° (range 10-80°). The mean VAS for pain was 1.1 (range 0-8), mean SSV 67.3% (range 40-90%), mean ASES score 85.5 (range 65-98.3), mean Absolute Constant score 58.6 (range 21-83), and mean Ponderate Constant score 77.5% (range 28.8-110.7%). No neurological injuries were reported.</p><p><strong>Conclusion: </strong>Utilizing a non-vascularized coracoid graft during shoulder arthroplasty revision is a safe, reproducible, and time-efficient technique that demonstrated satisfactory osseointegration, implant stability, good functional results, and a low complication rate.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"3159-3166"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is outpatient joint arthroplasty safe in a high volume academic centre? A retrospective monocentric study using an institutional pathway.","authors":"Gérald Delfosse, Guillaume Mesnard, Martin Ecki, Cécile Batailler, Elvire Servien, Sébastien Lustig","doi":"10.1007/s00264-024-06333-y","DOIUrl":"10.1007/s00264-024-06333-y","url":null,"abstract":"<p><strong>Purpose: </strong>Hip and knee arthroplasties are daily procedures in orthopaedic departments. Recently, same-day discharge (SDD) became increasingly popular, but doubts remain about its safety and generalization. Our hypothesis is that outpatient arthroplasty, in a high volume centre and with an institutional protocol, is an effective and reliable practice.</p><p><strong>Methods: </strong>We realized a monocentric retrospective study of patients undergoing outpatient partial (UKA) or total (TKA) knee or hip arthroplasty (THA) in a high volume academic centre using a well-defined institutional pathway. Epidemiological data and complications occurring in the month following surgery were studied.</p><p><strong>Results: </strong>498 patients undergoing 501 arthroplasties (219 hips and 282 knees) were examined. The percentage of men and women was 60.28% and 39.72% respectively, mean age was 64.56 ± 9.59 years, mean BMI was 26.87 ± 4.2 and the most represented ASA score was 2. The success rate for same-day discharge was 97.21%. The most frequent causes of failure were urinary retention (28.6%), orthostatic hypotension (28.6%) and insufficiently controlled pain (14.3%). The readmission rate in the month following the operation was 0.8% and the rate of emergency department visits was 1.6%. Finally, the rate of early consultation visits was 7.98%. The comparison between success and failure subgroups in the outpatient setting of our cohort did not highlight statistically significant differences for studied parameters.</p><p><strong>Conclusion: </strong>Outpatient arthroplasty, performed in a center used to managing such operations and with a well-established institutional pre- and post-operative protocol, is a safe practice.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"3057-3065"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstruction of severe acetabular defects (Paprosky type III A) in total hip arthroplasty using modular tantalum augments in combination with a cemented cup.","authors":"David Spranz, Lisa-Marie Müller, Raphael Trefzer, Pit Hetto, Timo Nees, Tobias Renkawitz, Tilman Walker, Tobias Reiner","doi":"10.1007/s00264-024-06334-x","DOIUrl":"10.1007/s00264-024-06334-x","url":null,"abstract":"<p><strong>Purpose: </strong>Acetabular defect reconstruction can be a complex and challenging surgical procedure, with stable long-term fixation of the implants remaining the ultimate goal. The purpose of this study was (1) to evaluate the radiological and clinical outcome of complex acetabular reconstruction surgery with the use of modular tantalum TM augments in combination with cemented revision cups; (2) to investigate blood tantalum concentrations in these patients; and (3) to report complications and mechanisms of failure related to this procedure at mid-term follow-up (mean 4.5 years).</p><p><strong>Methods: </strong>We retrospectively reviewed 29 patients (29 hips) with severe acetabular bone loss (Paprosky type III A) reconstructed using a modular tantalum TM augment in combination with a cemented cup. We evaluated the implant survival and the radiological and clinical outcomes after a mean follow-up of 4.5 years (SD 2.2; range 8.4 - 2.1 years) using patient reported outcome scores (PROMs). Blood samples were analysed regarding tantalum concentration and compared with a control group.