Chapter 120 Three-dimensional reconstruction
The next day, at 8:30, the operation started on time, the first operation in the Department of Comprehensive Orthopedics.
Director Han also took the time to sit and watch, so that he could check and fill in the gaps in the work process.
The experience in the multifunctional operating room is wonderful. The high-definition LCD screen is fixed with a cantilever extending from the ceiling and can be moved freely at multiple angles.
There are several screens, one for the surgeon, one for the assistant, and one connected to the computer host in the operating room. The patient's medical records and imaging data can be transferred to the screen at any time for the doctor to temporarily check during the operation.
Moreover, the control panel of this screen connected to the host computer is covered with a transparent sterile isolation film. If the surgeon is dissatisfied with the off-stage control, he can personally control the screen and call up the desired information.
Using color ultrasound positioning, sciatic nerve and femoral nerve block anesthesia, Fatty Liang is very skilled in his business.
"How long will it take?" Fatty Liang asked.
This kind of block is a one-time medication and cannot be added midway. If there is too much anesthesia, the patient will not be able to move his lower limbs after the operation. If there is too little anesthesia, the patient will start to feel pain before the operation is completed. This requires extremely precise calculation of the anesthetic dose based on weight, age, liver and kidney function, and familiarity with the surgeon's operating speed.
"Half an hour!" Yang Ping said.
"Is it enough?" Fatty Liang confirmed.
In half an hour, apart from washing hands, disinfecting, dressing, and post-operative bandaging, there is only about ten minutes left for intraoperative operations.
"Enough!" Yang Ping said firmly.
Brush your hands! Song Zimo is Song Zimo's assistant who disinfects and spreads the drapes, disinfects the hands again, puts on clothes, puts on the disposable arthroscopy drapes, connects various lines of pipes, drives out blood, and inflates the tourniquet.
The sharp knife pierces the skin and joint capsule, and a small incision of 0.5 cm is made on both sides of the knee. A puncture sheath is inserted on the left side, enters the knee joint cavity, straightens it, enters the suprapatellar bursa, withdraws the puncture cone, inserts the lens, and the surgery begins.
A clear circular field of view was displayed on the cantilever screen. After a comprehensive examination of the joint, a probe hook was inserted with the right hand. The popliteus tendon hiatus appeared to be perfectly normal.
The exploration hook enters, and the synovial membrane is gently pulled out.
The basket forceps enter and bite off the synovial strip, and the plasma knife performs hemostatic ablation on the stump of less than two millimeters.
The whole process takes just over ten minutes, attracting and withdrawing the device.
The two small incisions were fully sealed with long-acting local anesthesia, the two 0.5 cm incisions were sutured, compressed with a cotton pad and elastic bandage, and the tourniquet was loosened.
The anesthesia was just right, the bandaging was finished, the patient's right lower limb could move, and the feeling was restored.
For the first operation, the entire team cooperated very well and controlled the rhythm very well. The damage and stimulation to the human body during this operation would not exceed the abrasions on the knee skin caused by a fall.
Nerve block anesthesia is also a type of local anesthesia. You can eat immediately after the operation and even walk out of the operating room on your own.
When the patient moves his knee joint, it no longer hurts or is stuck, and he can experience the effect immediately.
"You can be discharged from the hospital tomorrow. Don't let the wound get wet until the stitches are removed. Go to a nearby hospital or our hospital regularly to change the dressing. The stitches will be removed after ten days." Song Zimo is responsible for postoperative education.
"Try! Walk back by yourself?" Xiao Wu supported her while Zhang Lin found her shoes.
"So fast? Let me try!" The patient put on his shoes and tried to step on the ground, but he still didn't dare.
Yang Ping encouraged her: "It's okay, just take a few steps!"
She mustered up the courage to take the first step, which felt very good and stable. She could really walk back and move her knee joint in the second and third steps. Except for the slight restrictions caused by the bandage, there were no problems and no pain. No lag either.
Director Han stood up. Yang Ping's proficiency in arthroscopic surgery exceeded his imagination.
The patient's daughter, who was waiting at the door of the operating room, saw her mother walking out of the operating room, talking and laughing with the doctor, and thought that the operation would not be performed.
"What's wrong?"
"It's done!"
Finished? So quickly, the patient moved her knee joint, then deliberately took a few steps and turned in circles to show her daughter that it was indeed normal.
"This time it's finally solved. Where is Yangyang? I'll pick him up." The patient was so happy that he couldn't open his mouth from ear to ear.
"Can I really be discharged from the hospital tomorrow?" The patient's daughter supported her mother and stared at her legs.
I had two surgeries, and the third time it was finally resolved. Fortunately, I was not in a hurry to leave the hospital.
The old lady was full of praises all the way.
"Are you not married?" the old lady asked. When she is happy, she wants to introduce her girlfriend to others.
"Getting married soon." Zhang Lin answered helpfully.
The old lady was a little disappointed.
"I have a friend whose knee joint is very swollen and can't walk now. Should I ask him to come and see you?" The old lady was very happy.
My daughter is unhappy because she thinks her mother is nosy and introducing doctors is a thankless task.
The old lady obviously didn't care and just wanted to help her friend.
The first operation was completed successfully, and everyone was very happy, marking the official start of operation of the comprehensive orthopedics department.
Song Zimo began to write operation records, and Zhang Lin wrote course records. The comprehensive orthopedics department has thirty beds, and Zhang Lin and Xiao Wu are each in charge of fifteen beds. Each of them has brought two more trainees, and the number of the team is enough to support thirty beds. hospital bed.
