2020年 · 第100卷第29期

To evaluate the effect of open reduction and internal fixation (ORIF) through an extended lateral incision in the treatment of delayed intra-articular calcaneal fractures, the data of 20 cases diagnosed and treated in the Department of Trauma and Orthopaedics of Harborview Medical Center who underwent open reduction and internal fixation (ORIF) for the treatment of displaced intra-articular calcaneal fractures 25 days after surgery were retrospectively analyzed. Calcaneal fracture types included OTA/AO 82-B and 82-C. All 20 patients underwent ORIF through lateral extended incision approach. The evaluation indexes included: Bohler angle measured by X-ray before, after and at the last follow-up and compared with the healthy side; Functional outcomes were assessed by musculoskeletal function (MFA). The results showed that the time from trauma to ORIF was 33.4 days (26-58 days) in the 20 patients enrolled. Eighteen (90%) patients obtained a mean follow-up of 26.1 (12.5 to 100) months. Among the follow-up patients, 11 had calcaneal articular surface collapse (OTA/AO 82-C) and 7 had tongue fracture (OTA/AO 82-B). The reasons for delayed visits included late transfer (11), post-injury hemodynamic instability due to polytrauma (2), excessive limb swelling after fracture (2) and sepsis (1). The average Bohler angle was 10.9° after trauma of the affected limb, 33.3° after correction, and decreased to 28.1° at the final follow-up. The Bohler angle of the contralateral limb averaged 32.3°. The mean MFA of the affected limb was 16.5 (1-34). There were no cases of wound infection and requiring subdistance arthrodesis during follow-up.

Reduced muscle mass in the lower limbs of diabetic peripheral neuropathy (DPN) has been suggested to contribute to increased joint load, altered stability, and disability, but the mechanism underlying it has not been understood. It may be due to muscle fiber volume reduction (muscle atrophy), muscle fiber destruction (degeneration) or both. Degenerative lesions require the involvement of muscle stem cells (satellite cells) to regenerate muscle fibers and reshape muscle mass. Determining the degenerative stage and residual regenerative capacity of diabetic peripheral neuropathy muscles will affect the utility of therapeutic strategies targeting regeneration. In this study, living muscle tissue was obtained from 12 individuals with or without diabetic neuropathy undergoing underknee amputation surgery, and further histological, transcriptional expression profiling and satellite cells were isolated and cultured. Histological analysis showed progressive muscle degeneration and regeneration in patients with diabetic peripheral neuropathy. Transcriptional expression profiling supports these findings, suggesting significant upregulation of regeneration-related pathways. However, in the samples exhibiting the most severe pathological structure, only very small amounts of immature regenerative muscle fibers were found, and the growth was limited. Immunostaining of satellite cells indicated a significant reduction in the relative number of satellite cells only in the pathologically severe subgroup. Similarly, reduced fusion of satellite cells cultured in this group indicates impaired regenerative capacity in severe diabetic peripheral neuropathy.