Chapter 51 I really don’t understand
"The traction abduction position, the fracture has not been reduced well, so just start the operation?"
"It will be troublesome later, the intramedullary nail cannot be inserted."
"Isn't this kind of fracture done very rarely?"
"Let's see, I don't know either."
"I heard that you will be able to walk normally the next day after the operation. It is still unknown whether the operation can be completed."
"If the cowhide is blown too much, it will break."
There was a discussion in the classroom next door. Everyone was disappointed with the start.
Just like a movie, it was so hyped before it was released that everyone was excited to see it. On the day of the release, the streets were packed with people. They crowded into the theater like crazy and finally bought a ticket. After watching it - it was a complete bad movie with nothing, not even a single attractive shot.
Yang Ping's tall image was naturally discounted in the minds of these young people. The Guizhou donkey had no skills and the Jiang man had exhausted his talents, and everyone sighed in their hearts.
Fractures of the greater trochanter of the femur are now generally treated with minimally invasive methods. In the elderly due to osteoporosis, PFNA intramedullary nails are the first choice for internal fixation. For this kind of surgery, body position is very important. It can be done in the adducted or neutral position. It cannot be done in the abducted position. In the abducted position, the intramedullary nail cannot be inserted at all. Fracture reduction is equally important. The fracture must be reduced first, otherwise, the following steps will not be possible. Correct posture and good reduction of the fracture are necessary conditions for surgery.
Now that the two necessary conditions are not met, how can the operation be successful?
In the demonstration classroom next door, senior doctors include Dr. Jin, and director-level doctors include Director Ouyang and Director Bai. They all want to come and see Yang Ping perform surgery. After all, everyone says that Yang Ping is miraculous.
Most of the young doctors, except for some rotation doctors and regular trainees, are orthopedics majors and have a certain understanding of these routine surgeries. I couldn't help but say a few words about this kind of posture repositioning before starting the stage.
"This guy didn't have much contact with the fractured lower limbs, so he went into battle in a hurry?" Fatty, Director Bai's chief physician, asked Dr. Jin.
Dr. King shook his head: "I don't understand!"
Fatty said: "How could Director Han just let him do it without any hesitation? Hand surgery is good, but other surgeries are a mess. There are too many."
"Director Han had a flight to catch, so he probably didn't explain clearly?" another doctor said.
"No, I heard that Old Man Zhang asked him to do it by name." An informed explanation.
"I'm embarrassed now, but it's okay. I'll definitely come to Tianyuan later. If I can't go to Tianyuan, it'll only take a few minutes." Someone from the spinal surgery department spoke to me.
"This operation is actually simple. I heard that the inner bone block is inserted into the muscle. It will definitely not be able to be reduced without incision. If it is done minimally invasively, this kind of bone block does not need to be treated. The main bone block is aligned in the front and side positions, and the nail is inserted into the bone block. If it’s inserted, it’s over. He hasn’t even reset the main bone. How will it end later?”
"What kind of reset, the posture is wrong."
Everyone is becoming more and more brave to speak.
Tian Yuan also came in at this time. He saw that Song Zimo was there and there was no shortage of manpower. He was afraid that staying in the operating room would make old man Zhang feel that there were too many people and he did not have a strong concept of sterility, so he simply came next door to watch the screen with everyone.
Although Su Yixuan is a nurse, she is an orthopedic specialist nurse and also knows a lot about surgery. She has done countless surgeries of this kind, so she naturally knows this. This position and reduction are really not good, and it will be very embarrassing to wait for the surgery.
She was sweating in her heart, this piece of wood, in normal operations, even laying a sheet would be perfect, but today she was performing surgery on Professor Zhang, why the positioning was not corrected, so she started the operation in a hurry, so she would not be nervous and make mistakes.
Yang Ping and Song Zimo went to wash their hands.
Through the glass, Song Zimo looked at the expressions of everyone next door and knew what everyone was thinking.
At the sink, Song Zimo said: "Everyone is worried, why don't you explain?"
Yang Ping said while washing his hands: "Explain what? You will know after you take two steps."
Rough words but not rough reasoning, boxers, it is more practical to say "I want to win" ten thousand times before the game than to go on stage and KO the opponent with one punch.
After washing his hands, Song Zimo disinfected, and Yang Ping began to put on surgical clothes and gloves. His face was calm and he did not react too much to everyone's questions.
Su Yixuan looked over several times, with a bit of anxiety in her eyes. Yang Ping smiled at her and told her not to worry, as he knew what was going on.
As if she had a clear understanding, Su Yixuan immediately calmed down and began to sort out the equipment, checking the PFNA intramedullary nail, spiral blade, locking nail, steel cable, and supporting equipment.
The engineer from the equipment dealer was standing by, checking with Su Yixuan with a laser pointer. If there were any mistakes, he would be scolded if he encountered a bad-tempered surgeon, so he did not dare to be careless at all.
After the disinfection and draping is completed, the electric knife and suction device are connected, the ritual pre-operative check is carried out, and the stage is started!
Yang Ping made a three-centimeter incision above and below the greater trochanter, took the bone hook from Su Yixuan, and gently inserted the bone hook through the incision under the greater trochanter.
"He doesn't want to reset the fracture on the inside. He should insert muscles into it. There is no way to reset it."
"When I was studying in the imperial capital, there was a big guy who wanted to show off his skills by minimally invasively resetting the bone that inserts the muscle on the inside. He didn't succeed, so he gave up in the end."
