Journal of Knee Surgery最新文献

{"title":"Planning Assistance Freeware for Surgical Management of the Multiple Ligament Knee Injury: From Historical to Modern Surgical Procedures.","authors":"Maxime Guerot, Baptiste Boukebous, Lucas Chanteux, Haroun Bouhali, Marc-Antoine Rousseau, Cédric Maillot","doi":"10.1055/a-2509-3322","DOIUrl":"10.1055/a-2509-3322","url":null,"abstract":"<p><p>Anatomical knowledge and identification of multiple ligament knee injuries have considerably evolved during the last decade. Consecutively, a trend for anatomical reconstruction of these injuries emerged. These procedures are challenging and require precise planning. Moreover, the planning itself is made difficult by the variety of techniques, whose descriptions are scattered throughout the literature. The objective is to reference and categorize the different ligament reconstruction techniques to provide free planning assistance software using a standardized graphic chart.The search for ligament reconstruction techniques on nine different databases produced 1,536 articles. After reviewing for relevance, the authors included the full papers of the remaining 306 articles. From the reference lists of the selected articles reviewed, 96 studies describing original techniques were retrieved. Techniques were extracted, drawn following the same graphics chart, and classified into conceptual categories.After selection, 10, 4, 28, 28, and 26 articles described anterior cruciate ligament, posterior cruciate ligament, posteromedial corner, posterolateral corner, and anterolateral corner procedures for reconstruction, respectively. Early techniques often used tenodesis while nowadays various grafts are fixed to isometric points or anatomic landmarks. An interactive tool was created. It allows the visualization of selected reconstructions on axial, frontal, and sagittal representations of the knee. Tunnel position, preferred transplant type, and fixation mode are represented. The freeware is available at: https://apps.medecine.u-paris.fr/multilig/.The techniques described for the reconstruction of an isolated ligament or corner cannot always be extrapolated for multiple ligament knee injuries treatment. Bone stock and tunnel convergence are two main concerns to consider during planning. Sometimes, it could be necessary to sacrifice a potentially biomechanically superior approach if simpler reconstructions provide equivalent knee kinematics. Surgical options are multiple and scattered throughout the literature. Our study provides an open-source and clinician-accessible research tool for multiple ligament injuries planification using a standardized graphic chart.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"367-374"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Boundaries in Kinematic Alignment: Why, When, and How.","authors":"Pier Francesco Indelli, Giuseppe Petralia, Stefano Ghirardelli, Pieralberto Valpiana, Giuseppe Aloisi, Andrea Giordano Salvi, Salvatore Risitano","doi":"10.1055/a-2395-6935","DOIUrl":"10.1055/a-2395-6935","url":null,"abstract":"<p><p>The use of alternative alignments in total knee arthroplasty (TKA) has recently been increasing in popularity: many of these alignments have been included in the broad spectrum of \"kinematic alignment.\" This alternative approach was recommended to increase patients' satisfaction since many studies based on patient-reported outcome measures (PROMs) showed that every fifth patient is not satisfied with the surgical outcome. In fact, the original kinematic alignment technique was designed as a \"pure resurfacing\" technique, maintaining the preoperative axes (flexion-extension and axial rotation) of the knee. In adjunct, many new classifications of the preoperative limb deformity have been proposed to include a large range of knee anatomies, few of them very atypical. Following those classifications, many surgeons aimed for a reproduction of unusual anatomies putting in jeopardy the survivorship of the implant according to the classical \"dogma\" of a poor knee kinematics and TKA biomechanics if the final hip-knee-ankle (HKA) axis was not kept within 5 degrees from neutral. This article reviews the literature supporting the choice of setting alignment boundaries in TKA when surgeons are interested in reproducing the constitutional knee anatomy of the patient within a safe range.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"324-327"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Benefit of Combining Kinematic Alignment and a Medial Pivot Implant in Total Knee Arthroplasty, The KA-MP Knee: Why and How.","authors":"Robert N Steensen","doi":"10.1055/a-2544-4116","DOIUrl":"10.1055/a-2544-4116","url":null,"abstract":"<p><p>Kinematic alignment (KA) has emerged as an alternative alignment technique for total knee arthroplasty with the goal of duplicating the pre-arthritic joint surface. Medial pivot (MP) total knee implants duplicate the medial stability of the natural knee and recreate the medial rotational axis of the knee. Each has had favorable results. Combining the two, the KA-MP knee, creates a synergy and achieves better results than KA or MP alone.