Foot and Ankle Surgery最新文献

{"title":"Younger age correlates with increased gutter impingement rates after total ankle arthroplasty","authors":"Kevin A. Wu,&nbsp;Albert T. Anastasio,&nbsp;Kishen Mitra,&nbsp;Conor N. O'Neill,&nbsp;James A. Nunley,&nbsp;Mark E. Easley,&nbsp;James K. DeOrio,&nbsp;Samuel B. Adams","doi":"10.1016/j.fas.2024.08.009","DOIUrl":"10.1016/j.fas.2024.08.009","url":null,"abstract":"<div><h3>Background</h3><div>While total ankle arthroplasty (TAA) has evolved over the years with improved designs and enhanced bony fixation methods, it remains a technically demanding procedure with a risk of early postoperative complications. One of the most common complications associated with TAA is medial and lateral gutter ankle impingement, which can lead to issues such as increased pain and decreased range of motion (ROM). However, there is a paucity of information in the literature discussing the impact of certain risk factors on gutter impingement complications.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on a cohort of patients who underwent a TAA at a single institution from 2003 to 2019 with a minimum of 2-year follow-up. Patient were identified as having gutter impingement based on diagnostic imaging and/or clinical examination. Data collection included demographics, implant type, follow-up time, and co-morbidities. Multivariate odds ratios (OR) of experiencing gutter impingement were calculated for perioperative variables.</div></div><div><h3>Results</h3><div>The study included a total of 908 patients who underwent TAA with a minimum of 2 year follow up and 121 patients (13.3 %) who subsequently experienced gutter impingement. The average follow-up time was 5.84 + /- 3.07 years. There were 178 patients under 55 years old, 495 patients aged 55 to 70, and 235 patients over 70 years old. A higher rate of gutter impingement was observed in patients under 55 years of age compared to those aged 55 to 70 and over 70 (20.8 % vs. 13.5 % vs. 7.2 %; p &lt; 0.01). Multivariable logistic regression revealed that patient age was significantly correlated with gutter impingement following TAA, with an OR of 0.94 (CI: 0.91–0.98; p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>This study demonstrated increased incidence of gutter impingement in younger patients who underwent TAA. Propensity for scar tissue formation may be higher in this population. Scar tissue deposition following TAA can cause narrowing of the medial and lateral clear spaces, potentially leading to gutter impingement. Additionally, younger patients may have increased activity demands, which subsequently may cause higher rates of symptomatic impingement. As increased impingement after TAA may require the need for additional debridement surgeries, it is important to understand the intricate relationship between age and gutter impingement for managing patient expectations following TAA.</div></div><div><h3>Level of Evidence</h3><div>Level III</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"31 2","pages":"Pages 148-152"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146613","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 clinical outcome comparison between trans-syndesmotic fixation and anatomic deltoid ligament repair in unstable ankle fractures with medial clear space widening: A systematic review and meta-analysis","authors":"Oliver Sogard ,&nbsp;John McDonald ,&nbsp;Michael Elder Waters ,&nbsp;Wonyong Lee","doi":"10.1016/j.fas.2024.08.008","DOIUrl":"10.1016/j.fas.2024.08.008","url":null,"abstract":"<div><h3>Background</h3><div>Due to the variability in evidence supporting either trans-syndesmosis fixation or deltoid ligament repair in unstable ankle fractures with medical clear space (MCS) widening makes it unclear which surgical technique leads to the best patient outcomes. The goal of our systematic review and meta-analysis was to compare clinical outcomes of trans-syndesmotic fixation versus anatomic deltoid ligament repair in the management of unstable ankle fractures with MCS widening.</div></div><div><h3>Methods</h3><div>Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized in this study. A comprehensive and systematic search was conducted using the PubMed, Embase, Web of Science and Cochrane Library databases. Outcomes investigated in this review included the rates of syndesmotic malreduction, removal of hardware, postoperative complications including wound issues, and functional/pain scores.</div></div><div><h3>Results</h3><div>A total of five level-3 studies were selected in this review, with 280 unstable ankle fractures with MCS widening: 165 for the trans-syndesmotic fixation group and 115 for the anatomic deltoid ligament repair group. Three out of five studies evaluated syndesmotic malreduction using CT. Compared to the trans-syndesmosis fixation group, the deltoid repair group showed significant lower rates of syndesmotic malreduction rates and removal of hardware: 6.5 % (4/61) Vs. 27 % (16/59) (RR=0.26, 95 % CI=[0.10, 0.68]), and 2.6 % (3/115) Vs.54.5 % (90/165) (RR=0.06, CI=[0.02, 0.14]), respectively. No significant differences were found between the two groups in postoperative wound complications, reoperations, and functional scores including AOFAS and VAS pain score.