Journal of Hand Surgery-American Volume最新文献

{"title":"The Scope and Distribution of Upper Extremity Nerve Injuries Associated With Combat-Related Extremity Limb Salvage","authors":"Colin J. Harrington MD ,&nbsp;Marissa E. Dearden MD ,&nbsp;Patrick McGlone MD ,&nbsp;Benjamin K. Potter MD ,&nbsp;Scott M. Tintle MD ,&nbsp;Jason M. Souza MD","doi":"10.1016/j.jhsa.2023.09.008","DOIUrl":"10.1016/j.jhsa.2023.09.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Chronic pain and functional limitations secondary to nerve injuries are a major barrier to optimal recovery for patients following high-energy extremity trauma. Given the associated skeletal and soft tissue management challenges in the polytraumatized patient<span><span><span>, concomitant nerve injuries may be overlooked or managed in delayed fashion. Whereas previous literature has reported rates of peripheral nerve injuries at &lt;10% in the setting of high-energy extremity trauma, in our experience, the incidence of these injuries has been much higher. Thus, we sought to define the incidence, pain </span>sequelae, and functional outcomes following upper extremity peripheral nerve injuries in the combat-related </span>limb salvage population.</span></div></div><div><h3>Methods</h3><div>We performed a retrospective review of all patients who underwent limb salvage procedures<span> to include flap coverage for combat-related upper extremity trauma at a single institution between January 2011 and January 2020. We collected data on patient demographics; perioperative complications; location of nerve injuries; surgical interventions; chronic pain; and subjective, patient-reported functional limitations.</span></div></div><div><h3>Results</h3><div>A total of 45 patients underwent flap procedures on 49 upper extremities following combat-related trauma. All patients were male with a median age of 27 years, and 96% (n = 47) of injuries were sustained from a blast mechanism. Thirty-three of the 49 extremities (67%) sustained associated nerve injuries. The most commonly injured nerve was the ulnar (51%), followed by median (30%) and radial/posterior interosseous (19%). Of the 33 extremities with nerve injuries, 18 (55%) underwent surgical intervention. Nerve repair/reconstruction was the most common procedure (67%), followed by targeted muscle reinnervation (TMR, 17%). Chronic pain and functional limitation were common following nerve injury.</div></div><div><h3>Conclusions</h3><div>Upper extremity peripheral nerve injury is common following high-energy combat-related trauma with high rates of chronic pain and functional limitations. Surgeons performing limb salvage procedures to include flap coverage should anticipate associated peripheral nerve injuries and be prepared to repair or reconstruct the injured nerves, when feasible.</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":"50 3","pages":"Pages 384.e1-384.e5"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139464602","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":"Long-Term Outcomes in Female Patients With Carpometacarpal Arthroplasty and Metacarpophalangeal Fusion Compared With the Unoperated Side or Carpometacarpal Arthroplasty","authors":"Carissa C. Dock BS ,&nbsp;Rebecca Stone McGaver MS, ATC ,&nbsp;Clare K. McCarthy MD","doi":"10.1016/j.jhsa.2023.09.002","DOIUrl":"10.1016/j.jhsa.2023.09.002","url":null,"abstract":"<div><h3>Purpose</h3><div><span><span>Patients with carpometacarpal (CMC) osteoarthritis (OA) often present with metacarpophalangeal (MP) </span>hyperextension<span><span> and/or thenar atrophy. This study hypothesizes that MP fusion (MPF) performed at the time of CMC </span>arthroplasty (CMCA) for patients who have moderate-to-severe thenar atrophy, MP hyperextension &gt;30°, or MP arthritis will have greater long-term pinch strength and improvements in the Quick Disabilities of the Arm, Shoulder and Hand (</span></span><em>Quick</em>DASH) score from preoperative values when compared with the unoperated side or those who had CMCA only.</div></div><div><h3>Methods</h3><div>This study involved a retrospective review of long-term results from patients who underwent either CMCA or CMCA/MPF. The <em>Quick</em><span>DASH score, the pain visual analog scale (VAS), and an average of three pinch readings from each thumb were measured on the Baseline pinch gauge and recorded with a correction for hand dominance in right-handed patients.</span></div></div><div><h3>Results</h3><div>Fifty-three female patients with 70 operated thumbs were included in the study. The mean age was 67.2 years. There were 29 CMCAs and 41CMCA/MPFs. The mean follow-up was 6.3 years (range 2–16.9 years). At the latest follow-up, the mean CMCA/MPF pinch strength (11.3 lbs) was significantly stronger than that of CMCA (8.0 lbs) and carpometacarpal osteoarthritis thumbs (8.9 lbs). There was no significant difference in pinch strength between patients who underwent a CMCA and CMCOA thumbs (8.0 lbs vs 8.9 lbs, respectively). Preoperative <em>Quick</em>DASH demonstrated worse function in the CMCA/MPF group (55.8 vs 36.5). At the latest follow-up, <em>Quick</em>DASH and VAS revealed similar values in both the CMCA/MPF (10.5 and 0.66) and CMCA (18.5 and 0.52) groups.