{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T18:15:50Z","timestamp":1773944150292,"version":"3.50.1"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,11,25]],"date-time":"2021-11-25T00:00:00Z","timestamp":1637798400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,25]],"date-time":"2021-11-25T00:00:00Z","timestamp":1637798400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University","award":["ZYJC18029"],"award-info":[{"award-number":["ZYJC18029"]}]},{"name":"Sichuan Province Science and Technology Support Program of China","award":["2020YFS0077"],"award-info":[{"award-number":["2020YFS0077"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Surg Res"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Heterotopic ossification (HO) is a common complication after cervical disc replacement (CDR). Biomechanical factors including endplate coverage and intervertebral disc height change may be related to HO formation. However, there is a dearth of quantitative analysis for endplate coverage, intervertebral height change and their combined effects on HO.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Patients who underwent single-level or two-level CDR with Prestige-LP were retrospectively reviewed. Clinical outcomes were evaluated through Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, and visual analogue scale (VAS) score. Radiological data, including the prosthesis-endplate depth ratio, intervertebral height change, posterior heterotopic ossification (PHO) and angular parameters, were collected. Logistic regression analysis was used to identify the potential risk factors. Receiver operating characteristic curves were plotted and the cut-off values of each potential factors were calculated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 138 patients with 174 surgical segments were evaluated. Both the prosthesis-endplate depth ratio (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and post-operative disc height change (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) were predictive factors for PHO formation. The area under the curve (AUC) of the prosthesis-endplate depth ratio, disc height change and their combined effects represented by the combined parameter (CP) were 0.728, 0.712 and 0.793, respectively. The risk of PHO significantly increased when the prosthesis-endplate depth ratio\u2009&lt;\u200993.77% (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001, OR\u2009=\u20096.909, 95% CI 3.521\u201313.557), the intervertebral height change\u2009\u2265\u20091.8\u00a0mm (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001, OR\u2009=\u20095.303, 95% CI 2.592\u201310.849), or the CP representing the combined effect\u2009&lt;\u200984.88 (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001, OR\u2009=\u200910.879, 95% CI 5.142\u201323.019).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Inadequate endplate coverage and excessive change of intervertebral height are both potential risk factors for the PHO after CDR. Endplate coverage less than 93.8% or intervertebral height change more than 1.8\u00a0mm would increase the risk of PHO. The combination of these two factors may exacerbate the non-uniform distribution of stress in the bone-implant interface and promote HO development.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13018-021-02840-5","type":"journal-article","created":{"date-parts":[[2021,11,25]],"date-time":"2021-11-25T11:07:49Z","timestamp":1637838469000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Effects of endplate coverage and intervertebral height change on heterotopic ossification following cervical disc replacement"],"prefix":"10.1186","volume":"16","author":[{"given":"Yi-Wei","family":"Shen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2992-6232","authenticated-orcid":false,"given":"Hao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Rong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chen","family":"Ding","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Meng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bei-Yu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Hong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,11,25]]},"reference":[{"key":"2840_CR1","doi-asserted-by":"publisher","unstructured":"Eck JC, Humphreys SC, Lim TH, Jeong ST, Kim JG, Hodges SD et al. Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine (Phila Pa 1976). 2002;27(22):2431\u20134. https:\/\/doi.org\/10.1097\/00007632-200211150-00003.","DOI":"10.1097\/00007632-200211150-00003"},{"key":"2840_CR2","doi-asserted-by":"publisher","unstructured":"Lavelle WF, Riew KD, Levi AD, Florman JE. Ten-year outcomes of cervical disc replacement with the BRYAN cervical disc: results from a Prospective, randomized, controlled clinical trial. Spine (Phila Pa 1976). 2019;44(9):601\u201308. https:\/\/doi.org\/10.1097\/BRS.0000000000002907.","DOI":"10.1097\/BRS.0000000000002907"},{"key":"2840_CR3","doi-asserted-by":"publisher","unstructured":"Findlay C, Ayis S, Demetriades AK. Total disc replacement versus anterior cervical discectomy and fusion: a systematic review with meta-analysis of data from a total of 3160 patients across 14 randomized controlled trials with both short- and medium- to long-term outcomes. Bone Jt J. 2018;100-B(8):991\u20131001. https:\/\/doi.org\/10.1302\/0301-620X.100B8.BJJ-2018-0120.R1.","DOI":"10.1302\/0301-620X.100B8.BJJ-2018-0120.R1"},{"issue":"2 Suppl","key":"2840_CR4","doi-asserted-by":"publisher","first-page":"61S","DOI":"10.1177\/2192568219898154","volume":"10","author":"JM Parish","year":"2020","unstructured":"Parish JM, Coric D. Cervical arthroplasty: long-term outcomes of FDA IDE trials. Global Spine J. 2020;10(2 Suppl):61S-64S. https:\/\/doi.org\/10.1177\/2192568219898154.","journal-title":"Global Spine J"},{"issue":"3","key":"2840_CR5","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1111\/os.12634","volume":"12","author":"H Guo","year":"2020","unstructured":"Guo H, Sheng J, Sheng WB, Liang WD, Wang J, Xun CH. An eight-year follow-up study on the treatment of single-level cervical spondylosis through intervertebral disc replacement and anterior cervical decompression and fusion. Orthop Surg. 2020;12(3):717\u201326. https:\/\/doi.org\/10.1111\/os.12634.","journal-title":"Orthop Surg"},{"key":"2840_CR6","doi-asserted-by":"publisher","unstructured":"Tian W, Fan M-X, Liu Y-j, Han X, Yan K, Wang H et al. An analysis of paravertebral ossification in cervical artificial disc replacement: a novel classification based on computed tomography. Orthop Surg. 2016;8(4):440\u201346. https:\/\/doi.org\/10.1111\/os.12286.","DOI":"10.1111\/os.12286"},{"key":"2840_CR7","doi-asserted-by":"publisher","unstructured":"Zhou F, Ju KL, Zhao Y, Zhang F, Pan S, Heller JG et al. Progressive bone formation after cervical disc replacement: minimum of 5-year follow-up. Spine (Phila Pa 1976). 2018;43(3):E163\u201370. https:\/\/doi.org\/10.1097\/BRS.0000000000002264.","DOI":"10.1097\/BRS.0000000000002264"},{"issue":"2","key":"2840_CR8","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/j.spinee.2020.09.005","volume":"21","author":"S Virk","year":"2021","unstructured":"Virk S, Phillips F, Khan S, Qureshi S. A cross-sectional analysis of 1347 complications for cervical disc replacements from medical device reports maintained by the United States Food and Drug Administration. Spine J. 2021;21(2):265\u201372. https:\/\/doi.org\/10.1016\/j.spinee.2020.09.005.","journal-title":"Spine J"},{"key":"2840_CR9","doi-asserted-by":"publisher","unstructured":"Nunley PD, Cavanaugh DA, Kerr EJ, 3rd, Utter PA, Campbell PG, Frank KA et al. Heterotopic ossification after cervical total disc replacement at 7 years-prevalence, progression, clinical implications, and risk factors. Int J Spine Surg 2018;12(3):352\u201361. https:\/\/doi.org\/10.14444\/5041.","DOI":"10.14444\/5041"},{"issue":"3","key":"2840_CR10","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1093\/neuros\/nyaa459","volume":"88","author":"K Kim","year":"2021","unstructured":"Kim K, Hoffman G, Bae H, Redmond A, Hisey M, Nunley P, et al. Ten-year outcomes of 1- and 2-level cervical disc arthroplasty from the Mobi-C investigational device exemption clinical trial. Neurosurgery. 