Journal of Knee Surgery最新文献

{"title":"Why Are Patients Without Identifiable Etiology of Failure Dissatisfied Following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.","authors":"Chiranjit De, Muhammad Tahir, Todd Pierce, Prashant Awasthi, Paul C Fonseca","doi":"10.1055/a-2638-9613","DOIUrl":"https://doi.org/10.1055/a-2638-9613","url":null,"abstract":"<p><p>Patient satisfaction following primary total knee arthroplasty (TKA) is of great importance to practitioners, and as many as one in five patients report postoperative dissatisfaction. The purpose of this study was to assess patient-specific factors that may have a correlation with being unsatisfied following primary TKA. A comprehensive literature review of four electronic databases was considered for inclusion in this meta-analysis. Upon review, 12 studies were included for analysis. Patient-specific factors for dissatisfaction without failure etiology were evaluated. The final cohort consisted of 27,496 patients who underwent primary TKA, and 2,815 (10.2%) were dissatisfied with their TKA. There was an association found between dissatisfaction and mild osteoarthritis (relative ratio [RR]: 1.86; 95% confidence interval [CI]: 1.41-2.45; <i>p</i> = 0.0001), female gender (RR: 1.06; 95% CI: 1.02-1.10; <i>p</i> = 0.004), and a diagnosis of depression and/or anxiety (RR: 1.46; 95% CI: 1.30-1.64; <i>p</i> = 0.0001). There was substantial heterogeneity among the studies. Those who may be at higher risk for dissatisfaction include those with mild arthritis, female gender, and depression/anxiety. Future research should focus on the role of any preoperative interventions and possible surgery-specific factors that may increase the chances of patient satisfaction.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592701","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":"Does Lateral Extraarticular Tenodesis Lead to Poor Patellofemoral Outcome in ACL Revision on Professional Soccer Players? A Minimum 3-Year, Clinical Radiographic Retrospective Study.","authors":"Mattia Alessio-Mazzola, Antonio Russo, Sean Ahmadi, Giacomo Placella, Lamberto Felli, Vincenzo Salini","doi":"10.1055/a-2640-3249","DOIUrl":"10.1055/a-2640-3249","url":null,"abstract":"<p><p>Lateral extra-articular tenodesis (LET) is indicated to decrease the pivot shift and to restore rotational control in anterior cruciate ligament (ACL) surgery. However, there are still concerns regarding the patellofemoral joint, as with increased tension on the iliotibial band, there is a hypothetical increase of lateralizing forces on the lateral patellar surface. To compare clinical and radiographic patellofemoral outcomes of professional soccer players who underwent LET and ACL revision with a control group of professional soccer players who underwent primary ACL reconstruction. Retrospective comparative study. Inclusion criteria were professional or elite soccer players with failed ACL reconstruction who underwent ACL revision and LET for anterior laxity >5 mm and a pivot-shift test >2. Exclusion criteria were a two-stage procedure, injuries to the contralateral knee, multi-ligament injuries, and patients with less than 3 years of follow-up. The control group was selected as standard ACL reconstruction with autograft in elite or professional soccer players. All included patients were assessed with a Tegner Lysholm, IKDC, and Kujala score. Patients recalled for radiographic patellofemoral assessment with bilateral skyline Merchant view which was compared with the contralateral unaffected knee. Sixty-four consecutive patients (30 in the study group and 34 in the control group) treated from 2015 to 2018 have been included in the study. All patients had a minimum 3-year follow-up, and the mean follow-up was 4.9 ± 2.8 (range: 3-7) years. Overall, patients demonstrated significant improvement in measured outcome measures from baseline to final follow-up. There were no significant differences between groups in Kujala, Tegner and Lysholm, and IKDC scores (<i>p</i> > 0.05). In the study group, no significant differences in lateral patellar tilt (<i>p</i> > 0.05) between treated and unaffected knees were found. LET represents a reliable solution to increase anteroposterior and rotational stability in revision ACL reconstruction with severe pivot shift. Clinical and radiographical results showed favorable patellofemoral outcomes, with clinical scores comparable to primary surgery and no significant patellar lateralization and degenerative changes.