Experimental Validation of the Radiographic Union Score for Tibial Fractures (RUST) Using Micro-Computed Tomography Scanning and Biomechanical Testing in an in-Vivo Rat Model
Experimental Validation of the Radiographic Union Score for Tibial Fractures (RUST) Using Micro-Computed Tomography Scanning and Biomechanical Testing in an in-Vivo Rat Model
复制标题
DOI：
10.2106/jbjs.18.00035
复制
发表时间：
2018-11-07
影响因子：
5.3
通讯作者：
Schemitsch, Emil H.
中科院分区：
文献类型：
--
作者：
Fiset, Sandra;Godbout, Charles;Schemitsch, Emil H.
背景资料：胫骨骨折放射学联合评分（RUST）和该系统的改良版mRUST是使用X线片评估骨折愈合进展的流行标准。据我们所知，这是第一项研究，以实验验证的能力，锈和mRUST，以准确地评估骨愈合的进展与使用两个微型计算机断层扫描（micro-CT）扫描和biomechanical testing.Methods：成年雄性大鼠（n = 29）进行了截骨术与使用聚醚醚酮板修复的中段骨折间隙。在5、6、7、8、9和17周的终点，在大鼠死亡之前对修复的股骨进行前后位和侧位X线片，并且2名经过研究员培训的骨科创伤外科医生独立地对修复的股骨进行RUST和mRUST评分。然后解剖修复和完整的对侧股骨。结果：RUST评分范围为5 ~ 12，mRUST评分范围为5 ~ 16。RUST的组内相关系数（ICC）为0.89（95%置信区间[CI]：0.78 - 0.94），mRUST为0.86（95% CI：0.74 - 0.93），属于ICC的“几乎完全一致”类别。斯皮尔曼等级相关系数（R-S）显示RUST（R-S范围，0.456至0.818）和mRUST（R-S范围，0.519至0.862）与矿化骨痂体积（BV）、骨痂总体积（TV）和BV/TV比值的微CT测量值相关，但与骨密度（BMD）相关性较低。此外，RUST（R-S范围，0.524至0.863）和mRUST（R-S范围，0.434至0.850）与一些生物力学特性相关。RUST评分为10或mRUST评分为15可被视为阈值，高于该阈值，接骨板骨“愈合”，因为在这些评分下，修复股骨与完整对侧femora.Conclusions相比，分别达到了120%或140%的失效扭矩：RUST和mRUST均显示出与micro-CT和生物力学参数的强统计相关性。
Background: The Radiographic Union Score for Tibial fractures (RUST) and the modified version of the system, mRUST, are popular standards for assessing fracture-healing progress with use of radiographs. To our knowledge, this is the first study to experimentally validate the ability of RUST and mRUST to accurately assess bone-healing progression with use of both micro-computed tomography (micro-CT) scanning and biomechanical testing.Methods: Adult male rats (n = 29) underwent osteotomy with a midshaft fracture gap repaired with use of a polyetheretherketone plate. Anteroposterior and lateral radiographs were made of the repaired femora prior to rat death at end points of 5, 6, 7, 8, 9, and 17 weeks, and 2 fellowship-trained orthopaedic trauma surgeons independently assigned RUST and mRUST scores to repaired femora. The repaired and intact contralateral femora were then dissected. Bones underwent dissection, micro-CT scanning, and biomechanical torsion testing at the end points.Results: RUST scores ranged from 5 to 12 and mRUST scores ranged from 5 to 16. Intraclass correlation coefficients (ICCs) were 0.89 (95% confidence interval [CI]: 0.78 to 0.94) for RUST and 0.86 (95% CI: 0.74 to 0.93) for mRUST, which fall within the "almost perfect agreement" category for ICCs. Spearman rank correlation coefficients (R-S) showed correlation of RUST (R-S range, 0.456 to 0.818) and mRUST (R-S range, 0.519 to 0.862) with micro-CT measurements of mineralized callus volume (BV), total callus volume (TV), and BV/TV ratio, but less so with bone mineral density (BMD). Additionally, RUST (R-S range, 0.524 to 0.863) and mRUST (R-S range, 0.434 to 0.850) were correlated with some biomechanical properties. A RUST score of 10 or an mRUST score of 15 may be considered the threshold above which a plated bone is "healed" because, at these scores, 120% or 140% of failure torque, respectively, was achieved by the repaired femora as compared with the intact contralateral femora.Conclusions: RUST and mRUST both show strong statistical correlations with micro-CT and biomechanical parameters.