Bone & Joint Journal最新文献

{"title":"Early aseptic loosening and inferior patient-reported outcomes of a cementless tibial baseplate in a modern total knee arthroplasty design.","authors":"Octavian Andronic, Yue H Yang, Moreica Pabbruwe, Chris W Jones, Piers J Yates","doi":"10.1302/0301-620X.107B4.BJJ-2024-0704.R1","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-0704.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study reports the outcome of a modern total knee arthroplasty design using a cementless tibial baseplate compared to the full-cemented version.</p><p><strong>Methods: </strong>Consecutive cohorts with 12-month follow-up were evaluated. Patients receiving a cementless tibial baseplate were compared to those who received a cemented tibial component. Endpoints included revision rates and reason for revision, patient-reported outcome measures (PROMs) using the Oxford Knee Score (OKS), and progressive radiolucency. Retrieval analysis was performed for the revised cases. Pearson correlation analysis and multiple regression analysis were used.</p><p><strong>Results: </strong>A total of nine knees (7%) from the cementless cohort were revised, all due to aseptic loosened baseplate at a mean follow-up of 10.4 months (3 to 19), whereas the incidence of aseptic loosening of the cemented tibial baseplate was significantly lower at 0.5% (3/534; p < 0.001). The cemented cohort PROMs outperformed the cementless baseplate group at both 12 months' follow-up and the improvement from baseline (mean OKS 40.4 (SD 6.8) vs 38.5 (SD 8.1); p = 0.006; mean ΔOKS 18.8 (SD 9.0) vs 15.5 (SD 12.8); p < 0.001). There were no significant differences between the groups in the occurrence of new radiolucency at 12 months (p = 0.325). An elevated BMI was the only factor to correlate (<i>r</i> = -0.195) with worse values of ΔOKS (p = 0.048) in the cementless cohort. The multiple regression analysis determined that an increased BMI was the single independent predictor for aseptic loosening (p = 0.024) for the knees with a cementless tibial baseplate. Retrieval analysis suggested failed osseointegration.</p><p><strong>Conclusion: </strong>In our cohort, there was a significantly higher incidence of aseptic loosening and worse PROMs at one year for the cementless tibial baseplate. An increased BMI may be an independent risk factor for aseptic loosening and inferior PROMs.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"440-448"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How are adults who had Perthes' disease functioning after total hip arthroplasty? : patient-reported outcome results from an international web-based survey.","authors":"Michael B Millis, Bella Vakulenko-Lagun, Harry K W Kim","doi":"10.1302/0301-620X.107B4.BJJ-2024-1019.R1","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-1019.R1","url":null,"abstract":"<p><strong>Aims: </strong>Perthes' disease is a hip disorder that presents in childhood but can lead to diminished quality of life (QoL) in adulthood from hip deformities and secondary arthritis. Little is known about adult outcomes following total hip arthroplasty (THA) from the patient's perspective. We employed a web-based survey to gather data on treatment history, demographic details, and patient-reported outcome measures (PROMs) from adults with Perthes' disease who underwent THA. We then compared these PROMs to those of age- and sex-matched normative cohorts, and a Perthes' disease cohort not treated with THA.</p><p><strong>Methods: </strong>We used an English REDCap-based survey on a Perthes' disease study group website, which included Perthes' disease history, University of California, Los Angeles Activity Scale scores, the 36-Item Short-Form Health Survey (SF-36), and the Hip disability and Osteoarthritis Outcome Score (HOOS). A total of 261 THA participants were analyzed (mean age at survey 44.6 years (SD 12.4); mean time since THA 7.2 yrs (SD 8.0)).</p><p><strong>Results: </strong>Compared to normative cohorts, THA participants had significantly lower HOOS QoL and Sports & Recreation scores across all age groups (p < 0.001). Female THA participants aged under 45 years reported worse HOOS Pain, Symptom, and Activities of Daily Living scores, as well as SF-36 Physical and Social scales (all p < 0.001) compared to normative cohorts. Hip dysplasia and number of years from THA were significantly associated with poorer outcome. In comparison to a Perthes' disease cohort without THA, female THA participants aged 35 to 54 years reported significantly better outcomes across all scores except for sports. Females aged 18 to 34 years had significantly better symptom and pain scores in the THA cohort.</p><p><strong>Conclusion: </strong>The Perthes' disease cohort who had THA had better pain and symptom scores than the Perthes' disease non-THA cohort, but reported substantially lower QoL scores compared to a normative population. These results highlight the symptom improvements that THA can offer, while suggesting the need for research to improve treatments which will reduce persisting impairments of QoL.