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337162","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":"Partial Meniscectomy or Physical Therapy in Degenerative Meniscus Tears: A Retrospective Cohort Study with 2-Year Follow-Up.","authors":"Yusuf Altuntas, Ismail Tuter, Raffi Armagan, Rodi Ertogrul, Muharrem Kanar, Güngör Alibakan, Osman T Eren","doi":"10.1055/a-2640-3369","DOIUrl":"10.1055/a-2640-3369","url":null,"abstract":"<p><p>Degenerative meniscal injuries are a common occurrence in orthopedic practice. However, there is currently no consensus regarding the optimal treatment algorithm and the efficacy of different treatment modalities. Therefore, this study aimed to analyze the clinical reflections of arthroscopic partial meniscectomy (APM) and physical therapy (PT) methods, as well as the potential development of osteoarthritis (OA) following treatment. The study group comprised patients diagnosed with degenerative meniscal tears who were treated with either conservative or APM methods at a center between March 2021 and January 2022. The radiographs of these patients prior to the commencement of treatment were classified according to the Kelgren-Lawrence system, and clinical and pain scores were recorded. Following a 2-year period of treatment, the radiographs and scores at the conclusion of the third, 12th, and 24th months were analyzed. Among 213 patients followed up with a diagnosis of degenerative meniscal damage, at the 3-month follow-up, the APM group demonstrated significantly better pain relief and functional outcomes compared with the PT group, with notable improvements in WOMAC (between score difference: -15.96; 95% confidence interval [CI]: -17.08 to -14.83), Lysholm (23.43; 95% CI: 22.15-24.71), and VAS (-6.98; 95% CI: -7.25 to -6.71) scores (<i>p</i> < 0.001). However, by the 12th and 24th months, both groups showed comparable long-term improvements. Radiographic assessments over 2 years revealed no significant differences in OA progression. These findings suggest that APM provides superior short-term benefits, but both APM and PT are equally effective in the long-term management of degenerative meniscus tears. A comparison of the APM and PT groups revealed that patients under 50 years of age who underwent APM demonstrated superior outcomes in terms of pain and functional scores at the 3-month follow-up. At the 2-year mark, the efficacy of the treatment methods was established, yet no significant differences were observed in their capacity to prevent OA.The level of evidence is III.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337163","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":"Use of Antibiotic Eluting Calcium Sulfate Beads in High-Risk Primary Total Knee Arthroplasty.","authors":"Lisa Su, Jeannie Park, Yifan V Mao, Murray T Wong, Matt V Dipane, Adam Sassoon","doi":"10.1055/a-2638-9688","DOIUrl":"https://doi.org/10.1055/a-2638-9688","url":null,"abstract":"<p><p>Local delivery of high-dose antibiotics via absorbable calcium sulfate beads has been investigated as a treatment of prosthetic joint infection (PJI). We investigate this strategy as a prophylactic measure for high-risk patients undergoing primary total knee arthroplasty (TKA). A retrospective review of a single-surgeon consecutive series of primary TKA patients with identified risk factors for PJI development was performed. These patients were treated with calcium sulfate beads containing 1 g of vancomycin and 1.2 g of tobramycin per 10 cc, with 10 cc placed intraarticularly. Outcomes included PJI, wound complications, revision surgery, and medical complications. There were 114 knees in 103 patients, with 76 women (66.7%), a mean age of 66.8 years (range: 21-91), and a mean follow-up of 16 months (range: 3-55). The mean preoperative lifetime PJI risk based on the 2018 International Consensus Meeting on the PJI calculator was 11.3% (standard deviation: 16.3%, range: 0.9-94.3%). Risk factors included medical comorbidities, homelessness, chronic urinary tract infection, other PJI or septic arthritis history, or prior ipsilateral knee surgeries. One delayed PJI occurred 1 year postoperatively from presumed hematogenous seeding following dialysis. There were no other known deep infections. There were nine patients who had delayed wound healing with marginal skin necrosis-six resolved with wound care and three underwent superficial extraarticular surgical debridement. There was one patient who underwent aseptic revision for patellar instability and nine patients required manipulation under anesthesia for stiffness. There was one patient who died after readmission for cardiac arrhythmia and one patient had bilateral DVT. No cases of chronic PJI, persistent wound drainage, or postoperative hypercalcemia were identified. Prophylactic use of antibiotic-eluting calcium sulfate beads in primary TKA has resulted in low rates of early PJI in a high-risk cohort, warranting further prospective studies and investigation.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561601","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 Size of Residual Patella Tendon Defect Following Bone-Patella Tendon-Bone Autograft Harvest Does Not Affect Patient-Reported Outcome Measures.","authors":"Emily M Pilc, Senah E Stephens, Rebecca P Liu, Jillian L Meyers, Katherine S Worcester, Robert B Patton, Justin W Griffin, Kevin F Bonner","doi":"10.1055/a-2640-3457","DOIUrl":"10.1055/a-2640-3457","url":null,"abstract":"<p><p>Consequences of ACL reconstruction (ACLR) utilizing the patellar tendon (PT) autograft include a residual defect in the PT and the potential for donor site morbidity, such as anterior knee pain and difficulty kneeling. The purpose of this study was (1) to evaluate the presence and size of PT defects following ACLR and (2) to determine if there is an association with knee pain and function. Patients who underwent ACLR with PT