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MRI hip morphology is abnormal in unilateral DDH and increased lateral limbus thickness is associated with residual DDH at minimum 10-year follow-up. 在至少10年的随访中,单侧DDH的MRI髋关节形态异常,外侧缘厚度增加与残留DDH有关。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-04-01 DOI: 10.1177/18632521221144060
Florian Schmaranzer, Pedro Justo, Jennifer R Kallini, Marianna G Ferrer, Patricia E Miller, Travis Matheney, Sarah D Bixby, Eduardo N Novais

Purpose: The purpose of the study was to compare the post-reduction magnetic resonance imaging morphology for hips that developed residual acetabular dysplasia, hips without residual dysplasia, and uninvolved contralateral hips in patients with unilateral developmental dysplasia of the hip undergoing closed or open reduction and had a minimum 10-year follow-up.

Methods: Retrospective study of patients with unilateral dysplasia of the hip who underwent open/closed hip reduction followed by post-reduction magnetic resonance imaging. Twenty-eight patients with a mean follow-up of 13 ± 3 years were included. In the treated hips, residual dysplasia was defined as subsequent surgery for residual acetabular dysplasia or for Severin grade > 2 at latest follow-up. On post-reduction, magnetic resonance imaging measurements were performed by two readers and compared between the hips with/without residual dysplasia and the contralateral uninvolved side. Magnetic resonance imaging measurements included acetabular version, coronal/ axial femoroacetabular distance, acetabular depth-width ratio, osseous/cartilaginous acetabular indices, and medial/lateral (limbus) cartilage thickness.

Results: Fifteen (54%) and 13 (46%) hips were allocated to the "no residual dysplasia" group and to the "residual dysplasia" group, respectively. All eight magnetic resonance imaging parameters differed between hips with residual dysplasia and contralateral uninvolved hips (all p < 0.05). Six of eight parameters differed (all p < 0.05) between hips with and without residual dysplasia. Among these, increased limbus thickness had the largest effect (odds ratio = 12.5; p < 0.001) for increased likelihood of residual dysplasia.

Conclusions: We identified acetabular morphology and reduction quality parameters that can be reliably measured on the post-reduction magnetic resonance imaging to facilitate the differentiation between hips that develop with/without residual acetabular dysplasia at 10 years postoperatively.

Level of evidence: level III, prognostic case-control study.

目的:本研究的目的是比较单侧髋关节发育不良患者进行闭合复位或开放复位后,发生残留髋臼发育不良的髋关节、未发生残留发育不良的髋关节和未累及的对侧髋关节的复位后磁共振成像形态学,并进行至少10年的随访。方法:回顾性研究单侧髋关节发育不良患者行髋关节切开/闭合复位,复位后行磁共振成像。28例患者平均随访13±3年。在接受治疗的髋关节中,残余发育不良定义为髋臼残余发育不良或在最近随访时Severin分级> 2的后续手术。复位后,通过两个读卡器进行磁共振成像测量,并比较有/没有残余发育不良的髋关节和对侧未受累侧的髋关节。磁共振成像测量包括髋臼形状、股髋臼冠状/轴状距离、髋臼深宽比、髋臼骨/软骨指数和内侧/外侧(边缘)软骨厚度。结果:“无残留发育不良”组15例(54%),“残留发育不良”组13例(46%)。结论:我们确定了髋臼形态和复位质量参数,这些参数可以在复位后的磁共振成像上可靠地测量,以便于在术后10年区分有无髋臼发育不良残留的髋关节。证据等级:III级,预后病例对照研究。
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引用次数: 1
Predictors for operative treatment in pediatric proximal third both-bone diaphyseal forearm fractures in children include age and translation, but not initial angulation. 儿童前臂近端第三双骨干骨折手术治疗的预测因素包括年龄和移位,但不包括初始角度。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-04-01 DOI: 10.1177/18632521231156941
Kevin Williams, Noelle Whyte, Jacob R Carl, Jennifer Marks, David Segal, Kevin J Little

Introduction: Proximal third diaphyseal fractures of the radius and ulna represent an onerous fracture pattern due to difficulty maintaining acceptable alignment with nonoperative management. Our aim was to identify the factors that increase the odds for a surgical treatment of these fractures. Recognizing these factors can raise awareness to patients who are more likely to require additional care and assist clinicians in counseling families, targeting treatment plans, and constructing follow-up protocols. We hypothesized that the age of the patient, the amount of initial fracture displacement, and the angulation of the fracture would predict the need for operative treatment.

