Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Controversies in osteo-articular infections: Interest of new technologies and older procedures revisited","authors":"Florence Aïm , Guillaume Auberger , Philippe Clavert , Simon Marmor","doi":"10.1016/j.otsr.2025.104422","DOIUrl":"10.1016/j.otsr.2025.104422","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104422"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058798","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":"Centromedullary nailing during the second stage of induced membrane (Masquelet) for tibia septic nonunion enables bone union to be achieved without increasing the risk of recurrence of infection, with an earlier return to weight-bearing","authors":"Marie Le Baron ,&nbsp;Mathieu Cermolacce ,&nbsp;Julie Falguières ,&nbsp;Richard Volpi ,&nbsp;Pascal Maman ,&nbsp;Xavier Flecher","doi":"10.1016/j.otsr.2024.104118","DOIUrl":"10.1016/j.otsr.2024.104118","url":null,"abstract":"<div><h3>Introduction</h3><div><span>Septic nonunion is one of the most feared complications in </span>traumatology<span>. Two-stage management using the induced membrane technique is a validated treatment option, but to date there is no consensus on the ideal type of osteosynthesis for the second stage of surgery. The aim of this study was to compare the results of two-stage treatment of tibial septic nonunion, depending on the type of osteosynthesis used.</span></div></div><div><h3>Hypothesis</h3><div><span>Our hypothesis was that internal centromedullary nailing osteosynthesis during the second stage of management of septic tibia nonunion would achieve </span>bone union and healing of the infection, while allowing faster resumption of weight-bearing without increasing the complication rate.</div></div><div><h3>Material &amp; methods</h3><div>This was a retrospective monocentric continuous comparative study including all 2-stage tibial septic nonunions treated from January 2008 to July 2018, with a minimum follow-up of 18 months. Healing and septic reactivation rates, as well as time to union and weight-bearing on the limb, were compared according to the type of osteosynthesis used. Primary success was defined as recovery from septic nonunion, and secondary success as recovery after at least one additional surgical procedure.</div></div><div><h3>Results</h3><div>Forty-nine patients were included, aged 39.5 +/− 14.8 years. Primary and secondary success rates were 77.6% (38/49) and 87.8% (43/49), with a mean follow-up of 29.4 +/− 11.3 months. Internal osteosynthesis did not lead to more septic reactivation than external stabilization (p = 0.49), while allowing union within the same deadlines. Osteosynthesis with a centromedullary nail allowed earlier weight-bearing (1.5 +/− 0.9 months) vs. plate (4.8 +/− 1.5) or vs. external fixator (5.3 +/− 1.8) (p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Secondary conversion to internal osteosynthesis during the second stage of nonunion cure allows consolidation in same delays, without increasing the risk of infectious recurrence. It also enables faster weight-bearing on the operated limb, particularly in the case of centromedullary nailing.</div></div><div><h3>Level of evidence</h3><div>III; comparative study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104118"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878497","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":"Extension patellar engagement index: a new measurement of patellar height","authors":"Vincent Chassaing ,&nbsp;Marie-Dominique Chancelier ,&nbsp;Jean-Louis Blin ,&nbsp;Jonathan Curado ,&nbsp;Jean-Marc Zeitoun","doi":"10.1016/j.otsr.2024.104086","DOIUrl":"10.1016/j.otsr.2024.104086","url":null,"abstract":"<div><h3>Introduction</h3><div><span>Patellar instability is a multifactorial pathology requiring precise evaluation of its contributing factors, particularly patella<span> alta. Patellotibial height measurement indexes, such as the Caton-Deschamps index, have the disadvantage of being referenced to the tibia. Patellotrochlear indexes are more appropriate but fail to account for variable knee flexion during </span></span>magnetic resonance imaging (MRI).</div></div><div><h3>Objective</h3><div>This study aims to validate a new MRI-based patellotrochlear measurement, the extension patellar engagement (EPE) index, which is reproducible and measures patellar height relative to the trochlea independently of knee flexion during MRI.</div></div><div><h3>Materials and methods</h3><div>A retrospective study was conducted on 77 MRIs (37 unstable patients with a history of patellar dislocation, 40 controls with meniscal injury). The EPE index is the ratio between the patellar engagement length on the cartilaginous trochlea and the patellar cartilage length, measured on a knee virtually extended. Four measurements on multiple sagittal slices were used to calculate the EPE index.</div></div><div><h3>Results</h3><div>The inteobserver intraclass correlation coefficient (ICC) was excellent (0.79). The mean EPE index's value for all knees was 0.22. It was significantly higher (p = 0.034) in the instability group (0.26) compared to the control group (0.19). The average knee flexion during MRI was 11 ° (range: −8 ° to 25 °).