</div></div><div><h3>Conclusions</h3><div>Based on our findings, anatomic deltoid ligament repair was associated with a lower rate of syndesmotic malreduction and the need for hardware removal while there was no significant difference in terms of postoperative wound complications, reoperation, AOFAS score, or VAS pain score. These results should be interpreted with caution due to limitations related to heterogeneity among the studies. Further high-level RCTs with larger sample sizes are necessary to establish a robust consensus.</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"31 2","pages":"Pages 95-104"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142191082","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":"Longitudinal observation of distal tibial degeneration in varus ankle osteoarthritis using plain radiograph","authors":"Hiroyuki Seki,&nbsp;Tetsuro Kokubo","doi":"10.1016/j.fas.2024.09.005","DOIUrl":"10.1016/j.fas.2024.09.005","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to explore the natural history of distal tibial deformity in varus ankle osteoarthritis and to identify risk factors for its progression.</div></div><div><h3>Methods</h3><div>This retrospective longitudinal observational study included 97 ankles with moderate to severe varus ankle osteoarthritis, monitored for &gt; 2 years. Radiographic assessments were conducted on weightbearing plain radiographs at the initial and final visit.</div></div><div><h3>Results</h3><div>Significant tibial anterior surface angle reduction (<em>p</em> = 0.008), talus center medial migration (<em>p</em> = 0.038), and tibial lateral surface angle increase (<em>p</em> = 0.034) occurred. Multiple logistic analysis revealed an association between progression and coronal talar tilt angle at the first visit (odds ratio 1.17, <em>p</em> = 0.015)</div></div><div><h3>Conclusion</h3><div>The progression of radiographic distal tibial deformity in varus ankle osteoarthritis was clarified, identifying the coronal talar tilt angle as a risk factor.</div></div><div><h3>Level of Evidence</h3><div>Level IV, retrospective longitudinal observation study</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"31 2","pages":"Pages 177-181"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356530","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":"Outcomes of cobalt-chrome 3D-printed total talus replacement with and without combined total ankle replacement","authors":"Kishen Mitra ,&nbsp;Albert T. Anastasio ,&nbsp;Kevin A. Wu ,&nbsp;Bijan Abar ,&nbsp;Karl M. Schweitzer ,&nbsp;Selene G. Parekh ,&nbsp;Mark E. Easley ,&nbsp;Samuel B. Adams","doi":"10.1016/j.fas.2024.07.011","DOIUrl":"10.1016/j.fas.2024.07.011","url":null,"abstract":"<div><h3>Background</h3><div>Collapse of the talus and peri-talar arthritis pose treatment challenges due to the anatomy and location of the talus as a keystone of the foot and ankle. Custom 3D-printed total talus replacement (TTR) and combined total ankle total talus replacement (TATTR) have emerged as treatment options for these pathologies. However, the safety and efficacy of these implants is unknown due to the limited number of cases and short follow-up durations.</div></div><div><h3>Methods</h3><div>This was a retrospective study to assess surgical outcomes of patients who underwent a TTR and TATTR with or without subtalar fusion. Patient demographics, intraoperative parameters, device related surgical and non-surgical events, imaging and clinical evaluations, and patient reported outcome (PRO) measures were compiled.</div></div><div><h3>Results</h3><div>A total of 38 patients received a custom 3D-printed implant with mean follow-up time of 22.1 (range: 12–45) months. In this cohort, 7 (18.4 %) required secondary surgery and 3 (7.9 %) required implant removal. Multivariate logistic regression revealed that patient diagnosis of depression was a significant predictor of secondary surgery with an OR 17.50 (p = 0.037). Significant postoperative improvements were observed in the talocalcaneal height (p = 0.005) and talar declination angle (p = 0.013) for the TATTR group. VAS and PROMIS pain interference (PI) scores demonstrated an initial significant improvement in pain, but this improvement did not maintain significance at most recent follow-up. However, there was a significant increase in the PROMIS physical function (PF) scores (p = 0.037) at most recent follow-up.</div></div><div><h3>Conclusion</h3><div>These results demonstrate that TTR and TATTR provide significant improvement in post-operative radiographic foot and ankle alignment and physical function at the two-year timepoint. PRO findings suggest that patients are more active after surgery. Surgeons considering proceeding with either of these procedures should counsel patients about pain and functional outcomes as well as realistic expectations in patients with depression.