Journal of Orthopaedic Science最新文献_第9页

Eight weeks of a lower limb resistance training protocol and gait performance in patients with symptomatic mild to moderate knee osteoarthritis 为期八周的下肢阻力训练方案与有症状的轻度至中度膝关节骨关节炎患者的步态表现。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-07-01 DOI: 10.1016/j.jos.2023.07.007

Mariana Rosada, Danielli Speciali, Felipe Bruno Dias de Oliveira, Rosana Ravagnani Campedelli, Henry Rodrigues, Eliane Antonioli, Mario Ferretti

Background

The role of strengthening the lower limbs to optimize the biomechanics of the hip, knee and ankle during walking in patients with knee osteoarthritis, is still unclear. This study aimed to analyse the walking biomechanics of individuals with symptomatic mild to moderate knee osteoarthritis before and after a simplified lower limb resistance training protocol, focused on knee joint exercises with individualized load.

Methods

Forty-one patients with symptomatic and radiographic mild to moderate knee osteoarthritis underwent 3D gait analysis pre-post 8 weeks lower limb resistance training protocol performed 3 times a week. Parameters investigated were spatiotemporal, sagittal range of motion, flexion and extension minimum and maximum values, power and moment of hip, knee and ankle, as well as self-reported pain and physical function by the Western Ontario MacMaster University Osteoarthritis Index. Paired t test, Wilcoxon, Spearman's correlation and a logistic model were used for statistical analysis, with p < 0.05. Pain improvement more than 2 points was considered clinically relevant. The effect size (ES) was calculated using Cohen's d.

Results

Post protocol walking speed increased 6.7% (ES: 0.711), cadence 3.7% (ES: 0.655), stride length 2.6% (ES: 0.542), and double support time reduced 6.9% (ES:0.459). It was also observed a significant increase in one maximum repetition test for legpress 46%, knee extension 23% and knee flexion chair 27% (p < 0.001). Patients reported a 62.5% reduction in pain (ES:1.518) and 64.9% improvement in physical function (ES:1.376). 82% of the patients presented more than 2 points improvement in pain. No evidence of strong correlations between pain, strength gains and gait parameters were found.

Conclusions

There was a significant and clinical improvement of spatiotemporal gait parameters, pain, physical function, and strength after 8-week lower limb resistance training protocol. Patients who had a clinically relevant pain improvement presented better gait performance.

背景：在膝关节骨性关节炎患者行走过程中，加强下肢力量对优化髋关节、膝关节和踝关节生物力学的作用尚不明确。本研究旨在分析有症状的轻度至中度膝关节骨性关节炎患者在接受简化下肢阻力训练方案前后的行走生物力学，该训练方案侧重于膝关节锻炼，并采用个性化负荷：41名有症状和影像学检查为轻度至中度膝关节骨关节炎的患者接受了每周3次、每次8周的下肢阻力训练方案前后的3D步态分析。研究参数包括髋关节、膝关节和踝关节的时空运动幅度、矢状运动幅度、屈伸最小值和最大值、力量和力矩，以及西安大略麦克马斯特大学骨关节炎指数对疼痛和身体功能的自我报告。统计分析采用了配对 t 检验、Wilcoxon 检验、Spearman 相关性检验和逻辑模型，P 结果：方案实施后，步行速度增加了 6.7%（ES：0.711），步频增加了 3.7%（ES：0.655），步长增加了 2.6%（ES：0.542），双支撑时间减少了 6.9%（ES：0.459）。此外，还观察到腿部推举、膝关节伸展和膝关节屈曲的最大重复次数分别增加了 46%、23% 和 27%（P 结论）：经过 8 周的下肢阻力训练后，患者的步态时空参数、疼痛、身体功能和力量都有了明显的临床改善。临床上，疼痛得到改善的患者步态表现更好。

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引用次数: 0

Is the increase in the number of total hip arthroplasties in Japan due to an aging society? 日本全髋关节置换术数量的增加是否与老龄化社会有关？

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-07-01 DOI: 10.1016/j.jos.2024.06.008

Maho Tsuchiya, Kensuke Fukushima, Yoshihisa Ohashi, Noritaka Mamorita, Hiroki Saito, Kentaro Uchida, Katsufumi Uchiyama, Naonobu Takahira, Masashi Takaso

Background: The number of total hip arthroplasty (THA) is increasing globally, including Japan. The Japanese Orthopaedic Association has been conducting a registry of joint replacement surgery, but there may be a gap between the reported numbers of THA in the registry and the actual number. This study aimed to investigate the exact number of THA and assess the trends in Japan using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB).

Methods: We downloaded data from 2014 to 2019 from the NDB Open Data. Data on primary THA were extracted, and we calculated the annual number and number for each 10-year age group and sex. We also compared the number and trends between elderly and non-elderly groups.

Results: During the study period, number of THAs increased by approximately 20,000, showing a continuous upward trend. The highest number of THAs were performed on patients in their 60s, except for the years 2014 and 2019. Comparison of the numbers in 2014 and 2019 by age group showed an increase in the number in patients in their 90s (by 2.05 times). There were significantly a greater number of elderly patients (P < 0.001). The number of THAs performed was higher in women than in men (P < 0.001).

Conclusion: The number of THAs in Japan increased substantially from 2014 to 2019, despite a decrease in population. Significantly higher number of THAs were performed on elderly patients in Japan, which might be due to an aging society. The NDB data is highly valuable for epidemiological research in Japan, as it might enable the early detection of issues occurring during THA, facilitating their prompt integration into daily clinical practice.

