Ureteral obstruction secondary to aortofemoral bypass

Hydroureteronephrosis is reported as a frequent late complication of aorto-femoral bypass grafts in patients with aorto-iliac obstruction. To define the actual incidence of this potentially critical complication, renal ultrasonography (US) was performed on 79 asymptomatic patients who had previously undergone aortic reconstruction, after a mean interval of 71.6 months. Unilateral hydronephrosis was found in 6 cases (7.6%). Dilatation was mild or moderate (grade I or II) in 4 cases, and severe (grade III) in 2. Ivp was performed in this selected group: hydronephrosis was mild in 3 patients with ureteral stenosis where the iliac limb of the graft crossed the ureter. In 2 cases nonfunctioning kidneys were demonstrated corresponding to severe sonographic hydronephrosis. These 2 patients underwent anterograde and retrograde pyelography, that showed the site and extent of the obstruction. One patient was a false positive because of obstruction of pyelo-ureteral junction. Even though X-rays showed high sensitivity and specificity in detecting this complication of aorto-femoral reconstruction, US is noninvasive and less expensive and does not require contrast medium. A routine pre- and post-operative ultrasound study is suggested in patients undergoing by-pass surgery to early recognise ureteral obstruction and to avoid irreversible renal damage.     

The hypothesis of a diagnostic-prognostic assessment of intestinal invagination with the aim of treatment by echo-guided pneumatic reduction]

The authors investigated the role of US in the diagnostic-prognostic evaluation of enteric intussusception, for the use of US-guided pneumatic reduction (RPEG). In the last 5 years, 59 young patients were examined; 44 of them had clinically suspected enteric intussusception which was confirmed by US. US allowed site and nature of the condition to be demonstrated (sensitivity and specificity: 100%), while supplying helpful predictive prognostic elements as to the extent of intussuscepted loop involvement (predictive prognostic value: 100%). On the contrary, its etiological screening capabilities were poor (11%) in the identification of secondary forms (5 ileal diverticula). A grading score was introduced to select the patients undergoing RPEG. Six clinical and US parameters were considered, with values increasing according to severity of the condition. The higher the score, the lower the chances of therapeutical success with RPEG. In 3 cases (2 loop necroses and 1 severe intestinal obstruction) with US score greater than 6 [9] and clinical score greater than 11 [15], RPEG, was replaced by surgery. Fourteen patients underwent RPEG: positive results were obtained in 12 cases (85%). In one case, a short-term relapse (within 6 hours) was observed.     

经皮加压钢板与动力髋螺钉手术治疗老年股骨粗隆间骨折疗效比较

目的探讨经皮加压钢板（PCCP）与动力髋螺钉（DHS）两种手术方式治疗老年股骨粗隆间骨折的围手术期反应、疗效,便于在老年股骨粗隆间骨折治疗中选择创伤小、疗效好的手术方式。方法收集我院2009年1月～2010年12月收治的年龄〉60岁并进行PCCP或DHS手术治疗的股骨粗隆间骨折67例,对比分析PCCP和DHS两种术式治疗的相关情况。结果 67例中,PCCP手术30例,DHS手术37例,术后随访6～30个月,两组患者的年龄、性别、合并疾病、致伤原因、诊断分型、手术时间、术后输血量、血红蛋白与白蛋白下降程度对比无显著性差异,PCCP组切口长度明显短于DHS组;术中失血量、输血量明显较DHS组少;PCCP组住院天数、术后下床时间早晚、治疗结果也明显优于DHS组。结论 PCCP较DHS的手术创伤减少,是更好的治疗老年股骨粗隆间骨折的手术方式。     

Effectiveness of MR Urography in the Evaluation of Kidney which Failed to Opacify during Excretory Urography: Comparison with Ultrasonography

Objective

The purpose of this study was to compare the effectiveness of MR urography (MRU) with that of ultrasonography (US) in the evaluation of urinary tract when this failed to opacify during excretory urography (EXU).

Materials and Methods

Twelve urinary tracts in 11 patients were studied. In each case, during EXU, the urinary system failed to opacify within one hour of the injection of contrast media, and US revealed dilatation of the pelvocalyceal system. Patients underwent MRU, using a HASTE sequence with the breath-hold technique; multi-slice acquisition was then performed, and the images were reconstructed using maximal intensity projection. Each set of images was evaluated by three radiologists to determine the presence, level, and cause of urinary tract obstruction.

