Mohamed Mohamed Moussa Elwan, Mohamed Salah Eldin Shawky, El Sayed Bayomy
The most common form of shoulder dislocation is the recurrent anterior traumatic type. Latarjet and Eden Hybinette are the two competing techniques in reconstructing significant bone loss accompanying this type. The aim is to evaluate the functional results in the management of recurrent shoulder dislocation with bone loss by comparing Latarjet and Eden Hybinette techniques. A prospective, randomized controlled trial was performed on forty adult patients suffering from recurrent shoulder dislocations. Two groups (a total of forty patients; twenty iliac graft cases and twenty Latarjet controls) were performed in a randomized method. We compared the two groups; clinical evaluation was completed before surgery and at least 1 year postoperatively, by using the modified Rowe score which consists of pain level, stability, motion loss, and limitation of function. Satisfactory results included excellent and good results, while unsatisfactory results included fair and poor results. Adverse events were prospectively recorded. CT studies were performed to assess the radiographic result preoperatively, immediately-postoperatively, and at final follow-up visits. Both groups did not differ significantly in either the clinical or the radiological aspects (P > 0.05) except for more limited range of motion (ROM) (external and internal rotation) in the Latarjet group at the final follow-up (P < 0.05). One case in the Latarjet group had recurrent dislocation due to tramadol fits. Two cases in each group had anterior apprehension only. Donor-site sensory disturbances were reported in 10% of the iliac group patients. Computed tomography revealed a larger graft size in the iliac group. Both Latarjet and Eden Hybinette can be used as reconstructive surgeries in restoring critical bone loss accompanying shoulder dislocations; they did not show significant differences except for the more limited external and internal rotation motions in the Latarjet group.
{"title":"Comparative Study Between Latarjet Procedure Versus Free Iliac Graft in the Management of Recurrent Shoulder Dislocation","authors":"Mohamed Mohamed Moussa Elwan, Mohamed Salah Eldin Shawky, El Sayed Bayomy","doi":"10.4103/jajs.jajs_77_23","DOIUrl":"https://doi.org/10.4103/jajs.jajs_77_23","url":null,"abstract":"\u0000 \u0000 \u0000 The most common form of shoulder dislocation is the recurrent anterior traumatic type. Latarjet and Eden Hybinette are the two competing techniques in reconstructing significant bone loss accompanying this type.\u0000 \u0000 \u0000 \u0000 The aim is to evaluate the functional results in the management of recurrent shoulder dislocation with bone loss by comparing Latarjet and Eden Hybinette techniques.\u0000 \u0000 \u0000 \u0000 A prospective, randomized controlled trial was performed on forty adult patients suffering from recurrent shoulder dislocations. Two groups (a total of forty patients; twenty iliac graft cases and twenty Latarjet controls) were performed in a randomized method. We compared the two groups; clinical evaluation was completed before surgery and at least 1 year postoperatively, by using the modified Rowe score which consists of pain level, stability, motion loss, and limitation of function. Satisfactory results included excellent and good results, while unsatisfactory results included fair and poor results. Adverse events were prospectively recorded. CT studies were performed to assess the radiographic result preoperatively, immediately-postoperatively, and at final follow-up visits.\u0000 \u0000 \u0000 \u0000 Both groups did not differ significantly in either the clinical or the radiological aspects (P > 0.05) except for more limited range of motion (ROM) (external and internal rotation) in the Latarjet group at the final follow-up (P < 0.05). One case in the Latarjet group had recurrent dislocation due to tramadol fits. Two cases in each group had anterior apprehension only. Donor-site sensory disturbances were reported in 10% of the iliac group patients. Computed tomography revealed a larger graft size in the iliac group.\u0000 \u0000 \u0000 \u0000 Both Latarjet and Eden Hybinette can be used as reconstructive surgeries in restoring critical bone loss accompanying shoulder dislocations; they did not show significant differences except for the more limited external and internal rotation motions in the Latarjet group.\u0000","PeriodicalId":38088,"journal":{"name":"Journal of Arthroscopy and Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710488","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}
Revision hip surgeries are increasing dramatically nowadays, and achieving hip center of rotation is challenging. Obtaining a press-fit implant and restoring the hip’s center of rotation might be difficult during the restoration of acetabular deformities during revision total hip arthroplasty (THA). The aim of the study was to evaluate the outcomes of using trabecular metal augments for reconstruction of the acetabulum in patients undergoing revision THA with short-term follow-up. This study was conducted in Benha University Hospital between April 2019 and March 2023. It is a prospective cohort study including 20 patients who are undergoing revision THA with acetabular defects. The mean age of patients in this study was 59 years old. According to Paprosky classification: 45% of type 2B. The postoperative Oxford Hip Score showed marked improvement in the outcomes, the score was excellent in 55% (11 patients), good in 40% (8 patients), and fair in only 5% (1 patient) over 16 months’ mean follow-up period. Due to its modularity, tantalum augments are considered a valuable method in the reconstruction of acetabular defects.
