GKD için Taranan Bebeklerde Kalça Ultrasonografisinde İki Farklı Projeksiyondaki Açı Ölçümleri Teşhisi Değiştirir mi?

Abstract

Hip ultrasonography with the Graf method is used worldwide. Four different projections can be used for the evaluation of sonographic images. The best projection with the lowest rate of wrong interpretation is the "standing-up right"-projection and the worst is the ''horizontal-cranial left'' projection. The aim of this study was to show the concordance of two researchers using these two different projections. Hip sonographic evaluation according to the Graf method was applied to 166 infants (332 hips) comprising 84 males (50.6%) and 82 females (49.4%). The hip sonographic images were obtained in both the standing-up right and horizontal-cranial left projections. Two researchers independently measured the alpha and beta angles manually with a goniometer and classified the hip type. The alpha, beta angle measurement values, comparisons of the angles in both projections and for both researchers are presented in detail in Tables 1 and 2. The inter-observer agreement of the Graf types of hips was as follows; Graf types between researcher 1 and 2, Right hip-(standing-up right) Kappa value 0.84, Left hip-(standing-up right) Kappa value 0.77, Right hip-(horizontal-cranial left) Kappa value 0.67, Left hip-(horizontal-cranial left) Kappa value 0.64. The intraclass correlation coefficient (ICC) values of the agreement between the two researchers for all the measured hip angles were as follows; right angle ICC: 0.96, right angle ICC: 0.91, left angle ICC: 0.93, and left angle ICC: 0.59. Although the standing-up right projection is known to be the best projection with the lowest rate of wrong interpretation according to the Graf guidelines, the results of this study showed the evaluation of similar Graf hip types on the two projections. Therefore, the horizontal cranial left projection, which is considered to be the worst of the four projections, can be used safely for hip evaluation if the Graf checklist is followed appropriately.