Journal of Hand Surgery-American Volume最新文献

{"title":"Save or Salvage: Radial Shortening Osteotomy and Proximal Row Carpectomy in Kienböck’s Disease—A Descriptive Study","authors":"Tanis Quaife MD, BMSc,&nbsp;Ian Diffey MD, BSc,&nbsp;Lukas Hashem MD,&nbsp;Wrist and Elbow Research Canada (WECAN) Affiliates,&nbsp;Ruby Grewal MD, MSc","doi":"10.1016/j.jhsa.2026.02.031","DOIUrl":"10.1016/j.jhsa.2026.02.031","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the mid- to long-term outcomes of radial shortening osteotomy (RSO) and proximal row carpectomy (PRC) in treating Kienböck’s disease, using patient-reported outcomes, functional measures, and rates of secondary surgery.</div></div><div><h3>Methods</h3><div>This multicenter cohort study evaluated 47 patients treated between 1998 and 2024 (31 RSOs, 16 PRCs). Radial shortening osteotomy and PRC groups included patients with Lichtman stage 2 through 4 as follows: RSO stage 2, 8 patients; stage 3A, 10 patients; stage 3B, 13 patients; stage 4, 0 patients; PRC stage 2, 0 patients; stage 3A, 3 patients; stage 3B, 9 patients; and stage 4, 4 patients. Primary outcomes included Patient-Reported Wrist Evaluation (PRWE); Quick Disabilities of the Arm, Shoulder, and Hand (<em>Quick</em>DASH); and satisfaction scores. Secondary outcomes were grip strength, range of motion, complications, and secondary surgeries. Subgroup comparison of primary and secondary outcomes in Lichtman stages 3A and 3B was performed.</div></div><div><h3>Results</h3><div>At a mean follow-up of 10.4 years, RSO patients demonstrated lower and therefore improved PRWE (23.5 [IQR, 12.0-52.5]) and <em>Quick</em>DASH (11.4 [IQR, 6.9-29.5]) scores with higher satisfaction (86%) compared with PRC (PRWE, 38.5 [IQR, 23.0-54.0]; <em>Quick</em>DASH, 23.0 [IQR, 13.6-43.2]; satisfaction, 62%). Radial shortening osteotomy and grip strength were similar between the groups. Reoperation rates were similar, although secondary surgeries in the RSO group were generally more limited than those in the PRC group (eg, hardware removal vs total wrist fusion). Subgroup descriptive comparison confirmed RSO’s benefits even in stages 3A/3B.</div></div><div><h3>Conclusions</h3><div>Radial shortening osteotomy offers at least comparable outcomes with PRC in treating Kienböck’s disease, particularly in preserving joint function and patient satisfaction. Interestingly, RSO is also an effective joint-preserving option even in late-stage disease (Lichtman stages 3A/B), demonstrating lower PRWE and <em>Quick</em>DASH scores and higher satisfaction scores than PRC in these groups. Further large-scale studies are needed to confirm these findings and refine treatment protocols.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 962.e1-962.e6"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148037824","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":"Timeline of Functional Recovery Following Hand and Upper-Extremity Transplantation","authors":"Isaac Mordukhovich BA,&nbsp;Connor Roncagli BS,&nbsp;Natalie Hoffner BS,&nbsp;Kyle Barclay BA,&nbsp;Antonio Rampazzo MD, PhD,&nbsp;Bahar Bassiri Gharb MD, PhD","doi":"10.1016/j.jhsa.2026.05.003","DOIUrl":"10.1016/j.jhsa.2026.05.003","url":null,"abstract":"<div><h3>Purpose</h3><div>The degree to which motor and psychosocial functions may recover following hand and upper-extremity transplantation (HUET) remains unclear. This study quantifies HUET outcome changes in the first 10 years post-transplantation to provide insight into this question.</div></div><div><h3>Methods</h3><div>A systematic review of PubMed, Embase, Cochrane, and Medline yielded 2104 records; 118 articles were included in the final review. HUETs above the proximal third of the forearm were designated as proximal and the remaining distal. Semmes-Weinstein Monofilament (SWMF) test, grip strength, Kapandji, finger and thumb total active range of motions (TAROMs), Carroll, Short Form 36 (SF-36), Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), and Hand Transplantation Score System (HTSS) were recorded according to patient and postoperative year (POY).</div></div><div><h3>Results</h3><div>Ninety-seven patients were identified between 1998 and 2025. Distal HUETs’ SWMF improved from POY1 (4 [4−4]) to POY2 (5 [4−6]). Power grip remained constant for distal and proximal HUETs, but proximal HUETs recovered less than distal HUETs (4.51 ± 1.49 kg vs 7.33 ± 0.71 kg). Lateral pinch strengths did not differ between groups. Proximal HUETs’ lateral grips demonstrated sustained improvement after POY3. Bilateral HUETs demonstrated higher SF-36 scores than unilateral HUETs across POY1−10. HTSS measured significant improvements in distal HUETs increasing from 65 (57−79.5) (POY1) to 76 (71−85) by POY3, while proximal HUET only improved from POY1 (61 [45−70.5]) at POY8−10 (82.5 [72−91.5]). Finger TAROMs remained largely unchanged after POY1 while distal and proximal Kapandji thumb opposition scores improved at POY3−6 and POY8−10, respectively.