背景：包括日本在内，全球全髋关节置换术（THA）的数量正在增加。日本骨科协会一直在进行关节置换手术登记，但登记中报告的全髋关节置换术数量与实际数量之间可能存在差距。本研究旨在利用日本全国健康保险索赔和特定健康检查数据库（NDB）调查日本 THA 的确切数量并评估其趋势：我们从 NDB 开放数据中下载了 2014 年至 2019 年的数据。方法：我们从 NDB 开放数据中下载了 2014 年至 2019 年的数据，提取了初级 THA 的数据，并计算了每年的数量以及每个 10 岁年龄组和性别的数量。我们还比较了老年人组和非老年人组的数量和趋势：研究期间，THA 的数量增加了约 20,000 例，呈持续上升趋势。除 2014 年和 2019 年外，60 多岁的患者接受 THAs 的人数最多。2014 年和 2019 年按年龄组进行的人数比较显示，90 多岁的患者人数有所增加（增加了 2.05 倍）。老年患者的数量明显增加（P 结论：老年患者的数量明显增加：尽管人口减少，但 2014 年至 2019 年日本的 THAs 数量却大幅增加。日本老年患者接受 THAs 的数量明显增加，这可能与老龄化社会有关。NDB 数据对日本的流行病学研究具有很高的价值，因为它可以及早发现 THA 期间出现的问题，促进其迅速融入日常临床实践。

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引用次数: 0

Relationship between systemic immune inflammation index and amputation in patients with diabetic foot ulcer 糖尿病足溃疡患者全身免疫炎症指数与截肢之间的关系。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-07-01 DOI: 10.1016/j.jos.2023.07.015

Mehmet Salih Aydın , Mehmet Ali Eren , Nida Uyar , Nazım Kankılıç , Hüseyin Karaaslan , Tevfik Sabuncu , Hakim Çelik

Aim

The systemic immune inflammation index (SII) is a cost-effective biomarker calculated by lymphocyte, neutrophil and platelet counts and is currently being studied in various diseases. Since there is no study examining the relationship between SII and diabetic foot ulcers (DFU) in the literature, our aim was to investigate the relationship between SII and amputation rate in DFU.

Methods

Type 2 DM 511 patients with DFU were screened from 2017 to 2021. Laboratory data obtained on the first day of hospitalization were considered. Platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and SII were calculated from routine blood count. Participants were divided into two groups as amputation (Group 1) and non-amputation (Group 2).

Results

Amputation rate was 18.8%. The A1c (8.80 (3.26) % vs. 9.52 (3.10) %, p = 0.007) and HGB (10.17 ± 2.16 g/dL vs. 12.05 ± 2.20 g/dL, p < 0.001) levels, and lymphocyte count (1.81 (1.16) vs. 2.05 (1.11), p = 0.015) were significantly lower in Group 1 than Group 2. The counts of WBC (14.01 (9.16) × 10⁹/L vs. 10.41 (5.82) × 10⁹/L), PLT (393.35 (196.98) × 10⁹/L vs. 312.05 (141.33) × 10⁹/L), neutrophil (11.52 (8.75) × 10⁹/L vs. 6.93 (5.96) × 10⁹/L), PLR (226.04 (159.24) × 10⁹/L vs. 153.12 (101.91) × 10⁹/L), NLR (6.64 (6.93) vs. 3.34 (3.99)) and SII (2505.86 (3957.47) × 10⁹/L vs. 1092.50 (1476.08) × 10⁹/L), and the levels of CRP (14.12 (12.66) mg/dL vs. 3.86 (12.63) mg/dL) and ESR (87.50 (50.50) mm/h vs. 63.00 (57.25) mm/h) were significantly higher in Group 1 than Group 2 (all p < 0.001). AUC of ROC analysis of PLR was 0.666 (95% CI, 0.604–0.728), NLR was 0.695 (95% CI, 0.638–0.752) and SII was 0.716 (95% CI, 0.661–0.772) for the predicting of amputation and the SII had the best AUC with 67.4% sensitivity and 63.3%specificty.

Conclusion

SII is a cost-effective and readily available marker, but alone may not be sufficient to predict the risk of amputation in DFU. In our results, the predictive role of SII alone or with other markers for future DFU and its role in predicting other chronic diabetic complications will be evaluated in extensive studies.

目的：全身免疫炎症指数（SII）是通过淋巴细胞、中性粒细胞和血小板计数计算得出的一种具有成本效益的生物标志物，目前正在对各种疾病进行研究。由于目前还没有文献研究 SII 与糖尿病足溃疡（DFU）之间的关系，我们的目的是调查 SII 与糖尿病足溃疡截肢率之间的关系：从2017年至2021年筛查了2型DM 511名DFU患者。考虑了住院第一天获得的实验室数据。根据血常规计数计算血小板与淋巴细胞比值（PLR）、中性粒细胞与淋巴细胞比值（NLR）和SII。参与者分为截肢组（第 1 组）和未截肢组（第 2 组）：结果：截肢率为 18.8%。A1c (8.80 (3.26) % vs. 9.52 (3.10) %, p = 0.007)、HGB (10.17 ± 2.16 g/dL vs. 12.05 ± 2.20 g/dL, p 9/L vs. 10.41 (5.82) × 109/L)、PLT (393.35 (196. 98) × 109/L vs. 31.41 (5.82) × 109/L)。98）×109/L vs. 312.05（141.33）×109/L）、中性粒细胞（11.52（8.75）×109/L vs. 6.93（5.96）×109/L）、PLR（226.04（159.24）×109/L vs. 153.12（101.91）×109/L）、NLR（6.64（6.93） vs. 3.34（3.99））和 SII（2505.86（3957.47）×109/L vs. 1092.50（1476.08）×109/L），以及 CRP 水平（14.12（12.66) mg/dL vs. 3.86 (12.63) mg/dL）和血沉（87.50 (50.50) mm/h vs. 63.00 (57.25) mm/h）明显高于第 2 组（均为 p 结论：SII 是一种经济有效的治疗方法：SII 是一种具有成本效益且容易获得的标记物，但仅靠它可能不足以预测 DFU 截肢的风险。根据我们的研究结果，SII 单独或与其他标记物一起对未来 DFU 的预测作用及其在预测其他慢性糖尿病并发症方面的作用将在广泛的研究中进行评估。

