Objective To explore the curative effect of dynamic hip screw(DHS) and proximal femoral nail (PFN)in treatment of intertrochanteric fractures. Methods Dynamic hip screw(DHS) group is A group:30 patients, proximal femoral nail( PFN) group is B group:30 patients. In the respect of the average length of the incision, operation time,blood loss,X-ray exposure times,postoperative drainage volume,blood transfusion volume,antibiotics usage time,hospitalization time,postoperative ambulation time,healing time of fracture,criteria of Harris hip function score after half a year,complication rate,this paper made the comparative analysis of clinical efficacy and statistical analysis between the two groups. Results 60 patients were followed up for 9 months to 4 years, with the average of 2 years and 3 months and no death. The average length of the incision, operation time, blood loss, X-ray exposure times, postoperative drainage volume,blood transfusion volume, DHS group were( 13. 4 ± 1. 9) cm, (92. 8 ± 13. 0) min, (321.0±39.4)ml,(5. 8 ± 1.2)times, (84.1 ± 10. 1)ml, (316.6 ±79. 1 )ml;PFN group were(7.6 ± 1.1 )cm,(59. 0±6. 9)min, (204. 6 ±32. 7) ml, (5.0 ±0.9) times, (53. 9 ± 8. 7) ml, ( 196. 6 ± 18. 2) ml; the differences between two groups were statistically significant ( all P ＜ 0. 05 ) . Hospitalization time, postoperative ambulation time, healing time of fracture,DHS group were(6.2±3.7)d,(17.8±1.8)d,(69. 8 ± 12. 3)d, (13. 0 ± 1. 6) weeks,PFN group were(4.7 ±2. 6)d,( 16.0 ±2. 2)d, (46.9 ±4. 9)d, (11. 3 ±0.7) weeks, the difference was statistically significant (all P＜0. 05). Antibiotic use of time,hip function(Harris score standard)excellent and good rate after half a year, there's no significant difference between the two groups( all P ＞ 0. 05). Complication rate, DHS group:40% ; PFN group: 10%. The difference was statistically significant (P ＜ 0. 05). Conclusion Intertrochanteric fracture fixation PFN group had an advantage of smaller surgical trauma,less bleeding,shorter healing time,more rapid postoperative recovery,lower complication rate and other characteristics comparing with the DHS group. So it was worth being recommended for a wider use.

Objective To evaluate the effects of Botulinum-A toxin (BTX-A) injection into detrusor to treat detrusor hyperreflexia and neurogenic incontinence in the patients with spinal cord injury (SCI). Methods A total of 31 patients with SCI(mean age,30 years;male 20,female 11) were included into the study.All the patients underwent urodynamic examination and voiding diary was recorded.300 U of BTX-A was dissolved in 15 ml of saline,and the solution of BTX-A was injected into 30 different points in detrusor using a flexible cystoscopic needle.The evaluation for the effects and follow-up included voiding diary,urodynamic testing and observation of adverse and toxic effects. Results After the first injection,29 of the 31 patients had symptom relief within 3 to 14 days;4 cases received the second injection;4 cases were treated in combination with anticholinergic medication;and 2 cases had no improvement and,therefore,received other treatments.The mean follow-up was 8.5 months. After 3-week treatment of BTX-A,the mean frequency of incontinence decreased from 14.2 to 2.5 times per day.The mean volume of intermittent catheterization (IC) increased from 124 to 495 ml each time.Urodynamic data showed that mean cystometric bladder storage volume increased from 133 to 475 ml,mean maximum storage detrusor pressure decreased from 62.7 to 17.1 cmH 2O(1 cmH 2O=0.098 kPa).No adverse and toxic effect was observed. Conclusions Our initial experience suggests that Botulinum-A toxin injection into detrusor to treat detrusor hyperreflexia and neurogenic incontinence in patients with SCI may be an effective,safe,feasible and micro-invasive treatment choice.However,it is necessary to observe its long term outcome.

ObjectiveTo observe the effect of urethral stent implantation on detrusor-sphincter dyssynergia caused by neurogenic lower urinary tract dysfunction.Methods13 patients with detrusor-sphincter dyssynergia caused by neurogenic lower urinary tract dysfunction were treated with the operation of the urethral stent implantation. Voiding function, renal function, residual urine volume and hytronephrosis were examined before and after the operation to evaluate the effect of this procedure.ResultsAfter operation, 7 patients normally emptied their bladders and 6 patients had urinary incontinence. Urethral stents were removed from 2 patients in this group due to the irritation symptoms, the second implantation was performed in a patient due to the voiding difficulty. The renal function of patients after the operation had a non-significant improvement, but the residual urine volume and hytronephrosis improved significantly.Conclusion Urethral stent implantation can decrease residual urine volume and hytronephrosis in patients with detrusor-sphincter dyssynergia caused by neurogenic lower urinary tract dysfunction.

Objective To explore the technique, efficacy and complications of transurethral sphincterotomy with Holmium laser for the treatment of male patients with neurogenic bladder and examine its long-term outcome. Methods 20 male cases who received transurethral sphincterotomy with Holmium laser were included in this retrospective analysis, in which 7 cases injuried at cervical spinal cord, 6 at thoracic spinal cord, 3 at cauda equine; 1 was spinal meningocele, 1 was sacral crack, 1 was ependymoma, and 1 was myelitis sequel. The age was 20~64 years, averaged 45.1 years. They were followed up for 3~95 months (averaged 43.6 months) since the last sphincterotomy. Results The 20 patients significantly improved in symptoms, laboratory examination, imaging demonstration and urodynamic index after the operation.There were 3 patients who required repeated laser surgery during the follow- up. 17 patients were stable. Conclusion Transurethral sphincterotomy with Holmium laser is effective on neurogenic bladder with less bleeding for the appropriately selected patients.