</div></div><div><h3>Conclusions</h3><div>Transplant level influenced recovery of power grip and HTSS. HUET power grip strength and finger TAROM stabilized after POY1 while lateral grip, Kapandji scores, HTSS, and SWMF showed improvements in the decade following transplantation, mostly for distal HUETs. Bilateral HUETs had better psychosocial (SF-36) outcomes than unilateral HUETs, but no difference in DASH scores.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 1028.e1-1028.e14"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148177301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter Regarding “Clinical Classification Versus MRI Patterns of Injury in Brachial Plexus Birth Injury”","authors":"Caroline H. Hu MD,&nbsp;Ann E. Van Heest MD,&nbsp;Michelle A. James MD,&nbsp;M. Claire Manske MD,&nbsp;Peter Y. Shen MD,&nbsp;Andrea S. Bauer MD","doi":"10.1016/j.jhsa.2026.05.013","DOIUrl":"10.1016/j.jhsa.2026.05.013","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 1002-1003"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859706","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":"Mapping Population-Level Differences in Brachial Plexus Birth Injury: An International Meta-Analysis","authors":"Holly Cordray BS,&nbsp;Miguel Fiandeiro BA,&nbsp;Seungjun Lee BA,&nbsp;Roger Cornwall MD,&nbsp;Petra Grahn MD,&nbsp;Marja Kaijomaa MD,&nbsp;M. Claire Manske MD,&nbsp;Melissa Previtera MA,&nbsp;Apurva S. Shah MD, MBA","doi":"10.1016/j.jhsa.2026.03.013","DOIUrl":"10.1016/j.jhsa.2026.03.013","url":null,"abstract":"<div><h3>Purpose</h3><div>The majority of brachial plexus birth injuries (BPBI) occur without prenatally identifiable risk factors. This meta-analysis mapped BPBI incidence worldwide as a preliminary step toward investigating population-level predictors.</div></div><div><h3>Methods</h3><div>This systematic review searched PubMed, Embase, Cochrane, and Web of Science. Eligible studies provided cross-sectional data on BPBI incidence without inclusion criteria predicated on known risk factors. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two reviewers screened studies, extracted data, and assessed risk of bias. Meta-analyses of proportions were conducted using random-effects models to estimate composite international incidence; covariates were incorporated with meta-regressions to compare population-based differences.</div></div><div><h3>Results</h3><div>Reviewers screened 1,245 studies; 116 were included, and 91 were eligible for meta-analyses. The review identified gaps in the literature regarding Central American, South American, African, and Northeast Asian epidemiology. Acknowledging these limitations, 71.5 million live births across 30 countries in all 6 populated continents were pooled for meta-analyses to estimate composite international incidence and population-level variation. Composite BPBI incidence was 1.4 per thousand births (95% confidence interval, 1.3–1.6), yet estimates from individual countries ranged from 0.4 to 4.6 per thousand births. Meta-regression confirmed significant international differences in BPBI incidence; country of birth explained 34.2% of between-study variance. From studies that tracked permanent BPBI, 18.4% (95% confidence interval, 15.3% to 22.0%) of cases persisted beyond a year.</div></div><div><h3>Conclusions</h3><div>These findings encourage the formulation of new research questions that may allow us to address the remaining unpredictability in BPBI incidence. Significant regional variation warrants exploration of population-level influences, including health-systems-level, environmental, or sociodemographic factors, along with unexplored individual-level factors such as genetic contributions.</div></div><div><h3>Type of study/level of evidence</h3><div>Symptom prevalence study 2a</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 1000.e1-1000.e14"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for Work-up and Treatment of Case Scenarios in Neurogenic Thoracic Outlet Syndrome","authors":"Harvey Chim MD","doi":"10.1016/j.jhsa.2026.03.014","DOIUrl":"10.1016/j.jhsa.2026.03.014","url":null,"abstract":"<div><h3>Purpose</h3><div>Considerable variation exists in strategies for the diagnosis and treatment of neurogenic thoracic outlet syndrome (NTOS). Additionally, different subtypes of NTOS present with different constellations of symptoms and signs. The aim of this study was to gather and evaluate different treatment plans from high-volume NTOS surgeons for standardized case scenarios.