| 摘要: |
| 目的 探讨不同经验不同条件下超声医师使用Graf法髋关节超声诊断及分型的一致性。 方法 对120例婴儿(240个髋关节)按3位对Graf技术的不同认知经验的超声医师及根据是否使用检查辅助装置设备随机平均分为A、B、C、D四组,分别为①第1位医师和第2位医师徒手对A组婴儿的髋关节进行检查；②第1位医师和第2位医师配备凹槽式记忆海绵床垫及金属连杆装置对B组婴儿进行检查；③第2位医师和第3位医师徒手对C组婴儿的髋关节进行检查。④第2位医师和第3位医师配备凹槽式记忆海绵床垫及金属连杆装置对D组婴儿进行检查。对各组内角度测量值及分型结果进行统计学比较。结果 各组内a角的测量差值的均数分别为0.45°、-0.10°、0.42°、-0.09°。各组的检查者之间对髋关节诊断分型一致率分别为76.7%、84.6%、55.8%、72.3%,A组与B组(X2=2.27,P=0.251)无统计学意义,C组与D组(X2=7.26,P=0.042)有统计学意义,一致性分别为K=0.52、0.76、0.37、0.54。各组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(X2=4.27,P=0.059)无统计学意义、C组与D组(X2=8.27,P=0.013)有统计学意义,一致性分别为K=0.55、0.82、0.43、0.67。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。 |
| 关键词: 髋关节 Graf法 一致性 |
| DOI： |
| 投稿时间：2016-12-13修订日期：2017-07-15 |
| 基金项目:无锡市卫生计生委妇幼健康科技成果与适宜技术推广项目(编号：FYTG201505) |
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| A study for evaluating consistency of the hip using Graf’s method by sonographers with different levels of experience under different conditions |
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| Abstract: |
| ABSTRACT
Objectives To study the evaluating consistency of the hip by sonographers with different levels of experience using Graf’s method under different conditions. Methods A total of 240 hips of 120 infants evaluated with Graf’s method were randomly divided into A, B, C, D groups according to 3 different experienced sonographers whether to use additional equipments or not based on their knowledges: Group A: Infants were examined the hips 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 the hips 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 ? angle measurement in four groups was 0.45°, -0.10°, 0.42° and -0.09° respectively. The inter-examiner agreement rate of diagnosing hip classification was 76.7%, 84.6%, 55.8% and 72.3% respectively. The difference, was not statistically significant between Group A and B, was statistically significant between Group C and D (X2=7.26，P=0.042). The diagnostic agreement of Graf''s sonographic classification between two sonographers in Group B were good (Kappa = 0.76, 95%CI: 0.44～0.81).The inter-examiner agreement 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 B, was statistically significant between group C and D (X2=8.27，P=0.013). The diagnostic agreement of abnormal hip between two sonographers in Group B were good (Kappa = 0.82, 95%CI: 0.70～0.95). Conclusions The consistency of evaluating the hip is irrelevant to the conditions, but is related to examiner experience and additional equipments. |
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