</div></div><div><h3>Discussion</h3><div>The EPE index is reproducible. It is an anatomical index to classify patella alta when the patella does not reach the trochlea in knee extension (EPE index ≤0). It is also a functional index, with a mean value of 0.19 in the control group.</div></div><div><h3>Conclusion</h3><div>The EPE index measures the patellar engagement on the trochlea taking into account the knee flexion during MRI. It may guide surgical decision-making for patellar distalization and quantify the required correction.</div></div><div><h3>Level of Evidence</h3><div>III; retrospective comparative study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104086"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822898","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":"Impact of preoperative measures on postoperative results in combined anterior cruciate and medial collateral ligament injuries: an analysis from the registry of the francophone arthroscopic society","authors":"Benjamin Freychet ,&nbsp;Nicolas Bouguennec ,&nbsp;Emilie Berard ,&nbsp;Alexandre Hardy ,&nbsp;Corentin Herce ,&nbsp;Charles Kajetanek ,&nbsp;Christian Lutz ,&nbsp;Thomas Neri ,&nbsp;Matthieu Ollivier ,&nbsp;Etienne Cavaignac","doi":"10.1016/j.otsr.2025.104185","DOIUrl":"10.1016/j.otsr.2025.104185","url":null,"abstract":"<div><h3>Background</h3><div>Combined injuries of the anterior cruciate ligament<span> (ACL) and medial collateral ligament (MCL) are frequent in knee trauma. Treatment approaches vary widely, including surgical and conservative methods. However, the impact of preoperative measures on postoperative outcomes remains unclear.</span></div></div><div><h3>Hypothesis</h3><div>Preoperative measures influence on postoperative outcomes for cases involving combined anterior cruciate and medial collateral ligament injuries.</div></div><div><h3>Patients and methods</h3><div><span><span><span>A prospective, multicenter study was conducted in 8 French surgical centers specializing in knee surgery. Data were collected on patients undergoing ACL reconstruction with concomitant MCL injury over a 12-month period. Inclusion criteria were primary </span>ACL injury<span> associated with MCL injury (Grade I, II or III) and requiring ACL reconstruction, patients aged ≥ 15 years. The use and type of preoperative brace, weight-bearing and the time between injury and surgery were assessed. A functional assessment of the IKDC, ACL-RSI, TEGNER and SKV scores was performed at final follow-up. Patients were evaluated with regards of iterative ACL rupture, </span></span>contralateral ACL rupture and </span>reoperation.</div></div><div><h3>Results</h3><div>The study included 408 patients with a mean follow-up of 18.5 months. Time between injury and surgery did not significantly affect the risk of iterative rupture, contralateral rupture, or reoperation. No significant impact of preoperative brace type or weight-bearing status on postoperative outcomes was observed. However, patients with higher grade MCL injuries underwent surgery earlier (p &lt; 0.0001) and had lower preoperative weight-bearing allowances (p &lt; 0.05). Patients with Grade 2−3 MCL injuries had lower functional scores compared to those with Grade 1 injuries (p &lt; 0.05).</div></div><div><h3>Discussion</h3><div>Preoperative measures, including time between injury and surgery, showed no significant influence on postoperative outcomes in combined ACL-MCL injuries. The type of preoperative brace and weight-bearing status did not significantly impact postoperative results. A functional approach with immediate full weight-bearing/recovery of full range of motion and with the use of bracing according to pain and patient apprehension is recommended. Further research is needed to refine preoperative treatment strategies for such injuries.</div></div><div><h3>Level of evidence</h3><div>IV; prospective study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104185"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426688","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 evolution of clinical evidence in orthopaedics and traumatology: Unlocking the potential of randomized controlled trials for traumatology.","authors":"Patrick Haubruck, Tobias L Grossner","doi":"10.1016/j.otsr.2025.104446","DOIUrl":"10.1016/j.otsr.2025.104446","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104446"},"PeriodicalIF":2.2,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193793","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":"Prevention and treatment of post-irradiation fractures and other complications.","authors":"Eric Mascard, Gualter Vaz, Valentine Martin","doi":"10.1016/j.otsr.2025.104441","DOIUrl":"10.1016/j.otsr.2025.104441","url":null,"abstract":"<p><p>Bone may be irradiated either as a target volume in the treatment of metastases or primary bone tumors, or as an organ at risk in soft tissue sarcomas (STS) and other cancers. This review aims to answer 5 key questions: 1. What are the causes, mechanisms, and locations of post-irradiation fractures (PIF)? Radiotherapy affects bone metabolism and surrounding soft tissues, contributing to fractures and complicating their treatment. In STS, periosteal stripping and radiation doses exceeding 50 Gy increase the risk of PIF, especially in the femur, which is the most frequently affected site. Fractures of the tibia, fibula, metatarsals, and upper limb are less common. PIF can also occur in the mandible (head and neck cancers), ribs or spine (lung and breast cancers), upper humerus, or pelvis. Osteoradionecrosis (ORN) is mostly associated with head and neck or maxillofacial sites but can affect other parts of the skeleton and pose significant therapeutic challenges. 