用于评估儿童和成人股骨干骨折愈合情况的RUST评分及改良RUST评分的可靠性

Reliability of RUST and modified RUST scores for evaluation of union in pediatric and adult femoral shaft fractures.

作者信息

Mısır Abdulhamit, Yıldız Kadir İlker, Kızkapan Turan Bilge, Uzun Erdal, Özçamdallı Mustafa, Oğuzkaya Sinan

机构信息

Department of Orthopaedics and Traumatology, Health Sciences University Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkey.

Department of Orthopaedics and Traumatology, Health Sciences University, Metin Sabancı Baltalimanı Bone and Joint Diseases Training and Research Hospital, İstanbul, Turkey.

出版信息

Acta Orthop Traumatol Turc. 2021 Mar;55(2):127-133. doi: 10.5152/j.aott.2021.20074.

DOI:10.5152/j.aott.2021.20074

PMID:33847574

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11229616/

Abstract

OBJECTIVE

This study aimed to determine the reliability levels of the radiographic union scale for tibial fractures (RUST) and the modified version of the system, mRUST, for femoral shaft fractures in pediatric and adult patients and to evaluate the value of the scores for total and each cortex in the decision making on fracture union.

METHODS

A total of 15 orthopedic surgeons scored the radiographs of 24 pediatric and 24 adult patients with femoral shaft fractures that were obtained at 0, 4, 8, 12, and 16 postoperative weeks treated with elastic stable intramedullary nail in pediatric patients and locked intramedullary nail in adult patients using the RUST and mRUST scores. Intra-class correlation coefficient (ICC) was used in the evaluation of reliability of the RUST and mRUST scores. The Fleiss kappa (k) coefficient was used in the agreement between evaluators regarding union decision (united or non-united). The thresholds for RUST and mRUST for radiographic union decision were determined. Receiver operating curves were created to evaluate the contribution of total and individual cortical scores in the decision of united or non-united.

RESULTS

Intra- and inter-rater reliabilities of mRUST (ICC: 0.92 and 0.86, respectively) were slightly higher than those of RUST (ICC: 0.81 and 0.77, respectively) with perfect intra- and inter-rater reliabilities for RUST (ICC: 0.92 and 0.90, respectively) and mRUST (ICC: 0.88 and 0.83, respectively) in pediatric patients and substantial intra- and inter-rater reliabilities in adult patients (ICC: 0.80 and 0.76, respectively, for mRUST, and 0.76 and 0.71, respectively, for RUST). At each time point, the mean mRUST and RUST scores were higher for pediatric fractures (p<0.001). The Fleiss k coefficient for union decision was perfect for pediatric fractures (0.88) and substantial for adult fractures (0.79). The total mRUST score had a higher predictive value of union than the total RUST score (area under the curve: 0.984 vs. 0.922 in adult fractures and 0.990 vs. 0.943 in pediatric fractures). A RUST score of ≥10 and mRUST score of ≥12 were excellent predictors of fracture union.

CONCLUSION

Fracture union of simple two-part pediatric and adult femoral shaft fractures treated with intramedullary fixation can be reliably assessed using the RUST and mRUST scores. The diagnostic value of the mRUST score is more evident in adult fractures.

LEVEL OF EVIDENCE

Level II, Diagnostic Study.

摘要

目的

本研究旨在确定儿童和成人患者股骨干骨折的胫骨骨折影像学愈合量表（RUST）及其改良版mRUST的可靠性水平，并评估总分及各皮质评分在骨折愈合决策中的价值。

方法

15名骨科医生使用RUST和mRUST评分，对24例儿童和24例成人股骨干骨折患者术后0、4、8、12和16周的X线片进行评分。儿童患者采用弹性稳定髓内钉治疗，成人患者采用带锁髓内钉治疗。组内相关系数（ICC）用于评估RUST和mRUST评分的可靠性。Fleiss卡方（k）系数用于评估评估者之间关于骨折愈合决策（愈合或未愈合）的一致性。确定了RUST和mRUST用于影像学骨折愈合决策的阈值。绘制受试者工作特征曲线，以评估总分及各皮质评分在判断骨折愈合或未愈合中的作用。

结果

mRUST的评分者内和评分者间可靠性（ICC分别为0.92和0.86）略高于RUST（ICC分别为0.81和0.77），儿童患者中RUST（ICC分别为0.92和0.90）和mRUST（ICC分别为0.88和0.83）的评分者内和评分者间可靠性极佳，成人患者中评分者内和评分者间可靠性较高（mRUST的ICC分别为0.80和0.76，RUST的ICC分别为0.76和0.71）。在每个时间点，儿童骨折的mRUST和RUST平均评分更高（p<0.001）。骨折愈合决策的Fleiss k系数在儿童骨折中极佳（0.88），在成人骨折中较高（0.79）。mRUST总分对骨折愈合的预测价值高于RUST总分（曲线下面积：成人骨折中分别为0.984和0.922，儿童骨折中分别为0.990和0.943）。RUST评分≥10和mRUST评分≥12是骨折愈合的良好预测指标。