</p><p><strong>Results: </strong>The cumulative survival rate at 4.5 years with the endpoint \"revision of the acetabular component for any reason\" was 96.2% (95% Confidence Interval 75.7-99.5). The PROMs improved significantly up to the latest follow-up, and radiographic data showed only one patient with signs of initial implant migration with a broken screw and a change of the position of the augment and the cup. Mean blood tantalum concentrations were significantly higher in the study group (0.16 µg/L) compared to the control group (0.002 µg/L) (P < 0.001).</p><p><strong>Conclusions: </strong>This study has demonstrated good mid-term (mean 4.5 years) clinical and radiological outcomes of modular tantalum TM augments in combination with a cemented cup for the reconstruction of major acetabular defects. Mean blood tantalum concentrations were increased in patients with stable tantalum implants compared to healthy controls.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"3083-3090"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11564221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unexpected positive cultures in conversion hip and knee arthroplasty.","authors":"Tiago Moreira, Yuri Lara-Taranchenko, T David Luo, Abdullah A Alfaraj, NAmir Sandiford, Ernesto Guerra-Farfán, Thorsten Gehrke, Mustafa Citak","doi":"10.1007/s00264-024-06341-y","DOIUrl":"10.1007/s00264-024-06341-y","url":null,"abstract":"<p><strong>Purpose: </strong>Total hip and knee arthroplasty in patients with previous history of periarticular surgery, such as osteosynthesis, can be surprisingly complex. This type of procedure is known as conversion arthroplasty (cTHA or cTKA) and has a higher risk of complications. The rates of unexpected positive cultures (UPC) and the risk of periprosthetic joint infection (PJI) compared to primary arthroplasty is unclear. The main purpose of this study was to evaluate rates of Unexpected Positive Cultures (UPC) in a series of conversion arthroplasty patients. The main questions to answer are: 1. Are the patients with conversion arthroplasties more susceptible to UPC than other causes of revision arthroplasties? 2. Are the conversion patients with UPC more susceptible to developing PJI?</p><p><strong>Methods: </strong>This was a retrospective review of patients submitted to cTHA and cTKA from January 2012 to September 2018. Patients with history of previous infection or with missing intraoperative cultures were excluded. The UPC was defined as a single positive culture obtained during a procedure previously considered aseptic and PJI was defined according to the 2018 ICM criteria. After excluding 141 cases, 205 patients were analyzed, 160 hips and 45 knees.</p><p><strong>Results: </strong>Nine (4.4%) UPC were identified, five (3.1%) in the hip group and four (8,9%) in the knee group. Staphylococcal species were the most common isolated bacteria (n = 7, 77.7%). During the study period, four (1,9%) patients were diagnosed with PJI. Only one case had an UPC and a different germ was identified during revision arthroplasty workup.</p><p><strong>Conclusions: </strong>While UPC are more prevalent in conversion knee arthroplasties compared to conversion hip arthroplasties, the rates are similar to those observed in revision arthroplasty for other indications. Importantly, the presence of a UPC in conversion arthroplasty does not appear to elevate the risk of subsequent periprosthetic joint infection, provided a thorough PJI workup has been conducted preoperatively. Therefore, in such cases, UPCs may be safely disregarded.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"3049-3055"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heterotopic ossification following total hip arthroplasty. Which is the predominant risk factor: surgical approach or post-operative prophylaxis?","authors":"Chao Wang, Yayuan Zhi","doi":"10.1007/s00264-024-06329-8","DOIUrl":"10.1007/s00264-024-06329-8","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"3253-3254"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative study on anterior pelvic plating and pubic ramus screw fixation for straddle fracture: a matched-pair outcome analysis.","authors":"Yong-Cheol Yoon, Joshua A Parry, Cyril Mauffrey","doi":"10.1007/s00264-024-06338-7","DOIUrl":"10.1007/s00264-024-06338-7","url":null,"abstract":"<p><strong>Purpose: </strong>Straddle fractures involving both the superior and inferior rami often require surgical fixation due to instability. This study compared the clinical and radiological outcomes of pubic ramus screw fixation (PRSF) and anterior pelvic plating (APP) for the treatment of these fractures to identify the superior method.