Methods: We retrospectively reviewed 276 proximal third diaphyseal forearm fractures at a single tertiary care institution. All patients underwent a nonoperative treatment trial, and if failed continued to surgery. Following a univariate analysis, we constructed a binary multivariate logistic regression model that included age, initial translation, and initial angulation to assess the association between the tested variables.

Results: A regression model revealed that age (10 years and older, odds ratio: 8.2, 95% confidence interval: 3.9-17.24, p < 0.001) and radius translation of more than 100% (odds ratio: 7.06, 95% confidence interval: 2.69-18.52, p < 0.001) were associated with the need for surgical treatment. Initial fracture angulation lacked an association with a surgical treatment (odds ratio: 0.81 95% confidence interval: 0.38-1.74, p = 0.59).

Conclusion: Age above 10 years and 100% initial translation of the radius fracture increased the odds for an ultimate decision to perform a surgery. Initial angulation, although often being the most remarkable radiographic feature, was not associated with a nonoperative treatment failure. We recommend an initial reduction attempt after counseling patients and their families that there is a high rate of conversion to operative treatment when the above features are met.

Level of evidence: level III.

介绍:桡骨和尺骨近端第三骨干骨折是一种复杂的骨折类型,因为非手术治疗难以维持可接受的骨折方向。我们的目的是确定增加手术治疗这些骨折几率的因素。认识到这些因素可以提高对那些更可能需要额外护理的患者的认识,并帮助临床医生咨询家庭、制定治疗计划和制定后续方案。我们假设患者的年龄、初始骨折位移量和骨折角度可以预测是否需要手术治疗。方法:我们回顾性分析了一家三级医疗机构的276例前臂第三骨干近端骨折。所有患者均接受非手术治疗试验,如果失败则继续手术治疗。在单变量分析之后,我们构建了一个二元多元逻辑回归模型,包括年龄、初始翻译和初始角度,以评估被测试变量之间的关联。结果:回归模型显示年龄(10岁及以上),优势比:8.2,95%可信区间:3.9-17.24,p结论:年龄大于10岁和100%的桡骨骨折初始移位增加了最终决定进行手术的几率。初始成角虽然是最显著的影像学特征,但与非手术治疗失败无关。我们建议在咨询患者及其家属后进行初始复位尝试,当满足上述特征时,手术治疗的转换率很高。证据等级:三级。
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引用次数: 2
Osteochondritis dissecans of the knee in adolescents: How to treat them? 青少年膝关节夹层性骨软骨炎:如何治疗?
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/18632521231152269
Joao Cabral, Julio Duart

Background: Osteochondritis dissecans is an acquired condition of the joint that affects the articular surface and the subchondral bone. The juvenile form of osteochondritis dissecans presents in those aged 5-16 years with open growth plates. The causes of osteochondritis dissecans are unknown.

Methods: The goals of treatment are to promote healing of the subchondral bone and prevent chondral collapse, subsequent fracture, osteochondral defect formation, and early joint degeneration. Treatment modality is influenced on clinical symptoms, skeletal maturity, as well as the size, stability, and location of the lesion. This article will review the treatment strategies of juvenile form of osteochondritis dissecans of medial femoral condyle and of atypical regions, such as lateral femoral condyle, patellofemoral joint, and tibial plateau.

Level of evidence: level III.

