Journal of Hand Surgery-American Volume最新文献

{"title":"Effect of Screw Length in Volar Plating for Intra-articular Distal Radius Fractures: A Biomechanical Study.","authors":"Thomas S Hong, Daniel J Lee, Babak Jahani, Kaitlyn S Broz, Donald A Aboytes, Simon Tang, Stephen DeMartini, David M Brogan","doi":"10.1016/j.jhsa.2024.07.019","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.07.019","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to compare the effect of varying screw lengths on load to failure and retention of the dorsal ulnar corner fragment after fixation of comminuted intra-articular distal radius fractures in a cadaveric model.</p><p><strong>Methods: </strong>Twenty-four fresh frozen cadaveric forearms were subjected to a standardized distal radius osteotomy to mimic an intra-articular fracture pattern. Dual X-ray absorptiometry scans were performed to ensure minimal variability in bone density. All fractures were fixed with a volar locking plate and distal locking screws. Three different lengths of distal locking screws were used in each group of eight specimens to simulate the clinical decision of different distal screw lengths. The screw lengths tested were bicortical, 100% of the width of the bone but unicortical, and 75% of the width of the bone and unicortical. All specimens were preconditioned with cyclic axial loading and then axially loaded using matching acrylic resin molds to clinical failure and fragment displacement as detected by a motion analysis system. Retention or loss of the dorsal ulnar corner fragment during loading was recorded as a binary variable.</p><p><strong>Results: </strong>Between the three groups, there were no statistically significant differences in precycling stiffness, postcycling stiffness, load at 2 mm displacement of the dorsal ulnar corner, or force at failure. The group with 75% length screws had a significantly higher loss of reduction of the dorsal ulnar corner (86%) compared with the other groups (0%).</p><p><strong>Conclusions: </strong>Varying screw lengths did not affect the stiffness or overall loads to failure of axially loaded specimens. However, the 75% length screws did not reliably secure the dorsal ulnar corner fragments. Although this did not significantly affect the overall load to failure of the construct, displacement of this fragment may have implications for rotation of the forearm through the distal radioulnar joint.</p><p><strong>Clinical relevance: </strong>Surgeons should consider the utilization of full-length unicortical locking screws to ensure adequate fixation of the dorsal ulnar corner.</p><p><strong>Type of study/level of evidence: </strong>Biomechanical study V.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Concepts in Management of Lateral Epicondylosis.","authors":"Ruby Gilmor, Ethan A Remily, John V Ingari","doi":"10.1016/j.jhsa.2024.07.003","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.07.003","url":null,"abstract":"<p><p>Lateral epicondylosis is a common cause of lateral elbow pain and can lead to disability and overall diminished quality of life. Repetitive gripping and wrist extension is thought to lead to microtearing and degeneration of the extensor tendons. In general, patients with symptoms of lateral epicondylosis experience relief of symptoms with non-operative management alone. However, controversy remains concerning the role of non-surgical management and which modality facilitates the quickest recovery. Moreover, debate remains throughout the literature regarding surgical intervention and other treatment options for refractory cases. This article serves to provide an updated review of the various treatment options and management for treating lateral epicondylosis.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct Economic Burden of Cubital Tunnel Surgery in the United States: Total Payments and Components of Cost.","authors":"David M Brogan, Andrew J Landau, Margaret A Olsen, Katelin B Nickel, Joanna L Buss, Christopher J Dy","doi":"10.1016/j.jhsa.2024.07.011","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.07.011","url":null,"abstract":"<p><strong>Purpose: </strong>Despite its widespread prevalence, the cost of cubital tunnel syndrome (CuTS) in the United States to patients and insurers is not well understood. The purpose of this study was to quantify the direct payments associated with operative treatment of CuTS. We hypothesized that CuTS represents a substantial cost to the payer in facility fees, surgeon fees and other expenses.</p><p><strong>Methods: </strong>Utilizing the MarketScan database of insured patients (commercial and Medicaid), we identified a cohort of 41,777 patients aged 18-64 years with surgically treated CuTS from 2006 to 2018. We estimated the median 90-day payments from encounters associated with cubital tunnel release (CuTR) and/or ulnar nerve transposition surgery by summing all payments for claims within 90 days after the index surgery. Published estimates of the annual number of cubital tunnel surgeries were used to calculate the annual expenditure.