</div></div><div><h3>Conclusion</h3><div>Long-term results demonstrate stronger pinch and greater improvement in <em>Quick</em>DASH scores in patients who underwent CMCA/MPF compared with those who underwent a CMCA or untreated carpometacarpal osteoarthritis thumbs.</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":"50 3","pages":"Pages 378.e1-378.e9"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159347","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":"Arthrodesis Versus Ligament Reconstruction and Tendon Interposition for Thumb Carpometacarpal Joint Arthritis: A Systematic Review and Meta-Analysis","authors":"Chul-Ho Kim MD, PhD ,&nbsp;Dong-Hoon Lee MD ,&nbsp;Jae-Sung Lee MD, PhD ,&nbsp;Hyoung-Seok Jung MD, PhD","doi":"10.1016/j.jhsa.2024.10.018","DOIUrl":"10.1016/j.jhsa.2024.10.018","url":null,"abstract":"<div><h3>Purpose</h3><div>Arthrodesis and ligament reconstruction and tendon interposition (LRTI) are commonly performed procedures for treatment of thumb carpometacarpal (CMC) osteoarthritis. Although LRTI is the most common surgical treatment, CMC arthrodesis has been performed because of its reported advantages. This systematic review and meta-analysis compared the differences between CMC arthrodesis and LRTI to better inform surgeons and patients when they are making treatment decisions.</div></div><div><h3>Methods</h3><div>We searched MEDLINE, Embase, and the Cochrane Library for studies published up to 27 August 2023 that directly compared arthrodesis with LRTI for thumb CMC joint arthritis. The pooled analysis compared the visual analog scale; Quick Disabilities of the Arm, Shoulder, and Hand scores; grip strength; key pinch strength; reoperation rates; and postoperative complication rates.</div></div><div><h3>Results</h3><div>Six studies describing 285 thumbs, including 141 and 155 thumbs that underwent arthrodesis and LRTI, respectively, were included. Visual analog scale (standard mean difference [SMD], −0.05; 95% CI, −0.40 to 0.30; <em>P</em> = .78), Quick Disabilities of the Arm, Shoulder, and Hand score (SMD, 0.53; 95% CI, −1.12 to 2.17; <em>P</em> = .53), and grip strength (SMD, −0.67; 95% CI, −1.85 to 0.51; <em>P</em> = .27) showed no difference between the two groups. The arthrodesis group showed significantly higher key pinch strength (SMD, 0.61; 95% CI, 0.32–0.90), reoperation rate (odds ratio, 8.02; 95% CI, 2.00–32.16), and postoperative complication rate (odds ratio, 2.08; 95% CI, 1.11–3.91; <em>I</em>² = 0%) compared with the LRTI group.</div></div><div><h3>Conclusions</h3><div>Carpometacarpal arthrodesis is associated with a better key pinch strength than LRTI. Nevertheless, no significant differences were observed in functional scores and grip strength. Patients who undergo arthrodesis have higher reoperation rates and incidence of postoperative complications than those who undergo LRTI. Thus, although arthrodesis may be a better operation for patients who require high pinch strength, surgeons should also consider the higher complication compared with LRTI.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic II.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 282-291"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803499","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":"Tendon Force and Range of Motion Changes After In Vitro Total Wrist Replacement","authors":"Gaurav G. Mookerjee MD ,&nbsp;Frederick W. Werner MME ,&nbsp;Walter H. Short MD","doi":"10.1016/j.jhsa.2024.11.011","DOIUrl":"10.1016/j.jhsa.2024.11.011","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to determine if there were differences in the tendon forces needed to cause wrist motion and in the passive range of wrist motion following total wrist replacement (TWR) using a contemporary arthroplasty design.</div></div><div><h3>Methods</h3><div>Eight fresh frozen cadaver arms were moved through five different wrist motions using a wrist joint simulator before and after the insertion of a TWR. Changes in the peak tendon forces and wrist range of motion were compared.</div></div><div><h3>Results</h3><div>During each of the five wrist motions following TWR, there were significant increases in the extensor tendon forces. Most notably, the force in the extensor carpi radialis longus more than doubled in four motions. Also, the range of motion significantly decreased in flexion (average 18 degrees, range of 23 to −5 [one wrist had an increase in flexion]), extension (average 23 degrees, range of 4-32), and radial deviation (average 19 degrees, range of 29 to −2 [one wrist had an increase in radial deviation]) following TWR. The hand and carpus shifted distally following the insertion of a wrist implant (average of 8.5 mm; range of 3.6–18.0).