背景:夹层性骨软骨炎是一种影响关节面和软骨下骨的关节后天性疾病。幼年型夹层骨软骨炎出现在5-16岁生长板开放的人群中。夹层性骨软骨炎的病因尚不清楚。方法:治疗目的是促进软骨下骨愈合,防止软骨塌陷、骨折、骨软骨缺损形成和早期关节退变。治疗方式影响临床症状、骨骼成熟度以及病变的大小、稳定性和位置。本文将回顾幼年型分离性股骨内侧髁骨软骨炎和非典型区域(如股骨外侧髁、髌股关节和胫骨平台)的治疗策略。证据等级:三级。
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引用次数: 1
Current concepts in the treatment of first-time patella dislocation in children and adolescents. 儿童和青少年首次髌骨脱位的治疗现状。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/18632521221149060
Jaakko Sinikumpu, Nicolas Nicolaou

Background: Lateral dislocation of the patella is a common injury in children. It can occur in previously healthy and anatomically normal knees, but there are several abnormalities that predispose to patellar instability. Magnetic resonance imaging is an essential part of assessing for associated injuries and risk of further instability. Treatment aims to prevent redislocation, residual instability, osteoarthritis, and allow return to previous activities. The purpose of this review was to assess evidence for management of first-time patella dislocation in children and adolescents.

Methods: Literature review was performed, accompanied by the current best practice by the authors.

Results: Non-operative treatment is preferred, except where there are associated injuries such as osteochondral fractures that would benefit from surgery. The exact method of ideal non-operative management is not clearly defined but should focus on restoration of range of movement and strength with bracing as indicated. There seems to be a trend toward operative intervention that may well be inappropriate.

Conclusion: Further prospective studies are required with focus on the younger patient to fully understand if there is an at-risk group that would benefit from early surgery.

Level of evidence: level III.

背景:髌骨外侧脱位是儿童常见的损伤。它可以发生在以前健康和解剖正常的膝盖,但有几种异常易导致髌骨不稳定。磁共振成像是评估相关损伤和进一步不稳定风险的重要组成部分。治疗的目的是防止再脱位,残余不稳定,骨关节炎,并允许恢复以前的活动。本综述的目的是评估儿童和青少年首次髌骨脱位治疗的证据。方法:回顾文献,并结合作者目前的最佳实践。结果:非手术治疗是首选,除非有相关损伤,如骨软骨骨折,将受益于手术。理想的非手术治疗的确切方法没有明确的定义,但应侧重于恢复活动范围和力量与支具。手术干预似乎是一种不合适的趋势。结论:需要对年轻患者进行进一步的前瞻性研究,以充分了解是否有高危人群可以从早期手术中获益。证据等级:三级。
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引用次数: 1
FIFA 11+ Kids: Challenges in implementing a prevention program. 《FIFA 11+儿童》:实施预防计划的挑战。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/18632521221149057
Méline Franchina, Marco Turati, Stéphane Tercier, Barbara Kwiatkowski

Purpose: Soccer is a popular sport among children and adolescents that exposes to a high risk of injury. Several prevention programs, including the FIFA 11+ Kids program have been developed to decrease this injury rate. The aim of the study was to investigate the knowledge and use of the FIFA 11+ Kids program among soccer coaches of skeletally immature soccer players in a Swiss canton and analyze difficulties of implementing such a prevention program.

Materials & methods: First, an online survey was sent to all soccer coaches involved in Swiss training programs for male players from 7 to 13 years of age. Coaches were identified through existing Swiss coaching networks. A total of 237 coaches completed the survey. Second, the FIFA 11+ Kids program was implemented in three soccer teams (players from 7 to 13 years of age) during 6 months in the same canton. Utilization of FIFA 11+ Kids program and compliance of coaches were recorded by the research staff.

Results: Around 84% of the included coaches in the survey were certified. Of those, 59% had been taught injury prevention during their course(s). Only 14% of the included coaches knew one of the FIFA programs (11, 11+, 11+ Kids), of those, about one-third (10 out of 237) used the FIFA 11+ Kids program. After 6 months, none of the soccer coaches applied the entire FIFA 11+ Kids program twice a week. One coach had completely abandoned the program. The main reasons for their disapproval were the time and surveillance needed and the players' lack of motivation. They stated, however, that the exercises were good if used occasionally.