{"title":"Trabecular Metal Augments for Reconstruction of Acetabular Bone Defects in Revision Total Hip Replacement: Short-Term Outcomes","authors":"Husam M. El Axir, M. Alashhab, Karim S. Khater","doi":"10.4103/jajs.jajs_90_23","DOIUrl":"https://doi.org/10.4103/jajs.jajs_90_23","url":null,"abstract":"\u0000 \u0000 \u0000 Revision hip surgeries are increasing dramatically nowadays, and achieving hip center of rotation is challenging. Obtaining a press-fit implant and restoring the hip’s center of rotation might be difficult during the restoration of acetabular deformities during revision total hip arthroplasty (THA).\u0000 \u0000 \u0000 \u0000 The aim of the study was to evaluate the outcomes of using trabecular metal augments for reconstruction of the acetabulum in patients undergoing revision THA with short-term follow-up.\u0000 \u0000 \u0000 \u0000 This study was conducted in Benha University Hospital between April 2019 and March 2023. It is a prospective cohort study including 20 patients who are undergoing revision THA with acetabular defects.\u0000 \u0000 \u0000 \u0000 The mean age of patients in this study was 59 years old. According to Paprosky classification: 45% of type 2B. The postoperative Oxford Hip Score showed marked improvement in the outcomes, the score was excellent in 55% (11 patients), good in 40% (8 patients), and fair in only 5% (1 patient) over 16 months’ mean follow-up period.\u0000 \u0000 \u0000 \u0000 Due to its modularity, tantalum augments are considered a valuable method in the reconstruction of acetabular defects.\u0000","PeriodicalId":38088,"journal":{"name":"Journal of Arthroscopy and Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141690403","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}
Hany Mohamed Abd Elfattah Bakr, Salah Mahmoud Abdelkader, Osam Metwally
The design of the study was a retrospective case series. This study evaluated the clinical and radiological manifestations of synovial chondromatosis (SC) of the hip, along with the role of hip arthroscopy in the diagnosis and treatment of this pathologic condition and its postoperative curative effect. With a minimum 1-year follow-up, 13 hips with SC received arthroscopic surgery. Preoperatively and postoperatively, patients were assessed for hip pain using the modified Harris Hip Score and Nonarthritic Hip Score. Considerable reduction in postoperative hip pain was observed in all cases, along with sufficient improvement in hip range of motion. Hip arthroscopy is a trusted and adequate treatment option for hip SC.
{"title":"Is Arthroscopic Management of Synovial Chondromatosis of the Hip Enough?","authors":"Hany Mohamed Abd Elfattah Bakr, Salah Mahmoud Abdelkader, Osam Metwally","doi":"10.4103/jajs.jajs_79_23","DOIUrl":"https://doi.org/10.4103/jajs.jajs_79_23","url":null,"abstract":"\u0000 \u0000 \u0000 The design of the study was a retrospective case series.\u0000 \u0000 \u0000 \u0000 This study evaluated the clinical and radiological manifestations of synovial chondromatosis (SC) of the hip, along with the role of hip arthroscopy in the diagnosis and treatment of this pathologic condition and its postoperative curative effect.\u0000 \u0000 \u0000 \u0000 With a minimum 1-year follow-up, 13 hips with SC received arthroscopic surgery. Preoperatively and postoperatively, patients were assessed for hip pain using the modified Harris Hip Score and Nonarthritic Hip Score.\u0000 \u0000 \u0000 \u0000 Considerable reduction in postoperative hip pain was observed in all cases, along with sufficient improvement in hip range of motion.\u0000 \u0000 \u0000 \u0000 Hip arthroscopy is a trusted and adequate treatment option for hip SC.\u0000","PeriodicalId":38088,"journal":{"name":"Journal of Arthroscopy and Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696085","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}
Abdoulrahman Elsayed Youssef, Mohamed Taha A. Mehanna, Mohamed Saleh Mustafa, A. Henawy
Hip arthroplasty is one of the most common reconstructive procedures done in adults.[1] The main purpose of this surgery is to eliminate pain, regain full extent of joint motion, maintaining hip stability, and improve the quality of life for patients. This work aims to compare the clinical and radiological outcomes of two techniques; the second-generation cementation technique and a newly introduced modification of the manual technique in primary cemented hip arthroplasty. This prospective, randomized clinical trial included 44 patients. Patients were allocated into two equal groups: the case Group A; who had primary hip arthroplasty operation with the modified manual cementation technique and the control Group B; who had arthroplasty using the second generation cementation technique. The average follow-up period was about 12 months after the operation. Operation time, intraoperative parameters, postoperative clinical and radiological outcomes, and complications were compared between the two groups. The operation duration was significantly longer in Group B (123.4 ± 9.0 vs. 107.5 ± 15.2, P = 0.001). No intraoperative complications were found among 77% while 13.6% showed allergic reaction to cementation 72% of them are in Group B, 6.8% needed blood transfusion, and 2.3% had pulmonary embolism on cementation. No significant difference between the two studied groups regarding postoperative Visual Analog Scale (VAS) score,[2] barrack grading,[3] complications and Harris hip score[4] at 3 months, 9 months, and 12 months was noted. In conclusion, this study concluded that Group A the newly introduced modified manual cementation technique might provide a cheaper and effective alternative to Group B the second-generation technique, with relatively less intraoperative complications and almost no difference in postoperative VAS, Harris hip score, and radiological outcomes over a period of 1-year follow-up.