{"title":"Relationship between systemic immune inflammation index and amputation in patients with diabetic foot ulcer","authors":"Mehmet Salih Aydın , Mehmet Ali Eren , Nida Uyar , Nazım Kankılıç , Hüseyin Karaaslan , Tevfik Sabuncu , Hakim Çelik","doi":"10.1016/j.jos.2023.07.015","DOIUrl":"10.1016/j.jos.2023.07.015","url":null,"abstract":"<div><h3>Aim</h3><p><span>The systemic immune inflammation index (SII) is a cost-effective biomarker calculated by lymphocyte, neutrophil and platelet counts and is currently being studied in various diseases. Since there is no study examining the relationship between SII and </span>diabetic foot ulcers (DFU) in the literature, our aim was to investigate the relationship between SII and amputation rate in DFU.</p></div><div><h3>Methods</h3><p>Type 2 DM 511 patients with DFU were screened from 2017 to 2021. Laboratory data obtained on the first day of hospitalization were considered. Platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and SII were calculated from routine blood count. Participants were divided into two groups as amputation (Group 1) and non-amputation (Group 2).</p></div><div><h3>Results</h3><p>Amputation rate was 18.8%. The A1c (8.80 (3.26) % vs. 9.52 (3.10) %, p = 0.007) and HGB (10.17 ± 2.16 g/dL vs. 12.05 ± 2.20 g/dL, p < 0.001) levels, and lymphocyte count (1.81 (1.16) vs. 2.05 (1.11), p = 0.015) were significantly lower in Group 1 than Group 2. The counts of WBC (14.01 (9.16) × 10<sup>9</sup>/L vs. 10.41 (5.82) × 10<sup>9</sup>/L), PLT (393.35 (196.98) × 10<sup>9</sup>/L vs. 312.05 (141.33) × 10<sup>9</sup>/L), neutrophil (11.52 (8.75) × 10<sup>9</sup>/L vs. 6.93 (5.96) × 10<sup>9</sup>/L), PLR (226.04 (159.24) × 10<sup>9</sup>/L vs. 153.12 (101.91) × 10<sup>9</sup>/L), NLR (6.64 (6.93) vs. 3.34 (3.99)) and SII (2505.86 (3957.47) × 10<sup>9</sup>/L vs. 1092.50 (1476.08) × 10<sup>9</sup><span>/L), and the levels of CRP (14.12 (12.66) mg/dL vs. 3.86 (12.63) mg/dL) and ESR (87.50 (50.50) mm/h vs. 63.00 (57.25) mm/h) were significantly higher in Group 1 than Group 2 (all p < 0.001). AUC of ROC analysis of PLR was 0.666 (95% CI, 0.604–0.728), NLR was 0.695 (95% CI, 0.638–0.752) and SII was 0.716 (95% CI, 0.661–0.772) for the predicting of amputation and the SII had the best AUC with 67.4% sensitivity and 63.3%specificty.</span></p></div><div><h3>Conclusion</h3><p>SII is a cost-effective and readily available marker, but alone may not be sufficient to predict the risk of amputation in DFU. In our results, the predictive role of SII alone or with other markers for future DFU and its role in predicting other chronic diabetic complications will be evaluated in extensive studies.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9929364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

AO/OTA 31A3 fractures and postoperative complications in older patients 老年患者的 AO/OTA 31A3 骨折和术后并发症。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-07-01 DOI: 10.1016/j.jos.2023.05.010

Takuya Yamanaka , Tomohiro Matsumura , Ryusuke Ae , Katsushi Takeshita

Background

AO/OTA 31A3 fractures (A3 fractures) have risk for postoperative complications with major impact on morbidity and mortality. For older patients, limited information is available for factors associated with postoperative complications. We aimed to assess factors associated with postoperative complications after surgery using cephalomedullary nails.

Methods

A retrospective cohort study was conducted using the information on patients aged ≥65 years who underwent surgery using cephalomedullary nails for trochanteric fractures due to low-energy trauma in three hospitals. Postoperative complications were diagnosed when patients were identified as nonunion, cutout of lag screw, or nail breakage. First, we compared differences including age, sex, body mass index, American Society of Anesthesiologists physical status classification system, preoperative waking ability, fracture type, nail length, neck shaft angle, reduction method, reduction quality and tip apex distance between patients with and without postoperative complications. Second, multivariable logistic regression analysis was employed to assess factors associated with postoperative complications resulting from A3 fractures.

Results

Among 120 patients with A3 fractures, postoperative complications were identified in 12 patients (10.0%). Postoperative complications were significantly more likely to develop among patients with poor reduction quality (adjusted odds ratio [95% confidence interval], 35.0 [4.43–275.9]) and a tip-apex distance ≥25 mm (16.4 [1.92–140.3]).

Conclusions

These findings suggest that surgeons should aim to perform appropriate postoperative reduction and to prevent postoperative complications when using a cephalomedullary nail for A3 fractures among older patients.