</p><p><strong>Results: </strong>Of 41,777 patients, the median (interquartile range [IQR]) values of total direct payments were $5,522 [$3,426, $9,541]. With an estimated 94,645 cases/year, this leads to an annual payment of more than $522 million. Index facility payments (median[IQR] $2,555 [$1,359, $4,708] were the highest, followed by index provider payments ($1,691 [$1,328, $2,217]). The median index surgeon payment (median[IQR] $905 [$707, $1,184]) represented just over half of the provider payments. Post-operative care had a median [IQR] payment of $377 ($424, $1,987). Limitations of claims databases prevented assessment of other indirect costs associated with cubital tunnel surgery.</p><p><strong>Conclusions: </strong>Payments for the surgical treatment of CuTS from the index surgery to 90 days post-operatively have an estimated median of $5,522 per patient, totaling $52 million annually. Index facility fees are responsible for more than 46% of payments, while index payments to surgeons represent approximately 16%. Defining this data is critical to understanding one component of the economic impact of CuTS.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Affecting Outcomes After Free Functional Gracilis Muscle Transfer for Elbow Flexion in Brachial Plexus Injury: A Systematic Review and Meta-Analysis.","authors":"Syeda Hoorulain Ahmed, Ramin Shekouhi, Yousef M Husseiny, Eddy Rios, Maryam Sohooli, Harvey Chim","doi":"10.1016/j.jhsa.2024.07.012","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.07.012","url":null,"abstract":"<p><strong>Purpose: </strong>Free functional gracilis transfer (FFGT) is a useful option for reconstruction of elbow flexion following brachial plexus injury presenting late or with poor outcomes from previous nerve surgery. In this systematic review and meta-analysis, we aimed to investigate variables associated with superior outcomes. The efficacy of single versus double FFGT, where the first FFGT is performed to restore elbow flexion, and the choice of donor nerve for neurotization were evaluated.</p><p><strong>Methods: </strong>A meta-analysis was conducted, including studies that provided postoperative Medical Research Council (MRC) grade for elbow flexion, Disabilities of the Arm, Shoulder, and Hand and visual analog scale scores, quantitative elbow flexion strength, and range of motion. A random effects meta-regression analysis was performed to identify factors associated with improved outcomes.</p><p><strong>Results: </strong>Thirty-seven studies, with 1,607 patients, were analyzed. Single FFGT was reported in 34 studies (n = 1,398), and double FFGT was reported in 10 studies (n = 209). The mean follow-up duration was 37.3 ± 21.1 months. Following single FFGT, 75.4% and 48.9% achieved MRC grades ≥3 and ≥4, respectively. Following double FFGT, 100% achieved an MRC grade ≥3 and 62.7% ≥4. The likelihood of achieving M3 and M4 was significantly greater for double FFGT. Overall, FFGT innervated by the spinal accessory nerve had significantly better recovery of MRC grade ≥3. When comparing only single and double FFGT innervated by spinal accessory nerve, there was no significant difference in recovery of elbow flexion. The meta-regression analysis showed a significant negative correlation between the patient's age and the probability of achieving an MRC grade of ≥3 and 4.</p><p><strong>Conclusions: </strong>In the overall analysis encompassing all innervating nerves, double FFGT was superior to single FFGT. Subgroup analysis of single and double FFGT innervated by the spinal accessory nerve showed no significant difference. Increasing age was a significant risk factor for poorer outcomes.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MAÏA Trapeziometacarpal Joint Arthroplasty: Clinical and Radiological Outcomes of 76 Patients With More Than 10 Years of Follow-Up","authors":"","doi":"10.1016/j.jhsa.2024.03.019","DOIUrl":"10.1016/j.jhsa.2024.03.019","url":null,"abstract":"<div><h3>Purpose</h3><p>Trapeziometacarpal (TMC) joint replacement has become a valid option in the therapeutic arsenal of TMC joint osteoarthritis in Europe. Good mid-term results of the MAÏA TMC joint prosthesis suggested that it is a reliable procedure. This study aimed to assess the long-term results of this modular uncemented ball-and-socket hydroxyapatite-coated implant.</p></div><div><h3>Methods</h3><p>This single-center retrospective study evaluated 92 MAÏA TMC joint prostheses in 76 patients with a minimum of 10 years of follow-up. Indications for the procedure were painful TMC joint osteoarthritis both at rest and during activity, despite nonsurgical treatment for more than six months. Pre- and postoperative clinical and radiographic outcomes were compared.