{"title":"Functional and Radiological Outcomes of a Newly Introduced Modified Manual Cementation Technique Versus Second-Generation Technique in Primary Cemented Hip Arthroplasty","authors":"Abdoulrahman Elsayed Youssef, Mohamed Taha A. Mehanna, Mohamed Saleh Mustafa, A. Henawy","doi":"10.4103/jajs.jajs_97_23","DOIUrl":"https://doi.org/10.4103/jajs.jajs_97_23","url":null,"abstract":"\u0000 \u0000 \u0000 Hip arthroplasty is one of the most common reconstructive procedures done in adults.[1] The main purpose of this surgery is to eliminate pain, regain full extent of joint motion, maintaining hip stability, and improve the quality of life for patients.\u0000 \u0000 \u0000 \u0000 This work aims to compare the clinical and radiological outcomes of two techniques; the second-generation cementation technique and a newly introduced modification of the manual technique in primary cemented hip arthroplasty.\u0000 \u0000 \u0000 \u0000 This prospective, randomized clinical trial included 44 patients. Patients were allocated into two equal groups: the case Group A; who had primary hip arthroplasty operation with the modified manual cementation technique and the control Group B; who had arthroplasty using the second generation cementation technique. The average follow-up period was about 12 months after the operation. Operation time, intraoperative parameters, postoperative clinical and radiological outcomes, and complications were compared between the two groups.\u0000 \u0000 \u0000 \u0000 The operation duration was significantly longer in Group B (123.4 ± 9.0 vs. 107.5 ± 15.2, P = 0.001). No intraoperative complications were found among 77% while 13.6% showed allergic reaction to cementation 72% of them are in Group B, 6.8% needed blood transfusion, and 2.3% had pulmonary embolism on cementation. No significant difference between the two studied groups regarding postoperative Visual Analog Scale (VAS) score,[2] barrack grading,[3] complications and Harris hip score[4] at 3 months, 9 months, and 12 months was noted.\u0000 \u0000 \u0000 \u0000 In conclusion, this study concluded that Group A the newly introduced modified manual cementation technique might provide a cheaper and effective alternative to Group B the second-generation technique, with relatively less intraoperative complications and almost no difference in postoperative VAS, Harris hip score, and radiological outcomes over a period of 1-year follow-up.\u0000","PeriodicalId":38088,"journal":{"name":"Journal of Arthroscopy and Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141702057","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}
W. Ebeid, Mohamed Taha A. Mehanna, Mohamed Saleh Moustafa, Khaled Mohamed Ahmed Abo ElNasr, Sameh Mahmoud Abo ElFadl
Patellar resurfacing with knee arthroplasty has always been controversial. The literature contains data that support both resurfacing and not resurfacing the patella. However, the literature does not review a lot of studies that address the impact of patellar resurfacing on the functional outcome following resection of distal femur tumors and limb salvage using modular prosthesis. Is patellar resurfacing better than nonresurfacing as regards functional outcome of modular prosthesis used for the treatment of tumors around the knee? Two groups of patients; both were subjected to wide excision of tumors around the knee and limb salvage using modular prosthesis. The first group underwent reconstruction with patellar resurfacing, while the second underwent reconstruction without patellar resurfacing. The age of these groups of patients ranged from 11 to 71 years. The patients were 17 males and 19 females. We evaluated patients using the musculoskeletal tumor society scoring system (MSTS), knee society final score, knee society function score, and anterior knee pain score. We found that MSTS functional score, knee society final score and knee society function score, and anterior knee pain score were all better in patients who underwent patellar resurfacing compared to nonresurfacing patients. However, only the difference in anterior knee pain score was statistically significant (P = 0.030). Differences in other scores between these two groups were all statistically insignificant (P value of the MSTS difference = 0.103, P value of the knee society final score difference = 0.423, and P value of the knee society function score difference = 0.337). Patellar resurfacing could be helpful in decreasing anterior knee pain and the necessity to future surgeries addressing patellofemoral pain, especially in revision cases, patients with patellofemoral problems, and patients with extensor mechanism weakness and those with anterior knee pain. Since Anterior Knee Pain Scale was the only scoring system, among all scoring systems used, that confirmed a significant impact of patellar resurfacing on the outcome following resections and reconstructions; we cannot give an explicit strong recommendation favoring the routine patellar resurfacing in all cases undergoing resections and reconstructions using modular prosthesis. We recommend patellar resurfacing in older patients, based on our results, which show possible benefit of patellar resurfacing in older patients. We think that old age and the preexisting knee arthritis could be relative indications for patellar resurfacing.
膝关节置换术中的髌骨复位一直存在争议。文献中包含支持或不支持髌骨复位的数据。然而，对于股骨远端肿瘤切除和使用模块化假体进行肢体救治后，髌骨复位对功能结果的影响，文献中并没有大量的研究综述。 就用于治疗膝关节周围肿瘤的模块化假体的功能效果而言，髌骨置换是否优于非置换？ 两组患者均接受了膝关节周围肿瘤的广泛切除术，并使用模块化假体进行肢体修复。第一组患者进行了髌骨复位重建，第二组患者则没有进行髌骨复位重建。这两组患者的年龄从 11 岁到 71 岁不等。患者中有 17 名男性和 19 名女性。我们使用肌肉骨骼肿瘤协会评分系统（MSTS）、膝关节协会最终评分、膝关节协会功能评分和膝关节前部疼痛评分对患者进行了评估。 我们发现，与未接受髌骨复位手术的患者相比，接受髌骨复位手术的患者的MSTS功能评分、膝关节社会最终评分和膝关节社会功能评分以及膝关节前部疼痛评分都更好。然而，只有膝关节前部疼痛评分的差异具有统计学意义（P = 0.030）。两组患者的其他评分差异均无统计学意义（MSTS 差异的 P 值 = 0.103，膝关节协会最终评分差异的 P 值 = 0.423，膝关节协会功能评分差异的 P 值 = 0.337）。 髌骨复位术有助于减轻膝关节前部疼痛，并减少今后针对髌骨股骨疼痛进行手术的必要性，尤其适用于翻修病例、髌骨股骨问题患者、伸肌无力患者和膝关节前部疼痛患者。由于膝关节前侧疼痛量表是所有评分系统中唯一证实髌骨复位对切除和重建手术后疗效有显著影响的评分系统，因此我们无法明确强烈建议所有使用模块化假体进行切除和重建的病例都常规进行髌骨复位。根据我们的研究结果，我们建议对老年患者进行髌骨复位，因为我们的研究结果表明，对老年患者进行髌骨复位可能会带来益处。我们认为，老年和原有的膝关节炎可能是髌骨重置术的相对适应症。