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"380-390"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delirium on presentation with a hip fracture is associated with adverse outcomes : a multicentre observational study of 18,040 patients using national clinical registry data.","authors":"Rose S Penfold, Luke Farrow, Andrew J Hall, Nick D Clement, Kirsty Ward, Lorraine Donaldson, Antony Johansen, Andrew D Duckworth, Atul Anand, Daniel E Hall, Bruce Guthrie, Alasdair M J MacLullich","doi":"10.1302/0301-620X.107B4.BJJ-2024-1164.R1","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-1164.R1","url":null,"abstract":"<p><strong>Aims: </strong>Delirium is common in hip fracture patients, but large-scale routine data studies examining the prevalence and associations of delirium at the time of initial presentation with a hip fracture are rare. This study aimed to describe the prevalence and outcomes of delirium on initial presentation with a hip fracture in a large national population sample.</p><p><strong>Methods: </strong>This study analyzed routinely collected national clinical registry data for all people in Scotland aged 50 years and over presenting with a hip fracture between 1 July 2019 and 31 December 2021. Delirium was assessed prospectively by clinicians as part of routine care using the 4AT, a validated two-minute assessment tool. Associations of 4AT score with mortality and return home within 30 days were analyzed using logistic regression models, adjusted for confounders.</p><p><strong>Results: </strong>Of 18,040 patients (mean age 80 years (SD 10); 70% female (n = 12,594)), 16,476 (91%) had a 4AT assessment on presentation and of these, 3,386 (21%) had a score ≥ 4, suggestive of delirium. Patients with delirium were older, more likely residing in care homes, and had higher American Society of Anesthesiologists grades (all p < 0.001). Delirium was independently associated with a twofold increased risk of inpatient mortality (adjusted odds ratio (aOR) 2.26 (95% CI 1.79 to 2.84)) and one-year mortality (aOR 2.05 (95% CI 1.83 to 2.29)), and a lower likelihood of returning home within 30 days (aOR 0.27 (95% CI 0.24 to 0.30)).</p><p><strong>Conclusion: </strong>Delirium affects around 20% of patients presenting with a hip fracture, and is associated with important adverse outcomes. Integrating delirium assessment into the initial clinical assessment of hip fracture patients is feasible at national scale, and should be considered as part of care for all hip fracture patients.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"470-478"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7617671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and performance of contemporary press-fit titanium osseointegration implants in lower extremity amputation : a five-year follow-up study.","authors":"Robin Atallah, Elmer Rutjes, Jan P M Frölke, Ruud A Leijendekkers","doi":"10.1302/0301-620X.107B4.BJJ-2024-0754.R1","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-0754.R1","url":null,"abstract":"<p><strong>Aims: </strong>Treatment using bone-anchored prostheses (BAPs) with press-fit femoral osseointegration implants (OIs) has been used in patients with lower limb amputations for more than two decades. The development of these OIs has enabled treatment in patients with a short transfemoral and a transtibial amputation. The aim of this follow-up study was to report the safety of this treatment at five years postoperatively, the prosthesis wearing time (PWT), and health-related quality of life (HRQoL).</p><p><strong>Methods: </strong>All consecutive patients undergoing treatment between March 2015 and June 2018 using one of three different OIs were eligible for inclusion. A total of 90 patients were included, of whom 14 were lost to follow-up, leaving 76 available for analysis. The curved- or gamma-osseointegration femoral implant (OFI-C, OFI-Y) was used in patients with a mid-diaphyseal or short transfemoral amputation, respectively. The osseointegration tibial implant (OTI) was used in those with a transtibial amputation. The adverse events which were evaluated included infection (soft-tissue, bone, implant), stoma-related complications, aseptic loosening, implant breakage, periprosthetic fracture, and complications between surgical stages. The functional outcomes which were assessed included the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA)-Prosthetic Use Score (PUS) and the Global Score (GS), for PWT and HRQoL, respectively.