E. A. Zakharyan, Bagauddin H. Dolgiev, Nikolay G. Chigvariya, D. Grankin, K. A. Afonichev, Y. Garkavenko, A.I. Arakelyan, Aleksandr P. Pozdeev
BACKGROUND: The use of a vascularized fibular graft during reconstructive interventions on the limbs in children is a promising direction in the replacement of extensive bone defects in children. AIM: This study aimed to conduct a systematic review of the literature on microsurgical transplantation of a fragment of the fibula in the replacement of long bone defects in children. MATERIALS AND METHODS: Articles were searched in systems such as eLibrary, PubMed, and Google Scholar, with a search time range of 10 years (from 20122022, last query 11/08/2022). The following keywords were used for searching in Russian-language search engines: replacement of bone defects in children and fibula transplantation in children, and in the English-language search engines, microsurgical and fibula, microvascular and fibula, and bone and defect were used. After sorting the published studies, 17 publications were analyzed. RESULTS: The study analyzed a total of 690 patients (mean age 12 2.6 years). The predominant cause of the defects was malignant tumors in 647 patients (93.7% of all patients). Benign processes were also noted, which accounted for 0.87% of all patients: osteomyelitis, 2.0%; congenital pathology, 2.17%, and trauma, 1.45%. The mean follow-up period was 4.8 2.4 years. The survival rate of patients with cancer was 78.4%. Donor-side complications accounted for 14.7% of all complications. Recipient-zone complications were frequent and accounted for 85.3% of all complications (n = 457 cases). The main type of complications reported in the studies was graft fracture or fracture at the graft-bone level (35.7% of all complications). CONCLUSIONS: The use of a fragment of the vascularized fibula in the replacement of extensive bone defects enables a one-stage reconstruction of the limb with good long-term results in large segmental defects of various features. Despite the complications, this technique is one of the few that enables simultaneous limb reconstruction. The decision to use microsurgical fibula autotransplantation is based on the preference and surgical experience of the surgeon.
背景:带血管腓骨移植物在儿童肢体重建干预中的应用是儿童广泛骨缺损替代的一个有前途的方向。目的:本研究旨在系统回顾有关腓骨碎片显微外科移植治疗儿童长骨缺损的文献。材料与方法:在library、PubMed、Google Scholar等系统中检索文章，检索时间范围为10年(自20122022年起，最后查询时间为11/08/2022年)。俄语搜索引擎中搜索关键词为:儿童骨缺损置换(replacement of bone defects in children)和儿童腓骨移植(fibula transplantation in children)，英语搜索引擎搜索关键词为:显微外科手术(microsurgical)和腓骨(fibula)、微血管(microvascular)和腓骨(bone and defect)。对已发表的文献进行整理后，对17篇文献进行分析。结果:该研究共分析了690例患者(平均年龄12 - 2.6岁)。647例(占93.7%)患者以恶性肿瘤为主。良性病变也有，占所有患者的0.87%:骨髓炎2.0%;先天性病理，2.17%，创伤，1.45%。平均随访时间为4.8 - 2.4年。肿瘤患者的生存率为78.4%。供体侧并发症占所有并发症的14.7%。受体区并发症较为常见，占所有并发症的85.3% (n = 457例)。研究中报告的主要并发症类型为移植物骨折或移植物骨水平骨折(占所有并发症的35.7%)。结论:使用带血管的腓骨碎片置换大面积骨缺损，可实现一期肢体重建，对于各种特征的大节段缺损具有良好的远期效果。尽管有并发症，这项技术是少数能够同时进行肢体重建的技术之一。采用显微外科腓骨自体移植的决定是基于外科医生的偏好和手术经验。
{"title":"Treatment of long bone defects in children: Microsurgical transplantation of a fibular fragment for replacement of long bone defects: A systematic review","authors":"E. A. Zakharyan, Bagauddin H. Dolgiev, Nikolay G. Chigvariya, D. Grankin, K. A. Afonichev, Y. Garkavenko, A.I. Arakelyan, Aleksandr P. Pozdeev","doi":"10.17816/ptors115230","DOIUrl":"https://doi.org/10.17816/ptors115230","url":null,"abstract":"BACKGROUND: The use of a vascularized fibular graft during reconstructive interventions on the limbs in children is a promising direction in the replacement of extensive bone defects in children. \u0000AIM: This study aimed to conduct a systematic review of the literature on microsurgical transplantation of a fragment of the fibula in the replacement of long bone defects in children. \u0000MATERIALS AND METHODS: Articles were searched in systems such as eLibrary, PubMed, and Google Scholar, with a search time range of 10 years (from 20122022, last query 11/08/2022). The following keywords were used for searching in Russian-language search engines: replacement of bone defects in children and fibula transplantation in children, and in the English-language search engines, microsurgical and fibula, microvascular and fibula, and bone and defect were used. After sorting the published studies, 17 publications were analyzed. \u0000RESULTS: The study analyzed a total of 690 patients (mean age 12 2.6 years). The predominant cause of the defects was malignant tumors in 647 patients (93.7% of all patients). Benign processes were also noted, which accounted for 0.87% of all patients: osteomyelitis, 2.0%; congenital pathology, 2.17%, and trauma, 1.45%. The mean follow-up period was 4.8 2.4 years. The survival rate of patients with cancer was 78.4%. Donor-side complications accounted for 14.7% of all complications. Recipient-zone complications were frequent and accounted for 85.3% of all complications (n = 457 cases). The main type of complications reported in the studies was graft fracture or fracture at the graft-bone level (35.7% of all complications). \u0000CONCLUSIONS: The use of a fragment of the vascularized fibula in the replacement of extensive bone defects enables a one-stage reconstruction of the limb with good long-term results in large segmental defects of various features. Despite the complications, this technique is one of the few that enables simultaneous limb reconstruction. The decision to use microsurgical fibula autotransplantation is based on the preference and surgical experience of the surgeon.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82754346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Agranovich, E. Petrova, S. Trofimova, S. F. Batkin, E. A. Kochenova, V. Kenis, Andrey V. Sapogovskiy, E. Melchenko, K. A. Afonichev, Evgeniy D. Blagoveschenskiy