{"title":"Functional Outcome of Patients with Malignant Tumors around the Knee Treated by Modular Endoprosthesis: A Comparative Study between Patellar Resurfacing and Nonresurfacing","authors":"W. Ebeid, Mohamed Taha A. Mehanna, Mohamed Saleh Moustafa, Khaled Mohamed Ahmed Abo ElNasr, Sameh Mahmoud Abo ElFadl","doi":"10.4103/jajs.jajs_2_24","DOIUrl":"https://doi.org/10.4103/jajs.jajs_2_24","url":null,"abstract":"\u0000 \u0000 \u0000 Patellar resurfacing with knee arthroplasty has always been controversial. The literature contains data that support both resurfacing and not resurfacing the patella. However, the literature does not review a lot of studies that address the impact of patellar resurfacing on the functional outcome following resection of distal femur tumors and limb salvage using modular prosthesis.\u0000 \u0000 \u0000 \u0000 Is patellar resurfacing better than nonresurfacing as regards functional outcome of modular prosthesis used for the treatment of tumors around the knee?\u0000 \u0000 \u0000 \u0000 Two groups of patients; both were subjected to wide excision of tumors around the knee and limb salvage using modular prosthesis. The first group underwent reconstruction with patellar resurfacing, while the second underwent reconstruction without patellar resurfacing. The age of these groups of patients ranged from 11 to 71 years. The patients were 17 males and 19 females. We evaluated patients using the musculoskeletal tumor society scoring system (MSTS), knee society final score, knee society function score, and anterior knee pain score.\u0000 \u0000 \u0000 \u0000 We found that MSTS functional score, knee society final score and knee society function score, and anterior knee pain score were all better in patients who underwent patellar resurfacing compared to nonresurfacing patients. However, only the difference in anterior knee pain score was statistically significant (P = 0.030). Differences in other scores between these two groups were all statistically insignificant (P value of the MSTS difference = 0.103, P value of the knee society final score difference = 0.423, and P value of the knee society function score difference = 0.337).\u0000 \u0000 \u0000 \u0000 Patellar resurfacing could be helpful in decreasing anterior knee pain and the necessity to future surgeries addressing patellofemoral pain, especially in revision cases, patients with patellofemoral problems, and patients with extensor mechanism weakness and those with anterior knee pain. Since Anterior Knee Pain Scale was the only scoring system, among all scoring systems used, that confirmed a significant impact of patellar resurfacing on the outcome following resections and reconstructions; we cannot give an explicit strong recommendation favoring the routine patellar resurfacing in all cases undergoing resections and reconstructions using modular prosthesis. We recommend patellar resurfacing in older patients, based on our results, which show possible benefit of patellar resurfacing in older patients. We think that old age and the preexisting knee arthritis could be relative indications for patellar resurfacing.\u0000","PeriodicalId":38088,"journal":{"name":"Journal of Arthroscopy and Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716478","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}
Mahmoud Shoukry, Amr Ahmed Abd El-Rhaman, H. Abdelazim, A. H. Khater, Mahmoud M. Abd El-Wahab, Maged Abouelsoud
The loss of the shoulder’s center of rotation is caused by massive rotator cuff tears, which can occur with or without arthritis and proximal humerus fractures that are nonunion or malunion. Because anatomical total shoulder arthroplasty cannot provide a stable center of rotation, reverse total shoulder arthroplasty (RTSA) is the appropriate procedure for these indications and in older patients who have primary glenohumeral osteoarthritis. Anatomical total shoulder arthroplasty carries a risk of failure because of the loosening of the glenoid component or cuff tear. The purpose of this study was to determine the short-term outcomes following RTSA in patients who had primary glenohumeral osteoarthritis, acute proximal humerus fractures, malunited or nonunited proximal humerus fractures, and massive cuff tears. This single-arm clinical trial (interventional study) was done in Ain Shams University Hospitals; 16 patients were included who underwent RTSA. Constant score, American Shoulder and Elbow Surgeon score, Visual Analog Scale score, and range of motion (ROM) were the short-term outcomes. Patients with cuff tear arthropathy, irreparable cuff tear with or without glenohumeral arthritis, elderly patients with unreconstructable proximal humerus fracture, proximal humerus fracture malunion or nonunion, and patients with glenohumeral osteoarthritis were included. Patients under the age of 50, as well as those with deltoid muscle dysfunction or injuries to the axillary nerve, were excluded. There were 16 patients in this study, 8 of whom were male and 8 of whom were female. The follow-up period lasted 2 years following surgery, with a mean age of 64.19 years. The study included 7 patients with irreparable cuff tears one of them had associated anterior shoulder instability and recurrent anterior shoulder dislocation. One patient had a neglected shoulder dislocation, two patients had proximal humerus fracture dislocation, two patients had a nonunited proximal humerus fracture, three patients had unreconstructable proximal humerus fracture, and two had glenohumeral osteoarthritis. Not only did RTSA provide good clinical and functional outcomes for the standard indication of a massive cuff tear, but it also proved beneficial for other disorders such as primary glenohumeral osteoarthritis, nonunited fracture, and acute proximal humerus fracture. Among all indications, irreparable cuff tears yielded the highest results; nonunited fractures displayed the least improvement regarding clinical outcomes. Enhancements in the design of prostheses, the expertise of surgeons, and clinical outcomes are crucial to maximize their effectiveness in treating various shoulder disorders.