</p><p><strong>Results: </strong>A 94.2% implant survival was achieved at five years (OFI-C = 93.8%, OFI-Y = 93.3%, OTI = 95.5%); five implants were removed. Overall, 27 patients (36%) had a total of 56 infections, 53 (95%) of which were infections of the soft-tissues. Septic loosening occurred in three patients (4%, OFI-C = 2, OTI = 1), resulting in removal of the implant in two. The infection/implant-year ratio was 0.09, 0.16, and 0.24 for OFI-C, OFI-Y and OTI, respectively. Periprosthetic fracture occurred in four patients (5%, all OFI-C); all were treated surgically, three with fixation, one with removal. One patient had asymptomatic radiological evidence of partial aseptic loosening; this was managed conservatively. Stoma-related problems required surgery on 26 occasions, mostly in patients treated with an OFI-Y. The implant was removed in two patients (2.6%) due to unexplained pain. Complications between surgical stages were mostly surgical site infections, requiring bringing forward stage 2 on seven occasions. Baseline Q-TFA-PUS and GS scores increased significantly in all patients, and also when stratified per type of implant with the passage of time.</p><p><strong>Conclusion: </strong>Contemporary press-fit titanium OIs, when used in lower limb amputations, result in acceptable rates of survival and safety, with considerable improvements in functional outcomes.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"486-494"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Follow-up after successful treatment for developmental dysplasia of the hip using a Pavlik harness : is two years enough?","authors":"Jessica P J Larwood, Opeyemi Idowu, Kirsten G B Elliott, Edward A Lindisfarne, Alexander Aarvold","doi":"10.1302/0301-620X.107B4.BJJ-2023-1213.R2","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2023-1213.R2","url":null,"abstract":"<p><strong>Aims: </strong>The length of time for which children, who are treated successfully for developmental dysplasia of the hip (DDH) in a Pavlik harness should be followed up, remains uncertain. The aim of this study was to examine whether children who are treated in this way, who have normal clinical and radiological findings at the age of two years, can be safely discharged from routine follow-up.</p><p><strong>Methods: </strong>Data were collected prospectively on all 101 children (170 hips) who were treated in a Pavlik harness in our children's hospital between January 2015 and June 2016, with follow-up to the age of five years. Demographic, clinical, and radiological parameters were recorded. Routine anteroposterior radiographs of both hips were taken at the age of one, two and five years. A normal radiograph of the hip was defined as one with an acetabular index (AI) within the normal range when adjusted for age, symmetrical and adequately sized ossific nuclei, an International Hip Dysplasia Institute grade of 1 and a centre-edge angle (CEA) of > 20°.</p><p><strong>Results: </strong>Of the 101 children (170 hips) who were successfully treated in this way and had radiographs available for analysis from the three timepoints, 157 hips (92%) were normal radiologically at the age of two years and all were normal radiologically at the age of five years. Every child who had normal radiographs at the age of two years had normal clinical and radiological findings at five years, with none having any intervention.</p><p><strong>Conclusion: </strong>These findings support the suggestion that, following successful treatment with a Pavlik harness, children with DDH can be safely discharged from the clinic, assuming that they are clinically and radiologically normal, at the age of two years instead of five.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"495-500"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case series of modular hip hemiarthroplasties employing a metal-on-metal taper-trunnion junction : are they a source of metal particle release?","authors":"Neil Chotai, Rajiv Kaila, Hannah Wilson, Rajib Pradhan, Vipin Asopa, George Grammatopoulos, A J Andrade","doi":"10.1302/0301-620X.107B4.BJJ-2024-0576.R1","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-0576.R1","url":null,"abstract":"<p><strong>Aims: </strong>Hip hemiarthroplasty is a common procedure in the treatment of intracapsular displaced femoral neck fractures. Modular hemiarthroplasties have a separate stem, neck, and head component which gives the surgeon more combinations to try and accurately recreate the patient's original hip geometry. Despite regular use, little is known regarding susceptibility to metal-on-metal debris wear in this specific situation.</p><p><strong>Methods: </strong>This single-centre, two-year prospective cohort study aimed to characterize in vivo wear and associated adverse reaction to metal debris (ARMD) in an uncemented CORAIL stem and Cathcart modular head hip hemiarthroplasty. The mean patient age was 80.5 years (62 to 96) and mean follow-up 2.2 years (1.0 to 4.6). Overall, 54 patients had a clinical, radiological, and serum metal ion (chromium (Cr) and cobalt (Co)) assessment. At follow-up radiological evidence of acetabular erosion was graded (0 to 3: normal to protrusio). Metal ion levels were considered high if ≥ 7 ppb as per current Medicines and Healthcare products Regulatory Agency guidelines.