Conclusion: Injury prevention should be integrated in every soccer coach education courses. An adaptation of the FIFA 11+ Kids program should be considered, especially for the youngest players.

目的:足球在儿童和青少年中是一项受欢迎的运动,暴露出很高的受伤风险。包括FIFA 11+儿童项目在内的几个预防项目已经开发出来,以降低这种伤害率。本研究的目的是调查瑞士一个州的足球教练对FIFA 11+儿童计划的了解和使用情况,并分析实施这种预防计划的困难。材料与方法:首先,向参与瑞士7 - 13岁男性球员培训项目的所有足球教练发送了一份在线调查。教练是通过现有的瑞士教练网络确定的。共有237名教练完成了调查。第二,在同一州的三个足球队(球员年龄从7岁到13岁)进行了为期6个月的国际足联11+儿童项目。研究人员记录了FIFA 11+ Kids项目的使用情况和教练员的依从性。结果:调查中约84%的教练获得了认证。其中,59%的人在他们的课程中学习了伤害预防。在被调查的教练中,只有14%的人知道FIFA的一个项目(11,11 +,11+ Kids),其中约三分之一(237名教练中有10名)使用了FIFA 11+ Kids项目。6个月后,没有一个足球教练每周两次应用整个《FIFA 11+ Kids》项目。一位教练完全放弃了这个项目。他们不赞成的主要原因是需要时间和监视,以及球员缺乏动力。然而,他们表示,如果偶尔使用这些练习是有益的。结论:损伤预防应纳入足球教练员教育课程。应该考虑改编FIFA 11+ Kids项目,特别是针对最年轻的球员。
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引用次数: 3
Clinical considerations of anatomy and magnetic resonance imaging in pediatric meniscus tear, with imaging-based treatment options. 解剖和磁共振成像在儿童半月板撕裂中的临床应用,以及基于成像的治疗选择。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/18632521231152270
Joao Cabral, Jaakko Sinikumpu

Background: The incidence of meniscal tears in children has been increasing. Early sport specialization, more intense training activity, and increasing participation in competitive sports may have affected to that increasing trend. Diagnosing acute menisci tear in children is based on suggestive clinical and magnetic resonance imaging findings. There are special particulars in immature menisci, due to relatively good vascular supply. Furthermore, growing skeleton makes differences in injury pattern, and a clinician needs to recognize not only meniscus but also potential injuries in growth plates and ligaments, which are usual in connection with pediatric meniscus leasion. Clinical and imaging investigation prior to treatment is crucial, because non-operative care is considerable, to achieve spontaneous healing, especially in peripherial tears of younger children. Second, repair is preferred always as possible, in spite of resection due to high rate of long-term sequelae after partial meniscectomy. High standard preoperative imaging aid in preparing to the meniscus sparing arthroscopic intervention.

Methods: In this current concept article, the clinical considerations of imaging the injured pediatric knee with a suspected meniscus tear and the treatment options by the imaging findings are reviewed.

Level of evidence: level III.

