Plumarom Yanin, Wilkinson Brandon G, Willey Michael C, An Qiang, Marsh Lawrence, Karam Matthew D
Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Department of Orthopaedic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
Bone Jt Open. 2021 Oct;2(10):796-805. doi: 10.1302/2633-1462.210.BJO-2021-0071.R1.
The modified Radiological Union Scale for Tibia (mRUST) fractures score was developed in order to assess progress to union and define a numerical assessment of fracture healing of metadiaphyseal fractures. This score has been shown to be valuable in predicting radiological union; however, there is no information on the sensitivity, specificity, and accuracy of this index for various cut-off scores. The aim of this study is to evaluate sensitivity, specificity, accuracy, and cut-off points of the mRUST score for the diagnosis of metadiaphyseal fractures healing.
A cohort of 146 distal femur fractures were retrospectively identified at our institution. After excluding AO/OTA type B fractures, nonunions, follow-up less than 12 weeks, and patients aged less than 16 years, 104 sets of radiographs were included for analysis. Anteroposterior and lateral femur radiographs at six weeks, 12 weeks, 24 weeks, and final follow-up were separately scored by three surgeons using the mRUST score. The sensitivity and specificity of mean mRUST score were calculated using clinical and further radiological findings as a gold standard for ultimate fracture healing. A receiver operating characteristic curve was also performed to determine the cut-off points at each time point.
The mean mRUST score of ten at 24 weeks revealed a 91.9% sensitivity, 100% specificity, and 92.6% accuracy of predicting ultimate fracture healing. A cut-off point of 13 points revealed 41.9% sensitivity, 100% specificity, and 46.9% accuracy at the same time point.
The mRUST score of ten points at 24 weeks can be used as a viable screening method with the highest sensitivity, specificity, and accuracy for healing of metadiaphyseal femur fractures. However, the cut-off point of 13 increases the specificity to 100%, but decreases sensitivity. Furthermore, the mRUST score should not be used at six weeks, as results show an inability to accurately predict eventual fracture healing at this time point. Cite this article: 2021;2(10):796-805.
改良胫骨放射学联合评分（mRUST）用于评估骨折愈合进程，并对干骺端骨折的愈合进行数值评估。该评分已被证明在预测放射学愈合方面具有价值；然而，对于该指数在不同截断值下的敏感性、特异性和准确性尚无相关信息。本研究旨在评估mRUST评分在诊断干骺端骨折愈合方面的敏感性、特异性、准确性和截断点。
回顾性分析我院146例股骨远端骨折患者。排除AO/OTA B型骨折、骨不连、随访时间少于12周以及年龄小于16岁的患者后，纳入104套X线片进行分析。由三位外科医生分别使用mRUST评分对六周、12周、24周及最终随访时的股骨正侧位X线片进行评分。以临床及进一步的放射学检查结果作为最终骨折愈合的金标准，计算平均mRUST评分的敏感性和特异性。同时绘制受试者工作特征曲线以确定各时间点的截断点。
24周时平均mRUST评分为10分，预测最终骨折愈合的敏感性为91.9%，特异性为100%，准确性为92.6%。在同一时间点，截断值为13分时，敏感性为41.9%，特异性为100%，准确性为46.9%。
24周时mRUST评分为10分可作为一种可行的筛查方法，对股骨干骺端骨折愈合具有最高的敏感性、特异性和准确性。然而，截断值为13分时虽特异性提高到100%，但敏感性降低。此外，六周时不应使用mRUST评分，因为结果显示此时无法准确预测最终骨折愈合情况。引用本文：2021；2(10):796 - 805。
