基于多准则决策模型评价缝合锚钉修复三角韧带Ⅲ度损伤在踝关节骨折切开复位内固定中的效益-风险

Evaluation of the benefit-risk of suture anchor repair of triangular ligament injury in open reduction and internal fixation of ankle fracture based on multi-criteria decision model

目的基于多准则决策模型评价缝合锚钉修复三角韧带Ⅲ度损伤在踝关节骨折切开复位内固定(open reduction and internal fixation,ORIF)中的效益-风险。方法选取2020年7月至2022年7月,在我院手术治疗的120例踝关节骨折合并三角韧带Ⅲ度损伤患者,缝合锚钉修复联合ORIF治疗的60例作为观察组,单纯ORIF治疗的60例患者作为对照组。比较两组患者的临床资料,建立多准则决策模型并评价其稳定性。结果观察组住院时间、骨折愈合时间、总有效率、术后并发症发生率分别为(15.72±2.28)天、(11.39±2.46)周、96.67%(58/60)和6.67%(4/60),对照组分别为(18.65±2.38)天、(13.62±2.74)周、75.00%(45/60)和21.67%(13/60),两组差异有统计学意义(P<0.05)。观察组内踝间隙、距骨倾斜角、视觉模拟评分(visual analog score,VAS)、美国矫形外科足踝协会(American Orthopedic Foot and Ankle Association,AOFAS)评分、β胶原降解产物(β-isomerized C-telopeptide,β-CTX)、骨钙素(bone glaprotein,BGP)、骨碱性磷酸酶(bone alkaline phosphatase,BALP)治疗前分别为(6.89±1.21)mm、(12.69±3.08)°、(6.72±1.59)分、(56.85±8.14)分、(0.88±0.25)μg/L、(3.46±1.01)μg/L、(79.49±9.52)U/L;治疗后分别为(2.12±0.95)mm、(4.36±1.11)°、(1.08±0.25)分、(85.96±9.28)分、(0.29±0.14)μg/L、(7.50±1.39)μg/L、(140.82±15.79)U/L。对照组内踝间隙、距骨倾斜角、VAS评分、AOFAS评分、β-CTX、BGP、BALP治疗前分别为(6.82±1.18)mm、(12.54±3.21)°、(6.65±1.64)分、(57.42±7.67)分、(0.85±0.21)μg/L、(3.61±0.92)μg/L、(80.73±10.64)U/L;治疗后分别为(3.72±1.03)mm、(5.72±1.39)°、(2.31±0.32)分、(78.36±9.06)分、(0.51±0.18)μg/L、(6.11±1.28)μg/L、(109.25±13.61)U/L。两组治疗前的内踝间隙、距骨倾斜角、VAS评分、AOFAS评分、β-CTX、BGP、BALP差异无统计学意义(P>0.05);两组治疗后上述指标较治疗前明显改善,差异有统计学意义(P<0.05),且观察组各项指标的改善效果较对照组显著,差异有统计学意义(P<0.05)。对照组和观察组的效益值分别为63、77,风险值分别为29、55,效益-风险值分别为46、66,模型的稳定性较好。结论缝合锚钉修复三角韧带Ⅲ度损伤在ORIF治疗踝关节骨折中的应用能够明显提高临床效益,降低术后并发症风险。

Objective To evaluate the benefit-risk of suture anchor to repair the third degree injury of the triangular ligament in the open reduction and internal fixation(ORIF)of ankle fracture for repairing based on the multi-criteria decision model.Methods From July 2020 to July 2022,120 patients with ankle fracture complicated with triangular ligament injury were treated in our hospital,60 patients were treated with suture and anchor repair combined with ORIF as the observation group,and 60 patients treated with ORIF alone as the control group.The clinical data of the two groups were compared,a multi-criteria decision-making model was established,and its stability was evaluated.Results The length of stay,fracture healing time,total effective rate and incidence of postoperative complications in the observation group were(15.72±2.28)d,(11.39±2.46)weeks,96.67%(58/60)and 6.67%(4/60),respectively,while those in the control group were(18.65±2.38)d,(13.62±2.74)weeks,75.00%(45/60)and 21.67%(13/60),respectively;there were significant differences between the two groups(P<0.05).Internal ankle space,talus inclination angle,visual analogue score(VAS),American Association of Orthopedic Foot and Ankle(AOFAS)scoreβCollagen degradation products(β-CTX),BGP,and BALP before treatment in the observation group were(6.89±1.21)mm,(12.69±3.08)°,(6.72±1.59),(56.85±8.14),(0.88±0.25)μg/L,(3.46±1.01)μg/L and(79.49±9.52)U/L,respectively.After the treatment,the indicators above were(2.12±0.95)mm,(4.36±1.11)°,(1.08±0.25),(85.96±9.28),(0.29±0.14)μg/L,(7.50±1.39)μg/L and(140.82±15.79)U/L,respectively.In the control group,the medial malleolus space,talus tilt angle,VAS score,AOFAS score,β-CTX,BGP and BALP before treatment were(6.82±1.18)mm,(12.54±3.21)°,(6.65±1.64),(57.42±7.67),(0.85±0.21)μg/L,(3.61±0.92)μg/L and(80.73±10.64)U/L,respectively.After treatment,the indicators above were(3.72±1.03)mm,(5.72±1.39)°,(2.31±0.32),(78.36±9.06),(0.51±0.18)μg/L,(6.11±1.28)μg/L and(109.25±13.61)U/L,respectively There was no significant difference in medial malleolus space,talus tilt angle,VAS score,AOFAS score,β-CTX,BGP and BALP between the two groups before treatment(P>0.05).After the treatment,the indexes of the two groups mentioned above were significantly improved as compared with those before treatment(P<0.05),and the improvement effect of each index in the observation group was significantly better than that in the control group(P<0.05).The benefit values of the control group and the observation group were 63 and 77,the risk values were 29 and 55,and the benefit-risk values were 46 and 66,respectively.The stability of the model was good.Conclusions The application of suture anchor to repair the third degree injury of triangular ligament can significantly improve the clinical benefit and reduce the risk of postoperative complications in the treatment of ankle fracture with ORIF.