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Site of Service Disparities Exist for Total Joint Arthroplasty. 全关节置换术存在服务地点差异。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2024-03-12 DOI: 10.3928/01477447-20240304-01
Nicole M Truong, Chelsea V Leversedge, Thompson Zhuang, Lauren M Shapiro, Matthew Whittaker, Robin N Kamal

Background: The rate of outpatient total joint arthroplasty procedures, including those performed at ambulatory surgical centers (ASCs) and hospital outpatient departments, is increasing. The purpose of this study was to analyze if type of insurance is associated with site of service (in-patient vs outpatient) for total joint arthroplasty and adverse outcomes.

Materials and methods: We identified patients undergoing unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), or total hip arthroplasty (THA) using Current Procedural Terminology codes in a national administrative claims database. Eligible patients were stratified by type of insurance (Medicaid, Medicare, private). The primary outcome was site of service. Secondary outcomes included general complications, procedural complications, and revision procedures. We evaluated the associations using adjusted multivariable logistic regression models.

Results: We identified 951,568 patients for analysis; 46,703 (4.9%) patients underwent UKA, 607,221 (63.8%) underwent TKA, and 297,644 (31.3%) underwent THA. Overall, 9.6% of procedures were outpatient. Patients with Medicaid were less likely than privately insured patients to receive outpatient UKA or THA (UKA: odds ratio [OR], 0.729 [95% CI, 0.640-0.829]; THA: OR, 0.625 [95% CI, 0.557-0.702]) but more likely than patients with Medicare to receive outpatient TKA or THA (TKA: OR, 1.391 [95% CI, 1.315-1.472]; THA: OR, 1.327 [95% CI, 1.166-1.506]). Patients with Medicaid were more likely to experience complications and revision procedures.

Conclusion: Differences in site of service and complication rates following hip and knee arthroplasty exist based on type of insurance, suggesting a disparity in care. Further exploration of drivers of this disparity is warranted and can inform interventions (eg, progressive value-based payments) to support equity in orthopedic services. [Orthopedics. 2024;47(3):179-184.].

背景:门诊全关节置换术(包括在非卧床手术中心(ASC)和医院门诊部进行的手术)的比例正在增加。本研究的目的是分析保险类型是否与全关节置换术的服务地点(住院与门诊)及不良后果有关:我们使用全国行政索赔数据库中的当前程序术语代码确定了接受单间室膝关节置换术(UKA)、全膝关节置换术(TKA)或全髋关节置换术(THA)的患者。符合条件的患者按保险类型(医疗补助、医疗保险、私人保险)进行了分层。主要结果是服务地点。次要结果包括一般并发症、手术并发症和翻修手术。我们使用调整后的多变量逻辑回归模型对相关性进行了评估:我们确定了 951568 名患者进行分析;46703 名患者(4.9%)接受了 UKA,607221 名患者(63.8%)接受了 TKA,297644 名患者(31.3%)接受了 THA。总体而言,9.6%的手术是门诊手术。与私人保险患者相比,医疗补助患者接受门诊 UKA 或 THA 的可能性较低(UKA:几率比 [OR],0.729 [95% CI,0.640-0.829];THA:OR,0.625[95%CI,0.557-0.702]),但比医疗保险患者更有可能接受门诊 TKA 或 THA(TKA:OR,1.391 [95% CI,1.315-1.472];THA:OR,1.327 [95% CI,1.166-1.506])。医疗补助患者更容易出现并发症和翻修手术:结论:根据保险类型的不同,髋关节和膝关节置换术后的服务地点和并发症发生率存在差异,这表明在护理方面存在差异。有必要进一步探讨造成这种差异的原因,并为干预措施(如基于价值的渐进式支付)提供依据,以支持骨科服务的公平性。[骨科。202x;4x(x):xx-xx]。
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引用次数: 0
Increased 90-Day Mortality and Morbidity Among Patients Recovering From Elective Primary Arthroplasty During the COVID-19 Pandemic in New York City. 在纽约市新冠肺炎大流行期间,从选择性初级关节成形术中恢复的患者90天死亡率和发病率增加。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2023-11-01 DOI: 10.3928/01477447-20231027-05
Megan M Mizera, Zeynep Seref-Ferlengez, Anna Tarasova, Evan Mostafa, Eli Kamara, Sun Jin Kim

All elective procedures were stopped in March 2020 because of the coronavirus disease 2019 (COVID-19) pandemic. We report the 90-day mortality and complications of patients who underwent primary arthroplasty before the stopping of elective procedures at a single academic medical center. A retrospective cohort study was conducted including patients who underwent elective primary arthroplasty between December 2019 and mid-March 2020. Their 90-day postoperative mortality and medical complications were statistically compared with those of a historical cohort from the same operative period in 2019. The 2020 and 2019 cohorts included 372 and 410 patients, respectively. Except for the prevalence of diabetes, there was no significant difference between the two cohorts regarding baseline characteristics or preoperative health. The 2020 cohort had statistically significant higher rates of pneumonia (2.7% vs 0.7%; P=.03), readmission (9.1% vs 5.4%; P=.04), pulmonary embolism (1.6% vs 0.2%; P=.04), and 90-day mortality (1.1% vs 0%; P=.04). The 2020 cohort also had a trend for increased rates of deep venous thrombosis (1.1% vs 0.7%; P=.7) and cardiac complications (1.9% vs 0.5%; P=.07) and no change in emergency department visits (14.0% vs 11.7%; P=.3). There were 7 confirmed cases of COVID-19 in the 2020 cohort and 1 death. This study demonstrates that patients who underwent primary arthroplasty procedures at our institution close to the time of the first wave of the COVID-19 pandemic experienced a statistically significant increase in mortality, pneumonia, pulmonary embolism, and readmission compared with a historical cohort. As elective procedures have resumed during the ongoing pandemic, providers and patients should be aware of these increased risks. [Orthopedics. 2024;47(3):135-140.].