{"title":"Short-Term Results after Reverse Total Shoulder Arthroplasty","authors":"Mahmoud Shoukry, Amr Ahmed Abd El-Rhaman, H. Abdelazim, A. H. Khater, Mahmoud M. Abd El-Wahab, Maged Abouelsoud","doi":"10.4103/jajs.jajs_6_24","DOIUrl":"https://doi.org/10.4103/jajs.jajs_6_24","url":null,"abstract":"\u0000 \u0000 \u0000 The loss of the shoulder’s center of rotation is caused by massive rotator cuff tears, which can occur with or without arthritis and proximal humerus fractures that are nonunion or malunion. Because anatomical total shoulder arthroplasty cannot provide a stable center of rotation, reverse total shoulder arthroplasty (RTSA) is the appropriate procedure for these indications and in older patients who have primary glenohumeral osteoarthritis. Anatomical total shoulder arthroplasty carries a risk of failure because of the loosening of the glenoid component or cuff tear. The purpose of this study was to determine the short-term outcomes following RTSA in patients who had primary glenohumeral osteoarthritis, acute proximal humerus fractures, malunited or nonunited proximal humerus fractures, and massive cuff tears.\u0000 \u0000 \u0000 \u0000 This single-arm clinical trial (interventional study) was done in Ain Shams University Hospitals; 16 patients were included who underwent RTSA. Constant score, American Shoulder and Elbow Surgeon score, Visual Analog Scale score, and range of motion (ROM) were the short-term outcomes. Patients with cuff tear arthropathy, irreparable cuff tear with or without glenohumeral arthritis, elderly patients with unreconstructable proximal humerus fracture, proximal humerus fracture malunion or nonunion, and patients with glenohumeral osteoarthritis were included. Patients under the age of 50, as well as those with deltoid muscle dysfunction or injuries to the axillary nerve, were excluded.\u0000 \u0000 \u0000 \u0000 There were 16 patients in this study, 8 of whom were male and 8 of whom were female. The follow-up period lasted 2 years following surgery, with a mean age of 64.19 years. The study included 7 patients with irreparable cuff tears one of them had associated anterior shoulder instability and recurrent anterior shoulder dislocation. One patient had a neglected shoulder dislocation, two patients had proximal humerus fracture dislocation, two patients had a nonunited proximal humerus fracture, three patients had unreconstructable proximal humerus fracture, and two had glenohumeral osteoarthritis.\u0000 \u0000 \u0000 \u0000 Not only did RTSA provide good clinical and functional outcomes for the standard indication of a massive cuff tear, but it also proved beneficial for other disorders such as primary glenohumeral osteoarthritis, nonunited fracture, and acute proximal humerus fracture. Among all indications, irreparable cuff tears yielded the highest results; nonunited fractures displayed the least improvement regarding clinical outcomes. Enhancements in the design of prostheses, the expertise of surgeons, and clinical outcomes are crucial to maximize their effectiveness in treating various shoulder disorders.\u0000","PeriodicalId":38088,"journal":{"name":"Journal of Arthroscopy and Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141697973","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}
Hany Mohamed Abd Elfattah Bakr, Salah Mahmoud Abdelkader, Yamen Safwat
Retrospective case series. In this study, we will identify if partial ACL tear is a common hidden cause of chronic pain and swelling of the knee in adults. And we will evaluate the effectiveness of arthroscopic selective bundle reconstruction in the management of this condition. The Anterior Cruciate Ligament (ACL) has two anatomical bundles, the anteromedial (AM) and the posterolateral (PL), each bundle was named according to the site of its tibial insertion.[1] Partial ACL tear is evident and symptomatic when the percentage of the torn fibers is more than 50% of ligament fibers. AM bundle is more liable to injury than PL.[2] Symptomps of partial ACL tear may be giving way and instability but persistent knee pain and swelling is often present as the main presenting symptom of the patient due to micro-instability of the knee, The primary complication of longstanding partial ACL tears is early knee degeneration.[3] 37 patients with chronic knee pain and swelling, related to activity and resistant to non-operative treatment, underwent diagnostic knee arthroscopy. In 3 cases diagnostic arthroscopy revealed osteochondral ulcers of the medial compartment of the knee managed by drilling and 4 cases showed non-specific synovitis managed by arthroscopic synovectomy. 30 of these patients, who were included in this study, were found to suffer from partial ACL tear and underwent single bundle reconstruction, 18 of them underwent selective AM bundle reconstruction while preserving PL bundle. Twelve patients underwent selective PL bundle reconstruction with AM bundle preservation. Semitendinosus tendon graft was utilized for all reconstructions. The femoral side was always fixed with an adjustable loop (Zimmer), and the tibial side with a biodegradable interference screw. Lysholm score[4] was used to assess the outcomes. Patients with severe degenerative disorders, lower limb mal-alignment and multiple ligamentous injuries of the knee were excluded from our study. Marked decrease in the knee pain and swelling postoperatively. The preoperative score had a mean value of 66.17±10.39. At 2 years, the postoperative score was 96.1±6.71, indicating a highly statistically significant improvement (P value 0.001). Partial ACL tears are the commonest hidden cause of pain and swelling of the knee among young adults. Arthroscopic selective bundle reconstruction diminishes knee pain and swelling with a very satisfactory postoperative clinical outcomes.