BACKGROUND: The absence of active elbow flexion is the most common problem in children with amyoplasia, leading to daily living difficulties. Many variants of muscle transfer are used for the restoration of active elbow flexion. The pectoralis major and latissimus dorsi muscles are the most used muscles for this purpose; however, the optimal age for these operations is not reported in the literature. AIM: This study aimed to determine the optimal age of children with amyoplasia for the restoration of active elbow flexion. MATERIALS AND METHODS: The retrospective study involved 61 patients (90 upper limbs) with amyoplasia (30 [49%] girls and 31 [51%] boys) who were examined and treated between 2011 and 2020. In 46 (51.1%) cases, we used major muscles, and in 44 (48.9%) cases, the latissimus dorsi muscle was used as a donor muscle. All patients were divided into four groups: group 1 included children aged 13 years (n = 17, 27.9%); group 2, 37 years (n = 30, 49.2%); group 3, 711 years (n = 8, 13.1%), and group 4, 1218 years (n = 6, 9.8%). The clinical examination of the patients was conducted before and after the operation (6 months). Statistical data processing was performed using Statistica 10 and SAS JMP 11. To describe the numerical scales, the average value and standard deviation (M SD) were used. RESULTS: The age of the patients at the time of surgery was 5.16 3.72 years, and the postoperative follow-up period was 41.93 30.13 months. Elbow flexion contractures were observed mainly in groups 13 (p 0.05). The greatest changes in indicators such as the strength of forearm flexor muscles, active elbow flexion, and function of the elbow were noted in group 1 (p 0.05). The same postoperative indicators were worse in group 4 than in younger patients (p 0.05). Groups 3 and 4 had less strength of the donor muscles than groups 1 and 2 (p 0.05). CONCLUSIONS: The retrospective analysis of the results of the restoration of active elbow flexion in children with amyoplasia allowed us to recommend these operations in children aged 13 years. The prevention of elbow flexion contractures and the formation of a new stereotype of movement help improve the self-ability of these patients and the treatment results.
{"title":"Restoration of elbow active flexion in children with amyoplasia: What is the better age to do the operation?","authors":"O. Agranovich, E. Petrova, S. Trofimova, S. F. Batkin, E. A. Kochenova, V. Kenis, Andrey V. Sapogovskiy, E. Melchenko, K. A. Afonichev, Evgeniy D. Blagoveschenskiy","doi":"10.17816/ptors109267","DOIUrl":"https://doi.org/10.17816/ptors109267","url":null,"abstract":"BACKGROUND: The absence of active elbow flexion is the most common problem in children with amyoplasia, leading to daily living difficulties. Many variants of muscle transfer are used for the restoration of active elbow flexion. The pectoralis major and latissimus dorsi muscles are the most used muscles for this purpose; however, the optimal age for these operations is not reported in the literature. \u0000AIM: This study aimed to determine the optimal age of children with amyoplasia for the restoration of active elbow flexion. \u0000MATERIALS AND METHODS: The retrospective study involved 61 patients (90 upper limbs) with amyoplasia (30 [49%] girls and 31 [51%] boys) who were examined and treated between 2011 and 2020. In 46 (51.1%) cases, we used major muscles, and in 44 (48.9%) cases, the latissimus dorsi muscle was used as a donor muscle. All patients were divided into four groups: group 1 included children aged 13 years (n = 17, 27.9%); group 2, 37 years (n = 30, 49.2%); group 3, 711 years (n = 8, 13.1%), and group 4, 1218 years (n = 6, 9.8%). The clinical examination of the patients was conducted before and after the operation (6 months). Statistical data processing was performed using Statistica 10 and SAS JMP 11. To describe the numerical scales, the average value and standard deviation (M SD) were used. \u0000RESULTS: The age of the patients at the time of surgery was 5.16 3.72 years, and the postoperative follow-up period was 41.93 30.13 months. Elbow flexion contractures were observed mainly in groups 13 (p 0.05). The greatest changes in indicators such as the strength of forearm flexor muscles, active elbow flexion, and function of the elbow were noted in group 1 (p 0.05). The same postoperative indicators were worse in group 4 than in younger patients (p 0.05). Groups 3 and 4 had less strength of the donor muscles than groups 1 and 2 (p 0.05). \u0000CONCLUSIONS: The retrospective analysis of the results of the restoration of active elbow flexion in children with amyoplasia allowed us to recommend these operations in children aged 13 years. The prevention of elbow flexion contractures and the formation of a new stereotype of movement help improve the self-ability of these patients and the treatment results.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91021703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrey V. Sapogovskiy, A. V. Ovechkina, Ilya A. Abramov, O. Agranovich, A. I. Shubina, Tatyana G. Budkevich
BACKGROUND: A flatfoot is the most common condition in the practice of a pediatric orthopedist. A flatfoot is primarily diagnosed based on the assessment of the degree of the foot flattening. Along with clinical examination, footprint analysis is often used in practice due to the safety of this study and convenience and ease of implementation. AIM: This study aimed to determine how much footprints can correlate with the clinical assessment of flatfoot in children and which footprint indices are the most valuable in flatfoot assessment. MATERIALS AND METHODS: The study included the survey results of 76 children aged 715 years of the St. Petersburg 49th school School of Health for 20212022. In this study, anthropometric data, clinical parameters (value of the heel valgus, arch angle, and Friedland index) and footprint indices and angles (Schwartz and Clarke angle, ChippauxSmirak index, Staheli index, Cavanagh and Rodgers index, and Irwin index) were analyzed. In the study, the average values were calculated, and correlation and regression analyses were performed. RESULTS: The footprint parameters did not have moderate and strong correlations with clinical parameters. Footprint parameters that assessed the area of the barefoot zone on the footprints (Irwin index and Cavanagh and Rodgers index) showed statistically significant moderate and strong correlations among plantographic parameters. Among linear and angular footprint parameters, the ChippauxSmirak index showed statistically significant moderate and strong correlations. CONCLUSIONS: The footprint criteria weakly correlated with the foot shape criteria in a clinical assessment, which does not allow us to interpolate the footprints data to the clinical evaluation data of the foot. The Cavanagh and Rodgers index, Irwin index, and ChippauxSmirak index had statistically significant moderate and strong correlations with other indices, which makes them more valuable in the assessment of feet according to the footprint analysis.