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"336-343"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quadriceps Tendon Ruptures After Total Knee Arthroplasty.","authors":"Gabrielle Swartz, James T Layson, Daniel Hameed, Jeremy A Dubin, Sandeep S Bains, Michael A Mont, Ronald E Delanois, Giles R Scuderi","doi":"10.1055/a-2585-4863","DOIUrl":"10.1055/a-2585-4863","url":null,"abstract":"<p><p>Quadricep tendon (QT) ruptures following total knee arthroplasty (TKA) represent a challenging complication with potentially severe consequences, including impaired function and the need for additional surgical intervention. This article reviews the relevant anatomic features, etiology, and risk factors of QT ruptures after TKA. The different treatment options and indications for nonoperative management, direct repair, augmented repair, extensor reconstruction with mesh, and complete extensor allograft reconstruction are reviewed.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Synovialization and Clinical Outcomes between Anterior Cruciate Ligament Anteromedial Bundle Augmentation and Double-Bundle Anterior Cruciate Ligament Reconstruction.","authors":"Gil Yeong Ahn, Sung Hyun Hwang, Seo Won Kang, Jun Hyeok Song, Jee Soo Park, Yeong Hyeon Lee","doi":"10.1055/s-0044-1801748","DOIUrl":"10.1055/s-0044-1801748","url":null,"abstract":"<p><p>This study aimed to compare clinical outcomes and second-look arthroscopic findings between double-bundle anterior cruciate ligament (ACL) reconstruction for complete ACL rupture and anteromedial (AM) bundle augmentation with preservation of the posterolateral (PL) bundle in isolated AM bundle rupture. Between 2014 and 2021, we retrospectively analyzed 95 ACL reconstructions with at least 2 years of follow-up. Patients undergoing primary ACL reconstruction from January 2014 to June 2021 were included in the study. Double-bundle ACL reconstruction (group 1) was performed in the cases involving male patients, high activity levels, age below 40 years, or when there was a patient preference for double-bundle reconstruction. In contrast, for partial ACL ruptures with an intact PL bundle confirmed on preoperative magnetic resonance imaging, AM augmentation was performed (group 2). Preoperative and final follow-up clinical outcomes, along with synovial coverage during second-look arthroscopy, were compared between group 1 (65 cases) and group 2 (30 cases). Statistical analysis included correlation coefficients between the groups. The Lysholm score, Tegner activity scores, and International Knee Documentation Committee (IKDC) knee evaluation form score at final follow-up were 81.8 (±5.5), 7.2 (±0.9), and 79.4 (±6.7), respectively, in group 1, and they were 88.0 (±6.4, <i>p</i> = 0.038), 7.9 (±0.5, <i>p</i> = 0.042), and 86.2 (±5.4, <i>p</i> = 0.081), respectively, in group 2. For group 1, the Lachman test (<i>p</i> = 0.093) and the pivot shift test (<i>p</i> = 0.176) at the final follow-up showed no laxity in 57 and 59 knees, and there was plus one laxity in 8 and 6 knees. For group 2, there were no laxity in 27 and 28 knees, and plus one laxity in 3 and 2 knees. Synovial coverage area percentages of the grafted tendon were 74.3 (±10.7) and 86.9 (±7.3, <i>p</i> = 0.002) in groups and group 2, respectively, with superior synovial coverage observed in group 2. The AM bundle augmentation with preservation of the PL bundle in ACL injury yielded better synovial coverage and clinical scores compared with double-bundle ACL reconstruction for complete ACL rupture.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"273-281"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidimensional Analysis of Preoperative Patient-Reported Outcomes Identifies Distinct Phenotypes in Total Knee Arthroplasty: Secondary Analysis of the SHARKS Registry in a Public Hospital Department.","authors":"Raquel McGill, Corey Scholes, Stephen Torbey, Lorenzo Calabro","doi":"10.1055/s-0044-1801750","DOIUrl":"10.1055/s-0044-1801750","url":null,"abstract":"<p><p>Traditional research on total knee arthroplasty (TKA) relies on preoperative patient-reported outcome measures (PROMs) to predict postoperative satisfaction. We aim to identify distinct patient phenotypes among TKA candidates, and investigate their correlations with patient characteristics. Between 2017 and 2021, patients with primary knee cases at a metropolitan public hospital were enrolled in a clinical quality registry. Demographics, clinical data, and the Veterans Rand 12 and Oxford Knee Score were collected. Imputed data were utilized for the primary analysis, employing <i>k</i>-means clustering to identify four phenotypes. Analysis of variance assessed differences in scores between clusters, and nominal logistic regression determined relationships between phenotypes and patient age, sex, body mass index (BMI), and