Results

Obstruction was present in all twelve cases, and in all of these, MRU accurately demonstrated its level. In this respect, however, US was successful in only ten. The cause of obstruction was determined by MRU in eight cases, but by US in only six. In all of these six, MRU also successfully demonstrated the cause.

Conclusion

MRU is an effective modality for evaluation of the urinary tract when this fails to opacify during EXU, and appears to be superior to US in demonstrating the level and cause of obstruction.     

The relevance of free fluid between intestinal loops detected by sonography in the clinical assessment of small bowel obstruction in adults

INTRODUCTION: The main role of the radiologist in the management of patients with suspicion of small bowel obstruction is to help triage patients into those that need immediate surgical intervention from those that require medical therapy or delayed surgery. Ultrasound examination is usually considered not helpful in bowel obstruction because of air in the intestinal lumen that interferes the evaluation of the intestinal loops, however recently some Authors attested the increasing important role of sonography in the acute abdominal disease. Aim of our report is to demonstrate the value of free fluid detected by US in differentiating between low and high-grade small bowel obstruction. MATERIALS AND METHODS: The study is based on 742 consecutive patients who presented symptoms of the acute abdomen; all patients had undergone initial serial abdominal plain film and US examinations prior to any medical intervention. We reviewed the imaging findings of 150 cases in whom small bowel obstruction was clinically suspected and confirmed at surgery. We consider the following radiographic and US findings: dilatation of small bowel loops; bowel wall thickness; presence of air-fluid levels; thickness of valvulae conniventes; evidence of peristalsis; presence and echogenicity of extraluminal fluid. We looked at the value of extraluminal peritoneal fluid at US examination in differentiating low and high-grade small bowel obstruction based on the surgical outcome. RESULTS: In 46 patients altered peristaltic activity, thin bowel walls, fluid filled loops with hyperechoic spots in the bowel segment proximal to obstruction were noted at US, whereas radiographic features were: moderate dilatation of small bowel loops, with thin bowel wall and evidence of numerous and subtle valvulae conniventes; presence of air-fluid levels was also noted. In 70 other patients, US examination revealed all the findings described in the precedent cases and also the presence of free extraluminal fluid; abdominal plain film showed an increased dilatation of small bowel loops with moderate thickened wall and air-fluid levels. In 34 other patients US examination revealed the presence of thick-walled loops, hypoperistalsis and a larger amount of free extraluminal fluid. Radiographic findings in these patients were: horizontal featured and markedly dilated small bowel loops presenting parietal thickness, presence of intraluminal fluid stasis and evidence of thickened, sparse and incomplete valvulae conniventes. At surgery etiology of small bowel obstructions was various, but most of cases related to adhesions (70 cases). The presence of extraluminal fluid were confirmed at surgery in 104 patients. CONCLUSIONS: Our experience using sonography in suspicion of SBO (small bowel obstruction) suggests the usefulness of this imaging modality to differentiate a functional or obstructive ileus, demonstrating the evidence of intestinal peristalsis. Furthermore, the presence of a large amount of fluid between dilated small bowel loops suggests worsening mechanical small bowel obstruction, that requires not a medical therapy but immediate surgery.     

Bile duct obstruction: radiologic evaluation of level, cause, and tumor resectability

In a prospective study of 65 patients with bile duct obstruction, various radiologic modalities were compared for their capability to demonstrate the level and cause of obstruction and to indicate accurately tumor resectability. Ultrasound (US) was performed in 65 patients, computed tomography (CT) in 51, direct cholangiography (DC) in 57, and angiography in 35. The level of obstruction was correctly indicated by US in 95% of patients and by CT in 90%, and the cause was correctly indicated by US in 88%, by CT in 63%, and by DC in 89%. In predicting tumor resectability, US was correct in 71% of patients, compared with 42% for CT, 58% for DC, and 25% for angiography. US therefore appears to be the single most useful modality in the evaluation bile duct obstruction.     

Renal colic: diagnosis and outcome.

