Chapter 103 Immediate results
Fatty Liang, Zhang Lin, and Xiao Wu went outside to smoke.
Yang Ping edited the first day's work into a WeChat report and reported it to Director Tian.
A separate key report was made on Teacher Yan's affairs. When reporting the surgical plan, he specifically did not mention partial closure during the operation.
Director Tian's reply: I agree with your opinion. The surgery will be carried out as originally planned. Please note that methylprednisolone will be used to partially seal the sciatic nerve entrapment segment during the surgery.
A good doctor must have both mental and courage.
If you have no courage and are timid, it will be difficult to achieve success; if you have no brains and are brave and foolhardy, something will happen sooner or later.
In order to ensure the success of the operation, Yang Ping entered the system space and dissected several experimental subjects. In addition to routine whole-body dissection, he also paid special attention to the local anatomy around the piriformis muscle.
Now he is slowly realizing the power of the super cultivation method. Every anatomy training is of great help to the surgery. This kind of improvement is spiral.
Just like basic science and applied technology, only when basic science is strong can applied technology be accumulated, otherwise applied technology will become rootless and stagnant.
After accumulating the anatomy knowledge of several experimental subjects, and adding a master's degree in traumatology and orthopedics as a foundation, this kind of sciatic nerve release is just a minor operation.
The next day, after the ward rounds in the morning, Yang Ping took everyone to read the films and then went to the operating room for surgery.
Director Zeng is very enthusiastic. Now he really wants to learn something from him: "I will give you help."
Yang Ping said: "Director Zeng, why are you so embarrassed? Just ask Dr. Song to help me. You will have to communicate with your family about your condition at any time later."
Yang Ping was the surgeon, with Song Zimo as an assistant. Director Zeng came on stage to take a look and move around freely.
The protection of nerves during surgery is particularly important. Once the operation is done carelessly, causing accidental injury or excessive traction, severe consequences may occur after surgery.
It was my first time to have surgery with Director Zeng. I was not familiar with the cooperation and was afraid of accidentally damaging the nerves during the operation. But it was difficult to directly ask Director Zeng not to come on stage, so Yang Ping arranged it this way.
Under general anesthesia with endotracheal intubation, Xiao Wu and Zhang Lin had positioned the patient in the prone position.
"Good morning, Director Yang!" Su Yixuan, accompanied by a nurse from Nanqiao Hospital, was sorting out the equipment when she saw Yang Ping coming in and said hello.
Yang Ping responded seriously: "Mr. Su, I'm sorry, I want the head nurse to arrange the table in person."
"Director Yang's surgery should be done." Su Yixuan smiled through her mask.
Everything is ready, wash hands and dress, disinfect the sheets, and open the table.
The incision is made at the lower edge of the gluteus maximus and the posterior gluteal fold to avoid the formation of scars at the ischial tubercle. Scars at the ischial tubercle can easily leave the sequelae of pain caused by prolonged sitting.
Open the skin to expose the gluteus maximus muscle. The gluteus maximus muscle has local fibrosis. Cut the fascial tissue at the lower edge of the gluteus maximus muscle without damaging the muscle fibers. Lift the gluteus maximus muscle upward to protect the inferior gluteal cutaneous nerve and hamstring skin. nerve.
The piriformis muscle was exposed, and sure enough, the lower third of the piriformis muscle had become fibrotic, that is, scarred, and was no longer muscle tissue at all.
The sciatic nerve does not pass through the lower edge of the piriformis muscle, but passes through the fibrotic piriformis muscle in the form of a trunk, and is trapped by scars at the exit.
No wonder, the symptoms of sciatic nerve are so severe, and the symptoms are more severe when walking, because when walking, the piriformis muscle contracts and squeezes the sciatic nerve, so the symptoms are more severe.
The nerve is carefully separated from the scar tissue, and the surrounding scar tissue is removed to completely expose the epineurium.