背景:扁平足是儿科骨科医生实践中最常见的疾病。扁平足的诊断主要基于对足部扁平化程度的评估。由于该研究的安全性和实施的便利性，足迹分析在临床检查中经常被应用于实践。目的:本研究旨在确定脚印与儿童平足临床评估的相关性，以及哪些足迹指标在平足评估中最有价值。材料与方法:研究纳入圣彼得堡第49学校卫生学院20212022年76名715岁儿童的调查结果。本研究分析了人体测量数据、临床参数(足跟外翻值、足弓角、Friedland指数)以及足印指数和角度(Schwartz and Clarke角、ChippauxSmirak指数、Staheli指数、Cavanagh and Rodgers指数、Irwin指数)。在研究中，计算平均值，并进行相关和回归分析。结果:足迹参数与临床参数不存在中度和强相关性。评价足迹上赤脚区面积的足迹参数(Irwin指数和Cavanagh和Rodgers指数)在植被参数之间显示出统计学上显著的中度和强相关性。在线性和角足迹参数中，ChippauxSmirak指数呈显著的中、强相关。结论:在临床评估中，足印标准与足形标准相关性较弱，因此我们无法将足印数据插入足部的临床评估数据。Cavanagh and Rodgers指数、Irwin指数和ChippauxSmirak指数与其他指数具有统计学上显著的中强相关性，这使得它们在足迹分析中对足部的评估更有价值。
{"title":"Footprint analysis in flatfoot assessment","authors":"Andrey V. Sapogovskiy, A. V. Ovechkina, Ilya A. Abramov, O. Agranovich, A. I. Shubina, Tatyana G. Budkevich","doi":"10.17816/ptors121335","DOIUrl":"https://doi.org/10.17816/ptors121335","url":null,"abstract":"BACKGROUND: A flatfoot is the most common condition in the practice of a pediatric orthopedist. A flatfoot is primarily diagnosed based on the assessment of the degree of the foot flattening. Along with clinical examination, footprint analysis is often used in practice due to the safety of this study and convenience and ease of implementation. \u0000AIM: This study aimed to determine how much footprints can correlate with the clinical assessment of flatfoot in children and which footprint indices are the most valuable in flatfoot assessment. \u0000MATERIALS AND METHODS: The study included the survey results of 76 children aged 715 years of the St. Petersburg 49th school School of Health for 20212022. In this study, anthropometric data, clinical parameters (value of the heel valgus, arch angle, and Friedland index) and footprint indices and angles (Schwartz and Clarke angle, ChippauxSmirak index, Staheli index, Cavanagh and Rodgers index, and Irwin index) were analyzed. In the study, the average values were calculated, and correlation and regression analyses were performed. \u0000RESULTS: The footprint parameters did not have moderate and strong correlations with clinical parameters. Footprint parameters that assessed the area of the barefoot zone on the footprints (Irwin index and Cavanagh and Rodgers index) showed statistically significant moderate and strong correlations among plantographic parameters. Among linear and angular footprint parameters, the ChippauxSmirak index showed statistically significant moderate and strong correlations. \u0000CONCLUSIONS: The footprint criteria weakly correlated with the foot shape criteria in a clinical assessment, which does not allow us to interpolate the footprints data to the clinical evaluation data of the foot. The Cavanagh and Rodgers index, Irwin index, and ChippauxSmirak index had statistically significant moderate and strong correlations with other indices, which makes them more valuable in the assessment of feet according to the footprint analysis.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87414612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Dimitrieva, V. Kenis, Irina Yu. Klychkova, Andrey V. Sapogovskiy, Vadim V. Kozhevnikov
BACKGROUND: To date, there is no consensus regarding the diagnostics of flatfoot in children and approaches to its classification and treatment. AIM: This study aimed to demonstrate the results of the first Russian consensus, performed according to the Delphi method, for the diagnostics and treatment of flatfoot in children. MATERIALS AND METHODS: The study was conducted in accordance with the principles of the Delphi survey and the RAND/UCLA and participated by 22 experts in their field. The questionnaire consisted of four main sections, namely, general clinical assessment, flatfoot diagnosis, classification approach, and treatment, including 179 close-ended and 11 open-ended statements in both rounds. A 5-point Likert scale was used to rank responses. The level of agreement was determined as follows: 70% of the experts agrees, the statement is accepted; 55%, rejected; 55%69%, reassessment by experts in subsequent rounds. To assess agreement among experts, parameters such as general agreement, agreement without doubt by experts, and percentage of doubting experts were calculated. Mean (M), standard deviation (SD), and Cronbachs alpha were calculated. RESULTS: The statement was accepted with an agreement without doubt by experts 70%, with Cronbachs alpha of 0.8. According to the survey data, in the two rounds using 179 close-ended statements, 96 statements were accepted, 63 were rejected, and no consensus was reached on 20. CONCLUSIONS: This scientific work presents the results of the first Russian Delphi survey on the diagnosis and treatment of flatfoot in children with a unique number of experts (n = 22). The lack of agreement on some of the statements, even among experts, showed that consensus was a necessary first step toward standardizing the diagnosis and treatment of flatfoot in children.
