Leow J M, Clement N D, Tawonsawatruk T, Simpson C J, Simpson A H R W
College of Medicine and Veterinary Medicine, University of Edinburgh, 11 Montague Street, Edinburgh EH8 9QT, UK
Trauma and Orthopaedics, Orthopaedic Department, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Bone Joint Res. 2016 Apr;5(4):116-21. doi: 10.1302/2046-3758.54.2000628.
The radiographic union score for tibial (RUST) fractures was developed by Whelan et al to assess the healing of tibial fractures following intramedullary nailing. In the current study, the repeatability and reliability of the RUST score was evaluated in an independent centre (a) using the original description, (b) after further interpretation of the description of the score, and (c) with the immediate post-operative radiograph available for comparison.
A total of 15 radiographs of tibial shaft fractures treated by intramedullary nailing (IM) were scored by three observers using the RUST system. Following discussion on how the criteria of the RUST system should be implemented, 45 sets (i.e. AP and lateral) of radiographs of IM nailed tibial fractures were scored by five observers. Finally, these 45 sets of radiographs were rescored with the baseline post-operative radiograph available for comparison.
The initial intraclass correlation (ICC) on the first 15 sets of radiographs was 0.67 (95% CI 0.63 to 0.71). However, the original description was being interpreted in different ways. After agreeing on the interpretation, the ICC on the second cohort improved to 0.75. The ICC improved even further to 0.79, when the baseline post-operative radiographs were available for comparison.
This study demonstrates that the RUST scoring system is a reliable and repeatable outcome measure for assessing tibial fracture healing. Further improvement in the reliability of the scoring system can be obtained if the radiographs are compared with the baseline post-operative radiographs.Cite this article: Mr J.M. Leow. The radiographic union scale in tibial (RUST) fractures: Reliability of the outcome measure at an independent centre. Bone Joint Res 2016;5:116-121. DOI: 10.1302/2046-3758.54.2000628.
惠兰等人制定了胫骨骨折影像学愈合评分（RUST），以评估髓内钉固定后胫骨骨折的愈合情况。在本研究中，在一个独立中心对RUST评分的可重复性和可靠性进行了评估，评估方式如下：(a) 使用原始描述；(b) 对评分描述进行进一步解读之后；(c) 有术后即刻X线片可供对比。
三名观察者使用RUST系统对15张经髓内钉固定（IM）治疗的胫骨干骨折的X线片进行评分。在讨论了应如何实施RUST系统的标准之后，五名观察者对45套（即前后位和侧位）经髓内钉固定的胫骨骨折的X线片进行评分。最后，利用可供对比的术后基线X线片，对这45套X线片重新进行评分。
前15套X线片的初始组内相关系数（ICC）为0.67（95%置信区间为0.63至0.71）。然而，对原始描述的解读方式各异。在就解读方式达成一致后，第二组的ICC提高到了0.75。当有术后基线X线片可供对比时，ICC进一步提高到了0.79。
本研究表明，RUST评分系统是评估胫骨骨折愈合的一项可靠且可重复的结果指标。如果将X线片与术后基线X线片进行对比，评分系统的可靠性可得到进一步提高。引用本文：J.M. 廖先生。胫骨骨折影像学愈合量表（RUST）：独立中心结果指标的可靠性。《骨与关节研究》2016年；5：116 - 121。DOI：10.1302/2046 - 3758.54.2000628。