autograft by two surgeons between 2011 and 2023 were identified. One surgeon routinely reapproximated the PT harvest site with suture, and the other left the tendon open while closing the overlying paratenon. Included patients were at least 1 year postoperative and 13 years or older at the time of surgery. Patients underwent ultrasound evaluation of the operative knee by an independent sonographer, measuring residual PT defect width and depth. International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, and Single Assessment Numeric Evaluation surveys were collected. Regression analysis determined correlations between defect size and knee outcomes. Eighty-one subjects met the criteria and completed the ultrasound and surveys. A PT defect was present in all patients at a mean follow-up of 2.97 years (1.0-9.6 years). Mean percent residual defect was 36.5 ± 17.5% of the original harvest width (mean: 10.3 mm), with a mean defect width of 3.8 ± 1.8 mm. Mean percent residual defect was significantly greater in the 57 patients who had the graft site left open (41.4 ± 13.5%) compared to the 24 patients who had the graft site reapproximated (26.1 ± 21.1%; <i>p</i> < 0.001). While 44.4% of patients reported moderate to extreme difficulty kneeling, it was not correlated with defect size. Patient-reported outcome scores were not correlated with defect size. A PT defect was present in 100% of patients even up to 9 years postoperatively. Defect width did not correlate with knee pain or the ability to kneel. Repeat harvesting of the PT for subsequent ACLR should be considered with caution.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337164","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":"Patients Undergoing Manipulation under Anesthesia following Primary Total Knee Arthroplasty: Are Their Patient-Reported Outcome Measures Inferior?","authors":"Michael N Sirignano, Robert S Rowe, James C Gainer, Brett W Royster, Langan S Smith, Kyle M Altman, Madhusudhan R Yakkanti, Arthur L Malkani","doi":"10.1055/a-2509-3109","DOIUrl":"10.1055/a-2509-3109","url":null,"abstract":"<p><p>Stiffness after total knee arthroplasty (TKA) can lead to decreased function and patient dissatisfaction. Manipulation under anesthesia (MUA) is often performed to improve range of motion (ROM); however, there is no consensus on indications or timing. The purpose of this study was to compare clinical results and patient-reported outcome measures (PROMs) between patients who underwent MUA versus those with an uncomplicated postoperative course following primary TKA. This was an institutional review board-approved retrospective review of 116 consecutive patients who underwent MUA from 2013 to 2019 following primary TKA due to stiffness. Indication for MUA was failure to achieve 105 degrees of knee flexion at 6 weeks following surgery. Five patients underwent revision surgery and 15 patients from the MUA group were excluded: 12 lost to follow-up and 3 deaths. The remaining 96 MUA patients were matched to 288 TKAs who did not require MUA or revision, all with a minimum 2-year follow-up. Patients who underwent MUA were younger (60.7 vs. 66.3 years, <i>p</i> < 0.001) and had less preoperative knee flexion (105.4 vs. 110.7 degrees, <i>p</i> < 0.001). There were five (4.9%) revisions in the MUA group: two instability, two chronic pain, and one arthrofibrosis. There were no differences between the groups with respect to postoperative Knee Society Knee Score, Western Ontario and McMaster Universities Osteoarthritis, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Forgotten Joint Score-12, satisfaction, or complications. Satisfaction rates were 88.5% among MUA patients and 89.6% among non-MUA patients (<i>p</i> = 1.0). Patients undergoing MUA following TKA, using the criteria of failure to achieve 105 degrees of flexion by 6 weeks postoperatively, were able to achieve similar PROMs and satisfaction compared with a control group with a low incidence of revision due to persistent arthrofibrosis.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"407-414"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053979","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":"Remote Patient Monitoring after TKA-What Surgeons Need to Know.","authors":"Kevin C Chang, John P Stelmach, Giles R Scuderi","doi":"10.1055/a-2545-5121","DOIUrl":"10.1055/a-2545-5121","url":null,"abstract":"<p><p>Multiple new technologies have been introduced in recent years to allow for remote patient monitoring (RPM) after total knee arthroplasty. These tools allow for the recording and transmission of various types of data from the patient to the surgeon throughout a recovery course without necessitating an in-person office visit.RPM has the ability to improve patient outcomes and experience throughout the rehabilitation period by providing much more data on patient progress than has been available in the past. However, these technologies are available in many forms, and different formats provide different types of data that may be of variable utility depending on surgeon preference and training. In this article, we will review different forms of RPM, benefits associated with each, and recommendations for incorporating RPM into a knee arthroplasty practice.