</p></div><div><h3>Results</h3><p>Mean follow-up was 134 months (range: 120–158 months). Mean age at the time of surgery was 67 years (range: 53–84 years). The cohort comprised 86.8% of women (n = 66). The mean Quick Disabilities of the Arm, Shoulder, and Hand score improved from 61.3 ± 17.1 to 19.6 ± 16. Range of motion was restored, and postoperative mobility was comparable with that of the contralateral side. Final Kapandji opposition score was almost normal (9.2 ± 0.7). Final key pinch and grip strength improved by 26% and 39%, respectively. Eight implants were surgically revised, six for trapezium cup loosening and two for instability because of polyethylene wear. Three cases of traumatic fracture of the trapezium in older patients were successfully treated with a cast for eight weeks. Five of 26 (20.8%) cases of preoperative-reducible z-deformity were not totally corrected after surgery. The Kaplan-Meier survival over 10 years was 88% (95% confidence interval: 84–93) versus 93% (95% confidence interval: 87–98) over 5 years.</p></div><div><h3>Conclusions</h3><p>MAÏA TMC joint prosthesis is a reliable long-term surgical procedure for TMC joint osteoarthritis, improving overall function beyond 10 years.</p></div><div><h3>Type of study/level of evidence</h3><p>Therapeutic IV.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journal CME Instructions","authors":"","doi":"10.1016/S0363-5023(24)00367-8","DOIUrl":"10.1016/S0363-5023(24)00367-8","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142128316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five-Year Follow-Up of Adolescent Gymnasts After Surgical Treatment of Osteochondritis Dissecans of the Elbow","authors":"","doi":"10.1016/j.jhsa.2022.12.009","DOIUrl":"10.1016/j.jhsa.2022.12.009","url":null,"abstract":"<div><h3>Purpose</h3><p>Elbow osteochondritis dissecans (OCD) is well-studied in throwing athletes; however, there are limited data regarding gymnasts with capitellar OCD lesions. We aimed to determine the overall rate of return to competition following surgical treatment of capitellar OCD lesions and to determine the relationship, if any, between arthroscopic grade of lesion and ability to return to competition.</p></div><div><h3>Methods</h3><p>A medical chart Current Procedural Terminology query from 2000 to 2016 yielded data on 55 competitive adolescent gymnasts who were treated surgically for elbow OCD lesions in a total of 69 elbows. Retrospective chart review was used to collect data on preoperative and postoperative symptoms and surgical treatment. Patients were contacted to complete questionnaires (Modified Andrews Elbow Scoring System, Disabilities of the Arm, Shoulder, and Hand) on return to sport. Current elbow function and follow-up data were available for 40 of 69 elbows.</p></div><div><h3>Results</h3><p>Average age at time of surgery was 12.1 years with 18 of 55 (33%) of patients competing at a pre-elite level of gymnastics (level 9 or 10 of 10) before surgery. Nine out of 31 gymansts (29%) underwent bilateral surgery for OCD lesions. Average OCD lesion size was 10 mm. Thirty-one of 40 elbows (78%) were treated with debridement<span> back to a stable cartilage rim with microfracture, and nine of 40 elbows (22%) were treated with debridement alone. Thirty-six of 40 patients (90% returned to competitive gymnastics with all returning patients competing at or above the same level after surgery. Among the patients who were followed up, 29 of 30 patients (97%) reported some difficulty with specific events on return to competition.</span></p></div><div><h3>Conclusions</h3><p>The rate of return to sport for gymnasts at 90% is similar to that observed in other sports. This study suggests that elbow OCD lesions are not career-ending injuries for adolescent gymnasts; however, gymnasts should not expect a fully asymptomatic return to all events in a sport.</p></div><div><h3>Type of study/level of evidence</h3><p>Therapeutic IV.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9357838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Thumb Metacarpophalangeal Hyperextension on Thumb Axial Load and Lateral Pinch Force in a Cadaver Model of Thumb Trapeziectomy and Flexor Carpi Radialis Suspensionplasty","authors":"","doi":"10.1016/j.jhsa.2022.11.018","DOIUrl":"10.1016/j.jhsa.2022.11.018","url":null,"abstract":"<div><h3>Purpose</h3><p>The purpose of our study was to investigate, in a cadaver model, the effect of increasing thumb metacarpophalangeal (MCP) joint hyperextension<span> on thumb axial load and key pinch force after thumb trapeziectomy and flexor carpi radialis suspensionplasty. We developed a cadaveric model to test whether thumb MCP joint hyperextension after trapeziectomy would have a negative effect on key pinch force and increase loads across a reconstructed thumb carpometacarpal (CMC) joint.