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 70 patients (37 males, 33 females; average age 47.6 years) treated surgically for straddle fractures at two Level 1 trauma centres between May 2017 and August 2022. The patients were divided into two groups, where 26 underwent PRSF and 44 underwent APP. The groups were matched based on preoperative characteristics such as age, sex, body mass index, injury mechanism, and severity. The key variables analysed included operation time, blood transfusion volume, early weight-bearing capability, and complication and reoperation rates.</p><p><strong>Results: </strong>After matching, PRSF was associated with a shorter operative time (71.0 min vs. 118.3 min for APP, p < 0.0009) and lower blood transfusion requirements (0 units vs. 1 unit, p < 0.0001). Postoperatively, 61.5% of PRSF patients tolerated early weight-bearing, compared to none in the APP group. However, in two cases, PRSF could not be performed due to severe comminution or anatomical limitations, necessitating conversion to APP. Complication rates were similar between the groups (30.8% for PRSF vs. 27.3% for APP, p = 0.93).</p><p><strong>Conclusion: </strong>PRSF demonstrated advantages, such as shorter operative time, reduced blood transfusions, and earlier weight-bearing. However, APP remains valuable for complex fracture patterns. Treatment should be individualized based on fracture complexity and patient-specific factors to optimize outcomes.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"3217-3225"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential analysis of the impact of lesions' location on clinical and radiological outcomes after the implantation of a novel aragonite-based scaffold to treat knee cartilage defects.","authors":"Pietro Conte, Giuseppe Anzillotti, Dennis C Crawford, Vinod Dasa, David C Flanigan, William E Nordt, Jason M Scopp, Robert J Meislin, Eric J Strauss, Sabrina M Strickland, Gennaro Fiorentino, Christian Lattermann","doi":"10.1007/s00264-024-06314-1","DOIUrl":"10.1007/s00264-024-06314-1","url":null,"abstract":"<p><strong>Purpose: </strong>There is limited comparative evidence on patient outcomes following cartilage repair in various knee compartments. The aim of this study was to compare clinical and imaging outcomes after treating cartilage defects in femoral condyles and trochlea with either an aragonite-based scaffold or surgical standard of care (SSoC, i.e., debridement/microfractures) in a large multicentre randomized controlled trial.</p><p><strong>Methods: </strong>247 patients with up to three knee joint surface lesions (ICRS grade IIIa or above) in the femoral condyles, trochlea or both (\"mixed\"), were enrolled and randomized to surgery with either a cell-free aragonite scaffold or SSoC. Patients were followed for up to 48 months by analysing subjective scores (KOOS and IKDC), radiological outcomes (defect filling on MRI), as well as treatment failure rates and adverse events. A differential analysis of outcomes for condylar, trochlear and mixed lesions was performed.</p><p><strong>Results: </strong>The scaffold group significantly outperformed the SSoC group regardless of lesion location with statistically significantly better KOOS Overall scores at 24 months (all p ≤ 0.0009) and 48 months (all p ≤ 0.02). Similar results were observed for KOOS subscales and IKDC scores. For KOOS responder rates, superiority of the implant group was demonstrated at 24, 36, and 48 months (all p ≤ 0.004). Higher defect filling on MRI for implants was observed for all locations. Lower treatment failure rates for the implant were observed in condylar and mixed lesions.</p><p><strong>Conclusion: </strong>The aragonite-based scaffold was safe and effective regardless of the defect location, providing superior clinical and radiological outcomes compared to SSoC up to four years follow-up.</p><p><strong>Level of evidence: </strong>I - Randomized controlled trial.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"3117-3126"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11564388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rotatory malunion following antegrade intramedullary femoral nailing for femoral shaft fractures: incidence and risk factors.","authors":"Marie Le Baron, Raphaël Allal, Jean Tarchichi, Pascal Maman, Richard Volpi, Xavier Flecher","doi":"10.1007/s00264-024-06332-z","DOIUrl":"10.1007/s00264-024-06332-z","url":null,"abstract":"<p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Level I academic Trauma Center.</p><p><strong>Patient selection criteria: </strong>Adult patients with femoral shaft fractures in which a bilateral computed-tomography (CT) scan of both femurs was performed, with a two years minimal follow-up.