To assess whether ultrasonography (US) with or without plain abdominal radiography (kidney, ureter, bladder [KUB] radiography) can replace intravenous urography (IVU) in detection of acute urinary tract obstruction, 101 consecutive patients with renal colic were evaluated with US followed immediately by IVU. Receiver operating characteristic (ROC) curves for US diagnosis of acute urinary tract obstruction yielded sensitivities of 91% and 92% for two reviewers at a specificity of 90%. There was no statistically significant difference between US and IVU results. When US was combined with KUB radiography, ROC curves yielded sensitivities of 94% and 97% for two reviewers at a specificity of 90%.KUB radiography alone was of limited diagnostic value. For US alone, no false-positive results occurred, and the false-negative results (n = 9 and n = 6 for two reviewers) were encountered in cases of grade 1 hydronephrosis and nondilated obstructive uropathy. The authors conclude that US combined with KUB radiography can replace IVU in initial evaluation and follow-up of the great majority of patients with renal colic.     

股骨近端锁定钢板与动力髋螺钉治疗转子间骨折的分析

目的 比较股骨近端锁定钢板与动力髋螺钉(DHS)治疗股骨转子间骨折的临床效果.方法 收集2007年6月～2010年12月来我院就诊的股骨转予间骨折的患者87例,随机分成两组,分别采用股骨近端锁定钢板(47例)和DHS(40例)治疗,比较两组患者的手术时间、术中出血、骨折愈合时间、髋关节功能Harris评分及术后并发症.结果 87例患者均获得随访,平均随访时间为11.6个月.两组患者在手术时间上无明显差异(P＞0.05),但近端锁定钢板组术中出血多于DHS组(P＜0.01);两组患者骨折愈合时间及Harris评分无统计学差异(P＞0.05);近端锁定钢板组出现2例锁定螺钉进入髋关节的并发症,DHS组出现1例髋内翻、1例头钉拔出.结论 股骨近端锁定钢板治疗转子间骨折临床效果与DHS相似,是一种较为理想的手术方式.     

小儿上消化道梗阻性病变的X线与超声诊断评价(附20例报告)

目的探讨X线和B型超声对小儿上消化道梗阻性病例的诊断价值。方法20例经手术证实的不同原因的小儿上消化道梗阻病例,分别对其X线表现和超声影像进行对比性研究。结果幽门狭窄12例:X线确诊11例,疑诊1例;超声确诊9例,疑诊2例,误诊1例。十二指肠闭锁3例:X线疑诊2例,误诊1例;超声确诊1例,疑诊1例,漏诊1例。肠旋转不良3例:X线疑诊1例,漏诊2例;超声确诊1例,漏诊2例。食管裂孔疝2例:X线确诊2例;超声漏诊2例。结论2种方法有明显的互补性,不能互相取代。在幽门狭窄和食管裂孔疝的诊断中,X线确诊性高于超声;而肠旋转不良所致的十二指肠梗阻超声诊断优势明显。     

Recurrence of ovarian and uterine neoplasms: diagnosis with transrectal US

Twenty-one patients with clinically suspected recurrence of ovarian (n = 3) or uterine (n = 18) carcinoma were examined with suprapubic ultrasound (US) and transrectal US with high-frequency linear probes. The examinations were performed 3, 6, 9, and 15 months after surgery and radiation therapy. Eight patients underwent radiation therapy before surgery and ten after surgery; three underwent only surgery. Criteria for recurrence included increased anteroposterior diameter of the vaginal cuff (greater than 2.2 cm); structural alterations or presence of a mass in the vaginal cuff; and infiltration of the rectovaginal septum, bladder, and parametria. Transrectal US findings were true positive for recurrence in nine cases, true negative in ten, and false positive in two. US findings were true positive in three cases, true negative in seven, false positive in two, and false negative in three. In six cases results from US were technically poor, and no diagnosis could be made. Transrectal US was highly sensitive in detection of pelvic recurrent carcinomas, while US had little diagnostic value. The authors believe transrectal US can replace US in the evaluation of patients at risk for recurrent pelvic neoplasm.     

Nondilated obstructive acute renal failure: diagnostic procedures and therapeutic management

We examined 80 patients with acute obstructive anuria by ultrasound (US). Four of the 80 patients did not have dilatation of the urinary tract. In all four cases, antegrade pyelography guided by real-time US demonstrated urinary tract obstruction after the four patients had experienced 4, 5, 8, and 34 days of anuria, respectively. Diuresis occurred as a result of percutaneous nephrostomy in all four cases. Three of the patients were successfully treated by percutaneous techniques alone. Our findings demonstrate that even a complete and long-term obstruction of the urinary tract does not necessarily induce dilatation in the upper part of the tract. In such cases, only the direct opacification of the urinary tract can help confirm that the obstruction is present. Even in the absence of dilatation, antegrade pyelography guided by real-time US is a possible diagnostic method and can be the first step in the performance of percutaneous nephrostomy.     