{"title":"Results of the first Russian Delphi survey on the diagnosis and treatment of flatfoot in children","authors":"A. Dimitrieva, V. Kenis, Irina Yu. Klychkova, Andrey V. Sapogovskiy, Vadim V. Kozhevnikov","doi":"10.17816/ptors112465","DOIUrl":"https://doi.org/10.17816/ptors112465","url":null,"abstract":"BACKGROUND: To date, there is no consensus regarding the diagnostics of flatfoot in children and approaches to its classification and treatment. \u0000AIM: This study aimed to demonstrate the results of the first Russian consensus, performed according to the Delphi method, for the diagnostics and treatment of flatfoot in children. \u0000MATERIALS AND METHODS: The study was conducted in accordance with the principles of the Delphi survey and the RAND/UCLA and participated by 22 experts in their field. The questionnaire consisted of four main sections, namely, general clinical assessment, flatfoot diagnosis, classification approach, and treatment, including 179 close-ended and 11 open-ended statements in both rounds. A 5-point Likert scale was used to rank responses. The level of agreement was determined as follows: 70% of the experts agrees, the statement is accepted; 55%, rejected; 55%69%, reassessment by experts in subsequent rounds. To assess agreement among experts, parameters such as general agreement, agreement without doubt by experts, and percentage of doubting experts were calculated. Mean (M), standard deviation (SD), and Cronbachs alpha were calculated. \u0000RESULTS: The statement was accepted with an agreement without doubt by experts 70%, with Cronbachs alpha of 0.8. According to the survey data, in the two rounds using 179 close-ended statements, 96 statements were accepted, 63 were rejected, and no consensus was reached on 20. \u0000CONCLUSIONS: This scientific work presents the results of the first Russian Delphi survey on the diagnosis and treatment of flatfoot in children with a unique number of experts (n = 22). The lack of agreement on some of the statements, even among experts, showed that consensus was a necessary first step toward standardizing the diagnosis and treatment of flatfoot in children.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74154834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Markova, V. Kenis, E. Melchenko, D. A. Reshchikov, A. E. Alieva, D. Osipova, L. Bessonova, Tatiana S. Nagornova, Natalya N. Vasserman, N. Y. Ogorodova, O. Shchagina, E. Dadali
BACKGROUND: Achondroplasia and pseudoachondroplasia are hereditary systemic skeletal dysplasias characterized by a certain similarity of clinical manifestations; however, they have different etiopathogenetic mechanisms and confirmation methods for molecular genetic diagnosis. Their common phenotypic features often make differential diagnosis difficult during the clinical examination of patients, planning DNA diagnostics, and appropriate time detection of neurosurgical and orthopedic complications. AIM: This study aimed to identify differential diagnostic criteria for achondroplasia and pseudoachondroplasia and optimize the strategy for their molecular genetic diagnosis. MATERIALS AND METHODS: A comprehensive examination of 76 children from 74 unrelated families aged 1 month to 18 years with phenotypic signs of achondroplasia and pseudoachondroplasia was conducted. To clarify the diagnosis through genealogical and amnestic analysis, clinical and neurological examination data according to the standard method and radiographic data were used. Molecular genetic confirmation of diseases was conducted by searching for hotspot mutations in the FGFR3 gene, assessing the number of GAC repeats located in exon 13 of the COMP gene, and new-generation sequencing of the target panel consisting of 166 genes responsible for hereditary skeletal pathology. RESULTS: Based on a comparative analysis of the specific phenotypic characteristics, the criteria for the differential diagnosis of achondroplasia and pseudoachondroplasia were identified. The leading signs of achondroplasia are disproportionate nanism from birth, macrocrania, and facial dysmorphism, which are not specific to pseudoachondroplasia. Certain radiological features are essential in the differential diagnosis of pseudoachondroplasia, which should be considered when referring to patients for molecular genetic analysis. A deletion of the GAC repeat c.1417_1419del in the COMP gene was identified in 27% of patients with pseudoachondroplasia. Thus, the analyses of these two mutations in FGFR3 and COMP were conducted first. In the absence of target mutations, further diagnostic search should be continued with a target panel consisting of 166 genes responsible for hereditary skeletal pathology or whole-exome sequencing. CONCLUSIONS: The analysis of the clinical, radiological, and molecular genetic characteristics of patients with achondroplasia and pseudoachondroplasia, together with the literature data analysis, made it possible to clarify the differential diagnostic criteria for these diseases and optimize the algorithm for their molecular genetic diagnosis.