由于2019冠状病毒病(新冠肺炎)大流行,所有选择性手术于2020年3月停止。我们报告了在单一学术医疗中心停止选择性手术前接受初次关节成形术的患者90天的死亡率和并发症。对2019年12月至2020年3月中旬期间接受选择性初次关节成形术的患者进行了回顾性队列研究。将他们90天的术后死亡率和医疗并发症与2019年同期的历史队列进行统计比较。2020年和2019年的队列分别包括372名和410名患者。除了糖尿病的患病率外,两组患者在基线特征或术前健康状况方面没有显著差异。2020年队列的肺炎发生率(2.7%对0.7%;P=0.03)、再次入院率(9.1%对5.4%;P=0.04)、肺栓塞发生率(1.6%对0.2%;P=0.04,和90天死亡率(1.1%对0%;P=.04)。2020年队列中深静脉血栓形成率(1.1%对0.7%;P=.7)和心脏并发症率(1.9%对0.5%;P=.07)也有增加的趋势,急诊就诊率没有变化(14.0%对11.7%;P=.3)。2020年间共有7例新冠肺炎确诊病例,1例死亡。这项研究表明,与历史队列相比,在新冠肺炎第一波大流行即将到来时,在我们机构接受初级关节成形术的患者的死亡率、肺炎、肺栓塞和再入院率在统计学上显著增加。随着选择性手术在持续的疫情期间恢复,提供者和患者应该意识到这些增加的风险。[骨科.202x;4x(x):xx-xx.]。
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引用次数: 0
Nearly All Peer-to-Peer Reviews for CT and MRI Prior Authorization Denials for Orthopedic Specialists Are Approved. 几乎所有CT和MRI的同行评审——骨科专家的事先授权拒绝——都得到了批准。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2023-11-01 DOI: 10.3928/01477447-20231027-08
Nareena Imam, Jay M Zaifman, Rocco Bassora, Chris Cherian, Eitan M Kohan, Frank G Alberta, John D Koerner

In the event of prior authorization denial, physicians may request peer-to-peer review, which may delay treatment and increase administrative burden. The purpose of this study was to quantify the approval rate of peer-to-peer review and evaluate its efficiency in the context of advanced imaging use in an orthopedic practice. Patients at a single outpatient orthopedic clinic initially receiving an insurance denial for computed tomography or magnetic resonance imaging requiring peer-to-peer review from March to December 2022 were prospectively enrolled. Characteristics of the request, peer-to-peer review, and the reviewer and dates in the process were collected. If the study was approved after peer-to-peer review, the date of the imaging study and brief results were recorded. A total of 62 denials were included. One denial was approved prior to peer-to-peer review. Fifty-eight (of 61, 95.1%) reviews were approved, of which 51 (of 58, 87.9%) studies were completed by patients. Reviewers were always physicians (61 of 61, 100%), but of those whose specialty was known, none were orthopedic surgeons. Forty-four of 61 (72.1%) reviewers reported reviewing clinical notes in advance. The median number of days from visit to peer-to-peer review was 9.0 (interquartile range, 7.0-13.25). The median number of days from visit to imaging center appointment was 13.5 (interquartile range, 9.0-20.75) for approved studies. Of the 51 approved studies completed by patients, the results of 38 (74.5%) confirmed the suspected diagnosis. In an orthopedic specialty practice, almost all peer-to-peer reviews were approved, with the majority of the completed studies confirming the suspected diagnosis. Thus, patient care was delayed. Reform is crucial to improve the efficiency of the review process, especially in light of additional administrative and financial burden. [Orthopedics. 2024;47(3):141-146.].

如果事先拒绝授权,医生可能会要求同行评审,这可能会延迟治疗并增加管理负担。本研究的目的是量化同行评审的批准率,并评估其在骨科实践中高级成像应用的效率。2022年3月至12月,在一家骨科门诊诊所接受计算机断层扫描或磁共振成像保险拒绝的患者被前瞻性纳入。收集了请求的特征、同行评审、评审人和过程中的日期。如果该研究在同行评审后获得批准,则记录成像研究的日期和简要结果。总共包括62项否认。在对等审查之前批准了一项否认。58项(61项,95.1%)审查获得批准,其中51项(58项,87.9%)研究由患者完成。评审员总是医生(61%,100%),但在那些已知专业的人中,没有一个是整形外科医生。61名评审员中有44名(72.1%)报告提前评审了临床记录。从就诊到同行评审的中位天数为9.0(四分位间距,7.0-13.25)。对于批准的研究,从就诊到预约成像中心的中位日期为13.5(四分位数间距,9.0-20.75)。在患者完成的51项获批研究中,38项(74.5%)的结果证实了疑似诊断。在骨科专业实践中,几乎所有的同行评审都获得了批准,大多数已完成的研究都证实了疑似诊断。因此,患者护理被推迟。改革对于提高审查进程的效率至关重要,特别是考虑到额外的行政和财政负担。[骨科.202x;4x(x):xx-xx.]。
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引用次数: 0
Early Postoperative Change in Hip Rotation Angle and Factors Contributing to It for Patients Undergoing Total Hip Arthroplasty. 全髋关节置换术患者术后早期髋关节旋转角度的变化及其影响因素。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2023-12-28 DOI: 10.3928/01477447-20231220-01
Toshiyuki Tateiwa, Toshinori Masaoka, Yasuhito Takahashi, Tsunehito Ishida, Takaaki Shishido, Kengo Yamamoto

Objective: A possible impairment in hip proprioception after total hip arthroplasty (THA) has been an issue of concern. The aims of this study were to investigate the extent of early postoperative change in standing hip rotation angle (HRAng) in patients with osteoarthritis (OA) undergoing THA and to consider a possible mechanism behind this.