背景:儿童半月板撕裂的发生率一直在上升。早期的体育专业化、更激烈的训练活动以及越来越多的人参与竞技体育可能对这种增长趋势产生了影响。诊断急性半月板撕裂在儿童是基于暗示性的临床和磁共振成像结果。未成熟半月板由于相对良好的血管供应而有特殊的特点。此外,骨骼的生长导致损伤模式的不同,临床医生不仅需要识别半月板,还需要识别生长板和韧带的潜在损伤,这通常与儿童半月板病变有关。治疗前的临床和影像学检查是至关重要的,因为非手术治疗是相当重要的,以实现自发愈合,特别是在年幼的儿童外周撕裂。其次,由于半月板部分切除术后的长期后遗症发生率高,尽管切除,但尽可能首选修复。术前高标准影像学检查有助于半月板保留关节镜介入手术的准备。方法:在这篇最新的概念文章中,对怀疑半月板撕裂的儿童膝关节损伤影像学检查的临床考虑和影像学检查结果的治疗选择进行综述。证据等级:三级。
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引用次数: 2
Pediatric anterior cruciate ligament tears and associated lesions: Epidemiology, diagnostic process, and imaging. 儿科前交叉韧带撕裂和相关病变:流行病学、诊断过程和影像学。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/18632521231153277
Julio Duart, Luca Rigamonti, Marco Bigoni, Mininder S Kocher
The incidence of anterior cruciate ligament injuries in skeletally immature patients has increased in recent years. The gold standard treatment of this type of trauma in children is not yet established. Conservative management may underestimate the risk of new meniscal and chondral tears; on the other hand, a more interventional approach may expose the patient to iatrogenic damage to the growth plate. A correct approach to the skeletally immature patient with knee trauma is therefore essential to guide the decision-making process. This review article aims to present an update on the epidemiology and diagnostic process of pediatric patients with anterior cruciate ligament tears and possible associated injuries. Level of Evidence: V.
近年来,骨未成熟患者前交叉韧带损伤的发生率有所增加。儿童这类创伤的黄金标准治疗尚未建立。保守治疗可能低估了新半月板和软骨撕裂的风险;另一方面,介入性更强的方法可能使患者暴露于医源性生长板损伤。因此,对骨骼发育不成熟的膝关节创伤患者的正确治疗方法对于指导决策过程至关重要。这篇综述文章的目的是介绍最新的流行病学和诊断过程的儿科患者前交叉韧带撕裂和可能的相关损伤。证据等级:V。
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引用次数: 3
Pediatric meniscal injuries: Current concepts. 儿童半月板损伤:当前概念。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/18632521221149056
Ajay Asokan, Anouska Ayub, Manoj Ramachandran

Meniscal pathology is widely prevalent in the adult population, secondary to acute trauma and chronic degeneration. It is less commonly seen in children, although its incidence is rising. The true prevalence in children remains unknown, as pathologies such as discoid menisci often go undiagnosed, or are found only incidentally. The rising incidence can be attributed to increased participation in sports at younger ages, both in intensity and frequency, with potentially year-round competition. Meniscal tears lead to pain and mechanical symptoms in the short to medium term, but more significantly, have been shown to lead to compartmental chondral degeneration and early arthritis in the long term. With advancing arthroscopic techniques, and children's propensity for better healing, osteoarthritis secondary to meniscal pathology is a potentially preventable problem. This article discusses meniscal injuries in children and adolescents and their management.

半月板病理在成年人中广泛流行,继发于急性创伤和慢性变性。虽然发病率在上升,但在儿童中不太常见。由于诸如盘状半月板之类的病理常常未被诊断,或者只是偶然发现,儿童中真正的患病率仍然未知。发病率的上升可归因于越来越多的年轻人参加体育运动,无论是强度还是频率,都可能是全年的比赛。半月板撕裂在中短期内会导致疼痛和机械症状,但更重要的是,长期来看会导致室状软骨变性和早期关节炎。随着关节镜技术的进步,以及儿童更好的愈合倾向,继发于半月板病理的骨关节炎是一个潜在的可预防的问题。本文讨论了儿童和青少年半月板损伤及其处理。
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引用次数: 3
Failure of isolated medial patellofemoral ligament reconstruction in children: Risk factors and management. 儿童孤立髌股内侧韧带重建失败:危险因素和处理。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/18632521221149055
Franck Accadbled, Aude Kerdoncuff, Sofia Hidalgo Perea, Daniel W Green

Background: Patellofemoral instability is a frequent cause of referral in pediatric sports medicine. Isolated medial patellofemoral ligament reconstruction is widely used and provides satisfactory outcomes with a low failure rate. Given the success of this surgical technique, the literature on medial patellofemoral ligament reconstruction failures in the pediatric population is limited. Moreover, given the multifactorial nature of patellofemoral instability, the heterogeneity of the current literature, and the paucity of pediatric studies, medial patellofemoral ligament reconstruction failures are often difficult to analyze.