2. How can post-irradiation fractures be prevented? Prevention of PIF mainly involves reducing skeletal radiation exposure and correcting any pre-existing osteopenia. Antioxidants and hyperbaric oxygen therapy are effective in preventing ORN. Preventive femoral nailing is recommended when general and especially local risk factors are present, such as during resection of STS of the thigh. Skeletal coverage with a flap can prevent complications caused by the sacrifice of soft tissue during resection of the primary tumor. 3. How is a post-irradiation fracture diagnosed? Some PIFs are easy to diagnose, while others are discovered fortuitously. It is important to differentiate PIFs from other lesions (metastasis, tumor progression, radiation-induced sarcoma, osteonecrosis), which may require a biopsy. 4. How are post-irradiation fractures treated? PIF treatment is associated with high rates of non-union and infection. Autologous bone grafts, and especially vascularized grafts, are recommended. Intra-medullary nailing is the preferred internal fixation technique. In certain cases, prosthetic replacement or even amputation may be necessary. 5. What are the specific features of radiotherapy in children and adolescents? Prevention and treatment of PIF in pediatric populations require a multidisciplinary approach, coordinated with the treatment of the underlying tumor, which remains the top priority. LEVEL OF EVIDENCE > V: Expert opinion.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104441"},"PeriodicalIF":2.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180004","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":"Management of forearm fracture in children in 2025.","authors":"Céline Klein","doi":"10.1016/j.otsr.2025.104439","DOIUrl":"10.1016/j.otsr.2025.104439","url":null,"abstract":"<p><p>Orthopedic surgeons frequently have to deal with diaphyseal fractures of the two forearm bones. The present update aims to answer five questions: (1) Have the epidemiology and trauma mechanisms of forearm fractures changed over the last two decades? (2) What displacements are acceptable, at what age? (3) Is there any real debate about treatment for diaphyseal fracture of the two forearm bones? (4) What other types of forearm fracture are found in children? (5) What therapeutic strategies should be proposed in the event of complications and sequelae of fracture of the two forearm bones? And how can rates be limited? Fractures of the forearm have increased in incidence over the last 2 decades. Trampolines are greatly implicated. Displacement is acceptable when remodeling is sufficient to restore the anatomical and functional framework of the forearm; non-operative treatment may therefore be proposed up to the age of 10 for <15 ° sagittal displacement and <10 ° frontal displacement with <50% translation. The surgical treatment of choice is elastic stable intramedullary nailing, which may be considered in school-age children. Compartment syndrome is rare, but not exceptional in fracture of both forearm bones in children, particularly in case of crushing, direct impact or numerous reduction maneuvers. To prevent secondary displacement and re-fracture, immobilization may be prolonged, for up to 3 months, with material removal only once the medullary canal is completely permeable. Forearm fractures in children have a very good prognosis. LEVEL OF EVIDENCE >V: Expert opinion.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104439"},"PeriodicalIF":2.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180017","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":"Articular and extra-articular scapula fracture.","authors":"Guillaume Villatte, Maxime Antoni, Mathieu Girard, Pierre-Sylvain Marcheix","doi":"10.1016/j.otsr.2025.104438","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104438","url":null,"abstract":"<p><p>Scapular fracture is varied but rare, and studies have only low levels of evidence. Surgical indications are increasingly numerous, but non-operative treatment with early rehabilitation is the gold-standard in the majority of cases, showing good results. Surgery is indicated according to the patient's functional demand, on certain anatomic criteria evaluated on CT: glenopolar angle < 20 °, > 10 mm frontal displacement (medialization) and sagittal angulation > 40 ° for fractures of the scapular neck and body, and > 4 mm joint displacement, involvement of more than 30% of the joint surface and persistent subluxation for glenoid fractures. Surgery provides good functional results but is technically difficult, with high rates of complications. Acromion fracture, and particularly stress fracture following reverse total arthroplasty, is difficult to treat and incurs frequent sequelae of pain and non-union. Conservative treatment is recommended only in non-displaced lateral fracture (Levy 1). In more medial fracture, osteosynthesis with one or two plates should be considered. Prosthetic revision is indicated in fewer than 10% of cases, for instability or glenoid loosening. The superior shoulder suspensory complex must be analyzed in the bone (scapular neck and clavicle) and ligaments (acromioclavicular and coracoclavicular). The extent of neck fracture displacement dictates surgical management, either (most frequently) by fixation of the clavicle alone or by double clavicular and scapular fixation.