laterality. The sample comprised 389 patients with 450 primary knees. Phenotype 4 (mild symptoms with good mental health) exhibited superior physical function and overall health. In contrast, patients in phenotype 2 (severe symptoms with poor mental health) experienced the most knee pain and health issues. Phenotype 1 (moderate symptoms with good mental health) reported high mental health scores despite knee pain and physical impairment. Patient characteristics significantly correlated with phenotypes; those in the severe symptoms with poor mental health phenotype were more likely to be younger, female, have a higher BMI, and bilateral osteoarthritis (<i>p</i> < 0.05). This multidimensional analysis identified TKA patient phenotypes based on common PROMs, revealing associations with patient demographics. This approach has the potential to inform prognostic models, enhancing clinical decision-making and patient outcomes in joint replacement.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"300-308"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analgesic Effect of Intermittent Multiple IPACK Block Combined with ACB in Patients with Flexion Contracture Knee Arthritis Undergoing Total Knee Arthroplasty.","authors":"Yuqi Ren, Zhouhui Hou, Yue Zhang, Yue Li, Huanqiu Liu","doi":"10.1055/s-0044-1801822","DOIUrl":"10.1055/s-0044-1801822","url":null,"abstract":"<p><p>We aimed to compare the analgesic effects of intermittent multiple infiltrations between the popliteal artery and capsule of the posterior knee (IPACK) combined with adductor canal block (ACB) and intermittent ACB alone in patients with flexion contracture knee arthritis undergoing total knee arthroplasty (TKA). Forty-six patients who underwent elective unilateral TKA were divided into two groups (<i>n</i> = 23 each): intermittent multiple IPACK combined with ACB (group IA) and intermittent multiple ACB (group A). ACB was performed with 20 mL of 0.375% ropivacaine in each group and IPACK with 20 mL of 0.25% ropivacaine in group IA. Intermittent multiple nerve blocks were used for postoperative analgesia (IPACK block combined with ACB in group IA and ACB in group A between 7:30 and 8:30 a.m. on postoperative day 1 [POD1] and postoperative day 2 [POD2]). Primary outcomes assessed were pain at rest, motion-evoked pain (MEP), and range of motion (ROM) on POD1 and POD2. Secondary outcomes included opioid consumption, first ambulation time, ambulation distance, and postoperative complications. We observed that compared with group A, MEP decreased, ROM became wider, ambulation distance was longer, and opioid consumption decreased in group IA. Other outcomes were either similar between the groups or showed clinically insignificant differences. We conclude that multiple intermittent IPACK therapy combined with ACB provides superior analgesia than multiple intermittent ACB therapy alone in patients with flexion contracture knee arthritis undergoing TKA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"316-322"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014470","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":"The Fate of the DAIR, Outcomes after 1 Year: A Large Database Study.","authors":"Andrew R Grant, Darren Z Nin, Ya-Wen Chen, Ruijia Niu, Michael Esantsi, Carl T Talmo, Brian L Hollenbeck, David C Chang, David A Mattingly, Eric L Smith","doi":"10.1055/a-2501-1024","DOIUrl":"10.1055/a-2501-1024","url":null,"abstract":"<p><p>Debridement with antibiotics and implant retention (DAIR) is commonly utilized for treatment of prosthetic joint infection (PJI) in total knee arthroplasty (TKA), particularly in cases of acute PJI. Reported success rates of DAIR have been highly variable, but the overall success rate of DAIR cohort studies is approximately 70 to 80%. However, no large database studies have investigated the success rate of DAIR. Therefore, we seek to provide a framework for large-database analysis of PJI interventions and their outcomes and to assess the success rate of DAIR. We queried the MarketScan Database for patients who underwent a DAIR (CPT 27310 and/or CPT 27486) procedure for indication of PJI (ICD-10 T84.53 OR T84.54) between January 1, 2017 and December 31, 2021. We identified reoperations (i.e., stage 1 revision, amputation, or arthrodesis) indicating failure of DAIR. Failure of DAIR treatment was defined by subsequent reoperation. We also identified prescriptions of suppression antibiotics more than 6 months after DAIR. We identified 1,018 patients who underwent a DAIR procedure for PJI. Of these patients, 195 (19.2%) underwent reoperation within 1 year and an additional 178 (17.5%) were prescribed suppressive antibiotics. For 780 patients with a minimum of 2 years of follow-up, 164 (21%) underwent reoperation and an additional 179 (22.9%) were prescribed suppressive antibiotics. Patients with obesity and patients younger than 60 years had significantly higher rates of having reoperation or suppressive antibiotics at 1 year following DAIR. DAIR is a viable option in the treatment of PJI, with an approximately 19% rate of reoperation at 2 years. Our findings are consistent with that of previously published literature.