"Once you insert a muscle, you either give up or open it up."
"Yes, open reduction of the fracture fragment inserted into the muscle is sometimes laborious. How can it be achieved by closed reduction?"
"This way you don't have to reset all the bones."
The bone hook went in, and without much testing, he hooked back.
"Four steel cables, hand them over one by one!"
Three steel cables, one after another, were attached to the bone surface and sent to their respective positions on the opposite side by the guide. The fourth steel cable is intertwined with the other three, and I don't know what it means.
"Traction, adduction!"
Zhang, Lin and Xiaowu immediately helped adjust the traction.
"Continue to adduct, yes, continue, stop!" "The adjustment rod moves back three turns."
"Okay! That's it."
Every sentence was like an order from a superior, clear and unquestionable. On the operating table, all actions are at the discretion of the surgeon, whose authority is the guarantee of surgical discipline.
Zhang, Lin, Xiaowu and Wu couldn't understand the steps at all now, so they could only follow them mechanically.
"I underestimated you. You know the muscle attachments in every part of the skeleton, the function of each muscle, and the relationship between different muscles." Song Zimo said next to him.
"You've already called me Senior Brother, but you don't have anything. Will you be convinced?" Yang Ping said while operating.
The bone fragment inserted into the muscle was easily hooked out. The tip of the bone hook clasped the bone fragment, and then moved and reset it gently. The first steel cable pressed on the center of the fracture fragment, the ring was locked, and the tail of the steel cable was cut. .
perspective!
Everyone exited the operating room again. After one exposure, they returned to the operating room. The X-ray on the C-arm machine screen showed that the fracture had been anatomically reduced. If you didn't look carefully, you would have thought there was no fracture.
This means that the direction and strength of the traction are precisely grasped.
"Holy shit! Can this still happen?"
"I don't understand."
"The position and reduction just now seems to be intentional, but I don't understand. Is it related to the bone inserted into the muscle on the inside of the reduction?"
Dr. Jin told Director Ouyang.
I don’t know what the people next door were thinking, but Xiao Wu Zhang Lin felt like he was being cheated. He thought he was rushing into battle at the beginning and was worried that he wouldn’t be able to get off the stage. Now I find it is completely redundant, even the bones inserted into the muscles have come out. As for how it came out, I have no idea.
The second steel cable, the third steel cable loop, lock, and cut off the tail.
The tip of the greater trochanter opens directly, the guide wire enters, and then the intramedullary nail follows. Once it is in place, the guide wire is withdrawn, and the guide pin of the spiral blade is driven in.
Perspective——
The guide pin of the spiral blade is exactly at the standard position, no more than one minute, no less than one minute, the midline of the femoral neck in the lateral position, the middle and lower third of the femoral neck in the orthorhombic position, and the tip is just a little away from the circular border of the femoral head. .
"90 mm spiral blade."
After the measurement is completed, drill the hole with an electric drill and drive the spiral blade in.
The locking screw at the lower end, drilling, depth measurement, and screwing in the screw are all done in one go.
Steel cable!
The fourth steel cable is locked and the tail is cut. Now you can see that it is actually intertwined with the first three heels to form an overall structure. It forms a wonderful tension band structure on the outside.
I can’t understand this operation, and even Song Zimo is a little confused: “What are you doing?”
"If you have an IQ close to 250, you don't have to ask me." Yang Ping screwed into the tail cap of the intramedullary nail and exchanged positions with Song Zimo.
Song Zimo began to rinse the sutured skin. There were only a few small incisions, and they were quickly sewn up without even draining them.
Final perspective confirmation.
The whole process takes about ten minutes, just like an ordinary intertrochanteric fracture. The top hospitals with a large volume of operations are very skilled. It takes about ten minutes to complete, and there are many people there. But in this case, the fracture end is inserted into the muscle, and there is no way to reduce it with minimal trauma. It is very likely that you will eventually have to make an incision or give up on reducing the fracture.
With everyone staring at the screen, is the operation over? Don’t understand? The first three steel cables are easy to understand, but the last steel cable is really hard to understand.
Dr. King sat in the crowd looking at the screen and taking pictures with his cell phone. Director Ouyang was also nearby and said, "This surgery is a bit wild. Do you understand the steel cable at the end?"
"I don't understand it yet, but I should understand it tomorrow." Dr. Jin shook his head.
Song Zimo opened the sheet, and Professor Zhang suddenly said: "I will ask an ophthalmologist to consult me tomorrow. My eyes are not working anymore."
He literally watched the entire operation while lying down.
He didn't say a word, which was not in line with his temper. He could at least give some advice.
Yang Ping held Professor Zhang's hand: "Don't worry, I will ask the nurse to give you a walker tomorrow morning, so you can walk. You won't give me zero money, right?"
Professor Zhang said: "We'll talk about it tomorrow after taking two steps."
The head nurse of the operating room came over: "Teacher Zhang, do you feel okay?"
Dean Xia also called, directly to the mobile phone of the head nurse in the operating room, and asked Yang Ping to answer it.
Yang Ping went to the locker room and called Director Han to check that he was safe.
Song Zimo leaned on the long chair: "Wonderful idea!"
Others were talking about it.
"What does the steel cable at the end mean? I really don't understand."
"You ask me, who should I ask?"
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(End of chapter)