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@#Objective To explore the clinical value of 99mTc-diethylenetriaminepentaacetic acid(DTPA)renal dynamic imaging in evaluating renal tubulointerstitial injury in early adult primary nephrotic syndrome(PNS)patients.Methods A total of 42 early adult PNS patients were selected as case group,and the diagnostic efficacy of 99mTc-DTPA renal dynamic imaging quantitative indicators and biochemical indicators of serum creatinine(SCr),blood urea nitrogen(BUN),blood uric acid(UA),blood retinol-binding protein(RBP),and blood β2-microglobulin(β2-MG)levels in renal tubulointerstitial injury was analyzed based on pathological results with or without renal interstitial injury as the standard.Results ①The total glomerular filtration rate(GFR),left kidney GFR and right kidney GFR were negatively correlated with blood SCr,BUN and β2-MG levels of patients in case group.②The diagnostic efficiency of total GFR in diagnosis of tubulointerstitial injury in early adult PNS patients is better than that of blood SCr,BUN and β2-MG,total GFR combined with time to peak(Tp),half discharge time(T1/2)and 20 minute residual rate(R20/p)can improve the diagnostic efficiency.Conclusion 99mTc-DTPA renal dynamic imaging is helpful in early diagnosis of tubulointerstitial injury in early adult PNS patients.
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Objective:To evaluate the various wire tension belt ventral compression wiring technologiesfor treating several types of femoral greater trochanter fractures in total hip replacement, according to the different types of greater trochanter of femur fractures.Methods:From March 2013 to June 2019, a total of 1 280 cases of primary total hip arthroplasty were completed in our hospital, 21 patients with greater trochanter fractures were identified in total hip replacement. There were 11 males and 10 females with an average age of 65.81±6.45 years (range 42-76 years). All of them were unilateral. There were 11 cases on the left and 10 cases on the right. There were 11 cases of osteoarthritis secondary to hip dysplasia, 4 cases of hip osteoarthritis, 4 cases of aseptic necrosis of femoral head and 2 cases of femoral neck fracture. Different wire tension belt ventral compression wiring technologies were used for each fracture type. Harris hip function score, Parker activity score, and visual analogue scale (VAS) score of hip pain were evaluated during follow-up. X-ray films were taken to evaluate the fracture healing, prosthesis position, loosening and dislocation.Results:Three new fracture types were proposed: A transverse fracture from the greater trochanter tip to the base (4 cases); B oblique fracture from the greater trochanter tip to the base (according to the fracture line direction, type B was further divided into types B1 (4 cases) and B2 (6 cases); and C fracture line from the greater trochanter to subtrochanteric plane (7 cases). Among the 21 patients, one died at an early stage, two were lost during follow-up, and 18 were followed up for an average of 30.7±7.6 months. In 18 patients, the mean operation time was 110.0±20.0 min, and the mean intraoperative blood loss was 356.9±115.7 ml. The patients' Harris score was 35.26±5.52 at the preoperative, 65.7±6.42 at the 3 months after operation, and 87.75±6.21 at the final follow-up. The difference was statistically significant ( F=377.23, P<0.001). The patients' Parker score was 2.17±0.98 at the preoperative, 5.94±1.11 at the 3 months after operation,and 8.01±0.77 at the final follow-up. The difference was statistically significant ( F=170.96, P<0.001). The patients' VAS score was 6.22±1.11 at the preoperative, 2.61±0.92 at the 3 months after operation, and 1.28±0.67 at the final follow-up. The difference was statistically significant ( F=139.71, P<0.001). Deep vein embolism, heterotopic ossification was noted in one and another patient, respectively. The patient with non-union refused reoperation and had a broken steel wire, lower-limb limp, and no notable pain at the 12-month follow-up examination. Radiographs of 17 patients showed good location of the femoral prosthesis and no chronic pain. Conclusion:Different types of greater trochanter fractures in total hip arthroplasty were proposed, using different wire tension belt ventral compression wiring technologies for the various types of femoral greater trochanter fractures during total hip replacement can improve clinical outcomes.