</div></div><div><h3>Level of evidence</h3><div>Level 3</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"31 2","pages":"Pages 126-137"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890665","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":"Use of computer-assisted hexapod external fixators for complex foot and ankle reconstructions – An analysis of functional outcomes and complications","authors":"Felipe Larios ,&nbsp;Marcos R. Gonzalez ,&nbsp;Kim Ruiz-Arellanos ,&nbsp;Maria L. Inchaustegui ,&nbsp;Juan Pretell-Mazzini ,&nbsp;Juan Carlos G. de la Blanca","doi":"10.1016/j.fas.2024.08.010","DOIUrl":"10.1016/j.fas.2024.08.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Foot and ankle pathology can often require complex surgical reconstruction. Until recently, circular external fixators such as the Ilizarov frame have proven to be useful, yet they fall short when progressive, precise corrections are required. Computer-assisted hexapod external fixators seek to address many of the shortfalls of traditional circular fixators. However, evidence for their use is scarce. The objective of this work was to evaluate the functional and quality of life outcomes and post-operative complications of patients treated with computer-assisted hexapod external fixation.</div></div><div><h3>Methods</h3><div>A retrospective, observational study was conducted. All cases were treated with either a TrueLok hex (TL-HEX) or a Taylor Spatial Frame (TSF) fixator. Primary outcomes were post-operative improvement in 12-Item Short Form Survey (SF12) and American Orthopaedic Foot and Ankle Score (AOFAS) scores, and complications following Paley’s classification.</div></div><div><h3>Results</h3><div>A total of 59 patients with complex foot and ankle conditions using 64 external fixation frames were included. The median sum of both SF12 score domains improved from a preoperative score of 63.6 to 91.3 at last follow-up (p &lt; 0.001). Median AOFAS improved from a preoperative score of 35 to 75.5 at last follow up (p &lt; 0.001). Functional improvement was not affected by the choice of external fixator. Complications occurred in 49 cases (77 %). The most common post-operative complications included pin tract complications in 37 (58 %) cases, joint rigidity in 24 (38 %) and axial deviation in 9 (14 %).</div></div><div><h3>Conclusions</h3><div>Computer-assisted hexapod external fixation is an effective technique to correct complex foot and ankle deformities and leads to a marked improvement in post-operative functional and quality-of-life outcomes with a high minor complication rate.</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"31 2","pages":"Pages 153-159"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156354","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":"Hallux valgus and pes planus: Correlation analysis using deep learning-assisted radiographic angle measurements","authors":"Youn-Ho Choi ,&nbsp;Si-Wook Lee ,&nbsp;Jae Hoon Ahn ,&nbsp;Gyu Jin Kim ,&nbsp;Mu Hyun Kang ,&nbsp;Yoon-Chung Kim","doi":"10.1016/j.fas.2024.09.003","DOIUrl":"10.1016/j.fas.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>The relationship between hallux valgus (HV) and pes planus remains unresolved. This study aims to determine the correlation between HV and pes planus using a deep learning (DL) model to measure radiographic angle parameters.</div></div><div><h3>Methods</h3><div>In total, radiographs of 212 feet detectable by the DL model were analyzed. HV was evaluated using the hallux valgus and intermetatarsal angles, while pes planus was assessed using the lateral talo-first metatarsal (Meary's) and calcaneal pitch angles. Correlation analyses were performed for each DL model-measured angle parameter. We investigated whether pes planus worsened with increasing severity of HV and vice versa.</div></div><div><h3>Results</h3><div>All parameters were significantly correlated with each other. Pes planus worsened with increasing severity of HV, and as the severity of pes planus increased, HV also worsened.</div></div><div><h3>Conclusion</h3><div>Utilizing the DL model-assisted radiographic angle measurements, this study established a significant correlation between HV and pes planus.</div></div><div><h3>Level of Evidence</h3><div>III</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"31 2","pages":"Pages 170-176"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356529","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":"Letter to the editor on \"Retromalleolar groove morphology of the tibialis posterior tendon (TPT) in patients without TPT pathology evaluated by axial computed tomography scans\".","authors":"Michael J Oddy, Anika Choraria, Alan Campbell, Kannan Rajesparan","doi":"10.1016/j.fas.2025.01.011","DOIUrl":"https://doi.org/10.1016/j.fas.2025.01.011","url":null,"abstract":"","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081662","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":"Response to letter to editor: \"Retromalleolar groove morphology of the tibialis posterior tendon (TPT) in patients without TPT pathology evaluated by axial computed tomography scans\".","authors":"Takuji Yokoe, Naosuke