{"title":"Principles of the differential diagnosis of achondroplasia and pseudoachondroplasia","authors":"T. Markova, V. Kenis, E. Melchenko, D. A. Reshchikov, A. E. Alieva, D. Osipova, L. Bessonova, Tatiana S. Nagornova, Natalya N. Vasserman, N. Y. Ogorodova, O. Shchagina, E. Dadali","doi":"10.17816/ptors114730","DOIUrl":"https://doi.org/10.17816/ptors114730","url":null,"abstract":"BACKGROUND: Achondroplasia and pseudoachondroplasia are hereditary systemic skeletal dysplasias characterized by a certain similarity of clinical manifestations; however, they have different etiopathogenetic mechanisms and confirmation methods for molecular genetic diagnosis. Their common phenotypic features often make differential diagnosis difficult during the clinical examination of patients, planning DNA diagnostics, and appropriate time detection of neurosurgical and orthopedic complications. \u0000AIM: This study aimed to identify differential diagnostic criteria for achondroplasia and pseudoachondroplasia and optimize the strategy for their molecular genetic diagnosis. \u0000MATERIALS AND METHODS: A comprehensive examination of 76 children from 74 unrelated families aged 1 month to 18 years with phenotypic signs of achondroplasia and pseudoachondroplasia was conducted. To clarify the diagnosis through genealogical and amnestic analysis, clinical and neurological examination data according to the standard method and radiographic data were used. Molecular genetic confirmation of diseases was conducted by searching for hotspot mutations in the FGFR3 gene, assessing the number of GAC repeats located in exon 13 of the COMP gene, and new-generation sequencing of the target panel consisting of 166 genes responsible for hereditary skeletal pathology. \u0000RESULTS: Based on a comparative analysis of the specific phenotypic characteristics, the criteria for the differential diagnosis of achondroplasia and pseudoachondroplasia were identified. The leading signs of achondroplasia are disproportionate nanism from birth, macrocrania, and facial dysmorphism, which are not specific to pseudoachondroplasia. Certain radiological features are essential in the differential diagnosis of pseudoachondroplasia, which should be considered when referring to patients for molecular genetic analysis. A deletion of the GAC repeat c.1417_1419del in the COMP gene was identified in 27% of patients with pseudoachondroplasia. Thus, the analyses of these two mutations in FGFR3 and COMP were conducted first. In the absence of target mutations, further diagnostic search should be continued with a target panel consisting of 166 genes responsible for hereditary skeletal pathology or whole-exome sequencing. \u0000CONCLUSIONS: The analysis of the clinical, radiological, and molecular genetic characteristics of patients with achondroplasia and pseudoachondroplasia, together with the literature data analysis, made it possible to clarify the differential diagnostic criteria for these diseases and optimize the algorithm for their molecular genetic diagnosis.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74448815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. A. Zakharyan, Nikolay G. Chigvariya, Y. Garkavenko, A. P. Pozdeev, D. Grankin, K. A. Afonichev
BACKGROUND: Numerous methods are available for the treatment of congenital pseudarthrosis of the tibia, but none of them offers a 100% satisfactory result and does not exclude the development of repeated refractories. One of the treatment methods is vascularized transplantation of a fragment of the fibula into the position of the defect of the tibia. However, the achievement of consolidation of the bone fragments of the lower leg does not stop the series of interventions necessary to restore the function of the affected segment. Therefore, specialists were asked about the advisability of performing amputations as an alternative to long-term and multistage interventions. AIM: To analyze the results of the use of microsurgical techniques for the treatment of patients with congenital pseudarthrosis of the tibia and, using the example of a patient, to show the way of multistage reconstruction of the lower limb. MATERIALS AND METHODS: The results of the use of microsurgical techniques in the elimination of a defect in the bones of the leg in five patients with congenital pseudarthrosis of the tibia were analyzed. Age, sex, presence of type 1 neurofibromatosis, bone defect size, autograft size, duration of consolidation, osteosynthesis index, refractory, range of joint motion, and secondary deformities of the segments after consolidation were assessed. The course of the patient when performing severe reconstructive interventions to restore the weight-bearing capacity of the limb was described. Vascularized autograft transplantation was performed by a qualified microsurgical team. RESULTS: The mean age was 7.8 2.2 years. Boys predominated, and type 1 neurofibromatosis was detected in 60% of the cases. The average defect size was 8.8 1.6 cm, and the autograft size was 10.8 1.6 cm. The duration of fixation was 260 90 days, and the fixation index was 24.6 10.6 days/cm. In two cases, 1 year after the fibula transfer, refractories were noted at the bonegraft interface. In 100% of the cases, patients had fibrous ankylosis at the level of the ankle joint, with a loss of functional range of motion, and in 40% of cases, there were flexionextension contractures of the knee joints with an extension deficit of up to 20. For this observation period, 3 of 5 patients underwent additional surgical interventions to correct the deformities of the affected limb. CONCLUSIONS: The use of VFT in patients with congenital pseudarthrosis of the tibia allows restoring the integrity of the tibia. Multiple interventions performed on the same segment can lead to irreversible secondary changes in adjacent joints and loss of function of this limb.
