Patel Shaun P, Anthony Shawn G, Zurakowski David, Didolkar Manjiri M, Kim Peter S, Wu Jim S, Kung Justin W, Dolan Martin, Rozental Tamara D
Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts.
Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts.
J Hand Surg Am. 2014 Aug;39(8):1471-9. doi: 10.1016/j.jhsa.2014.05.022. Epub 2014 Jul 2.
To evaluate the intra- and interobserver reliability of a scoring system for distal radius fracture union based on specific radiographic parameters obtainable from x-rays.
Two sets of 35 anteroposterior and lateral x-rays were obtained by retrospective review of consecutive patients with distal radius fractures (AO types A and C) treated by a single surgeon in 2009. One set was assembled for those patients treated nonsurgically and 1 set for those treated with open reduction and internal fixation (ORIF) with volar plating. Radius union scoring system (RUSS) scores were compiled from a 5-person review panel consisting of hand surgeons and musculoskeletal radiologists. Union of each of the 4 cortices was graded on a 3-point scale (0, fracture line visible with no callus; 1, callus formation but fracture line present; 2, cortical bridging without clear fracture line). Reviewers also recorded their overall impression of fracture union (united or not united). Each set of radiographs was reviewed twice by the 5 reviewers, 2 weeks apart. Inter- and intraobserver reliability were determined using intraclass correlation coefficients.
For nonsurgically treated fractures, substantial agreement in union scores was found with regard to both intra- and interobserver reliability. For fractures treated with ORIF, substantial agreement was found in union scores with regard to intraobserver reliability and moderate agreement with regard to interobserver reliability. In addition, when using the reviewers' overall assessment of union as a reference standard, RUSS had a statistically significant predictive value in being able to differentiate between united and not united fractures.
This radiographic union tool demonstrated substantial intra- and interobserver reliability for the determination of fracture union in the distal radius. The RUSS is a simple method for a standardized assessment of radiographic union of DRF treated nonsurgically or with ORIF.
TYPE OF STUDY/LEVEL OF EVIDENCE: Economic/decision analysis IV.
基于X线片可获取的特定影像学参数，评估桡骨远端骨折愈合评分系统在观察者内和观察者间的可靠性。
通过回顾性分析2009年由同一位外科医生治疗的连续桡骨远端骨折（AO A型和C型）患者，获得两组共35张前后位和侧位X线片。一组为非手术治疗患者的X线片，另一组为接受掌侧钢板切开复位内固定（ORIF）治疗患者的X线片。桡骨愈合评分系统（RUSS）评分由一个由手外科医生和肌肉骨骼放射科医生组成的5人评审小组编制。对4个皮质的每个愈合情况按3分制进行分级（0分，可见骨折线且无骨痂；1分，有骨痂形成但骨折线仍存在；2分，皮质桥接且无明显骨折线）。评审人员还记录了他们对骨折愈合的总体印象（愈合或未愈合）。每组X线片由5名评审人员分两次进行评审，间隔2周。使用组内相关系数确定观察者间和观察者内的可靠性。
对于非手术治疗的骨折，在观察者内和观察者间的可靠性方面，愈合评分均有高度一致性。对于接受ORIF治疗的骨折，在观察者内可靠性方面愈合评分有高度一致性，在观察者间可靠性方面有中度一致性。此外，以评审人员对愈合的总体评估作为参考标准时，RUSS在区分愈合和未愈合骨折方面具有统计学显著的预测价值。
这种影像学愈合工具在确定桡骨远端骨折愈合方面显示出较高的观察者内和观察者间可靠性。RUSS是一种简单的方法，用于对非手术治疗或ORIF治疗的DRF的影像学愈合进行标准化评估。
研究类型/证据水平：经济/决策分析IV级。
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