</div></div><div><h3>Methods</h3><div>Six case scenarios were distributed to 19 self-designated level IV expert NTOS surgeons. These included standardized patients presenting with Gilliat-Sumner hand, upper plexus involvement with scapular winging, pectoralis minor syndrome, electrically negative TOS with pain and sensory changes only, NTOS with concomitant distal double crush compression neuropathies, and recurrent NTOS following previous first rib resection. Each surgeon independently reviewed case information and formulated an investigative and treatment plan using a free-text response.</div></div><div><h3>Results</h3><div>The most common investigation ordered was a cervical spine or brachial plexus magnetic resonance imaging. Where exposure of the supraclavicular brachial plexus was indicated, the preferred surgical approach was a supraclavicular approach, with the majority of experts also recommending a concomitant pectoralis minor tenotomy. In the presence of scapular winging, some surgeons would perform a long thoracic nerve neurolysis or nerve transfer. In the absence of motor symptoms, all experts would recommend surgery only after failure of conservative treatment. With findings suggesting concomitant distal nerve compression sites, the most common recommendation was a comprehensive surgical approach to decompress the brachial plexus and distal sites simultaneously. A smaller proportion of experts preferred a “distal first” approach.</div></div><div><h3>Conclusions</h3><div>Consistent trends were seen in recommendations for work-up and treatment of NTOS patients. Compared with other surgical specialties treating NTOS, hand surgeons have a tendency toward (1) a supraclavicular approach for brachial plexus decompression, (2) increased preference for rib-sparing scalenectomy over first rib resection, and (3) consideration of concomitant or staged surgery to address distal nerve compression sites.</div></div><div><h3>Type of study/Level of evidence</h3><div>Therapeutic V</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 982.e1-982.e9"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Ortho-Bridge System for Simplified Ulna-Shortening Osteotomy","authors":"Xiaoqing He MD,&nbsp;Jianping Zhang MD,&nbsp;Wenqian Mo MD,&nbsp;Ying Xiong MD,&nbsp;Yongqing Xu MD,&nbsp;Xi Yang MD","doi":"10.1016/j.jhsa.2025.10.009","DOIUrl":"10.1016/j.jhsa.2025.10.009","url":null,"abstract":"<div><h3>Purpose</h3><div>To report the effect of the bridge-combined internal fixation system to achieve simplified ulnar shortening osteotomy in the treatment of ulnar impaction syndrome.</div></div><div><h3>Methods</h3><div>A total of 25 patients with ulnar impaction syndrome caused by positive ulnar variance were included in the case series. They were 14 women and 11 men with average age of 43.2 ± 10.1 years. All operations were carried out by the same senior surgeon. The clinical outcomes were evaluated in terms of range of motion, grip strength, visual analog scale and Mayo wrist score. The ulnar variance and complications of rotation, angulation, and nonunion were determined radiographically.</div></div><div><h3>Results</h3><div>Mean duration of follow-up was 13.5 ± 1.2 months. The ulnar variance was corrected successfully in all 25 cases without rotation, angulation, and nonunion. The visual analog scale score at the last follow-up decreased from the preoperative score, and the Mayo wrist score increased. Grip strength and joint range of motion improved compared with preoperative values.</div></div><div><h3>Conclusions</h3><div>The bridge-combined internal fixation system achieved successful restoration of ulnar variance without rotation, angulation, and nonunion. It represents an alternative for treating ulnocarpal impaction syndrome.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 969.e1-969.e9"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Series in the Journal of Hand Surgery: Innovator’s Corner","authors":"Greg Merrell MD","doi":"10.1016/j.jhsa.2026.07.001","DOIUrl":"10.1016/j.jhsa.2026.07.001","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Page 945"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859366","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 Ring Avulsion Injuries","authors":"Lacey Smith MD, MSc,&nbsp;Igor Immerman MD,&nbsp;Nicole Schroeder MD,&nbsp;Lauren M. Shapiro MD, MS","doi":"10.1016/j.jhsa.2026.01.020","DOIUrl":"10.1016/j.jhsa.2026.01.020","url":null,"abstract":"<div><div>Ring avulsion injuries, though rare, represent a uniquely devastating subset of hand trauma, with circumferential damage to skin, tendon, bone, and neurovascular structures. Historically, these injuries were almost universally treated with amputation; however, advances in microsurgical repair have transformed management and opened the possibility of