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"381-385"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505214","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":"Posterior Cruciate Ligament Revision Surgery: Outcomes, Failure Rates, and Complications: A Systematic Review of the Literature.","authors":"Riccardo D'Ambrosi, Alessandro Carrozzo, Fabrizio Di Feo, Edna Skopljak, Srinivas B S Kambhampati, Manish Attri, Amit Meena","doi":"10.1055/a-2542-2417","DOIUrl":"10.1055/a-2542-2417","url":null,"abstract":"<p><p>To synthesize and qualitatively assess the currently available evidence in the literature regarding the revision of posterior cruciate ligament (PCL) reconstruction. A systematic review was conducted on the basis of the preferred reporting items for systematic reviews and meta-analyses guidelines. The outcome data extracted from the studies were the Lysholm score, Orthopadische Arbeitsgruppe Knie (OAK) scoring system, KT-2000, International Knee Documentation Committee (IKDC) subjective and objective, radiological changes, rate of return to sports, complications, and failures and/or revision surgeries. The cohort consisted of 54 patients (42 [77.8%] men and 12 [22.2%] women), with a mean age of 33.14 ± 3.67 years (range: 17-48 years). The mean postoperative follow-up was 71.8 ± 45.32 months, whereas the mean time from primary surgery to revision was 41.7 ± 4.5 months. All studies reported a clinical improvement from preoperative to final follow-up in terms of the Lysholm, OAK, KT-2000, and IKDC scores (<i>p</i> < 0.05). Posterior displacement was significantly improved in all studies, demonstrating the stability of the knee. The mean posterior displacement ranged from a preoperative value of 10.68 ± 0.7 mm to a final value of 2.7 ± 0.2 mm (<i>p</i> < 0.05). A total of two (3.7%) failures were reported, and there were also eight (14.8%) revision surgeries. Studies on PCL reconstruction revisions have shown satisfactory clinical outcomes and a high level of knee stability, with minimal risk of new reruptures. However, the rate of returning to preinjury sports activity is relatively low. Whenever possible, it is recommended to perform the ligament revision in a single stage. The level of evidence is a systematic review of level IV.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"448-456"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469665","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 Impact of Innovative Interactive Technology on Patient Recovery in TKA.","authors":"Giles R Scuderi","doi":"10.1055/a-2552-5780","DOIUrl":"10.1055/a-2552-5780","url":null,"abstract":"","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":"38 8","pages":"375"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259200","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":"Relationship of Medial Meniscus Posterior Root Tears with Proximal Tibial Morphology and Knee Osteoarthritis.","authors":"Eren Çamur, Semra Duran","doi":"10.1055/a-2525-4565","DOIUrl":"10.1055/a-2525-4565","url":null,"abstract":"<p><p>The meniscus is vital to knee function. Medial meniscus posterior root tear (MMPRT) causes a loss of hoop tension. This, in turn, reduces the meniscus's ability to transmit load. Thus, the higher pressure on the weight-bearing surface speeds up joint degeneration. proximal tibial morphology (PTM) describes the geometric structure of tibia near the knee joint and tibial plateau. Medial posterior tibial slope angle (MPTSA) has the most significant impact on knee biomechanics among PTM measurements. This study aims to investigate the relationship between PTM and MMPRT, and evaluate the association between medial meniscal extrusion amount (MMEA) and osteoarthritis (OA) in patients with MMPRT. This retrospective study analyzed knee magnetic resonance imaging (MRI) of 100 patients with MMPRT and 100 age, gender, side-matched controls. MPTSA, mediolateral length (MLL), medial anteroposterior width (MAW), and lateral anteroposterior width (LAW) were used to evaluate PTM. MMEA and tear gap (TG) correlation and their relationship with knee OA severity was assessed. MPTSA was significantly higher in MMPRT group compared with controls (<i>p</i> < 0.001). Moderate positive correlation was found between MMEA and OA severity (<i>R</i> ²= 0.445, <i>p</i> < 0.001). Cartilage loss was observed when MMEA exceeded 4 mm (sensitivity: 80.68%; specificity: 83.33%). MMEA increased by 1.10 mm for each 1 mm increase in TG. This groundbreaking study reveals that steeper medial tibial plateau is a significant risk factor for MMPRT. Strikingly, MMEA exceeding 4 mm serves as a critical threshold for cartilage loss which is the first finding of OA, potentially revolutionizing treatment decisions. These findings not only enhance our understanding of MMPRT pathomechanics but also provide crucial insights for early intervention strategies, potentially altering the course of OA progression in patients with MMPRT.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"433-439"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765481","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}