</span></p></div><div><h3>Methods</h3><p>We created a cadaveric biomechanical model that varied thumb MCP joint hyperextension while measuring thumb CMC axial and key pinch force under standardized loads. Direct observations were made of how key pinch and axial thumb CMC force change with increasing thumb MCP joint hyperextension. We measured the thumb key pinch force and axial thumb CMC joint load with the thumb MCP joint in 0°, 10°, 20°, 30°, 40°, 50°, and 60° of hyperextension.</p></div><div><h3>Results</h3><p>There was a 0.88 N (2.4%) increase in axial force across the thumb CMC per every 10° of increasing thumb MCP joint hyperextension. We found a 0.53 N (4.4%) reduction in key pinch force for every 10° of increasing thumb MCP joint hyperextension. Therefore, at 60° of thumb MCP joint hyperextension, the axial force across the thumb CMC increased by 5.3 N (14.6%) and the key pinch force was weakened by 3.2 N (26.6%).</p></div><div><h3>Conclusions</h3><p>With progressive thumb MCP joint hyperextension after thumb CMC arthroplasty, we found a decrease in key pinch force and an increase in axial thumb CMC joint force. The decrease in key pinch force was larger than the relatively small increase in thumb CMC force.</p></div><div><h3>Clinical relevance</h3><p>This study helps elucidate the biomechanics of the thumb CMC joint after resection arthroplasty with thumb MCP joint hyperextension and helps understand the interplay between these 2 conditions.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10761287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiolunate Arthrodesis in the Rheumatoid Wrist: A Retrospective Clinical and Radiologic Long-Term Follow-Up","authors":"","doi":"10.1016/j.jhsa.2022.11.014","DOIUrl":"10.1016/j.jhsa.2022.11.014","url":null,"abstract":"<div><h3>Purpose</h3><p><span><span>This study aimed to determine the results of radiolunate arthrodesis for </span>rheumatoid arthritis (RA) after a long-term follow-up period of up to 20 years under tight postoperative medical control of RA. We also compared the results between patients with and without degenerative changes in the midcarpal joints at follow-up. We determined the radiologic </span>factors predictive of secondary degenerative changes in the midcarpal joint.</p></div><div><h3>Methods</h3><p>This was a long-term retrospective analysis of 16 wrists of 14 patients with RA treated with radiolunate arthrodesis first reported in 2013. The mean follow-up period was 14 years (range, 8–23 years; SD, 4.6 years). Ten wrists had a Larsen classification of grade III, whereas 6 wrists had grade IV. The range of motion was assessed, and clinical outcomes were graded using the Mayo Wrist Score and Stanley classification system. The Carpal Height Index, Ulnar Translation Index, and changes in the midcarpal joint contour were determined from radiographs. We categorized the changes in the midcarpal joint as unchanged or degenerative.</p></div><div><h3>Results</h3><p>At final follow-up, the clinical scores improved; however, the extension and flexion range of motion was significantly reduced compared with that before surgery. The Carpal Height Index and Ulnar Translation Index improved immediately after surgery and remained stable at final follow-up. The changes in the midcarpal joint were categorized as unchanged in 6 wrists and degenerative in 10 wrists. The clinical outcomes were similar between the groups. The mean preoperative Ulnar Translation Index was significantly higher in the degenerative group than in the unchanged group.</p></div><div><h3>Conclusions</h3><p>Radiolunate arthrodesis in patients with RA maintained good clinical results and corrected alignment, even during long-term follow-up. Preoperative severe ulnar translation deformity was a risk factor for postoperative degeneration of the midcarpal joint, and pre-existing degenerative changes at the midcarpal joint might lead to loss of wrist range of motion.</p></div><div><h3>Type of study/level of evidence</h3><p>Therapeutic IV.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9072253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Resonance Imaging Assessment of Ulnar Wrist Pain: A Practical Guide for Surgeons","authors":"","doi":"10.1016/j.jhsa.2024.05.012","DOIUrl":"10.1016/j.jhsa.2024.05.012","url":null,"abstract":"<div><p><span>Ulnar-sided wrist pain is a challenging clinical scenario due to multiple overlapping pathologies and involved </span>anatomic structures. Advanced imaging such as magnetic resonance imaging can be used as an effective diagnostic adjunct if interpreted correctly. In this article, clinically relevant structures and radiographic correlates of the ulnar wrist are discussed and a corresponding systematic approach to reviewing magnetic resonance imaging is presented.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}