{"title":"Reconstructive surgery in the treatment of congenital pseudarthrosis of the tibia in children using microsurgical techniques: Reconstruction or amputation?","authors":"E. A. Zakharyan, Nikolay G. Chigvariya, Y. Garkavenko, A. P. Pozdeev, D. Grankin, K. A. Afonichev","doi":"10.17816/ptors110805","DOIUrl":"https://doi.org/10.17816/ptors110805","url":null,"abstract":"BACKGROUND: Numerous methods are available for the treatment of congenital pseudarthrosis of the tibia, but none of them offers a 100% satisfactory result and does not exclude the development of repeated refractories. One of the treatment methods is vascularized transplantation of a fragment of the fibula into the position of the defect of the tibia. However, the achievement of consolidation of the bone fragments of the lower leg does not stop the series of interventions necessary to restore the function of the affected segment. Therefore, specialists were asked about the advisability of performing amputations as an alternative to long-term and multistage interventions. \u0000AIM: To analyze the results of the use of microsurgical techniques for the treatment of patients with congenital pseudarthrosis of the tibia and, using the example of a patient, to show the way of multistage reconstruction of the lower limb. \u0000MATERIALS AND METHODS: The results of the use of microsurgical techniques in the elimination of a defect in the bones of the leg in five patients with congenital pseudarthrosis of the tibia were analyzed. Age, sex, presence of type 1 neurofibromatosis, bone defect size, autograft size, duration of consolidation, osteosynthesis index, refractory, range of joint motion, and secondary deformities of the segments after consolidation were assessed. The course of the patient when performing severe reconstructive interventions to restore the weight-bearing capacity of the limb was described. Vascularized autograft transplantation was performed by a qualified microsurgical team. \u0000RESULTS: The mean age was 7.8 2.2 years. Boys predominated, and type 1 neurofibromatosis was detected in 60% of the cases. The average defect size was 8.8 1.6 cm, and the autograft size was 10.8 1.6 cm. The duration of fixation was 260 90 days, and the fixation index was 24.6 10.6 days/cm. In two cases, 1 year after the fibula transfer, refractories were noted at the bonegraft interface. In 100% of the cases, patients had fibrous ankylosis at the level of the ankle joint, with a loss of functional range of motion, and in 40% of cases, there were flexionextension contractures of the knee joints with an extension deficit of up to 20. For this observation period, 3 of 5 patients underwent additional surgical interventions to correct the deformities of the affected limb. \u0000CONCLUSIONS: The use of VFT in patients with congenital pseudarthrosis of the tibia allows restoring the integrity of the tibia. Multiple interventions performed on the same segment can lead to irreversible secondary changes in adjacent joints and loss of function of this limb.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"27 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80966485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. M. Belokrylov, N. Polyakova, Aleksei N. Belokrylov, Dmitrii V. Antonov, E. A. Zhuzhgov
BACKGROUND: Alternative methods of hip arthroplasty as a result of the complete destruction of the epiphysis and femoral neck using the preserved part of the apophysis of this segment are not widely reported, which may be useful for specialists who are faced with the choice of providing such assistance. AIM: To present the long-term results of treating children with the hip joint reconstruction method developed in the clinic using trochanteric arthroplasty by utilizing the intact cartilaginous part of the greater trochanter apophysis for the treatment of defects resulting from osteolysis of the femoral head and neck after epiphyseal osteomyelitis. MATERIALS AND METHODS: The results of the surgical treatment of seven children (two of them had a bilateral process) who underwent reconstruction of nine hip joints according to the proposed method were analyzed. The procedures were performed at the age of 210 years. The intervention involved the surgical preparation of the acetabulum with repositioning of the greater trochanter after proximal angulation osteotomy of the hip at the metadiaphyseal level. In four patients with a unilateral process, Salter innominate osteotomy was additionally performed in one or two stages. In five patients with a unilateral process with further growth, limb lengthening was performed. The efficiency index was evaluated using both anatomical and functional results. In a bilateral process, the assessment considered the function of the worst operated joints. RESULTS: In six children, good and, in one child with a bilateral process, satisfactory long-term clinical and functional results were obtained (assessed 1020 years after the first reconstructive surgery). All of them had restored limb support without pain, with a sufficient range of motion. The method was organ-preserving, which enabled an opportunity for walking, and an anatomically favorable situation for further arthroplasty has been created, the timing of which has been postponed to a mature period. CONCLUSIONS: The method developed in the clinic for the surgical use of the greater trochanter for the reconstruction of the hip joint after infectious osteolysis of the head and neck of the femur is effective, allowing for a long time to maintain leg support using the patients tissues.