背景：AO/OTA 31A3 骨折（A3 骨折）具有术后并发症风险，对发病率和死亡率有重大影响。对于老年患者，有关术后并发症相关因素的信息非常有限。我们旨在评估使用头髓内钉手术后出现术后并发症的相关因素：我们利用三家医院中因低能量创伤而接受头髓内钉手术治疗的≥65岁患者的信息进行了一项回顾性队列研究。术后并发症在患者被确认为不愈合、滞留螺钉切出或钉子断裂时进行诊断。首先，我们比较了有术后并发症和无术后并发症患者之间的差异，包括年龄、性别、体重指数、美国麻醉医师协会身体状况分类系统、术前清醒能力、骨折类型、钢钉长度、颈轴角度、复位方法、复位质量和尖端顶点距离。其次，采用多变量逻辑回归分析评估与A3骨折术后并发症相关的因素：在 120 名 A3 骨折患者中，有 12 名患者（10.0%）出现了术后并发症。在还原质量差（调整后的几率比[95%置信区间]，35.0 [4.43-275.9]）和尖端-后端距离≥25 mm（16.4 [1.92-140.3]）的患者中，术后并发症的发生率明显更高：这些研究结果表明，外科医生在使用头髓内钉治疗老年患者的A3骨折时，应力求在术后进行适当的复位，并预防术后并发症。

{"title":"AO/OTA 31A3 fractures and postoperative complications in older patients","authors":"Takuya Yamanaka , Tomohiro Matsumura , Ryusuke Ae , Katsushi Takeshita","doi":"10.1016/j.jos.2023.05.010","DOIUrl":"10.1016/j.jos.2023.05.010","url":null,"abstract":"<div><h3>Background</h3><p>AO/OTA 31A3 fractures (A3 fractures) have risk for postoperative complications with major impact on morbidity and mortality. For older patients, limited information is available for factors associated with postoperative complications. We aimed to assess factors associated with postoperative complications after surgery using cephalomedullary nails.</p></div><div><h3>Methods</h3><p><span>A retrospective cohort study was conducted using the information on patients aged ≥65 years who underwent surgery using cephalomedullary nails for trochanteric fractures due to low-energy trauma in three hospitals. Postoperative complications were diagnosed when patients were identified as </span>nonunion<span><span>, cutout of lag screw, or nail breakage. First, we compared differences including age, sex, body mass index, American Society of Anesthesiologists physical status classification system, preoperative waking ability, fracture type, nail length, neck shaft angle, reduction method, reduction quality and tip apex distance between patients with and without postoperative complications. Second, multivariable </span>logistic regression analysis was employed to assess factors associated with postoperative complications resulting from A3 fractures.</span></p></div><div><h3>Results</h3><p>Among 120 patients with A3 fractures, postoperative complications were identified in 12 patients (10.0%). Postoperative complications were significantly more likely to develop among patients with poor reduction quality (adjusted odds ratio [95% confidence interval], 35.0 [4.43–275.9]) and a tip-apex distance ≥25 mm (16.4 [1.92–140.3]).</p></div><div><h3>Conclusions</h3><p>These findings suggest that surgeons should aim to perform appropriate postoperative reduction and to prevent postoperative complications when using a cephalomedullary nail for A3 fractures among older patients.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9698649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cross-cultural adaptation, reliability, validity, and psychometric evaluation of the Tamil version STarT back screening tool among low back pain subjects 对泰米尔语版 STarT 背痛筛查工具进行跨文化适应性、可靠性、有效性和心理测量学评估。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-07-01 DOI: 10.1016/j.jos.2023.07.004

Srinithi Vengatraman, Antony Leo Aseer Peter, Soundararajan Kannan

Background

The STarT back screening tool helps primary care workers make the initial clinical decision and classify low back pain subjects into subgroups. Currently, the tool is required for stratification/triaging of low back pain and is commonly used in clinical practice, and requires linguistic validation in Tamil. The study aimed to determine the validity and reliability of the Tamil version of the STarT back screening tool.

Methods

The baseline measurements include the Tamil version of the STarT back screening tool-, pain severity using the Numeric pain rating Scale (NPRS), disability status using the Tamil version of the Roland Morris Disability Questionnaire (RMDQ), and fear avoidance beliefs using the fear-avoidance beliefs questionnaire (FABQ) - Tamil were obtained. After five days, the retest measures are done to investigate the test-retest reliability.

Results

The current study showed excellent test-retest reliability of total score (ICC – 0.80) and psychosocial subscore (ICC-0.82) with excellent internal consistency and moderate to high validity with clinical outcomes.

Conclusion

The study concludes that the Tamil version of the STarT Back Screening Questionnaire is a reliable and valid tool that reported good understanding and easy completion by the subject.

背景：STarT 背痛筛查工具可帮助初级保健工作者做出初步临床决定，并将腰背痛患者分为不同的亚组。目前，该工具是对腰背痛进行分层/三组划分的必备工具，在临床实践中被普遍使用，需要在泰米尔语中进行语言验证。本研究旨在确定泰米尔语版 STarT 背痛筛查工具的有效性和可靠性：基线测量包括泰米尔语版 STarT 背痛筛查工具、数字疼痛评分量表（NPRS）显示的疼痛严重程度、泰米尔语版罗兰-莫里斯残疾问卷（RMDQ）显示的残疾状况，以及泰米尔语版恐惧-回避信念问卷（FABQ）显示的恐惧-回避信念。五天后进行重测，以调查重测信度：结果：目前的研究显示，总分（ICC - 0.80）和心理社会子分数（ICC-0.82）的重测可靠性极佳，具有极好的内部一致性，与临床结果的效度为中高：研究得出结论，泰米尔语版 STarT 背部筛查问卷是一种可靠有效的工具，受试者能够很好地理解并轻松完成问卷。

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引用次数: 0

Radiation exposure in pediatric patients with early onset scoliosis: A longitudinal single-center study 早期脊柱侧凸儿科患者的辐射暴露：单中心纵向研究

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-07-01 DOI: 10.1016/j.jos.2023.07.008

Ryo Sugawara , Hideaki Watanabe , Naoya Taki , Saki Onuma , Ichiro Kikkawa , Katsushi Takeshita

Background

There is no consensus regarding the acceptable level of medical radiation exposure in patients with early-onset scoliosis. This study aimed to quantify radiation exposure in these patients and investigate factors associated with high exposure.

