Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Orhopaedics, Institute of Clinical Sciences at Sahlgrenska Acadamy, University of Gothenburg, Gothenburg, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2018 Jul;26(7):2011-2020. doi: 10.1007/s00167-017-4606-7. Epub 2017 Jun 21.
The relationship between the duration of operative time (DOT), healing response and patient outcome has not been previously investigated. An enhanced healing response related to DOT may potentiate repair processes, especially in hypovascular and sparsely metabolized musculoskeletal tissues such as tendons. This study aimed to investigate the association between DOT and the metabolic healing response, patient-reported outcome and the rate of post-operative complications after acute Achilles tendon injury.
Observational cohort, cross-sectional study with observers blinded to patient grouping. A total of two-hundred and fifty-six prospectively randomized patients (210 men, 46 women; mean age 41 years) with an acute total Achilles tendon rupture all operated on with uniform anaesthetic and surgical technique were retrospectively assessed. At 2 weeks post-operatively, six metabolites were quantified using microdialysis. At 3, 6 and 12 months, patient-reported pain, walking ability and physical activity were examined using self-reported questionnaires, Achilles tendon total rupture score, foot and ankle outcome score and physical activity scale. At 12 months, functional outcome was assessed using the heel-rise test. Complications, such as deep venous thrombosis, infections and re-operations, were recorded throughout the study.
Patients who underwent longer DOT exhibited higher levels of glutamate (p = 0.026) and glycerol (p = 0.023) at 2 weeks. At the 1-year follow-up, longer DOT was associated with significantly less loss in physical activity (p = 0.003), less pain (p = 0.009), less walking limitations (p = 0.022) and better functional outcome (p = 0.014). DOT did not significantly correlate with the rate of adverse events, such as deep venous thrombosis, infections or re-ruptures. Higher glutamate levels were associated with less loss in physical activity (p = 0.017). All correlations were confirmed by multiple linear regressions taking confounding factors into consideration.
The results from this study suggest a previously unknown mechanism, increased metabolic response associated with longer DOT, which may improve patient outcome after Achilles tendon rupture surgery. Allowing for a higher amount of traumatized tissue, as reflected by up-regulation of glycerol in patients with longer DOT, may prove to be an important surgical tip for stimulation of repair of hypometabolic soft tissue injuries, such as Achilles tendon ruptures.
II.
手术时间（DOT）、愈合反应和患者预后之间的关系尚未得到研究。与 DOT 相关的增强愈合反应可能增强修复过程，尤其是在血管较少和新陈代谢较低的肌肉骨骼组织（如肌腱）中。本研究旨在探讨 DOT 与代谢愈合反应、患者报告的结果以及急性跟腱损伤后术后并发症的发生率之间的关系。
前瞻性队列，观察者对患者分组进行盲法的横断面研究。共有 256 名前瞻性随机患者（210 名男性，46 名女性；平均年龄 41 岁），所有患者均因急性完全跟腱断裂接受相同的麻醉和手术技术进行手术。术后 2 周，使用微透析定量分析 6 种代谢物。术后 3、6 和 12 个月，使用自我报告问卷、跟腱总断裂评分、足踝结果评分和体力活动量表评估患者报告的疼痛、行走能力和体力活动。术后 12 个月，使用脚跟抬高试验评估功能结果。整个研究过程中记录了深静脉血栓形成、感染和再次手术等并发症。
DOT 较长的患者在术后 2 周时谷氨酸（p=0.026）和甘油（p=0.023）水平更高。在 1 年随访时，DOT 较长与明显较少的体力活动丧失（p=0.003）、较少的疼痛（p=0.009）、较少的行走受限（p=0.022）和更好的功能结果（p=0.014）相关。DOT 与深静脉血栓形成、感染或再断裂等不良事件的发生率无显著相关性。谷氨酸水平升高与体力活动丧失减少相关（p=0.017）。所有相关性均通过考虑混杂因素的多元线性回归得到确认。
本研究结果表明，存在一种以前未知的机制，即与 DOT 较长相关的代谢反应增强，这可能改善跟腱断裂手术后患者的预后。DOT 较长的患者中甘油上调反映出允许更多的创伤组织，这可能成为刺激低代谢软组织损伤（如跟腱断裂）修复的重要手术技巧。
II。