{"title":"Is Partial ACL Tear a Cause of Painful Swollen Knees?","authors":"Hany Mohamed Abd Elfattah Bakr, Salah Mahmoud Abdelkader, Yamen Safwat","doi":"10.4103/jajs.jajs_96_23","DOIUrl":"https://doi.org/10.4103/jajs.jajs_96_23","url":null,"abstract":"\u0000 \u0000 \u0000 Retrospective case series.\u0000 \u0000 \u0000 \u0000 In this study, we will identify if partial ACL tear is a common hidden cause of chronic pain and swelling of the knee in adults. And we will evaluate the effectiveness of arthroscopic selective bundle reconstruction in the management of this condition.\u0000 \u0000 \u0000 \u0000 The Anterior Cruciate Ligament (ACL) has two anatomical bundles, the anteromedial (AM) and the posterolateral (PL), each bundle was named according to the site of its tibial insertion.[1] Partial ACL tear is evident and symptomatic when the percentage of the torn fibers is more than 50% of ligament fibers. AM bundle is more liable to injury than PL.[2] Symptomps of partial ACL tear may be giving way and instability but persistent knee pain and swelling is often present as the main presenting symptom of the patient due to micro-instability of the knee, The primary complication of longstanding partial ACL tears is early knee degeneration.[3]\u0000 \u0000 \u0000 \u0000 \u0000 37 patients with chronic knee pain and swelling, related to activity and resistant to non-operative treatment, underwent diagnostic knee arthroscopy. In 3 cases diagnostic arthroscopy revealed osteochondral ulcers of the medial compartment of the knee managed by drilling and 4 cases showed non-specific synovitis managed by arthroscopic synovectomy. 30 of these patients, who were included in this study, were found to suffer from partial ACL tear and underwent single bundle reconstruction, 18 of them underwent selective AM bundle reconstruction while preserving PL bundle. Twelve patients underwent selective PL bundle reconstruction with AM bundle preservation. Semitendinosus tendon graft was utilized for all reconstructions. The femoral side was always fixed with an adjustable loop (Zimmer), and the tibial side with a biodegradable interference screw. Lysholm score[4] was used to assess the outcomes. Patients with severe degenerative disorders, lower limb mal-alignment and multiple ligamentous injuries of the knee were excluded from our study.\u0000 \u0000 \u0000 \u0000 Marked decrease in the knee pain and swelling postoperatively. The preoperative score had a mean value of 66.17±10.39. At 2 years, the postoperative score was 96.1±6.71, indicating a highly statistically significant improvement (P value 0.001).\u0000 \u0000 \u0000 \u0000 Partial ACL tears are the commonest hidden cause of pain and swelling of the knee among young adults.\u0000 \u0000 \u0000 \u0000 Arthroscopic selective bundle reconstruction diminishes knee pain and swelling with a very satisfactory postoperative clinical outcomes.\u0000","PeriodicalId":38088,"journal":{"name":"Journal of Arthroscopy and Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710144","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}
Saeid Abouelyazid, Mahmoud A. Hafez, A. Toreih, Mohamed Soliman Kotb, Ahmed Tamer
Simultaneous bilateral total knee arthroplasty (simBTKA) has been a favored surgical solution to reduce costs and patient suffering. We aimed to evaluate the rate of asymmetry of component size in patients undergoing simBTKA and its impact on knee function as we believe that implant asymmetry may affect the functional outcomes in those patients. A cross-sectional study design was done on on 60 patients (120 knees) with simBTKA using patient-specific templating (PST). Patients were included if they had Kellgren–Lawrence Grade III-IV osteoarthritis. Revision surgeries, staged BTKA, or patients with bone defects, valgus deformity, severe varus deformity (defined as above 20°), and extra-articular deformities were excluded from the study. The outcome measures were interlimb component asymmetry, Knee Society Score (KSS), and range of motion (ROM). The comparison between pre- and postoperative findings was done using a dependent t-test. A total of 29 (48.34%) patients had symmetrical femoral and tibial components, whereas the rest had asymmetry, of them, 11.7% had both femoral and tibial component size asymmetry. There were no statistically significant differences between the changes in KSS and ROM in the smaller implant and larger implant groups (P = 0.5 and P = 0.4, respectively). The total number of complications was eight and as follows: superficial infection, aseptic loosening, rupture of the patellar tendon after a bathroom fall, anemia requiring blood transfusion, residual varus deformity, deep venous thrombosis, periprosthetic fracture, and malalignment. There is no correlation between the interlimb component asymmetry and the knee function. However, there was statistically significant improvement from preoperative to postoperative KSS and ROM in small and large implants.