Methods

Patients with early-onset scoliosis who received care for their spine deformity and other comorbidities in our institution were retrospectively reviewed. Cumulative radiation exposure and total number of imaging studies were recorded. Patients with ≥30 mSv exposure were classified as high exposure and analyzed to clarify factors associated with high exposure.

Results

Thirty-five patients were included for analysis. The etiology of scoliosis was idiopathic in 8 patients, congenital in 7, syndromic in 8, and neuromuscular in 12. Fifteen patients underwent 19 spinal surgeries. The types of operation performed were definitive fusion (n = 12), vertebrectomy for hemivertebra (n = 2), growing rod (n = 1), lengthening (n = 3), and revision/partial implant removal (n = 1). The mean cumulative radiation dose was 22.3 mSv (range, 2.5–94.5 mSv). Spine radiography and computed tomography combined accounted for 15.0 mSv (range, 2.4–52.5 mSv, 67.3% of the mean cumulative dose). The mean radiation dose was significantly higher in patients who underwent spinal surgery than in those who did not (31.2 mSv vs. 15.6 mSv). The high-exposure group comprised 10 patients (1 idiopathic, 1 congenital, 5 syndromic, and 3 neuromuscular scoliosis) and 8 underwent 11 spinal operations. Among 8 patients who underwent spinal surgery, the cumulative radiation dose for spine was ≥30 mSv and spine computed tomography was performed an average of 4.0 times.

Conclusions

Nearly one-third of patients with early-onset scoliosis and half of patients who underwent spinal surgery had >30 mSv radiation exposure due to multiple computed tomography. Medical radiation exposure and associated cancer risk should be considered when treating these patients.

背景：关于早期脊柱侧凸患者可接受的医疗辐射量，目前尚无共识。本研究旨在量化这些患者的辐射量，并调查与高辐射量相关的因素：方法：对在我院接受脊柱畸形和其他合并症治疗的早发性脊柱侧凸患者进行回顾性研究。记录累计辐射量和成像检查总数。辐照量≥30 mSv的患者被归类为高辐照量患者，并对其进行分析，以明确与高辐照量相关的因素：结果：35 名患者被纳入分析。脊柱侧弯的病因有8例为特发性，7例为先天性，8例为综合征，12例为神经肌肉性。15 名患者接受了 19 次脊柱手术。手术类型包括最终融合术（12 例）、半椎体椎体切除术（2 例）、生长棒（1 例）、延长术（3 例）和翻修/部分植入物移除术（1 例）。平均累积辐射剂量为 22.3 mSv（范围为 2.5-94.5 mSv）。脊柱放射摄影和计算机断层扫描合计占 15.0 mSv（范围为 2.4-52.5 mSv，占平均累积剂量的 67.3%）。接受脊柱手术的患者的平均辐射剂量明显高于未接受手术的患者（31.2 mSv 对 15.6 mSv）。高辐射组包括10名患者（1名特发性脊柱侧弯、1名先天性脊柱侧弯、5名综合征脊柱侧弯和3名神经肌肉性脊柱侧弯），其中8人接受了11次脊柱手术。在接受脊柱手术的8名患者中，脊柱的累积辐射剂量≥30 mSv，脊柱计算机断层扫描平均进行了4.0次：结论：近三分之一的早发性脊柱侧弯患者和半数接受脊柱手术的患者因多次接受计算机断层扫描而受到大于30 mSv的辐射照射。在治疗这些患者时，应考虑医疗辐射照射和相关的癌症风险。

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引用次数: 0

The effect of kinesio taping on edema, pain, and functionality after total knee arthroplasty: A randomised sham-controlled double blinded clinical study 肌动贴对全膝关节置换术后水肿、疼痛和功能的影响：随机假对照双盲临床研究。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-07-01 DOI: 10.1016/j.jos.2023.05.012

Mehmet-Fevzi Cakmak , Basak Cigdem-Karacay

Background

There are current studies on kinesio taping (KT) application after total knee arthroplasty (TKA), but there is no definite consensus on its effectiveness and application method yet. This study aims to evaluates the effectiveness of KT applied added to the conservative postoperative physiotherapy program (CPPP) after TKA on postoperative edema, pain, range of motion, and functions on the early period.

Materials and methods

This prospective, randomized, controlled, double-blind study was conducted in with 187 patients undergoing TKA. The patients were divided into 3 groups as kinesio taping (KTG), sham taping (STG) and control group (CG). KT lymphedema technique and epidermis, dermis, fascia technique were applied on the 1st and 3rd days postoperatively. Extremity circumference and joint range of motion (ROM) were measured. Visual Analog Scale, Oxford Knee Scale filled. All patients were evaluated preoperatively, on the 1st day, 3rd day, and 10th day postoperatively.

Results

There were 62 patients in CTG, 62 patients in STG, and 63 patients in CG. In all circumference measurements, the difference between post-op10th day (PO10D) diameter and preoperative diameter measurement was less in KTG than in CG and STG (p < 0.001). CG was higher than the STG in the ROM values measured at PO10D.There was no significant difference between the groups in terms of OKS values (P:0.648). CG was higher than STG in post-op 1st day VAS values (P:0.042).

Conclusion

Adding KT to CPP after TKA reduces edema in the acute phase, but has no additive effect on pain, functionality, and ROM.

