改良胫骨骨折X线愈合评分系统评价儿童股骨干骨折愈合的可信度及可重复性研究

Inter/intra-observer reliability of evaluating femoral shaft fracture healing in children through Modified Radiographic Union Score for Tibial Fractures (MRUST)

目的探讨改良胫骨骨折X线愈合评分系统(modified radiographic union score for tibial fractures,MRUST)评价儿童股骨干骨折愈合的可信度及可重复性,为儿童股骨干骨折手术后骨愈合的评估与负重管理提供理论依据。方法本研究为回顾性研究,收集中国医科大学附属盛京医院2012年1月至2021年1月收治的45例儿童股骨干骨折弹性稳定髓内针(elastic stable intramedullary nailing,ESIN)固定术后4~8周的正位及侧位股骨X线片。共收集到45组正位及侧位X线片,由3名观测者使用MRUST分别进行3次评分。采用95%置信区间(95%CI)的组内相关系数(intraclass correlation coefficient,ICC)评价观测者内和观测者间MRUST评分的一致性。结果本组45例MRUST评分为(9.02±1.94)分,范围为4~12分。总体ICC评分为0.81(95%CI:0.74~0.88)。在3次观测中,3名观测者之间一致性评价较强或强,ICC评分分别为0.74(95%CI:0.62~0.84)、0.88(95%CI:0.82~0.93)和0.88(95%CI:0.81~0.92)。每名观测者的观测值平均后,3名观测者之间一致性评价强,ICC为0.92(95%CI:0.88~0.95)。3名观测者内一致性评价为较强或强,ICC分别为0.93(95%CI:0.89~0.96)、0.78(95%CI:0.68~0.87)和0.73(95%CI:0.60~0.83)。每次3名医师的观测值平均后,3名观测者内一致性评价为强,ICC为0.89(95%CI:0.83~0.94)。结论MRUST评分系统评价儿童股骨干骨折ESIN治疗后骨愈合情况,可信度及可重复性好,这为儿童股骨干骨折的愈合评估及负重管理提供了理论依据。

Objective To assess inter/intra-observer reliability of evaluating femoral shaft fracture healing in children through Modified Radiographic Union Score for Tibial Fractures(MRUST)and provide theoretical rationales for weight-bearing management and bone healing after femoral shaft fractures in children.Methods A total of 45 sets(i.e.AP&lateral)of radiographs of femoral shaft fractures in children treated by elastic stable intramedullary nailing(ESIN)within 4-8 weeks post-operation were scored thrice.The intraclass correlation coefficient(ICC)with 95%confidence intervals was utilized for quantifying inter/intra-observer agreement of MRUST score.Results RUST scores of all 45 radiographs were measured.The values of MRUST score ranged from 4 to 12 with a mean score of 9.02[standard deviation(SD)1.94].The overall ICC score was 0.81(95%CI,0.74 to 0.88).Among three observers,inter-observer agreement was strong with ICC of 0.74(95%CI,0.62-0.84),0.88(95%CI,0.82 to 0.93)and 0.88(95%CI,0.8 to 0.92).After averaging the observations of observers,inter-observer agreement was strong with ICC of 0.92(95%CI,0.88 to 0.95).The intra-observer agreement was strong with ICC of 0.93(95%CI,0.89 to 0.96),0.78(95%CI,0.68 to 0.87)and 0.73(95%CI,0.60 to 0.83).After averaging the observations of observers,the agreement of intra-observer was strong with ICC of 0.89(95%CI,0.83 to 0.94).Conclusion With excellent inter/intra-observer reliability agreements in evaluating femoral shaft fracture healing in children,MRUST scoring system provides theoretical rationales for weight-bearing management and bone healing.