{"title":"Hip arthroplasty using the cartilaginous part of the greater trochanter in the treatment of the sequelae of epiphysal osteomyelitis in children","authors":"N. M. Belokrylov, N. Polyakova, Aleksei N. Belokrylov, Dmitrii V. Antonov, E. A. Zhuzhgov","doi":"10.17816/ptors108205","DOIUrl":"https://doi.org/10.17816/ptors108205","url":null,"abstract":"BACKGROUND: Alternative methods of hip arthroplasty as a result of the complete destruction of the epiphysis and femoral neck using the preserved part of the apophysis of this segment are not widely reported, which may be useful for specialists who are faced with the choice of providing such assistance. \u0000AIM: To present the long-term results of treating children with the hip joint reconstruction method developed in the clinic using trochanteric arthroplasty by utilizing the intact cartilaginous part of the greater trochanter apophysis for the treatment of defects resulting from osteolysis of the femoral head and neck after epiphyseal osteomyelitis. \u0000MATERIALS AND METHODS: The results of the surgical treatment of seven children (two of them had a bilateral process) who underwent reconstruction of nine hip joints according to the proposed method were analyzed. The procedures were performed at the age of 210 years. The intervention involved the surgical preparation of the acetabulum with repositioning of the greater trochanter after proximal angulation osteotomy of the hip at the metadiaphyseal level. In four patients with a unilateral process, Salter innominate osteotomy was additionally performed in one or two stages. In five patients with a unilateral process with further growth, limb lengthening was performed. The efficiency index was evaluated using both anatomical and functional results. In a bilateral process, the assessment considered the function of the worst operated joints. \u0000RESULTS: In six children, good and, in one child with a bilateral process, satisfactory long-term clinical and functional results were obtained (assessed 1020 years after the first reconstructive surgery). All of them had restored limb support without pain, with a sufficient range of motion. The method was organ-preserving, which enabled an opportunity for walking, and an anatomically favorable situation for further arthroplasty has been created, the timing of which has been postponed to a mature period. \u0000CONCLUSIONS: The method developed in the clinic for the surgical use of the greater trochanter for the reconstruction of the hip joint after infectious osteolysis of the head and neck of the femur is effective, allowing for a long time to maintain leg support using the patients tissues.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84783836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bahauddin H. Dolgiev, Dmitriy V. Ryzhikov, S. Vissarionov
BACKGROUND: The surgical treatment of children with pectus excavatum is regarded as an urgent problem still demanding solution despite the multitudes of surgical correction methods available nowadays. The currently available well-known techniques cannot be considered perfect because they are not proper enough for solving all the tasks, not to mention the problem of asymmetric forms of pectus excavatum treatment. AIM: To analyze publications containing information on the methods of surgical treatment used for children with pectus excavatum. MATERIALS AND METHODS: The study presents the results of literature review on the methods of surgical correction of pectus excavatum. Information was retrieved in PubMed, Google Scholar, and eLibrary scientific databases using keywords. Consequently, 63 foreign and domestic scientific sources over the period from 1609 to 2022 were identified. Among them, 29 publications refer to the latest decade. RESULTS: Given the variety of methods used for chest deformity correction, thoracoplasty by D. Nuss has become the gold standard for the treatment of pectus excavatum. However, according to the search results, it is impossible to name one universal method of surgical intervention that could solve all the urgent problems at present. Modern surgery methods used for pectus excavatum correction can be considered only as modifications of treatment methods having been used before. CONCLUSIONS: The shortcomings of modern thoracoplasty determine the necessity to keep searching for new techniques and improve those available at present. Besides, the standard suitable for both surgeons and patients should be elaborated.
{"title":"Surgical treatment of children with asymmetric pectus excavatum: Literature review","authors":"Bahauddin H. Dolgiev, Dmitriy V. Ryzhikov, S. Vissarionov","doi":"10.17816/ptors112043","DOIUrl":"https://doi.org/10.17816/ptors112043","url":null,"abstract":"BACKGROUND: The surgical treatment of children with pectus excavatum is regarded as an urgent problem still demanding solution despite the multitudes of surgical correction methods available nowadays. The currently available well-known techniques cannot be considered perfect because they are not proper enough for solving all the tasks, not to mention the problem of asymmetric forms of pectus excavatum treatment. \u0000AIM: To analyze publications containing information on the methods of surgical treatment used for children with pectus excavatum. \u0000MATERIALS AND METHODS: The study presents the results of literature review on the methods of surgical correction of pectus excavatum. Information was retrieved in PubMed, Google Scholar, and eLibrary scientific databases using keywords. Consequently, 63 foreign and domestic scientific sources over the period from 1609 to 2022 were identified. Among them, 29 publications refer to the latest decade. \u0000RESULTS: Given the variety of methods used for chest deformity correction, thoracoplasty by D. Nuss has become the gold standard for the treatment of pectus excavatum. However, according to the search results, it is impossible to name one universal method of surgical intervention that could solve all the urgent problems at present. Modern surgery methods used for pectus excavatum correction can be considered only as modifications of treatment methods having been used before. \u0000CONCLUSIONS: The shortcomings of modern thoracoplasty determine the necessity to keep searching for new techniques and improve those available at present. Besides, the standard suitable for both surgeons and patients should be elaborated.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"127 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85236418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Agranovich, Zoya E. Agranovich, E. I. Ermolovich, E. Petrova, E. Blagovechtchenski
BACKGROUND: Obstetrics plexus occurs in 0.44 cases per 1000 newborns. Moreover, 70%92% of the patients have mild injuries that spontaneously recover within 2 months after delivery, and the remaining patients have secondary deformities of the limbs, leading to motor disorders of varying severities. Studies have reported that the limited or absence of hand motor functions can lead to cognitive deficits and speech underdevelopment. AIM: To study the features of speech development in children with obstetrics palsy. MATERIAL AND METHODS: From 2020 to 2021, we performed speech examination of 33 children with obstetrics palsy from the age of 315 (average age, 8.10 3.71) years. All patients were divided into four groups: group 1 (34 years, n = 6), group 2 (56 years, n = 10), group 3 (710 years, n = 9), and group 4 (1115 years, n = 8). Speech examination and orthopedic, neurological, and statistical tests were performed. The results of the examination were analyzed statistically. RESULTS: In this study, 78.8% of the patients with obstetric palsy had speech pathology. Children with speech disorders had more severe neurology and motor disturbance than children without speech pathology. In group 1, speech disorders were identified in 66.7%; group 2, 90.0%; group 3, 66.7%; group 4, 87.5%. Group 1 had speech development delay and phoneticphonemic underdevelopment. Group 2 had general speech underdevelopment and phoneticphonemic underdevelopment. Group 3 had general speech, lexicalgrammatical, and phoneticphonemic underdevelopment, Group 4 had general speech and lexicalgrammatical underdevelopment. Moreover, 73.1% of the children had minimal dysarthria (predominantly in children of groups 1 and 2). Groups 3 and 4 had written expression disorder. CONCLUSIONS: The study demonstrates a high incidence of speech disorders in children with obstetrics palsy. These children demand early speech examination and timely correction of existing disorders.