Materials and methods: A total of 82 hips (82 patients; 63 women and 19 men) undergoing unilateral primary THA with total capsulectomy were included. We characterized the standing HRAng and internal/external range of motion (ROM) in the prone position before THA and 2 weeks after THA. Acetabular/cup and femoral/stem anteversion, combined anteversion (CA), and leg length discrepancy were also characterized. Correlations were examined postoperatively between the HRAng and the other analyzed variables.

Results: The median standing HRAng showed a significant internal shift from external to more medial position (6.3° to 1.7°) 2 weeks after THA (P<.0001). The postoperative change in standing HRAng was significantly negatively correlated with the difference between the postoperative femoral anteversion and the stem anteversion (rs=-0.429, P<.0001) and with the pre- to postoperative change in CA (rs=-0.3012, P=.0063).

Conclusion: This study demonstrated that the extent of the rotational shift of the distal femur toward medial direction was significantly associated with increasing stem anteversion and CA. This phenomenon can be interpreted as a compensatory mechanism for maintaining the relative positional relationship between the pelvis and the proximal femur using proprioception. Therefore, we conclude that the extracapsular/extra-articular components may be prominent determinants of joint position sense. [Orthopedics. 2024;47(3):e114-e118.].

目的:全髋关节置换术(THA)后髋关节本体感觉可能受损一直是人们关注的问题。本研究旨在调查接受全髋关节置换术的骨关节炎(OA)患者术后早期站立时髋关节旋转角度(HRAng)的变化程度,并考虑其背后的可能机制:共纳入了 82 例髋关节(82 例患者,其中 63 例为女性,19 例为男性),这些患者均接受了单侧原发性全髋关节置换术(THA)和全帽切除术。我们对髋关节置换术前和术后两周内的站立位 HRAng 和俯卧位内/外侧活动范围 (ROM) 进行了分析。我们还对髋臼/髋臼杯和股骨/股骨干内翻、合并内翻(CA)以及腿长差异进行了分析。术后研究了HRAng与其他分析变量之间的相关性:结果:THA术后2周,中位站立位HRAng显示出明显的内侧移位,从外侧移至更内侧的位置(6.3°至1.7°)(Prs=-0.429,Prs=-0.3012,P=.0063):本研究表明,股骨远端向内侧旋转移位的程度与骨干内翻和CA的增加显著相关。这一现象可解释为利用本体感觉维持骨盆与股骨近端之间相对位置关系的一种补偿机制。因此,我们得出结论,囊外/关节外组件可能是关节位置感的主要决定因素。[骨科。202x;4x(x):xx-xx]。
{"title":"Early Postoperative Change in Hip Rotation Angle and Factors Contributing to It for Patients Undergoing Total Hip Arthroplasty.","authors":"Toshiyuki Tateiwa, Toshinori Masaoka, Yasuhito Takahashi, Tsunehito Ishida, Takaaki Shishido, Kengo Yamamoto","doi":"10.3928/01477447-20231220-01","DOIUrl":"10.3928/01477447-20231220-01","url":null,"abstract":"<p><strong>Objective: </strong>A possible impairment in hip proprioception after total hip arthroplasty (THA) has been an issue of concern. The aims of this study were to investigate the extent of early postoperative change in standing hip rotation angle (HRAng) in patients with osteoarthritis (OA) undergoing THA and to consider a possible mechanism behind this.</p><p><strong>Materials and methods: </strong>A total of 82 hips (82 patients; 63 women and 19 men) undergoing unilateral primary THA with total capsulectomy were included. We characterized the standing HRAng and internal/external range of motion (ROM) in the prone position before THA and 2 weeks after THA. Acetabular/cup and femoral/stem anteversion, combined anteversion (CA), and leg length discrepancy were also characterized. Correlations were examined postoperatively between the HRAng and the other analyzed variables.</p><p><strong>Results: </strong>The median standing HRAng showed a significant internal shift from external to more medial position (6.3° to 1.7°) 2 weeks after THA (<i>P</i><.0001). The postoperative change in standing HRAng was significantly negatively correlated with the difference between the postoperative femoral anteversion and the stem anteversion (<i>r</i><sub>s</sub>=-0.429, <i>P</i><.0001) and with the pre- to postoperative change in CA (<i>r</i><sub>s</sub>=-0.3012, <i>P</i>=.0063).</p><p><strong>Conclusion: </strong>This study demonstrated that the extent of the rotational shift of the distal femur toward medial direction was significantly associated with increasing stem anteversion and CA. This phenomenon can be interpreted as a compensatory mechanism for maintaining the relative positional relationship between the pelvis and the proximal femur using proprioception. Therefore, we conclude that the extracapsular/extra-articular components may be prominent determinants of joint position sense. [<i>Orthopedics</i>. 2024;47(3):e114-e118.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e114-e118"},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139040335","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
Establishment of a Rabbit Model of Adjacent Intervertebral Disk Degeneration After Lumbar Fusion and Fixation and Evaluation of Autophagy Factor Expression in Nucleus Pulposus Cells 建立腰椎融合固定术后相邻椎间盘退变兔模型并评估髓核细胞中自噬因子的表达情况
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 DOI: 10.3928/01477447-20240424-04
Jiawen Sun, MMed, Fuyu Chen, MMed, Xiaodong Wei, MMed, Yufu Ou, MD

Background:

The objectives of this research were to establish an animal model of adjacent segment degeneration (ASD) bordering lumbar fusion and to investigate the expression of autophagy factors in nucleus pulposus cells of adjacent intervertebral disks.

