Chapter 41 Rubik’s Cube Restoration
The news spread quickly, and the entire orthopedics department knew that Yang Ping was going to perform a 3,000-piece comminuted fracture of the lower end of the humerus, using only steel wires and pins.
Including spine, joint, and sports medicine, many young doctors, graduate students, and interns inquire about the operation time in advance.
Xiaowu Zhang Lin had already said: "One seat, one meal! No bargaining." He even went to the head nurse to get the registered textbooks.
They also took away the ink pad that Corey signed, saying that it would be written in black and white by then.
"Old man Zhang will be here then. He must be sitting in the middle of the front row. I'll put a layer of glue on his chair." Zhang Lin has many clever ideas.
"I've been called to the operating room three times, but you're still applying glue here." Yao Ling, the head nurse, took the medical record and patted him gently.
The head nurse still has a relatively high prestige in Corey, and is equivalent to Corey's housekeeper.
Everyone found the person who would take over the surgery, rolled up their sleeves, and got ready to take a good look. Anyway, there are a lot of people in the department, and there are a lot of postgraduate students waiting in line for surgery, so allocating manpower couldn't be easier.
Song Zimo, Zhang Lin, Fang Yan, and several other groups, people under Director Ouyang and Director Bai also came, and a dozen people from the spine, joint, and sports medicine departments also came.
Everyone wants to see how this 3,000-yuan surgery is performed. The key is to use wire Kirschner wires, which is impossible.
After the class was handed in on Thursday, everyone was afraid that they would not have a seat, so they sat in the demonstration classroom next to the main operating room early in the morning, barely holding a box of popcorn.
Wearing hand sanitizer and wearing masks, everyone greeted each other. They are both majoring in orthopedics, and they look up and down, and they may even work together during the previous rotation.
Doctors who have just graduated usually first do rotations in the surgical or internal medicine departments. They stay in one department for three months to become fully familiar with the knowledge of surgery or internal medicine, and also get familiar with their colleagues in each department.
Some interns didn't have a seat, so they stood in the back, and those with whom they were close squeezed into a chair. The front row is automatically reserved for Old Man Zhang and the director. The director may or may not come.
But when Old Man Zhang heard that he was coming, his assistant had already made the announcement.
"Professor Zhang, hello!" Dr. Peng on the other side of the spine saw Zhang Lin and immediately greeted him.
Everyone's hearts jumped in fright, thinking that Professor Zhang Zongshun had arrived.
Zhang Lin immediately shook hands: "Nice to meet you, Professor Peng, come in person?"
These young doctors tease each other in private and call each other professor and director.
Next door, Song Zimo was disinfecting, Xiao Wu raised his hand, Director Tian was sitting on the side, equipment nurse Su Yixuan was arranging the equipment, Yang Ping had put on surgical clothes and was standing aside waiting.
Director Tian is relatively stable and has solid skills. He is the kind of person who is usually inconspicuous but can come in handy at any time.
Seeing the pair of reading glasses wrapped with tape, everyone didn't dare to say anything, and their bodies shrunk by half. He was really here.
Professor Zhang Zongshun, guided by his assistant, came in and sat in the middle seat. Zhang Lin quickly informed Director Han, and soon Director Han also showed up.
It's just an operation, so it won't delay anything. Other operations can be pushed forward, so Director Han also arranged the time.
Director Han shook hands with Old Man Zhang: "Professor Zhang, why are you here in person? We can just send the video over and give you a grade."
"Let's take a look. Didn't you say that Kirschner wire can't be used for this kind of fracture? I just want to see how you can get to the imperial capital without money to buy a plane ticket?" Mr. Zhang always speaks with such a spicy and humorous tone.
Director Han accompanied him: "Quickly, find a mat for Mr. Zhang to lean on."
A student brought a silicone posture cushion over. Mr. Zhang was not polite and put it on the back of his waist: "Young man, if you dare to go on stage, you will get one extra point."
"Young people are inexperienced, and their basic skills are not as solid as the doctors at Zhang's time." Director Han said.
"Don't be humble for him. I'm afraid this kid is a bit fierce. It's hard to estimate the weight without squeezing it out. His clavicle is broken, and his few Kirschner needles are not something that anyone can punch out. Besides, it's really not possible. , Aren’t you the one who has the whole story?” Mr. Zhang said slowly.