Kamei","doi":"10.1016/j.fas.2025.01.010","DOIUrl":"https://doi.org/10.1016/j.fas.2025.01.010","url":null,"abstract":"","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068941","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":"Radiological safety atlas of minimally invasive midfoot fusion: A cadaver study.","authors":"Bedri Karaismailoglu, Matthias Peiffer, Fernando Raduan, Julian J Hollander, Ashley Knebel, John Y Kwon, Soheil Ashkani-Esfahani, Christopher P Miller","doi":"10.1016/j.fas.2025.01.009","DOIUrl":"https://doi.org/10.1016/j.fas.2025.01.009","url":null,"abstract":"<p><strong>Purpose: </strong>The popularity of minimally invasive (MIS) foot surgery continues to grow. However, it comes with certain limitations that present notable challenges. One significant hurdle is the absence of direct visualization of neurovascular structures and tendons. The objective of this study is to present fluoroscopic heatmaps that illustrate the trajectories of major structures encountered during MIS midfoot procedures.</p><p><strong>Methods: </strong>Sequential dissection was performed on nine below-knee cadaveric specimens and critical structures were identified and marked, including anterior tibialis tendon (ATT), extensor hallucis longus tendon (EHL), extensor digitorum longus tendon (EDL), superficial peroneal nerve (SPN) and dorsal neurovascular bundle (DNVB) were dissected. Subsequently, flexible wires were positioned and securely placed adjacent to the medial and/or lateral borders of these structures to visualize their trajectories on X-ray imaging. Anteroposterior (AP) and oblique fluoroscopic images of the foot, featuring a calibration marker, were obtained alongside standard photographs. All fluoroscopy images were adjusted to a uniform scale and standardized to a single foot fluoroscopy. The coordinates of the structures were marked on these standardized foot AP and oblique fluoroscopic views. These coordinates were then utilized to generate heatmaps.</p><p><strong>Results: </strong>Successfully generated heatmaps encompassed the DNVB, ATT, EDL, EHL, and SPN, on AP and oblique fluoroscopic images of the foot. The color gradient used visually represents varying magnitudes, with red indicating the most frequent locations of the structures and blue signifying lower occurrences. These heatmaps also illustrate the highest-risk areas for iatrogenic injury to the structures during MIS procedures.</p><p><strong>Conclusion: </strong>This study can empower surgical navigation and improve safety in MIS midfoot procedures by providing surgeons with a fluoroscopic heatmap detailing the trajectories of major anatomical structures. The findings from this study present a valuable opportunity to improve surgical accuracy and safety.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061142","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":"Diagnostic accuracy of 99^mTc-HDP SPECT/CT and MRI for foot and ankle osteoarthritis (ProSPECT-trial): Study protocol.","authors":"Arthur J van Hasselt, Astrid J de Vries, Andele D de Zwart, Inge H F Reininga, Paul C Jutte, Tom M van Raaij","doi":"10.1016/j.fas.2025.01.008","DOIUrl":"https://doi.org/10.1016/j.fas.2025.01.008","url":null,"abstract":"<p><strong>Background: </strong>Accurate localisation of symptomatic osteoarthritic (OA) lesions in the midfoot, hindfoot and ankle remains challenging due to their complex anatomy. Conventional radiographs have limitations in complex areas or overlapping structures. SPECT/CT has shown promising results in detecting symptomatic OA lesions, yet its superiority over MRI, the current standard for soft tissue pathology, remains uncertain. We designed the ProSPECT-trial to systematically investigate the diagnostic accuracy of SPECT/CT compared to MRI in OA of the foot and ankle.</p><p><strong>Methods: </strong>The ProSPECT-trial is a non-randomised single-center prospective cohort study. Eligible patients with suspected OA of the midfoot, hindfoot and ankle are recruited. Diagnostic performance of SPECT/CT and MRI is assessed based on sensitivity, specificity, positive and negative predictive values. Intra- and interobserver reliability of both imaging modalities are evaluated. Imaging protocols include SPECT/CT using technetium-99^m hydroxymethylene disphosphonate (99mTc-HDP) and MRI without contrast agents. Anatomical regions are scored for OA presence using standardised radiographic- and clinical criteria. Diagnoses are confirmed via ultrasound-guided injections containing steroid and anaesthetics. With a calculated sample size of 369 patients, the study aims to show significant sensitivity and specificity differences between SPECT/CT and MRI, assuming a 15 % clinically relevant difference.</p><p><strong>Implications: </strong>The ProSPECT trial assesses the diagnostic accuracy of SPECT/CT and MRI in midfoot, hindfoot, and ankle OA. The findings aim to standardise clinical decision-making and guide future treatment protocols, ultimately optimising patient care and resource utilisation in managing midfoot, hindfoot, and ankle OA.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014609","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}