Nondilated obstructive uropathy: percutaneous nephrostomy performed to reverse renal failure

Ureteral obstruction can lead to renal failure without involving detectable dilatation of the calyces, renal pelvis, or ureter proximal to the obstruction. This phenomenon was noted in seven patients who had clinical obstruction that we were not able to diagnose using computed tomography (CT) or ultrasonography (US). These patients underwent percutaneous nephrostomy (PCN), which resulted in brisk diuresis and improved renal function. We obtained an accompanying antegrade urogram in these cases, which demonstrated the level of obstruction and indicated that dilatation of the collecting system was minimal or not present. When obstructive uropathy is suspected, we believe it is essential to consider performing PCN to evaluate and potentially reverse renal failure, even when CT and US scanning do not demonstrate obstruction.     

MRI、US、CT对胆道良恶性梗阻鉴别诊断的对比研究

目的评价MRI、US、CT在胆道梗阻性病变良恶性鉴别诊断中的价值。方法对86例同时行MRI、US(包括34例兼有CT)检查的胆道梗阻患者,采用ROC曲线进行良恶性诊断效能的比较。结果MRI对胆道梗阻性病变良恶性鉴别诊断的效能优于US和CT诊断(P<0.05)。结论MRI是鉴别胆道梗阻性病变良恶性的一种准确、非侵入性的检查方法。     

Role of CT and ultrasonography in acute blunt trauma of the abdomen

From March 1985 to April 1989, one hundred thirty-one patients were examined using computed tomography (CT) and/or ultrasonography (US) in the evaluation of acute blunt trauma of the abdomen (CT and US in 36 patients, CT in 25 US in 70). Twenty-three out of the 131 cases (17.6%) showed positive findings of abdominal trauma on CT and/or US. Sixteen of the 23 patients with positive findings underwent therapeutic laparotomy, while all of the other 108 patients with negative findings were successfully managed conservatively. This fact suggests that one of the roles of CT and/or US is to pick up patients with negative findings who do not have any laparotomy. Free fluid collection was demonstrated in all of the 23 patients with positive findings in: all 22 on CT (100%), and 13 of 14 on US (92.9%). In all of the 23 patients but one with an injured mesenterium, injured organ was demonstrated by CT and/or US in: 21 of 22 by CT (95.5%), and 11 of 14 by US (78.6%). In one of the 11 patients, not an immediate US but a follow-up on the next day revealed an injured organ. In 6 out of the 12 patients who underwent both plain and contrast enhancement (CE), CT, CE-CT demonstrated the injured organ more clearly than plain CT. US with sector probe was also useful for demonstrating the injured lesion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of bowel ischemia with contrast-enhanced US: initial experience

PURPOSE: To prospectively evaluate the accuracy of contrast material-enhanced ultrasonography (US) in the depiction of bowel ischemia in patients with radiographic evidence of small-bowel dilatation. MATERIALS AND METHODS: The ethics committee approved this study, and informed consent was obtained from all patients. Fifty-one patients (34 men and 17 women; mean age, 67.1 years) with evidence of small-bowel dilatation at conventional radiography were enrolled. Twenty patients had bowel ischemia (15 cases of bowel strangulation and five of thromboembolism of the superior mesenteric artery) and 31 patients had simple obstruction. After injection of SHU-508A, the most dilated or the least peristaltic bowel segments were imaged at contrast-enhanced power Doppler US (interval, 4 seconds) for 2 minutes. Color signals obtained in the bowel wall were classified as normal, diminished, or absent. Contrast-enhanced US and classification of color signals were performed by a sonologist. The US systems were equipped with 3-12-MHz transducers. Fisher exact test was used to evaluate the significance of the differences between each group of patients, and P < .01 was considered to indicate a significant difference. RESULTS: The color signals were absent in five patients with superior mesenteric arterial thromboembolism and in seven patients with strangulation, were diminished in five patients with strangulation, and were normal in three patients with strangulation and in 31 patients with simple obstruction. By pooling the absent and diminished color signals together as a diagnostic indicator of bowel ischemia, the sensitivity was 85% (95% confidence interval [CI]: 62.1%, 96.8%), the specificity was 100% (95% CI: 90.8%, 100%), the positive predictive value was 100% (95% CI: 83.8%, 100%), the negative predictive value was 91.2% (95% CI: 76.3%, 98.1%), the likelihood ratio for a positive test result was infinity, and the likelihood ratio for a negative test result was 0.15 (95% CI: 0.032, 0.379). CONCLUSION: Contrast-enhanced US shows promise for the noninvasive diagnosis of bowel ischemia based on initial experience in patients with radiographic evidence of small-bowel dilatation.     

