Objective To investigate the effect of ventricle-peritoneal (V-P) shunt in treatment of patients who developed post-traumatic hydrocephalus (PTH) with no symptoms or with atypical symptoms due to an excessively severe traumatic brain injury (TBI).Methods A retrospective study was performed in patients who developed PTH with atypical symptoms undergone V-P shunt from January 2004 to June 2007.Patients' general information,TBI data,PTH severity and postoperative follow-up data were collected and applied to assay the improvement rate in prognosis and its associated factors.Results Thirty-one patients were involved in this study.After 12 months of follow-up,20 (65％) patients revealed significant improvements in clinical symptoms.Among 10 patients who developed PTH after decompressive craniectomy,cranioplasty was performed following V-P shunt and significant improvements were observed in nine patients.Patients' age and severity of PTH based on CT evaluation before shunt placement were strongly correlated with the surgical outcome.Conclusions Most PTH patients with atypical symptoms can benefit from V-P shunt.Additionally,younger patients and those with less severe PTH before V-P shunt are expected a better outcome.

Objective To explore the influence factors for femoral head necrosis after treatment of femoral neck fractures with dynamic hip screw (DHS) and anti-rotation screw.Methods A retrospective case series analysis was made on the clinical data of 106 cases of femoral neck fractures who had undergone fixation with DHS and anti-rotation screw between May 2010 and May 2015.There were 59 males and 47 females,with an average age of 57.0 years (range,27-76 years).By Garden classification,there were 27 cases of type Ⅱ,51 cases of type Ⅲ and 28 cases of type Ⅳ.All cases were divided into femoral head necrosis group (18 cases) and none-necrosis group (88 cases) according to the radiographs of the fractured hip at the follow-up.Univariate analyses and a multivariate logistic regression analysis were made to test whether the following factors were significantly associated with femoral neck necrosis:sex,age,Garden classification,Pauwels classification,Singh index,injury-to-surgery time interval,reduction methods,reduction quality,complete weight-bearing time,implant removal and the time cost of implant removal surgery.Results All the 106 patients obtained a mean follow-up of 49 months (range,26-76 months).Femoral head necrosis occurred in 18 cases (17.0％).In univariate analyses,Garden classification,reduction quality,implant removal and long time of the implant removal surgery were significantly associated with femoral head necrosis (P ＜ 0.01).In multivariate logistic regression analysis,high level of Garden classification(95％ CI 0.008,0.998,P ＜ 0.05),implant removal and long time of the implant removal surgery (95％ CI 0.000,0.143,P ＜ 0.01) were found to have a significant effect on femoral head necrosis development.Conclusions Fracture displacement,removal of internal fixation and broadening the screw canal,which cand hinder the blood supply of femoral head,will enhance the rate of femoral head necrosis.As a result,it needs prudent consideration to remove internal fixation after internal fixation with DHS combined with anti-rotation screw for femoral neck fractures.When it is difficult to remove the anti-rotation screw,it is better to give up,rather than to force a removal.