Sonographic hip examination according to Graf is widely accepted standard for diagnosing developmental dysplastic hips (DDH) but it is criticized for alleged intra- and interobserver variations. This review was conducted to evaluate whether objective quality criteria according to the Graf method are fulfilled within scientific literature.

A systematic literature search on Pubmed was performed using the search string: [(DDH) OR (Hip dysplasia)] AND (Graf). Studies suitable by title, abstract, manuscript, containing an image of sonographic hip examination and online accessibility were included into analysis.

131 studies were included into final analysis. Only 68 (51.9%) presented correct sonographic images according Graf’s criteria. 98 (74.8%) studies plotted alpha-angles (angle between bony roof line and base line) but only 85 (64.8%) studies beta-angles (angle between cartilage roof line and base line). Studies were contributed from 25 countries.

Assumingly, skepticism regarding the Graf method is based on user errors and insufficient application of the Graf quality assessment algorithm resulting in high intra- and interobserver variations. When performed correctly, the Graf method is of high diagnostic value.

根据 Graf 的超声髋关节检查是广泛接受的诊断发育性髋关节发育不良 (DDH) 的标准，但它因所谓的观察者内部和观察者之间的差异而受到批评。进行这项审查是为了评估根据 Graf 方法的客观质量标准是否在科学文献中得到满足。

使用搜索字符串对 Pubmed 进行了系统的文献搜索：[(DDH) OR (Hip dysplasia)] AND (Graf)。根据标题、摘要、手稿、包含超声髋关节检查图像和在线可访问性的研究被纳入分析。

131 项研究被纳入最终分析。根据 Graf 的标准，只有 68 (51.9%) 人提供了正确的超声图像。98 项 (74.8%) 研究绘制了 α 角（骨顶线和基线之间的角度），但只有 85 项（64.8%）研究了 β 角（软骨顶线和基线之间的角度）。研究来自 25 个国家。

假设，对 Graf 方法的怀疑是基于用户错误和 Graf 质量评估算法的应用不足，导致观察者内和观察者间的高度差异。如果正确执行，Graf 方法具有很高的诊断价值。