Materials and Methods:

Twenty-four adult New Zealand white rabbits were enrolled and divided into two groups: group A (n=12) and group B (n=12). Posterolateral fusion and fixation were performed after intervertebral disk degeneration occurred in group A, and the rabbits were monitored for 6 months. Group B was the control group and did not undergo fusion surgery. These rabbits were monitored for 6 months. Real-time quantitative polymerase chain reaction and immunohistochemistry were performed to detect the mRNA and protein expressions of PTEN-induced kinase 1 (PINK1), Parkin, ADAMTS-4, and MMP-3. An external database, the GEO database, was used to examine the expression of these genes and analyze them for differential expression.

Results:

After lumbar fusion in rabbits, the animal model of ASD exhibited gradual degeneration of adjacent intervertebral disks over time. Group A displayed significantly higher mRNA and protein expressions of PINK1 and MMP-3 but lower expression of ADAMTS-4 compared with group B (P<.05). The results analyzed in the GEO database showed that the expression of PINK1 was higher in group A than in group B, while the expression of ADAMTS-4 was lower in group A than in group B.

Conclusion:

After posterolateral lumbar fusion in rabbits, the animal ASD model showed gradual deterioration of adjacent intervertebral disks with prolonged follow-up. The findings indicate the important role of autophagy in the apoptosis of nucleus pulposus cells in adjacent intervertebral disks. [Orthopedics. 202x;4x(x):xx–xx.]

背景:本研究的目的是建立腰椎融合术邻近节段退变(ASD)的动物模型,并研究自噬因子在邻近椎间盘髓核细胞中的表达。A 组在椎间盘发生退变后进行后外侧融合固定,观察 6 个月。B 组为对照组,未进行融合手术。对这些兔子进行了为期 6 个月的监测。采用实时定量聚合酶链反应和免疫组织化学方法检测 PTEN 诱导的激酶 1 (PINK1)、Parkin、ADAMTS-4 和 MMP-3 的 mRNA 和蛋白表达。结果表明:兔腰椎融合术后,ASD动物模型的相邻椎间盘随着时间的推移逐渐退化。与 B 组相比,A 组 PINK1 和 MMP-3 的 mRNA 和蛋白表达量明显较高,但 ADAMTS-4 的表达量较低(P< .05)。在 GEO 数据库中分析的结果显示,A 组中 PINK1 的表达高于 B 组,而 A 组中 ADAMTS-4 的表达低于 B 组。研究结果表明,自噬在相邻椎间盘髓核细胞凋亡过程中发挥了重要作用。[骨科。202x;4x(x):xx-xx。]
{"title":"Establishment of a Rabbit Model of Adjacent Intervertebral Disk Degeneration After Lumbar Fusion and Fixation and Evaluation of Autophagy Factor Expression in Nucleus Pulposus Cells","authors":"Jiawen Sun, MMed, Fuyu Chen, MMed, Xiaodong Wei, MMed, Yufu Ou, MD","doi":"10.3928/01477447-20240424-04","DOIUrl":"https://doi.org/10.3928/01477447-20240424-04","url":null,"abstract":"<section><h3>Background:</h3><p>The objectives of this research were to establish an animal model of adjacent segment degeneration (ASD) bordering lumbar fusion and to investigate the expression of autophagy factors in nucleus pulposus cells of adjacent intervertebral disks.</p></section><section><h3>Materials and Methods:</h3><p>Twenty-four adult New Zealand white rabbits were enrolled and divided into two groups: group A (n=12) and group B (n=12). Posterolateral fusion and fixation were performed after intervertebral disk degeneration occurred in group A, and the rabbits were monitored for 6 months. Group B was the control group and did not undergo fusion surgery. These rabbits were monitored for 6 months. Real-time quantitative polymerase chain reaction and immunohistochemistry were performed to detect the mRNA and protein expressions of PTEN-induced kinase 1 (PINK1), Parkin, ADAMTS-4, and MMP-3. An external database, the GEO database, was used to examine the expression of these genes and analyze them for differential expression.</p></section><section><h3>Results:</h3><p>After lumbar fusion in rabbits, the animal model of ASD exhibited gradual degeneration of adjacent intervertebral disks over time. Group A displayed significantly higher mRNA and protein expressions of PINK1 and MMP-3 but lower expression of ADAMTS-4 compared with group B (<i>P</i>&lt;.05). The results analyzed in the GEO database showed that the expression of PINK1 was higher in group A than in group B, while the expression of ADAMTS-4 was lower in group A than in group B.</p></section><section><h3>Conclusion:</h3><p>After posterolateral lumbar fusion in rabbits, the animal ASD model showed gradual deterioration of adjacent intervertebral disks with prolonged follow-up. The findings indicate the important role of autophagy in the apoptosis of nucleus pulposus cells in adjacent intervertebral disks. [<i>Orthopedics</i>. 202x;4x(x):xx–xx.]</p></section>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"39 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140832313","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
Four-Year Outcomes of Cementless Versus Cemented Fixation of a Newly Introduced Total Knee Arthroplasty Design. 一种新推出的全膝关节置换术设计的无骨水泥固定与有骨水泥固定的四年疗效对比。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2024-01-25 DOI: 10.3928/01477447-20240122-02
Timothy G Costales, David F Dalury

Background: Aseptic loosening continues to be a major cause of failure of total knee arthroplasty (TKA). Although cemented fixation remains the gold standard, there is renewed interest in cementless fixation as a means of decreasing this risk via biologic fixation. The purpose of this study was to evaluate the clinical outcomes of cemented and cementless versions of a newly introduced TKA design at an average of 4 years postoperatively.