Director Han knew in his heart that Mr. Zhang knew what he was doing and wanted to test Yang Ping. But if it didn't work, the two of them could give him the truth. The purpose of Mr. Zhang coming to the operating room was to give him the truth.
"When the show starts later, just pretend that the old man doesn't exist and just do your best -" Tian Yuan cheered to Yang Ping.
"Side-lying position is a good choice of position." Old Man Zhang said.
Prepare for operation and check before operation.
The knife was slapped on the palm of Yang Ping's hand. He held the pen in a standard way, opening and closing the knife in place. The skin was cut in one go, neither deep nor shallow. I changed the electrosurgical knife. Before the blood came out, the electric knife had already touched it. With a single tap, the bleeding point was completely eliminated. Continue to cut through the deep fascia with the knife.
Olecranon osteotomy approach is the most convenient approach for exposure. Use a mini electric saw to open the olecranon upwards in a beautiful V shape, exposing the entire joint surface of the lower end of the humerus.
The suction device removes the accumulated blood, and the broken bones inside are exposed, some with cartilage, some without cartilage, coronal plane, sagittal plane, cross section, all kinds of shapes, a mess.
"How to do this?" It was worse than the X-ray showed.
Everyone looked at the video on the screen clearly, and they were all stunned. I originally wanted to see how to do it, but it was impossible to do the surgery like this.
There is a special word to describe this: abagbone!
A bag of bones!
The broken bones are like stones, and the outer skin and soft tissue are like a bag.
Putting these bone fragments together is extremely difficult and can be said to be impossible.
If it is an extra-articular fracture, it is easier to deal with and there is no need to put it back together. Intra-articular fractures are different. Any unevenness will wear out the joint. Once worn out, there will be long-term pain and mobility impairment. Intra-articular fractures require anatomical reduction, that is, what you want to restore to the original appearance.
If you can't fight it back, it's just a little bit worse and you'll be left with arthritis; if it's a little bit worse, you'll be disabled.
After a lot of training in the system, Yang Ping summarized the rules. There are certain methods for this kind of bone fragment assembly. The order of reduction and the distribution of K-wires are the most important. The whole step is like trying to solve a Rubik's Cube. There must be a scientific order and it cannot be done casually.
Something that seems simple requires a huge amount of effort.
If an empty eggshell is broken, someone can restore it with bare hands. Believe it or not, Yang Ping believes it anyway.
The fractures were a mess, and no large pieces could be found that could reflect the original appearance. Even the largest bone fragments could not be seen where they came from.
It's like a house that collapsed and turned into a pile of rotten bricks. Can you still tell where the bricks are?
Director Han frowned and Old Man Zhang remained silent.
The most powerful ghost eye can identify the few leaves it has seen among thousands of the same leaves.
A lot of training gave Yang Ping a sharp eye. He carefully held the bones and identified them one by one. If the bones had soft tissue attached, no matter how much, they were absolutely protected.
The vascular forceps are like clamping egg shells, with excellent control of force, which is stable without breaking.
After all the bone pieces have been identified, I already know where each piece should be, and the order in which to construct the restoration is gradually taking shape in my mind. If the scientific order cannot be found, one piece will be put back up, but the other piece will fall off; this piece is in good place, but it blocks the reset of the other piece; just after this piece is placed, that piece will be missed again, and it still cannot be done. to recovery.
"Cut the other end of the K-wire to a sharp point and prepare five of these."
Xiao Wu did as he was told. A normal K-wire has only one end that is pointed and the other end that is flat. Now he needs to cut the other end into a beveled tip.
"He really wants to reset, how can he reset?"
"This is difficult to make even with steel plates."
“No CT was done.”
"He wouldn't dare to go on stage even if he was beaten to death by a CT scan."
"I'm embarrassed now. How can I get off the stage?"
Everyone started discussing carefully. They originally wanted to see surgery, but how to deal with the situation now? Likely open, closed.
Some people were very disappointed and came to observe and learn with enthusiasm, but the result was like this.
Old man Zhang leaned against the silicone pad, took off his glasses, and wiped them.
In the irrigated surgical field, the Kirschner wires have been cut and loaded into the power drill.
The first bone fragment is moved up, and the Kirschner wire is firmly set on the proximal end of the humerus, allowing the Kirschner wire to penetrate the bone on the opposite side and the skin, and the bone fragments are aligned and sutured tightly.