Objective To evaluate the effectiveness and safety of Botulinum toxin-A (BTX-A) injection into detrusor to treat neurogenic detrusor overactivity in patients with spinal cord injury (SCI).Methods A total of 78 patients with SCI were treated with transurethral injection of BTX-A (300 IU dissolved in 15 ml of saline) into 30 different points of detrusor with 15 ml in every patients. Urodynamic parameters and voiding diary were assessed at baseline and 3 weeks and 3 months after the injections. Adverse events were recorded after the injection if present.Results After the first injection, 78 patients showed that the mean frequencies of incontinence decreased from 13.5 to 2.7 times per day, the mean volume of intermittent catheterization (IC) increased from 131 ml to 389 ml per time, the mean volume of incontinence decreased from 1 690 ml to 281 ml per day, the mean getting effect time was 7.6 days. 10 patients received second injection at 8.9 months after first injection, the results showed that the mean frequencies of incontinence decreased from 9.7 to 3.7 times per day, the mean IC volume increased from 108 ml to 387 ml. 6 patients received third injection at 5.8 months after second injection, the results showed that the mean frequencies of incontinence decreased from 9.2 to 3.9 times per day, the mean IC volume increased from 116 ml to 364 ml. No side effects were observed during the follow-up.Conclusion BTX-A injection into detrusor to treat neurogenic detrusor overactivity in patients with SCI seems to be an effective, safe and miniinvasive solution.

Objective：Our aim was to investigate the QT dispersion in patients with cor pulmonale and whether the QT dispersion was affected by cardiac function and hypoxemia of the patients with cor pulmonale. Methods：Fifty-one patients with cor pulmonale and 28 age-matched normal controls underwent electrocardiography, echocardiography, and arterial blood gas analysis. The　QT　dispersion　was measured manually. Results:The QT dispersion was significantly longer in patients with cor pulmonale than those in the controls (70.1 ± 25.8 ms vs 37.6 ± 12.5 ms, P< 0.001). The QT dispersion in the patients with right heart failure was markedly longer compared with those with normal cardiac function (87.9 ± 21.6 ms vs 51.7 ± 14.2 ms, P<0.001). The QT dispersion was affected by hypoxemia. The QT dispersion in the groups of PaO2< 8 kPa　or ≥ 8 kPa was 81.0 ± 25.9 ms and 62.1 ± 21.1 ms, respectively. There was significant difference between the groups (P< 0.01). The QT dispersion was significantly correlated with the interior diameter of right ventricle in the patients with cor pulmonale (r= 0.489, P< 0.01). Conclusion: The QT dispersion may be a useful parameter in the diagnosis for cor pulmonale and in the assessment of cardiac function in the patients with cor pulmonale.

ObjectiveTo observe the effects of intravesical electric stimulation (IVES) on bladder sensation of neurogenic bladder.Methods28 patients with neurogenic bladder was evaluated, which all underwent intravesical bladder stimulation. Their bladder sensation were analyzed before and after the treatment.Results57.1% of the patients increased bladder sensation after treatment, 32.1% appeared the first sensation and urge sensation after treatment, 42.9% remained stable.ConclusionIntravesical bladder stimulation is effective to improve bladder sensation in a majority of the patients with neurogenic bladder.

ObjectiveTo study risk factors of urinary calculus formation in spinal cord injured patients. MethodsThe clinical data of 128 patients with spinal cord injury following urinary calculi were retrospectively reviewed.ResultsAmong the 128 cases, there were 32 cases receiving bladder stoma; 34 cases, regular replacement of indwelling catheter; 12 cases, intermittent catheterization; 19 cases, triggered reflex voiding; 11 cases, voiding by abdominal straining; 20 cases, condom catheters with urine collection devices. 120 cases presented with urinary tract infection, and 11 cases presented serum calcium increase. Video urodynamic suggested detrusor areflexia in 39 cases, detrusor overactivity in 63 cases, detrusor external sphincter dyssynergia in 41 cases, detrusor bladder neck dyssynergia in 11 cases, external urethral sphincter overactivity in 27 cases, and urethral sphincter deficiency in 11 cases. The pathology of several physiological conditions coexisted in some patients.ConclusionBladder management after spinal cord injury have a major impact on urinary stones formation. Low urinary tract infection, detrusor-urethral sphincter dyssynergia and other lower urinary tract dysfunction, long-term indwelling urinary catheter and cystostomy were main risk factors for urinary calculus formation. The abnormal calcium metabolism after spinal cord injury may be a risk factor for calculus formation.

Objective To investigate the effect of Holmium laser urethrotomy under ureteroscopy on urethral stricture.Methods 30 men with urethral stricture who accepted urethrotomy with Holmium laser under ureteroscopy were observed.Results Operation was performed successfully in 21 cases;7 cases underwent 2～3 endoscopic surgical treatments.Endoscopic surgical treatment failed in 2 cases,and open surgery were performed on them.21 cases were followed up for 3～37 months,and 8 of them need urethral dilatation termly.Conclusion Endoscopic surgery with ureteroscopy and Holmium laser may be effective on urethral stricture with slight trauma.

Objective To explore the technique,efficacy and complications of external sphincterotomy with Holmium laser for the treatment of detrusor external sphincter dyssynergia (DSD). Methods 7 male cases with neurogenic DSD who received the procedure were reported. Results All patients got significant improvement after the operation in symptoms,laboratory,imaging and urodynamic index. No one required transfusion. 1 case lost the erection. There was no need of re-operation during the follow-up. Conclusion External sphincterotomy with Holmium laser for the treatment of DSD shows the advantages of less bleeding,safety and good effectiveness for the well selected patients.