Evaluation of Fracture and Osteotomy Union in the Setting of Osteogenesis Imperfecta: Reliability of the Modified Radiographic Union Score for Tibial Fractures (RUST)
Evaluation of Fracture and Osteotomy Union in the Setting of Osteogenesis Imperfecta: Reliability of the Modified Radiographic Union Score for Tibial Fractures (RUST)
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DOI：
10.1097/bpo.0000000000001068
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发表时间：
2020-01-01
影响因子：
1.7
通讯作者：
Kruse, Richard W.
中科院分区：
文献类型：
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作者：
Franzone, Jeanne M.;Finkelstein, Mark S.;Kruse, Richard W.
背景资料：评价骨形成障碍（OI）患者的截骨术和骨折愈合是患者护理的关键组成部分。到目前为止，对OI患者人群的研究使用了各种标准来评价骨愈合。胫骨骨折的放射学愈合评分（RUST），后来被修订为改良RUST，是一种客观的标准化方法，评价骨折愈合。我们试图评价改良RUST在OI患者胫骨中的可靠性。方法：30例OI骨折或截骨患者的胫骨X线片由3名观察员在2个不同的场合进行评分。对4个皮质中的每一个进行评分（1=无愈伤组织，2=存在愈伤组织，3=桥接愈伤组织，4=重塑，骨折不可见），改良RUST是这些评分的总和（范围，4至16）。使用组内系数（ICC）和95%置信区间评价观察者间和观察者内的可靠性。结果如下：代表第一次评分迭代的观察者间可靠性的ICC为0.926（0.864至0.962），第二次系列为0.915（0.845至0.957）。对于系列1和系列2中的测量，代表3名审查员中每一位的观察者内可靠性的ICC分别为0.860（0.707至0.934）、0.994（0.986至0.997）和0.974（0.946至0.988）。结论：改良RUST在OI的情况下具有良好的观察者间和观察者内可靠性，尽管存在与骨质差及其发育不良性质相关的挑战。改良RUST在OI人群中的应用和常规使用将有助于我们对截骨术和骨折愈合的评价标准化。
Background: Evaluation of the union of osteotomies and fractures in patients with osteogenesis imperfecta (OI) is a critical component of patient care. Studies of the OI patient population have so far used varied criteria to evaluate bony union. The radiographic union score for tibial fractures (RUST), which was subsequently revised to the modified RUST, is an objective standardized method of evaluating fracture healing. We sought to evaluate the reliability of the modified RUST in the setting of the tibias of patients with OI. Methods: Tibial radiographs of 30 patients with OI fractures, or osteotomies were scored by 3 observers on 2 separate occasions. Each of the 4 cortices was given a score (1=no callus, 2=callus present, 3=bridging callus, and 4=remodeled, fracture not visible) and the modified RUST is the sum of these scores (range, 4 to 16). The interobserver and intraobserver reliabilities were evaluated using intraclass coefficients (ICC) with 95% confidence intervals. Results: The ICC representing the interobserver reliability for the first iteration of scores was 0.926 (0.864 to 0.962) and for the second series was 0.915 (0.845 to 0.957). The ICCs representing the intraobserver reliability for each of the 3 reviewers for the measurements in series 1 and 2 were 0.860 (0.707 to 0.934), 0.994 (0.986 to 0.997), and 0.974 (0.946 to 0.988). Conclusions: The modified RUST has excellent interobserver and intraobserver reliability in the setting of OI despite challenges related to the poor quality of the bone and its dysplastic nature. The application and routine use of the modified RUST in the OI population will help standardize our evaluation of osteotomy and fracture healing.