摘要
目的探讨Graf法髋关节超声检查技术的规范化程度对发育性髋关节异常(DDH)诊断的可靠性及其影响因素。方法对210例行髋关节超声检查的婴儿按照受检时间、医师对Graf技术的认知程度及辅助设备的配置情况分为A、B、C3组,每组70例(140个髋关节),共210例(420个髋关节)。在Graf髋关节检查技术规范化前,由两位(第1位及第2位)操作经验相近的医师对A组婴儿髋关节进行检查与诊断;Graf髋关节检查技术规范化后,由两位(第1位及第2位)操作经验相近的医师对B组婴儿髋关节进行检查与诊断;由两位(第1位及第3位)操作经验不同的医师对C组婴儿髋关节进行检查与诊断。对最终所得组内与组间角度测值与分型结果进行比较。结果 A、B、C各组检查者之间对α角测量差值的均数分别为0.33°、-0.10°与-0.01°。在诊断正常髋关节或异常髋关节方面,每组140个髋关节中,A组检查者对124个髋关节的诊断一致,一致率为88.6%;B组对132个髋关节的诊断一致,一致率为94.3%;C组对135个髋关节的诊断一致,一致率为96.4%。A组与C组的诊断一致率差异有统计学意义(P=0.013),而A组与B组、B组与C组的诊断一致率差异均无统计学意义(P=0.088,P=0.394)。3组医师诊断正常髋关节与异常髋关节的一致性以C组最高(K=0.86),其次为B组(K=0.82)及A组(K=0.49)。结论采用Graf法超声诊断发育性髋关节异常的可靠性主要取决于检查者对操作标准程序的认识与依从性,而检查者操作经验对诊断可靠性的影响不大。
Objective To investigate the effect of the standardization degree of hip uhrasonography with the Graf method on diagnosis of developmental dysplasia of the hip （ DDH ） and influence factors. Methods The hip ultrasonography was performed on 420 hips of 210 infants and classified into three groups based on different visit time, different expertise for the Graf method of performers and different additional equipments for performing the method. Group A, B and C included 70 infants or 140 hips. Before standardization of the Graf method, the infants in group A were separately examined by two performers with similar operating experiences. After standardization of the Graf method, the infants in group B and C were respectively examined by performers with similar and different operating experiences. The intra-group and inter-group results in terms of angle and type classification were compared. Results The mean difference of ot angle measurements in group A, B and C was 0.33°, - 0.10°and - 0. 01 o respectively. For the classification of normal versus abnormal, performers in group A reached an agreement in 124 of the 140 hips （ 88.6% ） , in group B with 132 of the 140 hips （94.3%）and in group C with 135 of the 140 hips （96.4%）. There was statistical significance in the different agreement rate between group A and group C （P=0. 013 ）while no statistical significance between group A and group C（P =0. 088） or between group B and group C（P =0. 394） was observed. Group C was at first place of agreement for classification of DDH （ Kappa = 0.86 ） following with group B （Kappa = 0.82） and C （ Kappa = 0.49）. Conclusion The reliability of hip ultrasonography using the Graf method in DDH diagnosis mainly depends on basic expertise of the performers and the method standardization, rather than operating experience.
出处
《中华医学超声杂志（电子版）》
2010年第7期23-26,共4页
Chinese Journal of Medical Ultrasound(Electronic Edition)
关键词
超声检查
髋关节
关节疾病
Uhrasonograhy
Hip joint
Joint diseases