Materials and methods: This was a retrospective case-control study of 100 primary TKAs comparing cementless vs cemented TKAs using the same cruciate-retaining implant design (ATTUNE Knee System; DePuy Synthes). Fifty patients undergoing cementless TKA with a mean age of 60.8 years (range, 48-71 years) and body mass index (BMI) of 31.6 kg/m2 (range, 23.7-41.9 kg/m2) were matched to 50 patients undergoing primary cemented TKA with a mean age of 62.7 years (range, 51-73 years) and BMI of 30.1 kg/m2 (range, 24.6-43.9 kg/m2). The mean follow-up was 4.2 years (range, 4.0-4.4 years) in the cementless group and 7.6 years (range, 7.5-7.7 years) in the cemented group. Complications, clinical outcomes using the Knee Society Score (KSS), and radiographic analyses were evaluated at final follow-up. Student's t tests were used for statistical analyses.

Results: There was no statistical difference in age, BMI, and preoperative KSS between the two groups (P=.12, P=.15, and P=.55, respectively). There were no complications or reoperations in either cohort. There were no statistical differences in range of motion and total KSS at final follow-up between the two groups. Final total KSS had a mean of 91.1 for the cementless group and 93.7 for the cemented group. There was no radiographic evidence of component subsidence or loosening in either cohort.

Conclusion: When compared with its cemented counterpart, the newly introduced cementless TKA design had similar excellent clinical improvements and radiologic results at an average of 4 years of follow-up. [Orthopedics. 2024;47(3):161-166.].

背景:无菌性松动仍然是全膝关节置换术(TKA)失败的主要原因。尽管骨水泥固定仍是金标准,但无骨水泥固定作为通过生物固定降低这一风险的一种手段,再次引起了人们的兴趣。本研究的目的是评估一种新引进的 TKA 设计的有骨水泥和无骨水泥版本在术后平均 4 年的临床效果:这是一项回顾性病例对照研究,对 100 例使用相同十字韧带固定假体设计(ATTUNE 膝关节系统;DePuy Synthes)的初次 TKA 进行了无骨水泥与有骨水泥 TKA 的比较。接受无骨水泥 TKA 治疗的 50 名患者的平均年龄为 60.8 岁(范围为 48-71 岁),体重指数 (BMI) 为 31.6 kg/m2(范围为 23.7-41.9 kg/m2);接受初次骨水泥 TKA 治疗的 50 名患者的平均年龄为 62.7 岁(范围为 51-73 岁),体重指数 (BMI) 为 30.1 kg/m2(范围为 24.6-43.9 kg/m2)。无骨水泥组的平均随访时间为4.2年(范围为4.0-4.4年),有骨水泥组的平均随访时间为7.6年(范围为7.5-7.7年)。在最终随访时对并发症、膝关节社会评分(KSS)的临床结果和放射学分析进行了评估。统计分析采用学生 t 检验:两组患者的年龄、体重指数和术前 KSS 均无统计学差异(分别为 P=.12、P=.15 和 P=.55)。两组患者均未出现并发症或再次手术。两组患者在最终随访时的活动范围和总 KSS 均无统计学差异。无骨水泥组的最终总 KSS 平均值为 91.1,有骨水泥组为 93.7。两组患者均未出现组件下沉或松动的影像学证据:结论:新引进的无骨水泥 TKA 与有骨水泥 TKA 相比,在平均 4 年的随访中具有相似的出色临床改善和放射学结果。[骨科。202x;4x(x):xx-xx]。
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引用次数: 0
Multiligament Knee Reconstruction With Suture Tape Augmentation: Patient-Reported Outcomes at Minimum 2-Year Follow-up 缝合带增强多韧带膝关节重建术:至少 2 年随访的患者报告结果
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 DOI: 10.3928/01477447-20240424-02
Brian Panish, MD, Jonathan J. Lawson, MS, Seleem Elkadi, MD, Eliana Schaefer, MD, Gregory Perraut, MD, Evan H. Argintar, MD

Background:

Multiligament knee injury (MLKI) is a severe subclass of orthopedic injury and can result in significant functional impairment. Novel MLKI graft constructs such as suture augmentation aim to enhance graft strength and optimize knee stability. The purpose of this study was to present patient-reported outcome measurements of a cohort at a minimum follow-up of 2 years after multiligament knee reconstruction (MLKR) with suture augmentation.

Materials and Methods:

A retrospective chart review was performed to identify patients who underwent MLKR with suture augmentation. Demographic and injury-specific variables were gathered preoperatively and postoperatively. Patients were contacted at a minimum of 2 years postoperatively to collect Patient-Reported Outcomes Measurement Information System, Multiligament Quality of Life, and Lysholm knee scores.

Results:

Twenty-seven patients underwent MLKR with suture augmentation, with 15 being female (55.6%) and 12 being male (44.4%). The mean pain score was 49.93±9.96, the mean physical function score was 49.56±10.94, and the mean mobility score was 47.56±8.58. The mean physical impairment score was 33.96±23.69, the mean emotional impairment score was 36.55±26.60, the mean activity limitation score was 28.00±25.61, and the mean societal involvement score was 30.09±27.45. The mean Lysholm knee score for the cohort was 67.93±22.36.

Conclusion:

Patients who underwent MLKR with suture augmentation had satisfactory scores across all patient-reported outcome measurements. On the basis of these criteria, the average patient achieved an acceptable clinical outcome, demonstrating that MLKR with suture augmentation is a safe and efficacious surgical technique for the treatment of MLKI. [Orthopedics. 202x;4x(x):xx–xx.]

