Objective To compare the clinical effects of hemiarthroplasty and dynamic hip screw (DHS) in treatment of unstable femoral intertrechanterie fractures in the elderly. Methods A total of 62 elderly patients with unstable femoral intertrochanteric fractures treated from January 2004 to April 2007 were randomly divided into DHS group and hemiarthroplasty group, with 31 patients in each group. The patients were foLlowed up to compare the clinical effects between two groups. Results Of all, 58 patients ( including 28 patients in the hemiarthroplasty group and 30 in DHS group) were followed up for 13-49 months. The mean operation time was ( 76.07 ± 6.29 ) minutes in hemiarthroplasty group and ( 117.50 ± 8.88 ) minutes in DHS group ( P < 0.05 ). The mean blood loss during operation was (305.36±34.26) ml in hemiarthroplasty group and (431.67±53.31) ml in DSH group (P<0.05). The postoperative complications occurred in three patients in hemiarthroplasty group and 10 in DHS group, with statistical difference ( P < 0. 05 ). The Harris score for hip function was ( 85.46 ± 3.05 ) points in hemiarthroplnsty group and ( 79.73 ± 2.57 ) points in DHS group, with no statistical difference between two groups ( P > 0.05 ). Conclusions DSH is still one of effective methods for patients with unstable femoral intertrochanterie fractures. Hemiarthroplasty can diminish bleeding during operation, help walk earlier and reduce complications and is a better selection for the elderly patients with osteoporosis and unstable femoral intertrochanteric fractures. However, hemiarthroplasty can not replace DHS.

Background and purpose: Many factors have impacts on the surgery approach of breast cancer. The purpose of this study was to analyze the influence factors of breast reconstruction for patients with breast cancer, focusing on the relationship between travel distance and breast reconstruction. Methods: Retrospective review of all female breast cancer patients staging 0-Ⅱ who underwent unilateral or bilateral mastectomy with or without breast reconstruction at Fudan University Shanghai Cancer Center from 1999 to 2015 was conducted in the study. Analysis of travel distance and breast reconstruction rate was performed. Results: Non-Shanghai patients have higher breast reconstruction rate after mastectomy compared with Shanghai patients (6.1％ vs 4.5％, P＜0.001). Travel distance may have an influence on the breast reconstruction rate (P=0.035). Univariate regression analysis showed that the increase of travel distance was the predictor of breast reconstruction, and that the increase of age or body mass index (BMI), or the later TNM stage had a negative correlation with breast reconstruction (P＜0.001). Multiple regression analysis demonstrated that the increase of age or BMI, or the later TNM stage was the independent predictor of the refusal of breast reconstruction (P＜0.001), but travel distance was not (P＞0.05). No significant correlation between the travel distance and breast reconstruction types was indicated. Negative correlation was observed between age and travel distance (P＜0.001). Conclusion: Age, BMI and tumor stage are the main influence factors of breast reconstruction, while travel distance shows a linear correlation with it.