背景：目前已有关于全膝关节置换术（TKA）后应用肌动贴的研究，但对其效果和应用方法尚未达成明确共识。本研究旨在评估在 TKA 术后保守理疗计划（CPPP）中应用 KT 对术后早期水肿、疼痛、活动范围和功能的效果：这项前瞻性、随机对照、双盲研究的对象是 187 名接受 TKA 的患者。患者被分为三组，分别为肌张力贴敷组（KTG）、假贴敷组（STG）和对照组（CG）。KT 淋巴水肿技术和表皮、真皮、筋膜技术分别在术后第 1 天和第 3 天使用。测量肢体周长和关节活动范围（ROM）。视觉模拟量表、牛津膝关节量表均已填好。所有患者均在术前、术后第 1 天、第 3 天和第 10 天接受了评估：结果：62 名患者接受了 CTG，62 名患者接受了 STG，63 名患者接受了 CG。在所有周径测量中，KTG 患者术后第 10 天（PO10D）直径与术前直径测量值之间的差异均小于 CG 和 STG（P 结论：KTG 患者术后第 10 天（PO10D）直径与术前直径测量值之间的差异均小于 CG 和 STG：在 TKA 术后的 CPP 中加入 KT 可减少急性期的水肿，但对疼痛、功能和 ROM 没有增加作用。

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引用次数: 0

Correction effects of peroneus longus contraction on hallux valgus radiographic parameters 腓骨长肌收缩对拇指外翻放射学参数的矫正效果。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-07-01 DOI: 10.1016/j.jos.2023.07.003

Yasunari Ikuta , Tomoyuki Nakasa , Akinori Nekomoto , Junichi Sumii , Shingo Kawabata , Nobuo Adachi

Background

Hypermobility of the first tarsometatarsal joint plays an important role in hallux valgus pathogenesis. The peroneus longus is recognized as a dynamic stabilizer of the first tarsometatarsal joint. However, the association between the peroneus longus function and the hallux valgus deformity remains unknown. This study aimed to determine the effect of peroneus longus contraction induced by electrical muscle stimulation on the correction of hallux valgus radiographic parameters in patients with hallux valgus.

Methods

Thirty-five patients with hallux valgus (47 feet; 2 men, 33 women; mean age 64.9 years) were included. Non-weight-bearing dorsoplantar radiographs of the foot were obtained with and without electrical muscle stimulation of the peroneus longus. Radiographic parameters of hallux valgus deformities, including the hallux valgus angle, intermetatarsal angle, first metatarsal protrusion distance, and distance between the first and second metatarsal bases, were measured and compared between the two conditions.

Results

All hallux valgus radiographic parameters were significantly improved by contraction of the peroneus longus. The median hallux valgus angle decreased by 13.2°. Fewer changes in the hallux valgus angle were identified in patients with severe deformity and geriatric patients.

Conclusions

Although the peroneus longus muscle has received little attention in the management of hallux valgus, our findings suggest that it has the potential to be a novel conservative approach for treating mild-to-moderate hallux valgus.

背景：第一跖跗关节的过度活动在拇指外翻的发病机制中起着重要作用。腓骨长肌被认为是第一跖跗关节的动态稳定器。然而，腓骨长肌功能与拇指外翻畸形之间的关系仍不清楚。本研究旨在确定通过肌肉电刺激引起的腓肠肌收缩对矫正拇指外翻患者的影像学参数的影响：研究纳入了 35 名足外翻患者（47 足；2 男，33 女；平均年龄 64.9 岁）。在对腓骨长肌进行电刺激和不进行电刺激的情况下，对足部进行非负重背跖X光检查。测量并比较两种情况下的拇指外翻畸形影像学参数，包括拇指外翻角度、跖骨间角度、第一跖骨突出距离以及第一和第二跖骨基底之间的距离：结果：通过收缩腓肠肌，所有的拇指外翻影像学参数都得到了明显改善。中位拇指外翻角度减少了 13.2°。严重畸形患者和老年患者的拇指外翻角度变化较小：尽管腓肠肌在治疗拇指外翻方面很少受到关注，但我们的研究结果表明，它有可能成为治疗轻度至中度拇指外翻的一种新型保守方法。

{"title":"Correction effects of peroneus longus contraction on hallux valgus radiographic parameters","authors":"Yasunari Ikuta , Tomoyuki Nakasa , Akinori Nekomoto , Junichi Sumii , Shingo Kawabata , Nobuo Adachi","doi":"10.1016/j.jos.2023.07.003","DOIUrl":"10.1016/j.jos.2023.07.003","url":null,"abstract":"<div><h3>Background</h3><p>Hypermobility of the first tarsometatarsal joint<span><span> plays an important role in hallux valgus<span> pathogenesis. The peroneus longus is recognized as a dynamic stabilizer of the first tarsometatarsal joint. However, the association between the peroneus longus function and the hallux valgus deformity remains unknown. This study aimed to determine the effect of peroneus longus contraction induced by </span></span>electrical muscle stimulation<span> on the correction of hallux valgus radiographic parameters in patients with hallux valgus.</span></span></p></div><div><h3>Methods</h3><p>Thirty-five patients with hallux valgus (47 feet; 2 men, 33 women; mean age 64.9 years) were included. Non-weight-bearing dorsoplantar radiographs of the foot were obtained with and without electrical muscle stimulation of the peroneus longus. Radiographic parameters of hallux valgus deformities, including the hallux valgus angle, intermetatarsal angle, first metatarsal protrusion distance, and distance between the first and second metatarsal bases, were measured and compared between the two conditions.</p></div><div><h3>Results</h3><p>All hallux valgus radiographic parameters were significantly improved by contraction of the peroneus longus. The median hallux valgus angle decreased by 13.2°. Fewer changes in the hallux valgus angle were identified in patients with severe deformity and geriatric patients.</p></div><div><h3>Conclusions</h3><p>Although the peroneus longus muscle has received little attention in the management of hallux valgus, our findings suggest that it has the potential to be a novel conservative approach for treating mild-to-moderate hallux valgus.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9873683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of the clinical outcomes of intramedullary nailing between impending and completed pathological fractures caused by metastatic femoral tumors from solid cancers 实体癌转移性股骨肿瘤引起的即将发生的病理性骨折与已完成的病理性骨折之间的髓内钉临床效果比较。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-07-01 DOI: 10.1016/j.jos.2023.07.001

Sho Yanagisawa, Yoshiyasu Uchiyama, Yoshikazu Tanzawa, Takuya Watanabe, Shiho Wasai, Takehisa Suzuki, Masahiko Watanabe

Background

We examined the treatment outcomes following intramedullary nailing in patients with metastatic femoral tumors, excluding those from hematological malignancies.