The nerve forms an indentation at the compressed site, and the indentation is edematous and swollen near and far.
Yang Ping gently raised his nerve: "Director Zeng, look!"
Sure enough, it turned out to be piriformis muscle entrapment syndrome. Director Zeng felt relieved again. His preoperative judgment was correct.
"Xiaowu takes pictures!"
Everyone got out of the way, and Xiao Wu used his mobile phone to focus and take pictures, being careful to prevent contamination of the surgical area.
The rubber strip gently retracts the nerve. At this time, be sure not to interfere with the sciatic nerve. Once the retraction is excessive, it will cause nerve damage. Although it can generally recover, it can take a few days or a few months to cause numbness and weakness in the lower limbs. , when the time comes, the patient will misunderstand and think that the operation failed, which will aggravate the symptoms.
Doctors, always walking on thin ice.
"Doctor Song, protect your nerves!" Yang Ping reminded.
He was not worried about Song Zimo, but he was afraid that Director Zeng did not pay attention to nerve protection and would damage the sciatic nerve through casual movements, such as sliding the retractor. On the operating table, it would be wrong to be cautious.
Song Zimo understood, and placed a hand between Director Zeng's hook and the nerve, tightly protecting the nerve.
The nerve was retracted, and Yang Ping bluntly separated the normal muscle fibers around the piriformis scar. Enter through the gap, separate a gap with your fingers, and then cut off the fibrotic piriformis muscle at the attachment points of the muscles at both ends. The fibrotic tissue was completely removed with some normal muscle fibers.
In this way, the nerve comes out from the lower edge of the remaining normal piriformis muscle and the greater sciatic foramen, and is no longer compressed, because it is separated from the natural muscle fiber gap without damaging the normal muscle, and will not leave scars or adhesions in the future. Avoid future troubles.
Scars must not form around the released nerve, otherwise the surgery will fail and the nerve will be compressed again.
Blunt separation and sharp separation, blunt separation is used for separation with natural gaps, and sharp separation is used for separation without natural gaps. The former follows the existing road, while the latter must open up a road because there is no road.
Rinse the surgical area and completely stop bleeding again.
"80 mg methylprednisolone, with 20 ml saline, syringe!"
Methylprednisolone is a glucocorticoid that has anti-inflammatory and edema-reducing effects. Gently insert the syringe needle into the nerve sheath at an angle, inject methylprednisolone into the nerve sheath, and then sprinkle some on the epineurium to partially seal the nerve, and wait for about five minutes.
Then use 20 mg of ropivacaine, diluted one to one with normal saline, to infiltrate the area where the muscle scar has just been cut, and then infiltrate the incision edge in layers, which can reduce postoperative pain.
After checking again, the release was very complete and the hemostasis was perfect. The whole operation was pleasing to the eye, with almost no bleeding and no gauze was used.
Several orthopedic surgeons observing the practice privately commented that those in big hospitals are just different.
The rubber strip is pulled out and the nerve is put back in place.
The drainage tube is placed, sutures are made in layers, and the operation is completed.
Just after the operation, the sterile drape was lifted and the patient woke up. Fatty Liang used a suction tube to clear the secretions from the patient's throat and trachea, and the tube was extubated smoothly. He cooperated very well.
After recovering from anesthesia, the patient was sent out of the operating room. The nurse called his family members, and his son came up immediately.
Yang Ping took out his mobile phone and showed him the pictures taken during the operation: "Mr. Yan, look, this is the sciatic nerve. It is stuck like this. It becomes thinner in the middle and swollen at both ends. If the operation is not performed, the nerve will lose its use. The legs are useless.”
When we arrived at the ward, the patient was fully awake and could talk normally.
Under general anesthesia, once you wake up, you can move your limbs without any problem.
The patient moved his right lower limb. Hey, the pain is gone. Could it be that the anesthetic is working? Anyway, the pain is relieved now.