背景:多韧带膝关节损伤(MLKI)是骨科损伤的一个严重亚类,可导致严重的功能障碍。缝合增强等新的多韧带膝关节损伤移植物结构旨在增强移植物强度并优化膝关节稳定性。本研究的目的是对缝合增强多韧带膝关节重建(MLKR)术后至少随访2年的患者报告结果进行测量。收集了术前和术后的人口统计学变量和损伤特异性变量。术后至少2年与患者联系,收集患者报告结果测量信息系统、多韧带生活质量和Lysholm膝关节评分。结果:27名患者接受了MLKR缝合增强术,其中15名为女性(55.6%),12名为男性(44.4%)。平均疼痛评分为(49.93±9.96)分,平均身体功能评分为(49.56±10.94)分,平均活动能力评分为(47.56±8.58)分。肢体功能障碍平均得分为(33.96±23.69)分,情感障碍平均得分为(36.55±26.60)分,活动受限平均得分为(28.00±25.61)分,社会参与平均得分为(30.09±27.45)分。结论:接受 MLKR 和缝合增量术的患者在所有患者报告的结果测量中都获得了令人满意的分数。根据这些标准,平均每位患者都获得了可接受的临床结果,这表明缝合增高的 MLKR 是治疗 MLKI 的一种安全有效的手术技术。[骨科。202x;4x(x):xx-xx。]
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引用次数: 0
Performance of Two Artificial Intelligence Generative Language Models on the Orthopaedic In-Training Examination. 两种人工智能生成语言模型在骨科内训考试中的表现。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2024-03-12 DOI: 10.3928/01477447-20240304-02
Marc Lubitz, Luke Latario

Background: Artificial intelligence (AI) generative large language models are powerful and increasingly accessible tools with potential applications in health care education and training. The annual Orthopaedic In-Training Examination (OITE) is widely used to assess resident academic progress and preparation for the American Board of Orthopaedic Surgery Part 1 Examination.

Materials and methods: Open AI's ChatGPT and Google's Bard generative language models were administered the 2022 OITE. Question stems that contained images were input without and then with a text-based description of the imaging findings.

Results: ChatGPT answered 69.1% of questions correctly. When provided with text describing accompanying media, this increased to 77.8% correct. In contrast, Bard answered 49.8% of questions correctly. This increased to 58% correct when text describing imaging in question stems was provided (P<.0001). ChatGPT was most accurate in questions within the shoulder category, with 90.9% correct. Bard performed best in the sports category, with 65.4% correct. ChatGPT performed above the published mean of Accreditation Council for Graduate Medical Education orthopedic resident test-takers (66%).

Conclusion: There is significant variability in the accuracy of publicly available AI models on the OITE. AI generative language software may play numerous potential roles in the future in orthopedic education, including simulating patient presentations and clinical scenarios, customizing individual learning plans, and driving evidence-based case discussion. Further research and collaboration within the orthopedic community is required to safely adopt these tools and minimize risks associated with their use. [Orthopedics. 2024;47(3):e146-e150.].

背景:人工智能(AI)生成大语言模型是一种功能强大且日益普及的工具,在医疗保健教育和培训中具有潜在的应用价值。一年一度的矫形外科在岗培训考试(OITE)被广泛用于评估住院医师的学习进度和美国矫形外科委员会第一部分考试的准备情况:对 Open AI 的 ChatGPT 和谷歌的 Bard 生成语言模型进行了 2022 年 OITE 测试。在输入包含图像的题干时,先不输入图像,然后再输入基于文本的成像结果描述:结果:ChatGPT 正确回答了 69.1% 的问题。当提供随附媒体的文字描述时,正确率提高到 77.8%。相比之下,Bard 回答的问题正确率为 49.8%。当在问题题干中提供描述成像的文字时,正确率上升到 58%(PC 结论:在 OITE 上公开提供的人工智能模型的准确性存在很大差异。人工智能生成语言软件未来可能会在骨科教育中发挥许多潜在作用,包括模拟患者陈述和临床场景、定制个人学习计划以及推动循证病例讨论。要安全地采用这些工具并最大限度地降低与使用这些工具相关的风险,还需要在骨科界开展进一步的研究与合作。[骨科。202x;4x(x):xx-xx]。
{"title":"Performance of Two Artificial Intelligence Generative Language Models on the Orthopaedic In-Training Examination.","authors":"Marc Lubitz, Luke Latario","doi":"10.3928/01477447-20240304-02","DOIUrl":"10.3928/01477447-20240304-02","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) generative large language models are powerful and increasingly accessible tools with potential applications in health care education and training. The annual Orthopaedic In-Training Examination (OITE) is widely used to assess resident academic progress and preparation for the American Board of Orthopaedic Surgery Part 1 Examination.</p><p><strong>Materials and methods: </strong>Open AI's ChatGPT and Google's Bard generative language models were administered the 2022 OITE. Question stems that contained images were input without and then with a text-based description of the imaging findings.</p><p><strong>Results: </strong>ChatGPT answered 69.1% of questions correctly. When provided with text describing accompanying media, this increased to 77.8% correct. In contrast, Bard answered 49.8% of questions correctly. This increased to 58% correct when text describing imaging in question stems was provided (<i>P</i><.0001). ChatGPT was most accurate in questions within the shoulder category, with 90.9% correct. Bard performed best in the sports category, with 65.4% correct. ChatGPT performed above the published mean of Accreditation Council for Graduate Medical Education orthopedic resident test-takers (66%).</p><p><strong>Conclusion: </strong>There is significant variability in the accuracy of publicly available AI models on the OITE. AI generative language software may play numerous potential roles in the future in orthopedic education, including simulating patient presentations and clinical scenarios, customizing individual learning plans, and driving evidence-based case discussion. Further research and collaboration within the orthopedic community is required to safely adopt these tools and minimize risks associated with their use. [<i>Orthopedics</i>. 2024;47(3):e146-e150.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e146-e150"},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140102090","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
An Inclusive Analysis of Racial and Ethnic Disparities in Orthopedic Surgery Outcomes. 骨科手术结果中种族和民族差异的包容性分析。
IF 1.1 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-05-01 Epub Date: 2024-01-25 DOI: 10.3928/01477447-20240122-01
Maveric K I L Abella, Tyler Thorne, Jeffrey Hayashi, Andrea K Finlay, Steven Frick, Derek F Amanatullah

Background: Despite increasing attention, disparities in outcomes for Black and Hispanic patients undergoing orthopedic surgery are widening. In other racial-ethnic minority groups, outcomes often go unreported. We sought to quantify disparities in surgical outcomes among Asian, American Indian or Alaskan Native, and Native Hawaiian or Pacific Islander patients across multiple orthopedic subspecialties.