Methods

We retrospectively evaluated treatment outcomes following intramedullary nailing between patients who underwent preventative surgery compared with those who had surgery following pathological fracture. Patients who underwent preventative surgery (Mirels’ score ≥8) were allocated to the impending fracture group (n = 11) and those who underwent surgery after pathological fracture were allocated to the completed fracture group (n = 20).

Results

Duration of surgery was significantly shorter in the impending fracture group than in the completed fracture group. Median blood loss was significantly less, and the median duration of hospital stay was significantly shorter in the impending fracture group than in the completed fracture group. Among patients who died following surgery, the median postoperative survival duration was significantly longer in the impending fracture group than in the completed fracture group. Significantly more patients regained walking function in the impending fracture group than in the completed fracture group. Regarding complications, infection occurred in one patient in the completed fracture group. No implant damage was observed in either group.

Conclusions

Patients with metastatic femoral tumors who underwent intramedullary nailing in the impending fracture group had better postoperative survival and gait function, less blood loss, and shorter durations of surgery and hospital stay than those in the completed fracture group. These findings indicate the importance of early diagnosis and treatment and value of treatment prior to fracture occurrence.

背景我们研究了转移性股骨肿瘤患者（不包括血液恶性肿瘤患者）髓内钉的治疗效果：我们对接受预防性手术与病理骨折后接受手术的患者进行了髓内钉治疗效果的回顾性评估。接受预防性手术（Mirels评分≥8分）的患者被分配到即将骨折组（n = 11），而在病理骨折后接受手术的患者被分配到已完成骨折组（n = 20）：结果：即将骨折组的手术时间明显短于完全骨折组。即将骨折组的中位失血量明显少于完全骨折组，中位住院时间也明显短于完全骨折组。在手术后死亡的患者中，即将骨折组的术后中位存活时间明显长于完全骨折组。骨折即将愈合组恢复行走功能的患者明显多于骨折已愈合组。在并发症方面，完成骨折组有一名患者发生了感染。两组患者均未发现植入物损坏：结论：与完全骨折组相比，接受髓内钉治疗的骨折预兆组转移性股骨肿瘤患者的术后生存率和步态功能更好，失血量更少，手术和住院时间更短。这些研究结果表明了早期诊断和治疗的重要性以及在骨折发生前进行治疗的价值。

{"title":"Comparison of the clinical outcomes of intramedullary nailing between impending and completed pathological fractures caused by metastatic femoral tumors from solid cancers","authors":"Sho Yanagisawa, Yoshiyasu Uchiyama, Yoshikazu Tanzawa, Takuya Watanabe, Shiho Wasai, Takehisa Suzuki, Masahiko Watanabe","doi":"10.1016/j.jos.2023.07.001","DOIUrl":"10.1016/j.jos.2023.07.001","url":null,"abstract":"<div><h3>Background</h3><p><span>We examined the treatment outcomes following </span>intramedullary nailing<span><span> in patients with metastatic femoral tumors, excluding those from </span>hematological malignancies.</span></p></div><div><h3>Methods</h3><p>We retrospectively evaluated treatment outcomes following intramedullary nailing between patients who underwent preventative surgery compared with those who had surgery following pathological fracture. Patients who underwent preventative surgery (Mirels’ score ≥8) were allocated to the impending fracture group (n = 11) and those who underwent surgery after pathological fracture were allocated to the completed fracture group (n = 20).</p></div><div><h3>Results</h3><p>Duration of surgery was significantly shorter in the impending fracture group than in the completed fracture group. Median blood loss was significantly less, and the median duration of hospital stay was significantly shorter in the impending fracture group than in the completed fracture group. Among patients who died following surgery, the median postoperative survival duration was significantly longer in the impending fracture group than in the completed fracture group. Significantly more patients regained walking function in the impending fracture group than in the completed fracture group. Regarding complications, infection occurred in one patient in the completed fracture group. No implant damage was observed in either group.</p></div><div><h3>Conclusions</h3><p>Patients with metastatic femoral tumors who underwent intramedullary nailing in the impending fracture group had better postoperative survival and gait function, less blood loss, and shorter durations of surgery and hospital stay than those in the completed fracture group. These findings indicate the importance of early diagnosis and treatment and value of treatment prior to fracture occurrence.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9878552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Independent and combined associations of dietary antioxidant intake with bone mineral density and risk of osteoporosis among elderly population in United States 美国老年人膳食抗氧化剂摄入量与骨矿物质密度和骨质疏松症风险的独立和综合关联。

IF 1.5 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2024-07-01 DOI: 10.1016/j.jos.2023.07.014

Qing Zhou , Xi Chen , Qiuyan Chen , Lu Hao

Background

The influence of dietary antioxidant intake on the occurrence and progression of osteoporosis may be significant. However, to date, evidence on the link between combined effect of dietary antioxidants on bone mineral density (BMD) level and risk of osteoporosis is limited. We aimed to assess the independent and combined association of dietary antioxidant intake with BMD level and risk of osteoporosis among elderly population in United States through analysis of data in the National Health and Nutrition Examination Survey.