2021;88(3):497\u2013505. https:\/\/doi.org\/10.1093\/neuros\/nyaa459.","journal-title":"Neurosurgery"},{"key":"2840_CR11","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyab298","author":"H Wang","year":"2021","unstructured":"Wang H, Wang X, Liu H, Meng Y, Guo Y, Hong Y. Risk factors for high-grade heterotopic ossification after total disc replacement: a single-center experience of 394 cases. Neurosurgery. 2021. https:\/\/doi.org\/10.1093\/neuros\/nyab298.","journal-title":"Neurosurgery"},{"issue":"6","key":"2840_CR12","doi-asserted-by":"publisher","first-page":"601","DOI":"10.3171\/2012.3.SPINE11436","volume":"16","author":"TH Tu","year":"2012","unstructured":"Tu TH, Wu JC, Huang WC, Wu CL, Ko CC, Cheng H. The effects of carpentry on heterotopic ossification and mobility in cervical arthroplasty: determination by computed tomography with a minimum 2-year follow-up: clinical article. J Neurosurg Spine. 2012;16(6):601\u20139. https:\/\/doi.org\/10.3171\/2012.3.SPINE11436.","journal-title":"J Neurosurg Spine"},{"issue":"5","key":"2840_CR13","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1007\/s10237-015-0752-3","volume":"15","author":"D Ganbat","year":"2016","unstructured":"Ganbat D, Kim YH, Kim K, Jin YJ, Park WM. Effect of mechanical loading on heterotopic ossification in cervical total disc replacement: a three-dimensional finite element analysis. Biomech Model Mechanobiol. 2016;15(5):1191\u20139. https:\/\/doi.org\/10.1007\/s10237-015-0752-3.","journal-title":"Biomech Model Mechanobiol"},{"key":"2840_CR14","doi-asserted-by":"publisher","unstructured":"Hui N, Phan K, Kerferd J, Lee M, Mobbs RJ. Cervical total disc replacement and heterotopic ossification: a review of literature outcomes and biomechanics. Asian Spine J. 2021;15(1):127\u201337. https:\/\/doi.org\/10.31616\/asj.2019.0234.","DOI":"10.31616\/asj.2019.0234"},{"key":"2840_CR15","doi-asserted-by":"publisher","unstructured":"Zeng J, Liu H, Chen H, Rong X, Meng Y, Yang Y et al. Effect of prosthesis width and depth on heterotopic ossification after cervical disc arthroplasty. Spine (Phila Pa 1976). 2019;44(9):624\u201328. https:\/\/doi.org\/10.1097\/BRS.0000000000002915.","DOI":"10.1097\/BRS.0000000000002915"},{"issue":"6","key":"2840_CR16","doi-asserted-by":"publisher","first-page":"E241","DOI":"10.1097\/bsd.0000000000000943","volume":"33","author":"Q Guo","year":"2020","unstructured":"Guo Q, Fang Z, Guan H, Xiong W, Li F. The effect of footprint mismatch on heterotopic ossification after cervical disk replacement. Clin Spine Surg. 2020;33(6):E241\u201350. https:\/\/doi.org\/10.1097\/bsd.0000000000000943.","journal-title":"Clin Spine Surg"},{"key":"2840_CR17","doi-asserted-by":"publisher","unstructured":"Xu S, Ou Y, Du X, He B, Li Y, Yu H. Heterotopic ossification after prestige-LP cervical disc arthroplasty is related to insufficient sagittal coverage of the endplate by the prosthesis. Med Sci Monit. 2021;27:e929890. https:\/\/doi.org\/10.12659\/MSM.929890.","DOI":"10.12659\/MSM.929890"},{"issue":"6","key":"2840_CR18","doi-asserted-by":"publisher","first-page":"E309","DOI":"10.1097\/bsd.0000000000000054","volume":"29","author":"KS Kim","year":"2016","unstructured":"Kim KS, Heo DH. Do postoperative biomechanical changes induce heterotopic ossification after cervical arthroplasty? A 5-year follow-up study. Clin Spine Surg. 2016;29(6):E309\u201313. https:\/\/doi.org\/10.1097\/bsd.0000000000000054.","journal-title":"Clin Spine Surg"},{"key":"2840_CR19","doi-asserted-by":"publisher","first-page":"e490","DOI":"10.1016\/j.wneu.2018.02.062","volume":"113","author":"W Yuan","year":"2018","unstructured":"Yuan W, Zhang H, Zhou X, Wu W, Zhu Y. The influence of artificial cervical disc prosthesis height on the cervical biomechanics: a finite element study. World Neurosurg. 2018;113:e490\u20138. https:\/\/doi.org\/10.1016\/j.wneu.2018.02.062.","journal-title":"World Neurosurg"},{"key":"2840_CR20","doi-asserted-by":"publisher","unstructured":"Yang MMH, Ryu WHA, Casha S, DuPlessis S, Jacobs WB, Hurlbert RJ. Heterotopic ossification and radiographic adjacent-segment disease after cervical disc arthroplasty. J Neurosurg Spine. 