Materials and methods: The National Surgical Quality Improvement Program was queried to identify all surgical procedures performed by an orthopedic surgeon from 2014 to 2020. Multivariable logistic regression models were used to investigate the impact of race and ethnicity on 30-day medical complications, readmission, reoperation, and mortality, while adjusting for orthopedic subspecialty and patient characteristics.

Results: Across 1,512,480 orthopedic procedures, all patients who were not White were less likely to have arthroplasty-related procedures (P<.001), and Hispanic, Asian, and American Indian or Alaskan Native patients were more likely to have trauma-related procedures (P<.001). American Indian or Alaskan Native (adjusted odds ratio [AOR], 1.005; 95% CI, 1.001-1.009; P=.011) and Native Hawaiian or Pacific Islander (AOR, 1.009; 95% CI, 1.005-1.014; P<.001) patients had higher odds of major medical complications compared with White patients. American Indian or Alaskan Native patients had higher risk of reoperation (AOR, 1.005; 95% CI, 1.002-1.008; P=.002) and Native Hawaiian or Pacific Islander patients had higher odds of mortality (AOR, 1.003; 95% CI, 1.000-1.005; P=.019) compared with White patients.

Conclusion: Disparities regarding surgical outcome and utilization rates persist across orthopedic surgery. American Indian or Alaskan Native and Native Hawaiian or Pacific Islander patients, who are under-represented in research, have lower rates of arthroplasty but higher odds of medical complication, reoperation, and mortality. This study highlights the importance of including these patients in orthopedic research to affect policy-related discussions. [Orthopedics. 2024;47(3):e131-e138.].

背景:尽管受到越来越多的关注,但接受骨科手术的黑人和西班牙裔患者的治疗效果差距却在不断扩大。在其他少数种族-族裔群体中,手术结果往往没有报告。我们试图量化亚裔、美国印第安人或阿拉斯加原住民、夏威夷原住民或太平洋岛民患者在多个骨科亚专科的手术结果差异:通过查询 "国家外科质量改进计划"(National Surgical Quality Improvement Program),确定了从 2014 年到 2020 年由骨科医生实施的所有外科手术。采用多变量逻辑回归模型研究种族和民族对 30 天医疗并发症、再入院、再手术和死亡率的影响,同时对骨科亚专科和患者特征进行调整:在1,512,480例骨科手术中,与白人患者相比,所有非白人患者接受关节成形术相关手术的可能性较低(PPP=.011),夏威夷原住民或太平洋岛民患者(AOR,1.009;95% CI,1.005-1.014;PP=.002)和夏威夷原住民或太平洋岛民患者的死亡率较高(AOR,1.003;95% CI,1.000-1.005;P=.019):结论:骨科手术在手术效果和使用率方面仍存在差异。美国印第安人或阿拉斯加原住民以及夏威夷原住民或太平洋岛民患者在研究中的代表性不足,他们接受关节置换术的比例较低,但出现医疗并发症、再次手术和死亡率的几率较高。这项研究强调了将这些患者纳入骨科研究以影响政策相关讨论的重要性。[骨科。202x;4x(x):xx-xx]。
{"title":"An Inclusive Analysis of Racial and Ethnic Disparities in Orthopedic Surgery Outcomes.","authors":"Maveric K I L Abella, Tyler Thorne, Jeffrey Hayashi, Andrea K Finlay, Steven Frick, Derek F Amanatullah","doi":"10.3928/01477447-20240122-01","DOIUrl":"10.3928/01477447-20240122-01","url":null,"abstract":"<p><strong>Background: </strong>Despite increasing attention, disparities in outcomes for Black and Hispanic patients undergoing orthopedic surgery are widening. In other racial-ethnic minority groups, outcomes often go unreported. We sought to quantify disparities in surgical outcomes among Asian, American Indian or Alaskan Native, and Native Hawaiian or Pacific Islander patients across multiple orthopedic subspecialties.</p><p><strong>Materials and methods: </strong>The National Surgical Quality Improvement Program was queried to identify all surgical procedures performed by an orthopedic surgeon from 2014 to 2020. Multivariable logistic regression models were used to investigate the impact of race and ethnicity on 30-day medical complications, readmission, reoperation, and mortality, while adjusting for orthopedic subspecialty and patient characteristics.</p><p><strong>Results: </strong>Across 1,512,480 orthopedic procedures, all patients who were not White were less likely to have arthroplasty-related procedures (<i>P</i><.001), and Hispanic, Asian, and American Indian or Alaskan Native patients were more likely to have trauma-related procedures (<i>P</i><.001). American Indian or Alaskan Native (adjusted odds ratio [AOR], 1.005; 95% CI, 1.001-1.009; <i>P</i>=.011) and Native Hawaiian or Pacific Islander (AOR, 1.009; 95% CI, 1.005-1.014; <i>P</i><.001) patients had higher odds of major medical complications compared with White patients. American Indian or Alaskan Native patients had higher risk of reoperation (AOR, 1.005; 95% CI, 1.002-1.008; <i>P</i>=.002) and Native Hawaiian or Pacific Islander patients had higher odds of mortality (AOR, 1.003; 95% CI, 1.000-1.005; <i>P</i>=.019) compared with White patients.</p><p><strong>Conclusion: </strong>Disparities regarding surgical outcome and utilization rates persist across orthopedic surgery. American Indian or Alaskan Native and Native Hawaiian or Pacific Islander patients, who are under-represented in research, have lower rates of arthroplasty but higher odds of medical complication, reoperation, and mortality. This study highlights the importance of including these patients in orthopedic research to affect policy-related discussions. [<i>Orthopedics</i>. 2024;47(3):e131-e138.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e131-e138"},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139576088","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
A Cost Analysis of Surgical Approach in Total Hip Arthroplasty. 全髋关节置换术手术方法成本分析。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2024-03-12 DOI: 10.3928/01477447-20240304-03
Niall H Cochrane, Colleen Wixted, Billy Kim, Patrick J Kelly, Michael P Bolognesi, David Holst, Samuel Wellman, Sean P Ryan