Transabdominal ultrasonography of the small bowel after oral administration of a non-absorbable anechoic solution: comparison with barium enteroclysis

AIM: The aim of this study was to determine if oral administration of a non-absorbable anechoic solution conveys any benefit during abdominal ultrasound (US), with special reference to its accuracy.MATERIALS AND METHODS: Fifty-three adult out-patients scheduled for small bowel barium enema (SBE) were included. The day before SBE all patients underwent abdominal US before and after oral administration of an isotonic non-absorbable electrolyte solution containing polyethylene glycol (PEG-ELS). Sensitivity and specificity were evaluated using SBE as a gold standard.RESULTS: After ingestion of PEG-ELS satisfactory distension of the intestinal lumen was obtained (11-25 mm) with sequential visualization of jejunoileal loops in 30.9 +/- 17.3 min. In 15 out of 53 cases both US and SBE showed bowel changes characteristic of Crohn's disease. In three out of 53 cases both US and SBE showed neoplasms. In one out of 53 cases US was negative, SBE positive for local nodularity and ulcerations typical of Crohn's disease. In one out of 53 cases US was negative, SBE positive for macronodularity consistent with coeliac disease. In five out of 53 cases US was negative, while SBE was positive for mininodularity expressive of lymphoid hyperplasia. In 28 out of 53 cases both examinations were negative.CONCLUSION: PEG-ELS administration allows a thorough US investigation of the small bowel, with fair sensitivity (72%) and excellent specificity (100%). False negative findings are mainly due to lymphoid hyperplasia, a feature of uncertain significance in adults.     

Ultrasound diagnosis of intragastric balloon complications in obese patients

PURPOSE: Our study describes ultrasonography (US) aspects of complications related to the use of the Bioenterics intragastric balloon (BIB) system for the treatment of moderate obesity. MATERIALS AND METHODS: Over the last three years 151 BIBs were endoscopically placed and inflated with 500-600 ml of saline plus 10 ml of methylene blue in 131 patients (mean age 38.4 years, range 18-72; 46 males, 85 females, mean body mass index 43.8 kg/m(2)). In all cases abdominal US was carried out before and 1-2 days after endoscopy and thereafter at scheduled follow-up visits and/or whenever the patient complained of heartburn, vomiting, a sensation of 'absence of the BIB' with or without staining of urine and/or faeces. RESULTS: The BIB appeared as a round anechoic structure, with a thick hyperechoic wall and a hyperechoic band-like valve inside. In 8 cases staining of urine and/or faeces prompted immediate endoscopic removal. In 10 patients US findings of BIB-related complications were: 1) decreased volume with a visible valve (5 cases; in two of these staining of urine was reported); 2) multiple hyperechoic streaks regularly spaced due to a completely collapsed BIB, not modified by decubitus changes (3 cases; one patient reported staining of urine); 3) migration through the bowel (2 cases): in one patient the BIB was passed after 4 days, whereas in the other case bowel obstruction required laparoscopic surgery. CONCLUSIONS: In conclusion, US provides a quick and accurate method for the assessment of BIB-related complications in obese patients.     