2019:1\u201310. https:\/\/doi.org\/10.3171\/2019.5.Spine19257.","DOI":"10.3171\/2019.5.Spine19257"},{"key":"2840_CR21","doi-asserted-by":"publisher","first-page":"E100","DOI":"10.1016\/j.wneu.2020.09.134","volume":"145","author":"XF Wang","year":"2021","unstructured":"Wang XF, Liu H, Meng Y, Hong Y, Wang BY, Ding C, et al. Effect of disc height and degree of distraction on heterotopic ossification after cervical disc replacement. World Neurosurg. 2021;145:E100\u20137. https:\/\/doi.org\/10.1016\/j.wneu.2020.09.134.","journal-title":"World Neurosurg"},{"key":"2840_CR22","doi-asserted-by":"publisher","unstructured":"Zhou F, Li S, Zhao Y, Zhang Y, Ju KL, Zhang F et al. Quantitative analysis of the correlation between preoperative cervical degeneration and postoperative heterotopic ossification after cervical disc replacement: minimum 10-year follow-up data. J Neurosurg Spine. 2020:1\u20136. https:\/\/doi.org\/10.3171\/2020.4.SPINE191303.","DOI":"10.3171\/2020.4.SPINE191303"},{"issue":"2","key":"2840_CR23","doi-asserted-by":"publisher","first-page":"123","DOI":"10.3171\/2018.1.SPINE171018","volume":"29","author":"DC Kieser","year":"2018","unstructured":"Kieser DC, Cawley DT, Fujishiro T, Mazas S, Boissiere L, Obeid I, et al. Risk factors for anterior bone loss in cervical disc arthroplasty. J Neurosurg Spine. 2018;29(2):123\u20139. https:\/\/doi.org\/10.3171\/2018.1.SPINE171018.","journal-title":"J Neurosurg Spine"},{"issue":"3","key":"2840_CR24","doi-asserted-by":"publisher","first-page":"E179","DOI":"10.1097\/bsd.0000000000000044","volume":"30","author":"W Tian","year":"2017","unstructured":"Tian W, Han X, Liu B, He D, Lv Y, Yue J. Generation and development of paravertebral ossification in cervical artificial disk replacement: a detailed analytic report using coronal reconstruction CT. Clin Spine Surg. 2017;30(3):E179\u201388. https:\/\/doi.org\/10.1097\/bsd.0000000000000044.","journal-title":"Clin Spine Surg"},{"key":"2840_CR25","doi-asserted-by":"publisher","unstructured":"Cho HJ, Shin MH, Huh JW, Ryu KS, Park CK. Heterotopic ossification following cervical total disc replacement: iatrogenic or constitutional? Korean J Spine. 2012;9(3):209\u201314. https:\/\/doi.org\/10.14245\/kjs.2012.9.3.209.","DOI":"10.14245\/kjs.2012.9.3.209"},{"issue":"4","key":"2840_CR26","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1016\/j.spinee.2012.11.048","volume":"13","author":"YJ Jin","year":"2013","unstructured":"Jin YJ, Park SB, Kim MJ, Kim KJ, Kim HJ. An analysis of heterotopic ossification in cervical disc arthroplasty: a novel morphologic classification of an ossified mass. Spine J. 2013;13(4):408\u201320. https:\/\/doi.org\/10.1016\/j.spinee.2012.11.048.","journal-title":"Spine J"},{"issue":"11","key":"2840_CR27","doi-asserted-by":"publisher","first-page":"2823","DOI":"10.1007\/s00586-020-06486-5","volume":"29","author":"M Genitiempo","year":"2020","unstructured":"Genitiempo M, Perna A, Santagada DA, Meluzio MC, Proietti L, Bocchi MB, et al. Single-level Bryan cervical disc arthroplasty: evaluation of radiological and clinical outcomes after 18 years of follow-up. Eur Spine J. 2020;29(11):2823\u201330. https:\/\/doi.org\/10.1007\/s00586-020-06486-5.","journal-title":"Eur Spine J"},{"key":"2840_CR28","doi-asserted-by":"publisher","unstructured":"Yang X, Donk R, Bartels R, Arts MP, Depreitere B, Vleggeert-Lankamp CLA. Comparing heterotopic ossification in two cervical disc prostheses. Spine (Phila Pa 1976). 2020;45(19):1329\u201334. https:\/\/doi.org\/10.1097\/BRS.0000000000003537.","DOI":"10.1097\/BRS.0000000000003537"},{"key":"2840_CR29","doi-asserted-by":"publisher","first-page":"2854175","DOI":"10.1155\/2018\/2854175","volume":"2018","author":"Q Yao","year":"2018","unstructured":"Yao Q, Yin P, Khan K, Tsai TY, Li JS, Hai Y, et al. Differences of the morphology of subaxial cervical spine endplates between Chinese and white men and women. Biomed Res Int. 2018;2018:2854175. https:\/\/doi.org\/10.1155\/2018\/2854175.","journal-title":"Biomed Res Int"},{"issue":"4","key":"2840_CR30","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1007\/s00586-012-2594-3","volume":"22","author":"M