Methods

The dietary antioxidant intake was assessed based on six antioxidants, including vitamin A, vitamin C, vitamin E, zinc, selenium, and total carotenoid. A composite dietary antioxidant index (CDAI) was used to evaluate the combined exposure of dietary antioxidant intake.

Results

A total of 5618 participants were included. Higher dietary vitamin A, vitamin C, vitamin E, zinc, selenium, and total carotenoid, were positively associated with BMD level. Compared with participants in the first quartile, those in the higher quartile of vitamin E (Q4: OR 0.652; 95% CI 0.463–0.918), zinc (Q4: OR 0.581; 95% CI 0.408–0.826), and selenium (Q3: OR 0.673; 95% CI 0.503–0.899) were associated with decreased risk of overall osteoporosis. Furthermore, compared to those in the first quartile, participants in the highest quartile of CDAI were associated with increased total femur (β 0.019; 95% CI 0.007–0.032), femur neck (β 0.020; 95% CI 0.009–0.032), trochanter (β 0.012; 95% CI 0.001–0.023), and intertrochanter BMD level (β 0.022; 95% CI 0.007–0.037); participants in the highest quartile of CDAI were associated with decreased risk of overall osteoporosis (OR 0.536; 95% CI 0.376–0.763). Furthermore, the associations of CDAI with the BMD level and osteoporosis risk were more significant among female participants.

Conclusion

Our study provides evidence that a combination of dietary antioxidants intake was associated increased BMD level and decreased osteoporosis risk.

背景：膳食抗氧化剂的摄入对骨质疏松症的发生和发展可能有重大影响。然而，迄今为止，有关膳食抗氧化剂对骨矿物质密度（BMD）水平的综合影响与骨质疏松症风险之间联系的证据还很有限。我们旨在通过分析美国国家健康与营养调查的数据，评估膳食抗氧化剂摄入量与美国老年人群骨矿物质密度水平和骨质疏松症风险之间的独立和综合关联：方法：根据六种抗氧化剂（包括维生素 A、维生素 C、维生素 E、锌、硒和总类胡萝卜素）评估膳食抗氧化剂摄入量。采用综合膳食抗氧化剂指数（CDAI）来评估膳食抗氧化剂摄入量的综合影响：结果：共纳入了 5618 名参与者。较高的膳食维生素 A、维生素 C、维生素 E、锌、硒和类胡萝卜素总量与 BMD 水平呈正相关。与第一四分位数的参与者相比，维生素 E（第四季度：OR 0.652；95% CI 0.463-0.918）、锌（第四季度：OR 0.581；95% CI 0.408-0.826）和硒（第三季度：OR 0.673；95% CI 0.503-0.899）含量较高的四分位数参与者患总体骨质疏松症的风险较低。此外，与第一四分位数的参与者相比，CDAI 最高四分位数的参与者的股骨总量（β 0.019；95% CI 0.007-0.032）、股骨颈（β 0.020；95% CI 0.009-0.032）、股骨转子（β 0.012；95% CI 0.001-0.023）和转子间 BMD 水平（β 0.022；95% CI 0.007-0.037）；CDAI 最高四分位数的参与者与总体骨质疏松症风险降低相关（OR 0.536；95% CI 0.376-0.763）。此外，CDAI与骨密度水平和骨质疏松症风险的关系在女性参与者中更为显著：我们的研究提供了证据，表明膳食抗氧化剂的综合摄入与增加 BMD 水平和降低骨质疏松症风险有关。

{"title":"Independent and combined associations of dietary antioxidant intake with bone mineral density and risk of osteoporosis among elderly population in United States","authors":"Qing Zhou , Xi Chen , Qiuyan Chen , Lu Hao","doi":"10.1016/j.jos.2023.07.014","DOIUrl":"10.1016/j.jos.2023.07.014","url":null,"abstract":"<div><h3>Background</h3><p><span>The influence of dietary antioxidant intake on the occurrence and progression of </span>osteoporosis may be significant. However, to date, evidence on the link between combined effect of dietary antioxidants on bone mineral density (BMD) level and risk of osteoporosis is limited. We aimed to assess the independent and combined association of dietary antioxidant intake with BMD level and risk of osteoporosis among elderly population in United States through analysis of data in the National Health and Nutrition Examination Survey.</p></div><div><h3>Methods</h3><p><span><span>The dietary antioxidant intake was assessed based on six antioxidants, including vitamin A<span>, vitamin C, </span></span>vitamin E, zinc, selenium, and total </span>carotenoid. A composite dietary antioxidant index (CDAI) was used to evaluate the combined exposure of dietary antioxidant intake.</p></div><div><h3>Results</h3><p>A total of 5618 participants were included. Higher dietary vitamin A, vitamin C, vitamin E, zinc, selenium, and total carotenoid, were positively associated with BMD level. Compared with participants in the first quartile, those in the higher quartile of vitamin E (Q4: OR 0.652; 95% CI 0.463–0.918), zinc (Q4: OR 0.581; 95% CI 0.408–0.826), and selenium (Q3: OR 0.673; 95% CI 0.503–0.899) were associated with decreased risk of overall osteoporosis. Furthermore, compared to those in the first quartile, participants in the highest quartile of CDAI were associated with increased total femur (β 0.019; 95% CI 0.007–0.032), femur neck (β 0.020; 95% CI 0.009–0.032), trochanter (β 0.012; 95% CI 0.001–0.023), and intertrochanter BMD level (β 0.022; 95% CI 0.007–0.037); participants in the highest quartile of CDAI were associated with decreased risk of overall osteoporosis (OR 0.536; 95% CI 0.376–0.763). Furthermore, the associations of CDAI with the BMD level and osteoporosis risk were more significant among female participants.</p></div><div><h3>Conclusion</h3><p>Our study provides evidence that a combination of dietary antioxidants intake was associated increased BMD level and decreased osteoporosis risk.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9934838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0