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"282-289"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-Articular Adductor Canal Block Has Equivalent Analgesic Effect to Traditional Ultrasound-Guided Adductor Canal Block after Total Knee Arthroplasty: A Prospective Randomized Controlled Trial.","authors":"Deyong Huang, Dazhi Zhang, Yi Jiang, Jun Yi, Ke Sun, Hongyi Shao","doi":"10.1055/a-2501-1143","DOIUrl":"10.1055/a-2501-1143","url":null,"abstract":"<p><p>An adductor canal block (ACB) is widely accepted as a regional nerve block for pain management following total knee arthroplasty (TKA). However, no consensus exists concerning whether the analgesic effect is greater when joint surgeons perform intra-articular ACBs (IA-ACBs) or when anesthesiologists perform ultrasound-guided ACBs (UG-ACBs). We hypothesized that IA-ACBs performed by joint surgeons and UG-ACBs performed by anesthesiologists based on periarticular injections (PAIs) would yield equivalent analgesic effects. This prospective randomized controlled trial included 61 patients who underwent IA-ACBs and 56 patients who received UG-ACB with additional PAI for post-TKA pain management. The primary outcome was postoperative pain assessed using numeric rating scale scores at rest and during exercise. Secondary outcomes included opioid consumption and functional recovery. We also investigated local and systemic adverse events, including nausea, vomiting, and wound complications. Both groups of patients experienced comparable analgesic effects for both IA-ACB and UG-ACB pain management; however, those who received IA-ACBs were prescribed more opioid equivalents than those in the UG-ACB group on postoperative day 1 (<i>p</i> = 0.048). No differences between the groups were observed regarding local or systemic adverse events. IA-ACBs performed by joint surgeons provided equivalent analgesic effects to UG-ACBs performed by anesthesiologists. However, IA-ACBs may lead to a higher postoperative requirement for opioid analgesics.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"309-315"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Evaluation of Clinical Outcomes of the Subchondroplasty Procedure for Treatment of Symptomatic Bone Marrow Lesions of the Knee.","authors":"Steven B Cohen, Christopher Hajnik, Gregory J Loren, Sam Akhavan, Patrick J DeMeo, Douglas J Wyland, Thomas Youm, Laith M Jazrawi, Robert J Daley, Jack Farr, Patrick Reischling, Jennifer E Woodell-May","doi":"10.1055/a-2501-0910","DOIUrl":"10.1055/a-2501-0910","url":null,"abstract":"<p><p>Bone marrow lesions (BMLs) have a strong correlation to patient-reported pain, functional limitations, joint deterioration, and rapid progression to total knee arthroplasty. The Subchondroplasty (SCP) procedure uses AccuFill, a calcium phosphate bone substitute material (BSM), to treat bone defects such as microtrabecular fractures and BML. This observational, prospective, multicenter, cohort study evaluated the effect of the SCP procedure at the 2-year follow-up for 70 patients with knee BML. Under arthroscopic and fluoroscopic guidance, the BML was injected with AccuFill. Patient-reported outcomes, including Visual Analog Scale (VAS) pain, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and modified Knee Society Score (mKSS) were collected through 24 months postoperatively. Radiographs and magnetic resonance imaging (MRI) were performed at baseline and up to 24 months postoperatively. Patient selection was not limited based on the degree of osteoarthritis (OA) as determined radiologically by the Kellgren-Lawrence (K-L) grade. For a subset of patients, patient-reported outcomes were collected up to 5 years including pain evaluation, patient knee global assessment, and satisfaction with the procedure. Preoperative radiographs indicated moderate to severe OA (K-L grades 2-4) in 65 patients (92.8%). Significant improvements (<i>p</i> < 0.0001) in mean VAS pain, IKDC, mKSS, and KOOS scores were observed compared with baseline. Kaplan-Meier survivorship free from conversion to knee arthroplasty was 76.2% at 2 years. The subset of patients followed for 5 years demonstrated low pain scores and high procedure satisfaction. This study presents statistically significant and clinically meaningful evidence of improvement in clinical outcomes following SCP for BMLs of the knee after 2 years. The survivorship rate from arthroplasty at 2 years was 76.2%. SCP for BMLs can relieve pain with a minimally invasive procedure and may delay the need for knee arthroplasty. REGISTRATION:  NCT01621893 (ClinicalTrials.gov). LEVEL OF EVIDENCE:  Level II, Prospective Cohort Therapeutic Study.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"290-299"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819897","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}