{"title":"Speech development in children with sequelae of obstetrics palsy","authors":"O. Agranovich, Zoya E. Agranovich, E. I. Ermolovich, E. Petrova, E. Blagovechtchenski","doi":"10.17816/ptors110783","DOIUrl":"https://doi.org/10.17816/ptors110783","url":null,"abstract":"BACKGROUND: Obstetrics plexus occurs in 0.44 cases per 1000 newborns. Moreover, 70%92% of the patients have mild injuries that spontaneously recover within 2 months after delivery, and the remaining patients have secondary deformities of the limbs, leading to motor disorders of varying severities. Studies have reported that the limited or absence of hand motor functions can lead to cognitive deficits and speech underdevelopment. \u0000AIM: To study the features of speech development in children with obstetrics palsy. \u0000MATERIAL AND METHODS: From 2020 to 2021, we performed speech examination of 33 children with obstetrics palsy from the age of 315 (average age, 8.10 3.71) years. All patients were divided into four groups: group 1 (34 years, n = 6), group 2 (56 years, n = 10), group 3 (710 years, n = 9), and group 4 (1115 years, n = 8). Speech examination and orthopedic, neurological, and statistical tests were performed. The results of the examination were analyzed statistically. \u0000RESULTS: In this study, 78.8% of the patients with obstetric palsy had speech pathology. Children with speech disorders had more severe neurology and motor disturbance than children without speech pathology. In group 1, speech disorders were identified in 66.7%; group 2, 90.0%; group 3, 66.7%; group 4, 87.5%. Group 1 had speech development delay and phoneticphonemic underdevelopment. Group 2 had general speech underdevelopment and phoneticphonemic underdevelopment. Group 3 had general speech, lexicalgrammatical, and phoneticphonemic underdevelopment, Group 4 had general speech and lexicalgrammatical underdevelopment. Moreover, 73.1% of the children had minimal dysarthria (predominantly in children of groups 1 and 2). Groups 3 and 4 had written expression disorder. \u0000CONCLUSIONS: The study demonstrates a high incidence of speech disorders in children with obstetrics palsy. These children demand early speech examination and timely correction of existing disorders.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"89 5 Pt 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89407460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Khodorovskaya, V. A. Novikov, Alexey V. Zvozil, V. V. Umnov, D. V. Umnov, D. S. Zharkov, S. Vissarionov
BACKGROUND: Sacral neuromodulation is a neurosurgical method for the correction of bladder and bowel dysfunctions of various origins that are refractory to conservative treatment. AIM: To analyze chronic sacral neurostimulation results as a correction method for pediatric bladder and bowel dysfunction of various origins. MATERIALS AND METHODS: The results of chronic sacral neurostimulation for treating urination and defecation disorders of various origins in children reported in the world literature were analyzed. The literature search was performed in the open electronic scientific databases eLIBRARY, PubMed, and Cochrane Library. The source selection was limited by 20022022. RESULTS: Most authors report good and satisfactory results in the treatment of bladder and bowel dysfunction by sacral neurostimulation. However, the level of evidence on the effectiveness of sacral neurostimulation remains low because data were obtained from small and heterogeneous groups of patients and studies employed different criteria for inclusion and methods for analyzing the results. CONCLUSIONS: Conducting randomized trials will allow for the assessment of the efficacy and safety of sacral neuromodulation in children with bladder and bowel dysfunctions of various origins that are refractory to standard conservative treatment.
{"title":"Sacral neuromodulation in pediatric bladder and bowel dysfunctions: Literature review","authors":"A. Khodorovskaya, V. A. Novikov, Alexey V. Zvozil, V. V. Umnov, D. V. Umnov, D. S. Zharkov, S. Vissarionov","doi":"10.17816/ptors111919","DOIUrl":"https://doi.org/10.17816/ptors111919","url":null,"abstract":"BACKGROUND: Sacral neuromodulation is a neurosurgical method for the correction of bladder and bowel dysfunctions of various origins that are refractory to conservative treatment. \u0000AIM: To analyze chronic sacral neurostimulation results as a correction method for pediatric bladder and bowel dysfunction of various origins. \u0000MATERIALS AND METHODS: The results of chronic sacral neurostimulation for treating urination and defecation disorders of various origins in children reported in the world literature were analyzed. The literature search was performed in the open electronic scientific databases eLIBRARY, PubMed, and Cochrane Library. The source selection was limited by 20022022. \u0000RESULTS: Most authors report good and satisfactory results in the treatment of bladder and bowel dysfunction by sacral neurostimulation. However, the level of evidence on the effectiveness of sacral neurostimulation remains low because data were obtained from small and heterogeneous groups of patients and studies employed different criteria for inclusion and methods for analyzing the results. \u0000CONCLUSIONS: Conducting randomized trials will allow for the assessment of the efficacy and safety of sacral neuromodulation in children with bladder and bowel dysfunctions of various origins that are refractory to standard conservative treatment.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75578692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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