Director Han secretly praised him for his good eyesight. This part was reset in one go without even trying to align it.
Use the key to unscrew the clamping head of the electric drill and withdraw it; in turn, clamp the exposed other end and slowly withdraw it until only a little bit of the flat bone surface of the tip is exposed.
The second piece comes up, still using the original Kirschner wire, but in reverse, and passing it back; the third piece, facing the proximal end of the humerus, has a Kirschner wire diagonally from the opposite side, 60 degrees from the first Kirschner wire. Cross each other, put the fourth piece in the middle, and put them on together.
I don’t know why the fourth piece is placed in the middle. Can’t you tell it’s in the middle?
Everyone is confused, let alone the fourth piece, among the pieces that are nailed on now, I can’t tell where they are from, and they still feel messy.
The fifth piece was inserted through a gap by the Kirschner needle just now.
Just like the recovery of a Rubik's Cube, each step is related to other steps and must be done according to the established method, otherwise it will not be recovered. Similarly, before recovery, what others see is also messy. Why is the red here at this step, and why is the blue there at that step?
After working on it for a long time, it's still a mess. It's a mess.
You won't just stick it out with a steel needle and call it a day, no matter what, right? Everyone is worried.
Song Zimo was worried that Yang Ping had been a little too distracted recently to undergo such an operation.
But looking at his serious look, he seemed to be confident, not like he was just messing around.
Is it really possible to put these bone fragments back together intact?
It can't be that awesome.
When the sixth piece was embedded, the two Kirschner needles were pushed back and both passed through the sixth piece; the seventh piece was pasted on the gap just now, and a new gap appeared. The ninth piece just filled this gap, and the third piece A Kirschner wire was inserted, not only through these two pieces, but also through other bone pieces.
The steel needle penetrates the bone block, and it is in place every time. Even the small and thin bone block, which is not allowed to be penetrated a second time, is safely passed through.
Song Zimo had already seen the clues and felt an indescribable feeling in his heart.
The lateral condyle has been formed, and the first layer of the Rubik's Cube has been assembled. The tenth, eleventh, and twelfth pieces are embedded in an oblique shape, and each piece is accurately positioned. The fourth thin Kirschner wire is fixed at once, just passing through the strongest part of the cortex.
In the medial condyle part, the prototype is beginning to appear, and the second layer of the Rubik's Cube is put together.
The thirteenth piece is attached, the fourth one is pushed through this piece, and the fifth K-wire is inserted, not only through this piece, but also through several other pieces.
The shape of the medial condyle is fully displayed, and the joint surface is successfully assembled, smooth and without defects.
The smooth joint surface is formed without any gaps or steps.
At this point, the third layer of the Rubik's Cube has been successfully restored.
Wow! There were small exclamations from the audience.
Those who felt bored began to cheer up; those who were about to leave early gave up their thoughts and focused their eyes on the screen. Some began to regret that they did not look at the details of the reset just now and wasted a precious learning opportunity.
A standard tension band is tied with steel wire on each side, and an oblique tension band is placed on each side to form a responsible three-dimensional triangle shape, just like the steel frame structure of a building.
Tighten the wire, cut it, and dispose of the tail. Cut the Kirschner wire and bend it to dispose of the tail.
Just like solving a Rubik's Cube, the process is incomprehensible, but the ending is clear.
It was really restored. The Kirschner wires and steel wires formed a wonderful three-dimensional stable structure.
Move your elbow joint, it's very stable.
Such an outrageous operation!
Only then did everyone understand that the order in which the bone pieces were put together and how to apply Kirschner needles were all planned. Only in this way can we achieve the greatest balance, lock each other, and finally form a whole. One step was messed up, and one was missing. , cannot be completed.
Don’t accept it!
wonderful! It was also the first time that Song Zimo saw someone using steel wires and Kirschner needles like this.
This is not surgery. This is building a miniature self-stable building using bone blocks, steel needles and wires.
"Second Brother Han, this kid under your command is not simple. Take good care of him." Old man Zhang stood up.
"Why, Mr. Zhang, don't you want to finish reading?" Director Han said.
"The prostate is not up to par, I can't hold it in any longer." Mr. Zhang stood up.
(End of chapter)