Virtual Mechanical Testing Based on Low-Dose Computed Tomography Scans for Tibial Fracture A Pilot Study of Prediction of Time to Union and Comparison with Subjective Outcomes Scoring
Virtual Mechanical Testing Based on Low-Dose Computed Tomography Scans for Tibial Fracture A Pilot Study of Prediction of Time to Union and Comparison with Subjective Outcomes Scoring
复制标题
DOI：
10.2106/jbjs.18.01139
复制
发表时间：
2019-07-03
影响因子：
5.3
通讯作者：
Harty, James A.
中科院分区：
文献类型：
--
作者：
Dailey, Hannah L.;Schwarzenberg, Peter;Harty, James A.
背景：定量结果评估仍然是骨科创伤的一个持续挑战。虽然患者报告的结果测量（PROMS）和放射学评估（如胫骨骨折放射学愈合量表（RUST）评分）经常使用，但很少有证据支持其测量结构性骨形成或生物力学完整性的有效性。方法：在这项试点研究中，前瞻性地招募了一组胫骨干骨折患者，观察标准扩髓髓内钉固定后，我是创伤中心的。第6、12、18和24周的随访包括X线片和PROMS（EuroQol五维[EQ-5D]和疼痛评分）的完成。还在12周时进行了低剂量计算机断层扫描（CT）。扫描重建在3个维度（3D），并通过有限元方法进行虚拟力学测试，以评估扭转刚度在骨折肢体相对于在完整的bone.Results：患者报告的流动性，自我护理，活动，和健康随时间的进展纵向改善，但PROMS与结构性骨愈合不相关。RUST评分显示中度组内一致性（组内系数[ICC] = 0.727），但12周时的评分与愈合时间无关（R-2 = 0.104，p = 0.193），仅与骨痂结构完整性中度相关（R-2 = 0.347，p = 0.010）。相反，患者特异性虚拟扭转刚度（VTR）与愈合时间显著相关（R-2 = 0.383，p = 0.005），明确区分1例延迟愈合（VTR = 10%，36周时愈合）（VTR > 60%;中位愈合时间19周）。结论：PROMS提供了对胫骨骨折后患者经历的自然史的深入了解，但作为结构性骨愈合的衡量标准，其实用性有限。RUST评分虽然可重复，但可能无法可靠地预测愈合时间。相比之下，低剂量CT扫描的虚拟力学测试提供了定量和客观的骨痂结构评估，可以可靠地预测愈合时间，并可以早期诊断受损愈合。
Background: Quantitative outcomes assessment remains a persistent challenge in orthopaedic trauma. Although patient-reported outcome measures (PROMS) and radiographic assessments such as Radiographic Union Scale for Tibial Fractures (RUST) scores are frequently used, very little evidence has been presented to support their validity for measuring structural bone formation or biomechanical integrity.Methods: In this pilot study, a sequential cohort of patients with a tibial shaft fracture were prospectively recruited for observation following standard reamed intramedullary nailing in a level-I trauma center. Follow-up at 6, 12, 18, and 24 weeks included radiographs and completion of PROMS (EuroQol 5-Dimension [EQ-5D] and pain scores). Low-dose computed tomography (CT) scans were also performed at 12 weeks. Scans were reconstructed in 3 dimensions (3D) and subjected to virtual mechanical testing via the finite element method to assess torsional rigidity in the fractured limb relative to that in the intact bone.Results: Patients reported progressive longitudinal improvement in mobility, self-care, activity, and health overtime, but the PROMS were not correlated with structural bone healing. RUST scoring showed moderate intrarater agreement (intraclass coefficient [ICC] = 0.727), but the scores at 12 weeks were not correlated with the time to union (R-2 = 0.104, p = 0.193) and were only moderately correlated with callus structural integrity (R-2 = 0.347, p = 0.010). In contrast, patient-specific virtual torsional rigidity (VTR) was significantly correlated with the time to union (R-2 = 0.383, p = 0.005) and clearly differentiated 1 case of delayed union (VTR = 10%, union at 36 weeks) from the cases in the normally healing cohort (VTR > 60%; median union time, 19 weeks) on the basis of CT data alone.Conclusions: PROMS provide insight into the natural history of the patient experience after tibial fracture but have limited utility as a measure of structural bone healing. RUST scoring, although reproducible, may not reliably predict time to union. In contrast, virtual mechanical testing with low-dose CT scans provides a quantitative and objective structural callus assessment that reliably predicts time to union and may enable early diagnosis of compromised healing.