Sari Ahmet Sinan, Karakus Ozgun
Nigde Omer Halisdemir University Teaching Hospital, Department of Orthopedic Surgery, Nigde.
Department of Orthopedic Surgery, Baskent University Ankara Hospital, Ankara.
Medicine (Baltimore). 2020 Apr;99(14):e19677. doi: 10.1097/MD.0000000000019677.
In the Graf method of hip ultrasonography, the diagnosis of the infantile hip with developmental dysplasia of the hip (DDH) is strictly dependent on the bony roof (alpha angle) and the cartilage roof (beta angle) measurements. In this study, we investigated whether the infant hip could be diagnosed with DDH solely by evaluating ultrasound images obtained in the standard plane, without bony roof and cartilage roof measurements, in respect to different professional experience levels.Two hundred ten hip ultrasounds were randomly selected from patients who presented to our hospital for DDH screening. A total of 6 ultrasound images were obtained for each hip. The hip morphology evaluations were made without the bony roof and the cartilage roof measurements by 2 orthopedic surgery residents; 2 orthopedic surgery specialists, trained in the diagnosis and the treatment of the DDH; and 2 pediatric orthopedic surgery professors, highly experienced in the diagnosis and treatment of DDH. After hip morphology evaluations, the bony roof and the cartilage roof measurements were obtained and hip type evaluations were made by the same raters, according to the Graf method of hip ultrasonography.The highest intraobserver agreements between the hip maturity evaluation before and the hip type evaluation after measurements were .676 (P < .001) and .577 (P < .001) in professors 2 and 1, respectively, and the lowest agreements were .185 (P < .01) and .289 (P < .001) in specialist 1 and resident 2, respectively.The diagnosis of the infant hip as DDH could not be made solely by evaluation of the ultrasound images obtained in the standard plane without the bony roof and the cartilage roof measurements. The bony roof and the cartilage roof measurements were obligatory for the diagnosis of the infant hip as DDH, even in the very experienced pediatric orthopedic surgeons.Level of evidence: 2.
在髋关节超声检查的格拉夫（Graf）方法中，婴儿髋关节发育性发育不良（DDH）的诊断严格依赖于骨顶（α角）和软骨顶（β角）的测量。在本研究中，我们针对不同专业经验水平，调查了是否仅通过评估在标准平面获得的超声图像，而不进行骨顶和软骨顶测量，就能诊断婴儿髋关节DDH。从到我院进行DDH筛查的患者中随机选取210例髋关节超声检查。每个髋关节共获得6张超声图像。由2名骨科住院医师、2名接受过DDH诊断和治疗培训的骨科专科医生以及2名在DDH诊断和治疗方面经验丰富的小儿骨科教授，在不进行骨顶和软骨顶测量的情况下对髋关节形态进行评估。在髋关节形态评估后，由相同的评估者根据髋关节超声检查的格拉夫方法进行骨顶和软骨顶测量，并进行髋关节类型评估。测量前髋关节成熟度评估与测量后髋关节类型评估之间，观察者内一致性最高的分别是教授2为0.676（P < 0.001）和教授1为0.577（P < 0.001），最低的分别是专科医生1为0.185（P < 0.01）和住院医师2为0.289（P < 0.001）。仅通过评估在标准平面获得的、不进行骨顶和软骨顶测量的超声图像，无法诊断婴儿髋关节为DDH。即使是经验丰富的小儿骨科医生，骨顶和软骨顶测量对于诊断婴儿髋关节DDH也是必不可少的。证据级别：2级。