Methods: The purpose of this study was to retrospectively review the associated risk factors, surgical management, and the clinical outcomes at 2-year follow-up of skeletally immature patients that presented to our clinic with a failed medial patellofemoral ligament reconstruction.

Results: Of the 181 cases in 155 patients included in this study, treatment failed in 12 (7%). All 12 patients presented with at least one risk factor for patellofemoral instability, the most common being trochlear dysplasia and a high-grade J sign.

Conclusions: We conclude that isolated medial patellofemoral ligament reconstruction for patellofemoral instability in children has a low failure rate. Clinicians must assess pre-operative risk factors before surgical treatment is considered. A high-grade J sign and high-grade trochlear dysplasia were associated with medial patellofemoral ligament reconstruction failure in this cohort. Tailoring treatment to patients' associated risk factors selection may improve outcomes.

背景:髌股不稳是儿童运动医学转诊的常见原因。髌股内侧韧带置换术应用广泛,失败率低,效果满意。鉴于这种手术技术的成功,关于内侧髌股韧带重建在儿科人群中的失败的文献是有限的。此外,考虑到髌股不稳定的多因素性质、现有文献的异质性以及儿科研究的缺乏,内侧髌股韧带重建失败通常难以分析。方法:本研究的目的是回顾性回顾相关的危险因素,手术处理和2年随访的骨骼不成熟患者髌股韧带内侧重建失败的临床结果。结果:在本研究纳入的155例患者的181例中,12例(7%)治疗失败。所有12例患者均表现出至少一种髌股不稳定的危险因素,最常见的是滑车发育不良和高度J征。结论:单纯髌股内侧韧带重建治疗儿童髌股不稳的失败率低。临床医生必须在考虑手术治疗前评估术前危险因素。在这个队列中,高度J征和高度滑车发育不良与内侧髌股韧带重建失败相关。根据患者相关的风险因素选择量身定制治疗可能会改善结果。
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引用次数: 1
Surgical techniques in the management of pediatric anterior cruciate ligament tears: Current concepts. 治疗小儿前交叉韧带撕裂的外科技术:目前的概念。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/18632521221149059
Chun Tang, Tariq Adam Kwaees, Franck Accadbled, Marco Turati, Daniel W Green, Nicolas Nicolaou

Background: Anterior cruciate ligament injury in the child and adolescent patient remains a controversial topic when considering management, especially regarding surgical choices. Treatment variations are seen not just when comparing different countries but also within nations. This arises partly as contemporary treatment is mostly inferred from the adult population who physiologically and in terms of outcomes differ significantly from children. There is an increasing body of evidence for this cohort of patients who have specific challenges and difficulties when determining the optimum treatment.

Methods: Within this article, we will summarize the current evidence for surgical management of anterior cruciate ligament injury for the pediatric patient.

Results and conclusions: There remain many controversies and gaps inthe treatment of Paediatric Anterior cruciate ligament reconstruction and this high risk cohort continues to cause difficulty in identifying the best mode of surgical management.

Level of evidence: level IV.

背景:儿童和青少年前交叉韧带损伤患者在考虑治疗时仍然是一个有争议的话题,特别是在手术选择方面。治疗差异不仅在比较不同国家时可见,而且在国家内部也可见。这在一定程度上是因为当代治疗大多是根据成年人进行的,他们在生理上和结果上都与儿童有很大不同。越来越多的证据表明,这组患者在确定最佳治疗方案时面临着特定的挑战和困难。方法:在这篇文章中,我们将总结目前的证据,手术治疗前交叉韧带损伤的儿童患者。结果和结论:在小儿前交叉韧带重建的治疗中仍存在许多争议和差距,这一高风险人群继续导致难以确定最佳手术治疗模式。证据等级:四级。
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引用次数: 0
期刊
Journal of Childrens Orthopaedics
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