finger salvage. We review the epidemiology, classification systems, treatment options, and biomechanical studies that have prompted innovations in ring manufacturing. Over time, classification systems have shifted treatment emphasis from survival to functional prognosis. Contemporary microsurgical practice supports revascularization and replantation for injuries distal to the flexor digitorum superficialis insertion, with survival rates approaching 80% to 85%. Proximal injuries, however, continue to carry a poor functional prognosis, making amputation the preferred option in most cases. As wearable technology drives renewed interest in ring design, future innovations should incorporate failure mechanisms that prevent tissue injury without sacrificing aesthetics. Ultimately, optimal management of ring avulsion injuries requires excellent microsurgical technique, appropriate functional expectations, an understanding of patient preferences, and incorporation of preventive measures.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 1029-1033"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488419","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":"Upper Limb Reconstruction in Arthrogryposis Multiplex Congenita: A Systematic Review","authors":"J. Terrence Jose Jerome FRCS (G), DNB (Ortho),&nbsp;G. Surendran MS Ortho, DNB,&nbsp;K. Thirumagal MD","doi":"10.1016/j.jhsa.2026.05.010","DOIUrl":"10.1016/j.jhsa.2026.05.010","url":null,"abstract":"<div><h3>Purpose</h3><div>The goal of this study is to synthesize and critically evaluate nonsurgical and surgical strategies for upper limb reconstruction in arthrogryposis multiplex congenita across the shoulder, elbow, forearm, wrist, and thumb, and to develop an evidence-informed treatment algorithm.</div></div><div><h3>Methods</h3><div>A Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-aligned systematic review was conducted using MEDLINE/PubMed from database inception to February 28, 2026, with backward and forward citation tracking. Eligible studies included randomized trials, cohort studies, and case series of at least five patients or limbs reporting upper limb-specific outcomes in arthrogryposis multiplex congenita. Extracted variables included phenotype, intervention, range of motion, functional outcomes, patient-reported outcome measures, radiographic findings, complications, reoperations, and follow-up. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I)–informed domains.</div></div><div><h3>Results</h3><div>Thirty-two studies met inclusion criteria, representing 412 patients who underwent 589 upper limb procedures. Thirteen joint-specific interventional studies with detailed procedure-linked outcomes formed the basis for structured narrative synthesis and treatment algorithm development. Posterior elbow release consistently improved passive elbow flexion and functional hand-to-mouth reach. Muscle transfer procedures, including latissimus dorsi, pectoralis major, Steindler flexorplasty, and selective triceps transfer, restored clinically meaningful active elbow flexion in selected patients with adequate passive motion and donor strength; however, outcomes depended heavily on donor muscle quality and reconstructive selection. Distal humeral external rotation osteotomy improved hand orientation and bimanual grasp, whereas carpal wedge osteotomy reliably corrected rigid wrist flexion deformity by recentering the wrist into a functional arc. Thumb-in-palm deformity was most effectively addressed using first-web reconstruction and metacarpophalangeal stabilization, with emerging support for severity-based staged reconstruction.</div></div><div><h3>Conclusions</h3><div>Upper limb reconstruction in arthrogryposis multiplex congenita improves functional independence primarily by repositioning joints into usable arcs and selectively restoring active motion. Posterior elbow release and individualized elbow flexion reconstruction procedures, humeral rotational osteotomy, wrist realignment osteotomy, and thumb stabilization represent the most consistently supported strategies, although the evidence remains limited by retrospective designs and heterogeneous outcome reporting.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 984-998"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273893","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":"Letter to the Editor Regarding “Denervation With Cheilectomy of the Distal Interphalangeal Joint: Technique and Medium-Term Results”","authors":"Joan Arenas-Prat","doi":"10.1016/j.jhsa.2026.04.022","DOIUrl":"10.1016/j.jhsa.2026.04.022","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 958-959"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859335","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}