同时双侧全膝关节置换术（simultaneous bilateral total knee arthropasty，simBTKA）一直是减少费用和患者痛苦的首选手术方案。我们认为植入物不对称可能会影响患者的功能预后，因此我们旨在评估接受 simBTKA 的患者膝关节组件大小不对称的比例及其对膝关节功能的影响。 我们采用横断面研究设计，使用患者特异性模板（PST）对 60 名患者（120 个膝关节）进行了 simBTKA。如果患者患有凯尔格伦-劳伦斯 III-IV 级骨关节炎，则将其纳入研究范围。翻修手术、分期 BTKA 或有骨缺损、外翻畸形、严重外翻畸形（定义为超过 20°）和关节外畸形的患者不在研究范围内。结果测量指标包括肢体间的不对称、膝关节社会评分（KSS）和活动范围（ROM）。术前和术后结果的比较采用依赖性 t 检验。 共有29名（48.34%）患者的股骨和胫骨组件对称，而其余患者的股骨和胫骨组件不对称，其中11.7%的患者股骨和胫骨组件大小均不对称。小植入体组和大植入体组的KSS和ROM变化差异无统计学意义（分别为P = 0.5和P = 0.4）。并发症总数为8例，具体如下：表皮感染、无菌性松动、浴室摔倒后髌腱断裂、贫血需要输血、残余屈曲畸形、深静脉血栓、假体周围骨折和错位。 肢体间组件不对称与膝关节功能之间没有相关性。不过，从统计学角度来看，小植入物和大植入物的 KSS 和 ROM 从术前到术后都有明显改善。
{"title":"Correlation between Component Size and Functional Knee Score in Patients Undergoing Bilateral Simultaneous Total Knee Arthroplasty: A Cross-Sectional Study","authors":"Saeid Abouelyazid, Mahmoud A. Hafez, A. Toreih, Mohamed Soliman Kotb, Ahmed Tamer","doi":"10.4103/jajs.jajs_82_23","DOIUrl":"https://doi.org/10.4103/jajs.jajs_82_23","url":null,"abstract":"\u0000 \u0000 \u0000 Simultaneous bilateral total knee arthroplasty (simBTKA) has been a favored surgical solution to reduce costs and patient suffering. We aimed to evaluate the rate of asymmetry of component size in patients undergoing simBTKA and its impact on knee function as we believe that implant asymmetry may affect the functional outcomes in those patients.\u0000 \u0000 \u0000 \u0000 A cross-sectional study design was done on on 60 patients (120 knees) with simBTKA using patient-specific templating (PST). Patients were included if they had Kellgren–Lawrence Grade III-IV osteoarthritis. Revision surgeries, staged BTKA, or patients with bone defects, valgus deformity, severe varus deformity (defined as above 20°), and extra-articular deformities were excluded from the study. The outcome measures were interlimb component asymmetry, Knee Society Score (KSS), and range of motion (ROM). The comparison between pre- and postoperative findings was done using a dependent t-test.\u0000 \u0000 \u0000 \u0000 A total of 29 (48.34%) patients had symmetrical femoral and tibial components, whereas the rest had asymmetry, of them, 11.7% had both femoral and tibial component size asymmetry. There were no statistically significant differences between the changes in KSS and ROM in the smaller implant and larger implant groups (P = 0.5 and P = 0.4, respectively). The total number of complications was eight and as follows: superficial infection, aseptic loosening, rupture of the patellar tendon after a bathroom fall, anemia requiring blood transfusion, residual varus deformity, deep venous thrombosis, periprosthetic fracture, and malalignment.\u0000 \u0000 \u0000 \u0000 There is no correlation between the interlimb component asymmetry and the knee function. However, there was statistically significant improvement from preoperative to postoperative KSS and ROM in small and large implants.\u0000","PeriodicalId":38088,"journal":{"name":"Journal of Arthroscopy and Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710404","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}
Mohamed Atef Mohamed Elhabet, Khaled Mohamed Abo-Elnasr, A. Henawy, Ahmed Metwally, A. Toreih
Ankle fractures constitute a challenging condition due to its high impact on the long term. Thus, advancements in management have been proposed to ensure the best possible outcome. Hence, we aimed to assess the role of arthroscopy in the treatment of ankle fractures that involve posterior malleolus fragments in adults. In a quasi-experimental, interventional, prospective, nonrandomized study, we included 16 adult patients with acute ankle fracture with posterior malleolus fragment. They underwent arthroscopically assisted technique for their fracture treatment. A standard systematic arthroscopic ankle examination, their fracture grade, and classification were assessed, and subsequent management was conducted. The patients were followed up for 6 months using the American Orthopedic Foot and Ankle Society (AOFAS) score and radiographic monitoring with standard X-ray. The mean AOFAS score improved significantly after 6 months of follow-up (from 84.81 in the 3rd month to 92.81 in the 6th month). Ankle dorsiflexion angle and ankle plantar-flexion angle showed a gradual increase during follow-up, reaching 17.31° ± 3.25° and 45° ± 5°, respectively. Only two patients developed complications. Age, body mass index, and grade of the osteochondral lesion were negatively correlated statistically significantly with the AOFAS score. This proves the effective role of arthroscopically assisted technique in the treatment of ankle fractures with posterior malleolus fragment. Arthroscopically assisted technique in the treatment of ankle fractures with posterior malleolus fragment in adults resulted in good functional outcomes with less complications and it allows the assessment of associated intra-articular injuries. Further studies with longer follow-up periods are needed for the assessment of outcomes and complications for comparison.