Background: With pressures to decrease the financial burden of total hip arthroplasty (THA), it is imperative to understand the cost drivers of this procedure. This study evaluated operative and total encounter costs for two surgical approaches to THA-posterior (P) and direct anterior (DA).

Materials and methods: A total of 233 THAs (134 P and 99 DA) performed by two fellowship-trained arthroplasty surgeons from 2017 to 2022 were reviewed. Demographics, comorbidities, mobility status, operative time, length of stay, implants used, discharge location, and complications until final follow-up were recorded. Total encounter cost was collected and itemized. Multivariable regression analyses evaluated predictors of cost.

Results: There were differences in age (67 years for DA and 63 years for P; P=.03), body mass index (28.0 kg/m2 for DA and 33.8 kg/m2 for P; P<.01), Elixhauser Comorbidity Index score (4.6 for DA and 5.6 for P; P=.04), and operative time (2.1 hours for DA and 1.9 hours for P; P<.01) between the two cohorts. The DA cohort trended toward shorter length of stay, with the highest percentage of patients discharged home (86.9%; P=.02). The P cohort had the lowest encounter ($9601 for DA and $9100 for P; P=.20) and intraoperative (including implant used) ($7268 for DA and $6792 for P; P<.01) costs. The DA cohort had a significantly higher cost of radiology during the encounter ($244; P<.01). Regression analysis demonstrated that length of stay and DA approach were both predictors of increased encounter cost.

Conclusion: The DA cohort had improved measures of health; however, this approach was associated with a higher operative cost and was predictive of increased encounter cost despite a shorter length of stay. [Orthopedics. 2024;47(3):e151-e156.].

背景:在减少全髋关节置换术(THA)经济负担的压力下,了解该手术的成本动因势在必行。本研究评估了THA的两种手术方式--后路(P)和直接前路(DA)的手术成本和总就诊成本:研究回顾了 2017 年至 2022 年期间由两名经过研究员培训的关节置换外科医生实施的 233 例 THA(134 例 P 和 99 例 DA)。记录了直至最终随访的人口统计学、合并症、活动状况、手术时间、住院时间、使用的植入物、出院地点和并发症。此外,还收集并逐项记录了手术总费用。多变量回归分析评估了费用的预测因素:年龄(DA为67岁,P为63岁;P=0.03)、体重指数(DA为28.0 kg/m2,P为33.8 kg/m2;PP=0.04)和手术时间(DA为2.1小时,P为1.9小时;PP=0.02)存在差异。P队列的手术费用(DA为9601美元,P为9100美元;P=.20)和术中费用(包括使用的植入物)(DA为7268美元,P为6792美元;PPC结论:DA队列的健康状况有所改善;但是,这种方法的手术费用较高,而且尽管住院时间较短,但预计会增加就诊费用。[骨科。202;4x(x):xx-xx]。
{"title":"A Cost Analysis of Surgical Approach in Total Hip Arthroplasty.","authors":"Niall H Cochrane, Colleen Wixted, Billy Kim, Patrick J Kelly, Michael P Bolognesi, David Holst, Samuel Wellman, Sean P Ryan","doi":"10.3928/01477447-20240304-03","DOIUrl":"10.3928/01477447-20240304-03","url":null,"abstract":"<p><strong>Background: </strong>With pressures to decrease the financial burden of total hip arthroplasty (THA), it is imperative to understand the cost drivers of this procedure. This study evaluated operative and total encounter costs for two surgical approaches to THA-posterior (P) and direct anterior (DA).</p><p><strong>Materials and methods: </strong>A total of 233 THAs (134 P and 99 DA) performed by two fellowship-trained arthroplasty surgeons from 2017 to 2022 were reviewed. Demographics, comorbidities, mobility status, operative time, length of stay, implants used, discharge location, and complications until final follow-up were recorded. Total encounter cost was collected and itemized. Multivariable regression analyses evaluated predictors of cost.</p><p><strong>Results: </strong>There were differences in age (67 years for DA and 63 years for P; <i>P</i>=.03), body mass index (28.0 kg/m<sup>2</sup> for DA and 33.8 kg/m<sup>2</sup> for P; <i>P</i><.01), Elixhauser Comorbidity Index score (4.6 for DA and 5.6 for P; <i>P</i>=.04), and operative time (2.1 hours for DA and 1.9 hours for P; <i>P</i><.01) between the two cohorts. The DA cohort trended toward shorter length of stay, with the highest percentage of patients discharged home (86.9%; <i>P</i>=.02). The P cohort had the lowest encounter ($9601 for DA and $9100 for P; <i>P</i>=.20) and intraoperative (including implant used) ($7268 for DA and $6792 for P; <i>P</i><.01) costs. The DA cohort had a significantly higher cost of radiology during the encounter ($244; <i>P</i><.01). Regression analysis demonstrated that length of stay and DA approach were both predictors of increased encounter cost.</p><p><strong>Conclusion: </strong>The DA cohort had improved measures of health; however, this approach was associated with a higher operative cost and was predictive of increased encounter cost despite a shorter length of stay. [<i>Orthopedics</i>. 2024;47(3):e151-e156.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e151-e156"},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140102088","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
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