Objective To compare the clinical effect of proximal femoral nail anti-rotation(PFNA) and dynamic hip screw(DHS) internal fixation in the treatment of femoral intertrochanteric fracture.Methods 80 patients with femoral intertrochanteric fracture were selected as research subjects.They were divided into PFNA group and DHS group by random number table,40 cases in each group.The operation time,intraoperative blood loss,postoperative wound drainage,postoperative weight-bearing time,healing time,complication rate,Harris hip function score between two groups were compared.Results The operation time of the PFNA group was lower than that of DHS group(t=22.66,P＜0.05),the amount of bleeding in operation was less than that in the DHS group(t=54.85,P＜0.05),the postoperative wound drainage volume was less than that of the DHS group(t=16.85,P＜0.05),the weight-bearing time after operation was shorter than that in the DHS group(t=20.18,P＜0.05),and the healing time was shorter than that in the DHS group(t=22.00,P＜0.05).The excellence rate of Harris hip function score in the PFNA group was 95.00％,which was significantly higher than 80.00％ in the DHS group,the difference was statistically significant(χ2=4.11,P＜0.05).The incidence rate of complication of the PFNA group was 7.50％,which was significantly lower than 25.00％ of the DHS group(χ2=4.50,P＜0.05).Conclusion Compared with DHS,PFNA internal fixation has the advantages of less operation time,less intraoperative blood loss,shorter healing time and low complication rate in the treatment of femoral intertrochanteric fracture.It is worthy to be promoted clinically.

Objective To report 1 case of iatrogenic botulinum poisoning misdiagnosed as myasthenia gravis,to discuss the clinical manifestation,distinguishing feature and prognosis of iatrogenic botulinum poisoning combined with literature.Methods We briefly introduced one patient with botulinum toxin poisoning misdiagnosed as myasthenia gravis.A 26-year old female was admitted in June 2017 in Gaochun People's Hospital of Nanjing,who received two injections of botulinum toxin 500 U for a short period of time due to cosmetic needs,then she suffered from fatigue,chest distress,eyelid ptosis and other symptoms.The patient was once misdiagnosed as myasthenia gravis,but the results of neostigmine test and repeated nerve stimulation examination were negative.After careful examination of the body (mandibular swelling) and repeated medical history requiring,the final diagnosis was clarified.After the treatment such as fluid infusion for 10 days,her discomforts were relieved.The literature was retrieved from "US National Library of Medicine National Institutes of Health (Pubmed) "," China National Knowledge Infrastructure (CNKI)" and "Wanfang Medicine Data China Information",a total of 17 articles were included in the analysis,including 30 effective cases.We analyzed the general characteristics,clinical manifestations and prognosis of botulinum toxin injection.Results Of the 30 cases,28 cases (96.7％) were female,2 cases (3.0％) were male,aged from 3 to 80 years old.Most of them were botulinum toxin type A,except 2 cases unknown.The clinical onset began from the injection day to 3 weeks after injection.The duration of the disease lasted from 10 days to 6 months.Most of the prognosis was good after treatment.Conclusion Careful attention should be paid to the serious reaction of botulinum toxin to ensure safe medication use.