</div></div><div><h3>Conclusions</h3><div>Wrist tendon forces increased with TWR insertion, even with a fourth-generation design. Positioning of the implant or differences in the biomechanical properties of the implant compared with the intact specimen may have been factors in the reduced range of motion and distal movement of the carpus. The difficulties of implanting a prosthesis that allows normal kinematics may also play a role in these results.</div></div><div><h3>Clinical relevance</h3><div>Despite the marked improvements in recent TWR designs, additional design and surgical technique modifications are needed to further reduce the tendon forces required to move a wrist following TWR and increase its range of motion.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 311-319"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882385","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":"Vascularized Cartilage: Development of a New Technique of Microsurgical Joint Reconstruction","authors":"James P. Higgins MD","doi":"10.1016/j.jhsa.2024.11.008","DOIUrl":"10.1016/j.jhsa.2024.11.008","url":null,"abstract":"<div><div>The Andrew J. Weiland Medal is presented by the American Society for Surgery of the Hand to a researcher dedicated to advancing patient care in the field of hand surgery. The purpose of this article is to summarize the progression of our research focused on achieving joint preservation using autogenous vascularized cartilage transfer.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 299-310"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529354","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":"Tendon interposition arthroplasty for degenerative arthritis of the trapeziometacarpal joint of the thumb","authors":"Richard G. Eaton M.D. ,&nbsp;Steven Z. Glickel M.D. ,&nbsp;J. William Littler M.D.","doi":"10.1016/j.jhsa.2025.01.018","DOIUrl":"10.1016/j.jhsa.2025.01.018","url":null,"abstract":"<div><div>Arthrosis of the trapeziometacarpal joint of the thumb is a predictable sequelae of ligament laxity. A new technique of tendon interposition arthroplasty with ligament reconstruction using the flexor carpi radialis tendon for a painful arthritic trapeziometacarpal joint of the thumb is described. Twenty-one patients had 25 operative procedures; 14 were women and seven were men. All of the patients presented with intractable pain, crepitus, and varying degrees of laxity of the basal joint. Pinch strength was diminished. Follow-up averaged 37 1/2 months. After surgery, 91.7% of patients had good to excellent results, and 56% were completely pain free. Range of motion and grip and pinch strengths were equal on the operated and unoperated sides.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 340-349"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529356","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":"Tetraplegic Hand Reconstruction Using Double Nerve Transfers for All Finger Flexion: Motor Grading and Hand Functional Tests.","authors":"Jirachart Kraisarin, Kanit Sananpanich, Siam Tongprasert, Wachiraporn Wittayanin, Phichayut Phinyo","doi":"10.1016/j.jhsa.2025.01.012","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.012","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate motor grading and hand functional outcomes of restoring tetraplegic hands using single-stage multiple nerve transfers, including double nerve transfers, for finger flexion.</p><p><strong>Methods: </strong>Patients with tetraplegia who had single-stage multiple nerve transfers between January 2016 and December 2021 were included in the study. We evaluated the patients using muscle grading, the International Spinal Cord Injury Upper Extremity basic data set, the Toronto Rehabilitation Institute-Hand Function Test, the Spinal Cord Independent Measure III, and the Spinal Cord Ability Ruler.</p><p><strong>Results: </strong>During the research study period, 7 patients with tetraplegia underwent a total of 41 nerve branch transfers for upper-extremity motor reanimation, including 6 posterior deltoid to the long head of the triceps, 11 supinator to the posterior interosseous nerve, 11 extensor carpi radialis brevis to the flexor digitorum profundus of the ulnar nerve, 9 brachialis to the anterior interosseous nerve, 2 pronator teres to the anterior interosseous nerve, 1 extensor carpi radialis brevis to the anterior interosseous nerve, and 1 pronator teres to the flexor digitorum profundus component controlled by the ulnar nerve. Following the nerve transfers, the motor grade, and functional tests of each limb showed improvement. The brachialis to anterior interosseous nerve transfer improved more slowly than the other nerve transfers, and two of those transfers only resulted in grade 1 thumb and index flexor strength, with the latter requiring tendon transfer.</p><p><strong>Conclusions: </strong>Single-stage multiple nerve transfers can increase the function of the hand in patients with tetraplegia. In C6 and C7 patients with tetraplegia who have two good donors, double nerve transfers to the anterior interosseous nerve and flexor digitorum profundus branch controlled by the ulnar nerve can restore flexion in all fingers. The brachialis to the anterior interosseous nerve transfer requires a longer recovery time than the other transfers and has a lower success rate.