{"title":"Arthroscopically Assisted Technique in the Treatment of Ankle Fractures with Posterior Malleolus Fragment in Adults","authors":"Mohamed Atef Mohamed Elhabet, Khaled Mohamed Abo-Elnasr, A. Henawy, Ahmed Metwally, A. Toreih","doi":"10.4103/jajs.jajs_84_23","DOIUrl":"https://doi.org/10.4103/jajs.jajs_84_23","url":null,"abstract":"\u0000 \u0000 \u0000 Ankle fractures constitute a challenging condition due to its high impact on the long term. Thus, advancements in management have been proposed to ensure the best possible outcome. Hence, we aimed to assess the role of arthroscopy in the treatment of ankle fractures that involve posterior malleolus fragments in adults.\u0000 \u0000 \u0000 \u0000 In a quasi-experimental, interventional, prospective, nonrandomized study, we included 16 adult patients with acute ankle fracture with posterior malleolus fragment. They underwent arthroscopically assisted technique for their fracture treatment. A standard systematic arthroscopic ankle examination, their fracture grade, and classification were assessed, and subsequent management was conducted. The patients were followed up for 6 months using the American Orthopedic Foot and Ankle Society (AOFAS) score and radiographic monitoring with standard X-ray.\u0000 \u0000 \u0000 \u0000 The mean AOFAS score improved significantly after 6 months of follow-up (from 84.81 in the 3rd month to 92.81 in the 6th month). Ankle dorsiflexion angle and ankle plantar-flexion angle showed a gradual increase during follow-up, reaching 17.31° ± 3.25° and 45° ± 5°, respectively. Only two patients developed complications. Age, body mass index, and grade of the osteochondral lesion were negatively correlated statistically significantly with the AOFAS score. This proves the effective role of arthroscopically assisted technique in the treatment of ankle fractures with posterior malleolus fragment.\u0000 \u0000 \u0000 \u0000 Arthroscopically assisted technique in the treatment of ankle fractures with posterior malleolus fragment in adults resulted in good functional outcomes with less complications and it allows the assessment of associated intra-articular injuries. Further studies with longer follow-up periods are needed for the assessment of outcomes and complications for comparison.\u0000","PeriodicalId":38088,"journal":{"name":"Journal of Arthroscopy and Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141689462","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}
Mahmoud Elsaid Eldadamouny, A. Toreih, Mohamed Saleh Mostafa, Mohamed Ezzat M. Eltaher
Intra-articular distal radius fractures (DRFs) are prevalent injuries that are usually difficult to treat and rehabilitate. These injuries may be associated with ligamentous injuries or intra-articular loose fragments. This study aims to assess the functional and radiological results of using arthroscopic-assisted reduction and fixation, which offers direct visualization of the joint surface, evaluation of intra-articular ligaments, and removal of loose fragments, potentially enhancing recovery outcomes. This quasi-experimental interventional study evaluated the functional and radiological outcomes of arthroscopic-assisted reduction and fixation for intra-articular DRFs. The study included 26 patients who met specific inclusion criteria, and data collection involved preoperative assessment, patient preparation, operative measures, postoperative care, and follow-up evaluations using various scoring systems. The range of motion showed a significant (P < 0.001) improvement over the study duration: flexion increased from 42.81° ± 11.81° at 6 weeks to 54.23° ± 14.95° at 12 months, and extension improved from 56.88° ± 13.28° to 68.38° ± 13.43°. In addition, there was a significant reduction in disability and wrist-related symptoms, as indicated by improvements in the Disabilities of the Arm, Shoulder, and Hand (DASH) scores (6 weeks: 25.80 ± 15.85 vs. 12 months: 5.27 ± 8.61; P < 0.01) and Patient-Rated Wrist Evaluation (PRWE) scores at the same follow-up intervals (6 weeks: 46.04 ± 22.49 vs. 12 months: 9.54 ± 12.03; P < 0.001). Chronic illness and injuries like triangular fibrocartilage complex tears affected outcomes negatively. Age, ulnar variance, and palmar tilt were significantly correlated with DASH and PRWE scores. Arthroscopic-assisted reduction and fixation for intra-articular DRFs resulted in favorable outcomes regarding the range of motion, disability, and wrist-related symptoms. Further research and long-term follow-up studies are recommended to validate the positive outcomes of arthroscopic-assisted reduction and fixation for intra-articular DRFs, compare it with other surgical approaches, and assess its economic implications.
{"title":"Functional and Radiological Outcomes Following Arthroscopic-Assisted Reduction and Fixation of Intra-Articular Distal Radius Fractures","authors":"Mahmoud Elsaid Eldadamouny, A. Toreih, Mohamed Saleh Mostafa, Mohamed Ezzat M. Eltaher","doi":"10.4103/jajs.jajs_83_23","DOIUrl":"https://doi.org/10.4103/jajs.jajs_83_23","url":null,"abstract":"\u0000 \u0000 \u0000 Intra-articular distal radius fractures (DRFs) are prevalent injuries that are usually difficult to treat and rehabilitate. These injuries may be associated with ligamentous injuries or intra-articular loose fragments. This study aims to assess the functional and radiological results of using arthroscopic-assisted reduction and fixation, which offers direct visualization of the joint surface, evaluation of intra-articular ligaments, and removal of loose fragments, potentially enhancing recovery outcomes.\u0000 \u0000 \u0000 \u0000 This quasi-experimental interventional study evaluated the functional and radiological outcomes of arthroscopic-assisted reduction and fixation for intra-articular DRFs. The study included 26 patients who met specific inclusion criteria, and data collection involved preoperative assessment, patient preparation, operative measures, postoperative care, and follow-up evaluations using various scoring systems.\u0000 \u0000 \u0000 \u0000 The range of motion showed a significant (P < 0.001) improvement over the study duration: flexion increased from 42.81° ± 11.81° at 6 weeks to 54.23° ± 14.95° at 12 months, and extension improved from 56.88° ± 13.28° to 68.38° ± 13.43°. In addition, there was a significant reduction in disability and wrist-related symptoms, as indicated by improvements in the Disabilities of the Arm, Shoulder, and Hand (DASH) scores (6 weeks: 25.80 ± 15.85 vs. 12 months: 5.27 ± 8.61; P < 0.01) and Patient-Rated Wrist Evaluation (PRWE) scores at the same follow-up intervals (6 weeks: 46.04 ± 22.49 vs. 12 months: 9.54 ± 12.03; P < 0.001). Chronic illness and injuries like triangular fibrocartilage complex tears affected outcomes negatively. Age, ulnar variance, and palmar tilt were significantly correlated with DASH and PRWE scores.\u0000 \u0000 \u0000 \u0000 Arthroscopic-assisted reduction and fixation for intra-articular DRFs resulted in favorable outcomes regarding the range of motion, disability, and wrist-related symptoms. Further research and long-term follow-up studies are recommended to validate the positive outcomes of arthroscopic-assisted reduction and fixation for intra-articular DRFs, compare it with other surgical approaches, and assess its economic implications.\u0000","PeriodicalId":38088,"journal":{"name":"Journal of Arthroscopy and Joint Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141713829","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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