Renal obstruction in patients with ileal loops: US evaluation

Ultrasound (US) is often employed as a screening test for hydronephrosis in the nondiverted kidney and has been used recently to evaluate the diverted kidney, specifically ileal loops, for obstruction. The utility of US in evaluating obstruction in patients with ileal loops has apparently not been previously explored. During a 2-year period, 87 kidneys drained by an ileal loop diversion were examined with US because of clinical indications of possible renal obstruction. In 33 kidneys, no hydronephrosis was seen on sonograms, and no obstruction was later proved; in 51 kidneys, shown by US to be hydronephrotic, only 19 (37%) were obstructed. Three left kidneys were not visualized with US. The percentage of hydronephrotic kidneys subsequently shown to be obstructed increased rapidly as the US appearance progressed from grade 1 (20%) to grade 3 (80%). In this series, US had a 100% sensitivity and a 50% specificity in evaluating patients with ileal loops for renal obstruction. Thus, for the adult patient, a direct contrast evaluation of the collecting system is suggested; for the pediatric patient, initial use of US is justified as a means to avoid radiation exposure.     

CT of small-bowel obstruction in children: sensitivity and specificity.

OBJECTIVE.:The aim of this study was to determine the sensitivity, specificity, and accuracy of CT in the diagnosis of small-bowel obstruction in children. MATERIALS AND METHODS: The CT scans of 30 children with surgically proven small-bowel obstruction, 22 children with ileus, and 29 children who served as controls were retrospectively reviewed by two of four interpreters who were unaware of the children's final diagnoses. Causes of obstruction in the patients included 19 adhesions, six cases of volvulus, five intussusceptions, four strictures, and two cases each of internal hernia and abscess. Eight obstructions had multiple causes. The CT scans were evaluated for the presence of small-bowel obstruction using a scale with five degrees of confidence. In cases of discrepancy of more than one level of certainty, a third interpreter was consulted. Criteria for small-bowel obstruction included a discrepancy in caliber between the proximal dilated and the more distal small bowels or generalized small-bowel dilatation (>2.5 cm) in the presence of a collapsed colon. An interpreter's rating that an obstruction was either present or probable was considered a positive finding; a rating indicating that the interpreter was not sure whether an obstruction was present or believed that an obstruction was not probable or saw normal anatomic structures was considered a negative finding for small-bowel obstruction. The cause and level of obstruction also were recorded. RESULTS: There were 26 true-positive (87%) and four false-negative (13%) interpretations for small-bowel obstruction. Among the interpretations of scans of patients with ileus, 68% were true-negative and 32% were false-positive interpretations for small-bowel obstruction. Among the control group, there were no false-positive readings. Sensitivity of CT was 87%, specificity was 86%, and accuracy was 86%. In the scans of children 2 years and younger, CT had a sensitivity of 100% and specificity of 0%. Of the patients with surgically confirmed levels of obstruction, the correct level of obstruction was described by both interpreters in 12 (86%) of 14 scans. The causes of obstruction were correctly identified in 14 (47%) of 30 scans. CONCLUSION: CT is both sensitive and specific for use in diagnosing small-bowel obstruction in children, especially in children older than 2 years.     

三种内固定方式治疗老年稳定性股骨粗隆间骨折的疗效对比

目的对比分析老年股骨粗隆间骨折Gamma钉、股骨近端防旋髓内钉(PFNA)及动力髋螺钉(DHS)三种内固定治疗的疗效。方法回顾性分析2013年2月—2016年8月南京梅山医院骨科治疗的稳定性股骨粗隆间骨折(Evans-JensenⅠ~Ⅱ型)老年患者(年龄≥65岁,均为单侧骨折)336例,其中接受Gamma钉治疗108例,PFNA治疗137例,DHS治疗91例,观察比较三组患者手术时间、术中出血量、术后引流量、骨折愈合时间等。结果 PFNA组手术时间和术中出血量分别为(68.41±17.64)min和(120.07±32.42)m L,明显低于Gamma钉组和DHS组(P0.05);Gamma钉组术后引流量为(70.46±29.87)mL,明显低于PFNA组和DHS组(P0.05);DHS组下地负重时间为(12.10±4.40)周,明显低于Gamma钉组和PFNA组(P0.05);Gamma钉组下地负重时间为(14.06±4.91)周,明显低于PFNA组(P0.05);三组骨折愈合时间、术后12个月Harris评分比较差异无统计学意义(P0.05);DHS组并发症发生率为20.88%,明显高于Gamma钉组和PFNA组(P0.05)。结论对于老年稳定性股骨粗隆间骨折患者,Gamma钉、PFNA和DHS内固定治疗均可获得满意疗效,PFNA和Gamma钉在缩短手术用时和减少术中出血量效果显著,DHS可使患者早期进行负重训练,临床上应根据患者具体情况进行选择。