</p><p><strong>Outcome measures and comparisons: </strong>Criteria related to the patient and the fracture were studied. We fixed the following angles, i.e. 10° and 15°, as references for calculating the RM.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"3235-3236"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The efficacy of Botulinum Toxin in Tennis Elbow: a meta-analysis of randomized clinical trials.","authors":"Eduardo Silva Reis Barreto, César Romero Antunes Júnior, Vinícius Borges Alencar, Márcio Passos Leandro, Luiz Marcelo Bastos Leite, Liliane Elze Falcão Lins-Kusterer, Durval Campos Kraychete","doi":"10.1007/s00264-024-06339-6","DOIUrl":"10.1007/s00264-024-06339-6","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to assess the efficacy of botulinum toxin type A (BT-A) in treating tennis elbow.</p><p><strong>Methods: </strong>We systematically reviewed the literature and included full-text randomized clinical trials (RCTs) published until June 2024, available in PubMed, Scopus, Embase, and Cochrane CENTRAL databases. Eligible studies involved patients with tennis elbow and compared BT-A with placebo or other injectable treatments. Primary outcomes included pain relief, while secondary outcomes assessed quality of life, adverse effects, and grip strength. The risk of bias was evaluated using the Cochrane Risk of Bias tool.</p><p><strong>Results: </strong>Seven RCTs with a total of 381 patients were included. The participants were predominantly middle-aged (mean age 46.64 ± 7.72 years) and diagnosed with chronic tennis elbow. BT-A doses ranged from 20U to 60U. Compared to placebo, BT-A effectively reduced pain at two to four weeks (MD = -1.37; 95% CI = -2.18 to -0.57) and at eight to 12 weeks (MD = -1.13; 95% CI = -1.62 to -0.65). Grip strength was comparable between the BT-A and placebo groups at both time points (2 to 4 weeks: SMD = -0.86; 95% CI -1.78 to 0.05; 8 to 12 weeks: SMD = 0.00; 95% CI = -0.95 to 0.95).</p><p><strong>Conclusion: </strong>This meta-analysis suggests that BT-A reduces pain in tennis elbow within two to 12 weeks compared to placebo. Findings are limited by study size, and further research is needed to confirm its efficacy and safety.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"3139-3149"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term surgical outcomes of open reduction and internal fixation (ORIF) in patients with Hoffa-like tibial plateau fractures: a clinical study and analysis.","authors":"Tianyu Wang, Changhui Li, Pengzhao Chen, Dongwei Wu, Chengsi Li, Xuebin Zhang, Yanbin Zhu, Yingze Zhang","doi":"10.1007/s00264-024-06315-0","DOIUrl":"10.1007/s00264-024-06315-0","url":null,"abstract":"<p><strong>Purpose: </strong>The Hoffa-like tibial plateau fracture is a rare intra-articular fracture and few studies have investigated its curative effect after treatment. We aimed to focus on patients with Hoffa-like tibial plateau fractures based on a large sample population and to evaluate their long-term surgical outcomes treated with open reduction and internal fixation (ORIF).</p><p><strong>Method: </strong>Between August 2017 and September 2020, a period in which 3256 tibial plateau fractures were treated in five trauma centres. Among them, patients with Hoffa-like tibial plateau fractures who treated with ORIF were retrospectively reviewed. Baseline characteristics, operative information, imaging findings, functional scores and any complications were accurately recorded. Each patient was followed for at least three years.</p><p><strong>Results: </strong>Hoffa-like tibial plateau fractures account for approximately 0.9% (29/3256) of all tibial plateau fractures, including 19 males and ten females with a mean age of 45.8 years. After surgery, all patients obtained anatomical reduction of the fractures and none experienced reduction loss. The final Hospital for Special Surgery score (HSS) was improved compared to one year postoperatively (92.76 ± 3.52 versus 89.03 ± 3.81, P < 0.01). No significant differences (P > 0.05) were found in VAS pain score, Rasmussen score, tibial plateau angle (TPA), and posterior slope angle (PSA) between one year and final follow-up. No serious postoperative complications occurred during the treatment and follow-up.</p><p><strong>Conclusion: </strong>Long-term follow-up results showed that patients with Hoffa-like tibial plateau fractures can achieve stable fracture fixation, low postoperative complications, excellent radiographic findings and good functional recovery with ORIF.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"3237-3243"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}