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104438"},"PeriodicalIF":2.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151940","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":"Childhood fibrous dysplasia.","authors":"Clémence Pfirrmann, Pierre Journeau, Franck Chotel, Roland Chapurlat","doi":"10.1016/j.otsr.2025.104440","DOIUrl":"10.1016/j.otsr.2025.104440","url":null,"abstract":"<p><p>Fibrous dysplasia is a rare, non-malignant bone disorder in which diagnosis may be easy (polyostotic forms) or more difficult (monostotic forms). Complementary radiological examinations (standard X-ray, CT, scintigraphy) are essential to pinpoint the location or locations of bone involvement. In case of diagnostic doubt, bone biopsy screens for GNAS gene mutation. Fibrous dysplasia may be isolated or part of McCune-Albright syndrome. In case of extraosseous involvement, it is essential to investigate the physiology of the various affected tissues (e.g., for phosphate diabetes). International guidelines were issued in 2019, for diagnosis of fibrous dysplasia and McCune-Albright syndrome and for patient management. There is no specific medical treatment for fibrous dysplasia, but appropriate analgesics and biphosphonates can improve quality of life. In fibrous dysplasia, the bone may be fragile, particularly in the femoral neck, leading to limping, bone deformities and pathological fractures. Orthopedic management ranges from simple monitoring for small monostotic lesions in non-weight-bearing areas to invasive surgery with axial correction and preventive osteosynthesis. In children, fibrous dysplasia lesions can be found at birth on histology, but appear progressively until puberty on X-ray. The impact of skeletal growth, with asymmetric growth due to fibrous dysplasia lesions, lower limb length discrepancy and epiphysiodesis, make surgical management complex. Intramedullary nailing is the surgical technique of choice. LEVEL OF EVIDENCE >V: Expert opinion.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104440"},"PeriodicalIF":2.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151981","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":"Pathologies of the cervical spine in skeletal syndromes and dysplasias.","authors":"Raphaël Vialle","doi":"10.1016/j.otsr.2025.104437","DOIUrl":"10.1016/j.otsr.2025.104437","url":null,"abstract":"<p><p>Skeletal syndromes and dysplasias include more than 150 entities, most often of genetic origin. Some of them cause abnormalities in the cervical spine, with or without instability, distortion or compression of the spinal cord. These abnormalities must be detected and treated if necessary because they can have serious consequences such as quadriplegia. Up to 30% of patients with Down syndrome are affected by occipitocervical or atlantoaxial instability. Dynamic cervical spine radiographs are the most common screening tool. Mucopolysaccharidoses (MPS) are a group of inherited lysosomal storage diseases that result in the accumulation of glycosaminoglycans sometimes responsible for craniocervical instability and cervical spinal canal stenosis. Their monitoring requires an MRI every two years. Neurofibromatosis type 1 and syndromes with connective tissue abnormalities (Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome) can cause severe and unstable cervical spine deformities that may remain asymptomatic for a long time. Cervical X-rays should therefore be performed if there is the slightest doubt. Some rare chondrodysplasias (punctate chondrodysplasia, Larsen syndrome, Metatropic dysplasia) or segmentation anomalies (Klippel Feil syndrome, Sprengel's disease) have cervical spine abnormalities that should be looked for. In case of progression of a deformity (usually kyphosis) or stenosis of the cervical spine, it is important to consider surgical treatment with correction and stabilization. Sometimes preceded by a period of Halo traction, the instrumentation must have \"wide\" limits and exceed the anatomical limits of the spinal deformity by at least 2-3 levels to prevent the development of an adjacent deformity. The increasing use of surgical navigation techniques allows for greater corrections and more efficient stabilizations, including severe cervical spinal deformities. Vigilance and the detection of these abnormalities remain the key to early and preventive treatment of the complications of these spinal anomalies on often difficult terrain. LEVEL OF EVIDENCE: >V (expert opinion).</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104437"},"PeriodicalIF":2.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114807","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}