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic V.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524172","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":"Quick Response and Management of Patients During a Mass Casualty Incident: Experiences After 2023 Türkiye Earthquake.","authors":"Ömer Faruk Yıkılmaz, Furkan Temizayak, Rıdvan Çit, Özden Baz, Engin Çetinkaya, Burak Yaşar, Ramazan Erkin Ünlü","doi":"10.1016/j.jhsa.2025.01.014","DOIUrl":"10.1016/j.jhsa.2025.01.014","url":null,"abstract":"<p><p>A devastating series of earthquakes hit Kahramanmaraş, Türkiye on February 6, 2023, affecting 14 million people. A true mass casualty incident, these earthquakes reminded us of the importance of being ready and able to address the consequences. Our clinic is a central referral center so during the first few days we had to treat hundreds of patients transferred to us with compartment syndrome in the upper extremities, finger amputations, tissue defects, and infected open wounds. Every member of our team showed tremendous effort and selfless nature to attend to the extreme number of patients in a limited time. We share our experiences during this trying time so that should a mass casualty incident occur again, a hand surgeon anywhere in the world can anticipate the aftereffect and respond adequately and quickly.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476893","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":"Clinical Outcome of Modified Wassel-Flatt Type IV Radial Polydactyly: Analysis of Subtype and Morphology.","authors":"Won Sun Lee, Young Ho Shin, Jae Kwang Kim","doi":"10.1016/j.jhsa.2025.01.017","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.017","url":null,"abstract":"<p><strong>Purpose: </strong>This study assessed the differences in clinical outcomes among the subtypes of type IV radial polydactyly and evaluated the distribution of the duplication range according to subtype.</p><p><strong>Methods: </strong>This retrospective study included 85 patients with 89 affected thumbs, who were treated at a single center from October 2017 to May 2023. The patients were classified according to the modified Wassel-Flatt classification, and only those with type IV radial polydactyly were included. The collected data included demographics, surgical techniques, clinical outcomes, and radiological outcomes. Clinical outcomes were analyzed using the Japanese Society for Surgery of the Hand (JSSH) scoring system.</p><p><strong>Results: </strong>The most common subtype of radial polydactyly was IV-B, accounting for 50 patients. Types IV-C and IV-D accounted for 17 and 22 patients, respectively. The median age at the time of surgery was 10 months, and the median follow-up was 24 months. Type IV-D demonstrated significantly lower total JSSH scores and functional parameter scores than types IV-B and IV-C. Regarding functional parameters, type IV-D exhibited significantly poorer outcomes in terms of interphalangeal joint stability and alignment, as well as range of motion; however, metacarpophalangeal joint stability and alignment were similar among the types. Type IV-D also exhibited significant differences in the distribution of the duplication range compared with type IV-B and IV-C. It had a more distal duplication level.</p><p><strong>Conclusions: </strong>Type IV-D radial polydactyly requires more complex surgical interventions and has less favorable outcomes than types IV-B and IV-C. It exhibits poorer functional outcomes, particularly in the interphalangeal joint and range of motion assessments. Furthermore, type IV-D exhibits differences in the duplication range compared with other subtypes, and has a more distal duplication level.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451007","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":"Resident Education in Hand Surgery: Barriers and Opportunities.","authors":"Gopal R Lalchandani, George S M Dyer, Nicole S Schroeder","doi":"10.1016/j.jhsa.2025.01.016","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.016","url":null,"abstract":"<p><p>Resident education is critical in the development, growth, and recruitment of young surgeons into the field of hand surgery. However, the increased emphasis on efficiency and productivity in clinical care, growth of hand fellowships, and wide-awake hand surgery can pose specific challenges to resident education. In this review, we explore barriers to resident education in hand surgery and discuss opportunities for improvement. We also provide a list of updated resources for resident education in hand surgery and review best practices in resident education to help educators and trainees alike.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451016","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}