Pain has a very negative impact on patients, seriously affecting their lives, such as nightmares that they cannot get rid of, and some people are tortured by pain and have suicidal tendencies.
The mountain was removed, even temporarily, and the patient felt very comfortable and felt like he had been reborn.
"It doesn't hurt anymore!" Teacher Yan's first words came back to the ward.
"Go and say thank you to the doctor!" Teacher Yan told his son.
The son said: "Don't worry, I know."
After this kind of nerve release, some will rebound and the symptoms will be more severe than before. In order to avoid this phenomenon, Yang Ping used the hormone methylprednisolone to partially seal the nerves to eliminate inflammation, reduce nerve edema, and avoid possible rebound after surgery. , improve the patient's postoperative experience. This experience is very important. The patient does not know whether the surgery is beautiful or not. His intuitive experience is whether the problem is solved and how much it is solved.
For Teacher Yan, pain relief is success, and saying it ten thousand times cannot match his own experience.
It’s been more than ten years and it’s the first pain-free day.
Teacher Yan's hands trembled with excitement, and she held her son's hand: "Remember, you must remember, and say thank you to Director Yang."
Although the whole process went smoothly, Yang Ping did not relax for the time being. The conclusion should not be too early. After all, partial closure was used during the operation. It still depends on whether rebound symptoms will occur in the next few days, although this probability is very low.
Yang Ping asked the doctor in charge of the bed to pay attention to protecting the stomach and use some neurotrophic drugs. When changing the dressing on the wound, he told Xiao Wu to do it himself. He asked him to come with him when changing the dressing. He wanted to see for himself.
After the operation, Yang Ping and Director Zeng rested in the office.
Teacher Yan's son came over. This time his expression was normal, not gloomy.
"Thank you, Director Yang!" He took the initiative to shake hands with Yang Ping.
Yang Ping said: "Yes, doctors and patients are comrades-in-arms, and the common enemy is disease."
"Director Zeng, thank you too." Seeing that Director Zeng was nearby, the old man's son expressed his gratitude.
I just had the surgery, and although I saw immediate results, I don't know if it can be maintained like this. Therefore, the old man's son can't talk too much, and can't turn too fast. Let's observe and see.
Dean Pan took Director Tian out of the department and happened to arrive at the Department of Orthopedics. From a distance, he heard Dean Pan's voice. Because he was missing a front tooth, his pronunciation was a little leaky, so his speech was very distinctive.
"Director Yang, thank you for your hard work! I heard that I just completed an operation." Dean Pan shook hands with Yang Ping.
Director Zeng said: "The person who just had the operation was Teacher Yan, who has been struggling with us for a year. After the operation, the pain is relieved now. The patient's family has just expressed his gratitude here."
Director Tian had reported the matter to Director Pan last night. This kind of patient is a special patient and the operation cannot be performed quietly.
Dean Pan: "Oh, it's so embarrassing to ask you to wipe your butt just after settling down. It's a family embarrassment, a family embarrassment."
Yang Ping said: "Dean Pan was serious. It was Director Zeng who figured out the condition. Because there was a deep misunderstanding between the two parties, I was asked to come forward, not to help."
Dean Pan turned to look at Director Zeng: "Director Zeng, learn more from professors in provincial capitals and dig deeper."
Director Zeng couldn't tell how happy he was. Although he knew that Yang Ping was telling lies, he didn't tell the lies clearly, so he said, "No, I pester Director Yang every day, trying to squeeze out more truth. This condition is too bad." Thanks to Director Yang’s guidance, I figured it out.”
Let’s chat for a while, ask about any difficulties at work, accommodation and living habits, and recommend some interesting places in Nanqiao.
Dean Pan and Director Tian left and went to other departments.
"The one with osteomyelitis of the left femoral shaft?" Director Zeng asked proactively.
During the ward rounds yesterday, he felt that Director Yang had something to say.
(End of chapter)