不同经验和不同条件下超声医师对Graf法髋关节超声诊断分型一致性的研究

Study for evaluating consistency of the hip using Graf's method by sonographers with different experience under different conditions

目的探讨不同经验和不同条件下超声医师应用Graf法髋关节超声诊断及分型的一致性。方法将120例婴儿(共240个髋关节)按3名对Graf技术有不同认知、经验的超声医师和根据是否使用检查辅助装置随机平均分为A、B、C、D四组,分别进行Graf法髋关节超声检查:A组,由医师1和医师2徒手进行检查;B组,由医师1和医师2使用凹槽式记忆海绵床垫及金属连杆装置进行检查;C组,由医师2和医师3徒手进行检查;D组,由医师2和医师3使用凹槽式记忆海绵床垫及金属连杆装置进行检查。比较各组内角度测量值及诊断一致率。结果 A、B、C、D组内α角的测量差值分别为0.45°、-0.10°、0.42°、-0.09°。A、B、C、D组内两名超声医师间对Graf法髋关节诊断分型一致率分别为76.7%、84.6%、55.8%、72.3%,其中A组与B组比较差异无统计学意义,C组与D组比较差异有统计学意义(χ~2=7.26,P=0.042);B组超声医师对Graf法髋关节诊断分型一致性良好(Kappa=0.76,95%CI:0.44~0.81)。A、B、C、D组内两名超声医师对正常髋关节和异常髋关节的诊断一致率分别为88.3%、93.3%、78.3%、85.0%,A组与B组比较差异无统计学意义,C组与D组比较差异有统计学意义(χ~2=8.27,P=0.013);B组超声医师对正常和异常髋关节的诊断一致性极好(Kappa=0.82,95%CI:0.70~0.95)。结论超声Graf法诊断髋关节的一致性与超声医师学习的场所无关,但与实际利用该技术操作经验和是否有辅助装备有关。

Objective To explore the consistency of the hip using Graf＇s method by sonographers with different experience under different conditions.Methods A total of 240 hips in 120 infants evaluated using Graf＇s method were randomly divided into A,B,C,D groups according to three different experienced sonographers whether to use additional equipments or not based on their knowledge,group A：infants were examined only using ultrasound by sonographer 1 and 2,group B：infants were examined using ultrasound assisted with dimple memory foam mattress and metal immobilization device by sonographer 1 and 2, group C：infants were examined only using ultrasound by sonographer 2 and 3,Group D：infants were examined using ultrasound assisted with dimple memory foam mattress and metal immobilization device by sonographer 2 and 3.The evaluating consistency were statistically compared with measurements of angle.Results The mean difference of α angle measurement in four groups were 0.45°,-0.10°,0.42° and-0.09°,respectively.The inter-sonographers consistency rate of diagnosing hip classification were 76.7%,84.6%,55.8%and 72.3%,respectively.The difference was not statistically significant between group A and group B,while there was statistically significant between group C and group D（χ2=7 . 26 , P=0 . 042）. The diagnostic consistency of Graf ＇ s sonographic classification by two sonographers in group B was good（Kappa=0.76,95%CI：0.44~0.81,）.The inter-sonographers consistency rate in the diagnosis of normal and abnormal hip were 88.3%,93.3%,78.3%and 85.0%,respectively.The difference was not statistically significant between group A and group B,while there was statistically significant between group C and group D （χ2=8.21,P=0.013）.The diagnostic consistency of normal and abnormal hip between two sonographers in group B was good （Kappa=0.82,95% CI：0.70~0.95）.Conclusion The consistency of evaluating the hip is irrelevant to the conditions,but is related to sonographers＇ experience and additional equipments.