</p><p><strong>Results: </strong>Final Cr and Co levels in ppb were 0.26 (IQR 1.33; 95% CI 0.67 to 5.16) and 0.68 (IQR 2.52; 95% CI 1.25 to 3.30), respectively. The mean one-year Oxford Hip Score was 35 (SD 10). Acetabular erosion was detected in 27 patients (50%). All eight patients (14.8%) with high metal ion levels had associated acetabular erosion, of which four (50%) had an ARMD lesion. Patients with high metal ion levels had a similar head size with the same taper size, similar OHS, and similar pre-fracture mobility to those with low metal ion levels.</p><p><strong>Conclusion: </strong>Modular hip hemiarthroplasty patients may be susceptible to metallosis and ARMD despite being less active individuals than those who receive a total hip arthroplasty. Acetabular erosion was associated with a 2.5-times increased risk of raised metal ion levels but cause and effect have not been established.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"479-485"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periprosthetic joint infection : navigating the literature.","authors":"Ian W Kennedy, Fares S Haddad","doi":"10.1302/0301-620X.107B4.BJJ-2024-1080","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-1080","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"374-377"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open reduction and fixation does not improve short-term outcome of medium-sized posterior fragments in AO type B ankle fractures: one-year results of the POSTFIX randomized controlled trial.","authors":"Adriaan L Franx, Samuel M Verhage, Pieta Krijnen, Eric L L Twiss, Inger B Schipper, Jochem M Hoogendoorn","doi":"10.1302/0301-620X.107B4.BJJ-2024-0521.R3","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-0521.R3","url":null,"abstract":"<p><strong>Aims: </strong>Guidelines for treatment of posterior malleolar fragments (PMFs) in trimalleolar fractures are scarce, mainly based on retrospective studies, and show varying advice. The need for fixation of smaller (< 25%) PMFs remains particularly controversial. This study aims to evaluate the superiority of fixation of medium-sized PMFs versus no fixation of the fragment.</p><p><strong>Methods: </strong>A multicentre randomized controlled trial was conducted between January 2014 and January 2022 in two Dutch level 1 trauma centres (protocol registration: NCT02596529). Patients presenting with an AO-44-B3 fracture with a medium-sized (5% to 25%) PMF were 1:1 randomized online between open reduction and internal fixation (ORIF) (FIX) versus no fixation (NO-FIX) of the fragment. A total of 41 patients were allocated online to FIX via the posterolateral approach and 40 patients to NO-FIX. The primary outcome was functionality measured by the American Academy of Orthopaedic Surgeons (AAOS) questionnaire one year postoperatively. Secondary outcomes were osteoarthritis (OA) measured on radiographs and the Olerud and Molander ankle score, visual analogue scale pain, and EuroQol five-dimension questionnaire during follow-up. Quality of reduction was assessed by step-off on postoperative CT scan and radiograph. Complications were recorded.</p><p><strong>Results: </strong>After one-year follow-up, no difference (p = 0.141) in AAOS was found after FIX (median 90 (IQR 68 to 95)) and NO-FIX (median 93 (IQR 85 to 97)). OA (≥ grade 2) was present in four (17%) of the cases after FIX and five (20%) after NO-FIX (p = 0.763). After one year, median pain scores were 20 (IQR 5 to 40) versus 10 (IQR 5 to 25) (p = 0.032), and perceived general median health scores were 80 (IQR 60 to 89) versus 83 (IQR 71 to 90) (p = 0.596) after FIX and NO-FIX, respectively. Postoperative step-off > 1 mm on CT scan was present in 56% after FIX versus 71% after NO-FIX (p = 0.193). Complication rates were 18% versus 5% (p = 0.071) after FIX and NO-FIX, respectively.</p><p><strong>Conclusion: </strong>ORIF of medium-sized posterior fragments in AO type B trimalleolar fractures does not prompt superior functional or radiological results after one-year follow-up. Longer follow-up is needed to evaluate intermediate or long-term effects.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"461-469"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What do orthopaedic surgeons need to know about frailty?","authors":"Antony Johansen, Arwel Poacher","doi":"10.1302/0301-620X.107B4.BJJ-2024-1333.R2","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2024-1333.R2","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"378-379"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum.","authors":"Adam M Galloway, Nicolas Nicolaou, Daniel C Perry","doi":"10.1302/0301-620X.107B4.BJJ-2025-00055","DOIUrl":"10.1302/0301-620X.107B4.BJJ-2025-00055","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 4","pages":"501"},"PeriodicalIF":4.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}