Thaler","year":"2013","unstructured":"Thaler M, Hartmann S, Gstottner M, Lechner R, Gabl M, Bach C. Footprint mismatch in total cervical disc arthroplasty. Eur Spine J. 2013;22(4):759\u201365. https:\/\/doi.org\/10.1007\/s00586-012-2594-3.","journal-title":"Eur Spine J"},{"key":"2840_CR31","doi-asserted-by":"publisher","unstructured":"Hui N, Phan K, Lee MY, Kerferd J, Singh T, Mobbs RJ. The changes in cervical biomechanics after CTDR and its association with heterotopic ossification: a systematic review and meta-analysis. Glob Spine J. 2020:2192568220922949. https:\/\/doi.org\/10.1177\/2192568220922949.","DOI":"10.1177\/2192568220922949"},{"key":"2840_CR32","doi-asserted-by":"publisher","unstructured":"Lin CY, Kang H, Rouleau JP, Hollister SJ, Marca FL. Stress analysis of the interface between cervical vertebrae end plates and the Bryan, Prestige LP, and ProDisc-C cervical disc prostheses: an in vivo image-based finite element study. Spine (Phila Pa 1976). 2009;34(15):1554\u201360. https:\/\/doi.org\/10.1097\/BRS.0b013e3181aa643b.","DOI":"10.1097\/BRS.0b013e3181aa643b"},{"key":"2840_CR33","doi-asserted-by":"publisher","unstructured":"Mehren C, Wuertz-Kozak K, Sauer D, Hitzl W, Pehlivanoglu T, Heider F. Implant design and the anchoring mechanism influence the incidence of heterotopic ossification in cervical total disc replacement at 2-year follow-up. Spine (Phila Pa 1976). 2019;44(21):1471\u201380. https:\/\/doi.org\/10.1097\/BRS.0000000000003098.","DOI":"10.1097\/BRS.0000000000003098"},{"key":"2840_CR34","doi-asserted-by":"publisher","unstructured":"Cao S, Zhao Y, Sun Y, Li W, Zhou F, Zhang F et al. Single-level cervical arthroplasty with prodisc-C vivo artificial disc: five-year follow-up results from one center. Spine (Phila Pa 1976). 2021. https:\/\/doi.org\/10.1097\/brs.0000000000004119.","DOI":"10.1097\/brs.0000000000004119"},{"issue":"7","key":"2840_CR35","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1016\/j.medengphy.2009.03.010","volume":"31","author":"V Palissery","year":"2009","unstructured":"Palissery V, Mulholland RC, McNally DS. The implications of stress patterns in the vertebral body under axial support of an artificial implant. Med Eng Phys. 2009;31(7):833\u20137. https:\/\/doi.org\/10.1016\/j.medengphy.2009.03.010.","journal-title":"Med Eng Phys"},{"issue":"8","key":"2840_CR36","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1016\/j.spinee.2020.04.017","volume":"20","author":"TY Chen","year":"2020","unstructured":"Chen TY, Chen WH, Tzeng CY, Huang CW, Yang CC, Chen HT, et al. Anterior bone loss after cervical Bryan disc arthroplasty: insight into the biomechanics following total disc replacement. Spine J. 2020;20(8):1211\u20138. https:\/\/doi.org\/10.1016\/j.spinee.2020.04.017.","journal-title":"Spine J"}],"container-title":["Journal of Orthopaedic Surgery and Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-021-02840-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13018-021-02840-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-021-02840-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,25]],"date-time":"2021-11-25T11:15:28Z","timestamp":1637838928000},"score":1,"resource":{"primary":{"URL":"https:\/\/josr-online.biomedcentral.com\/articles\/10.1186\/s13018-021-02840-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,25]]},"references-count":36,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2840"],"URL":"https:\/\/doi.org\/10.1186\/s13018-021-02840-5","relation":{},"ISSN":["1749-799X"],"issn-type":[{"value":"1749-799X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,25]]},"assertion":[{"value":"28 August 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 November 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol was approved by the Medical Ethical Committee of West China Hospital of Sichuan University and was conducted following the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All patients provided signed, informed consent prior to study participation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"693"}}