Yang Ping began to study Mr. Ning's condition again. There were images of nerves in the cross-section of CT and images of nerves in three sections of MRI.
Three-dimensional reconstruction is to use these cross-sectional images to reconstruct a three-dimensional image. This work is completed by the software that comes with the CT or magnetic resonance machine.
Yang Ping found that his brain's composition ability improved rapidly, and his memory, especially the memory of details, was very strong, almost to the point of photographic memory. This was the result of the system's super training program. He tried to use his brain to reconstruct a three-dimensional image of the patient.
One image after another appears, superimposes, and combines in the mind, and the details that are of concern and those that are not concerned can be retained as they are.
The three-dimensional spine, tumors, blood vessels, and nerves are gradually taking shape. This is not the function of the system, but the processing of my own brain, without relying on the system.
For the sake of eye-catching, the nerves are marked in red, and the direction of the red nerves gradually becomes clear.
Constructing this three-dimensional image is not easy, it is very laborious. Some key details need to be strengthened repeatedly to achieve stability and clarity. Here they are supplemented, and there are missing. This side is clear, and that side is blurred. After repeated strengthening and repetition, the image is barely formed.
Song Zimo stood not far away, watching Yang Ping staring at the screen, his eyes focused, like a thinker sculpture. He didn't want to disturb Yang Ping, but wanted to see what he was doing, so focused and immersed.
Yang Ping took out a piece of paper and started sketching on it with a pencil, starting with outlines, then lines, and finally three-dimensional processing, and then details.
The perfect application of surrealist painting techniques in medicine, an image jumped out on the paper. Song Zimo approached, but Yang Ping didn't notice because he was too involved.
"What is this? He actually made a reconstruction using CT and magnetic resonance images? He made a reconstruction using his brain? Then he expressed the reconstruction in pictures."
Is this still a human being? Are you working with a mortal?
Director Han also came in. He saw Song Zimo's strange expression and Yang Ping's sculpture-like concentration, and he didn't know what was going on.
Take a closer look at the drawings and the images on the screen.
I also understand, this is reconstruction using the brain? The reconstructed image is drawn with a pencil?
This requires a strong brain composition ability. No wonder it is said that the content of genius' thinking is pictures, while the content of ordinary people's thinking is simulated language sounds.
Neither of them wanted to disturb him, so they put down their pens. Yang Ping touched his forehead and saw that he was sweating. It seemed that it was still very difficult to construct such an image, and his composition skills would need to continue to improve in the future.
"Oh, Director Han!" Yang Ping felt a breath behind his back. He turned around and saw Director Han and Song Zimo.
"Song Zimo, how is the patient after the operation?"
"It's okay, very good!"
"Director Han, this is the picture I drew based on CT and MRI. You see, this is the spine, this is the spinal cord and the thecal sac, this is the nerve root, this is the intervertebral foramen, the thoracic 2 nerve root is invaded by the tumor, and It was pushed away by the tumor, and the tumor has a very rich blood supply," Yang Ping said, pointing to the picture he drew.
"The oncology department has performed embolization treatment for liver cancer. There are still relatively few blood vessels now, compared with more before embolization." Director Han said. Song Zimo pulled out a chair for Director Han to sit on, and he sat around him.
"Are you still thinking about nerve root block?" Director Han knew what he was thinking.
"Yes, it seems that there is no other way except this?" Yang Ping was very distressed.
"Is this the reconstructed image you drew?" Director Han asked.
"Sketch!" Yang Ping nodded slightly and answered simply.
This sketch can already catch up with the real three-dimensional reconstruction of CT or magnetic resonance, and the details are clearer than it. It is right not to treat him as a normal person.
"Is there any good way?" Director Han couldn't help but asked curiously.
"Not yet!" The answer was confident and precise.
It is not easy to find a method. It must be feasible in theory and practice, safe, and must not cause side injuries. This is why medicine progresses more slowly than other disciplines.
Director Han checked his mobile phone and received a notification: Patients in Huaqiao Building will have a general consultation at 5 p.m. In addition to the directors of various departments in the hospital, there will also be orthopedics, oncology and pain experts from the first and second appendices.
The consultation was originally scheduled for three o'clock in the afternoon, but Professor Su Qingyun was not available and could not arrive until five o'clock in the afternoon, so it could only be arranged at five o'clock in the afternoon. The family members used many connections to invite Professor Su.
Professor Su, Meng Heng from the Imperial Capital, Hong Zhigang from the Magic Capital, and Fu Shancheng from the West are all popular candidates for academicianship.
"Would you like to join us this afternoon?" Director Han not only appreciated his talent, but also his attitude towards medicine.
Yang Ping himself wants to participate. He heard that Professor Su Qingyun is very dignified, rigorous in his scholarship, and forward-thinking. Whether it is surgery or academic achievements, he is top-notch in the country and has a place in the world. He is a spiritual banner in the orthopedic academic community.
Being able to invite him must not be about money, it must be about friendship. Maybe Mr. Ning has a deep friendship with Professor Su in a certain relationship.
What a rare opportunity to have the opportunity to discuss cases with him up close! Yang Ping thought.
The voice outside was very familiar. The aunt who had had surgery today was speaking.
I took another aunt and the family members pushed her directly to the doctor's office in a wheelchair.
"Doctor Yang, this is the friend I'm talking about. Look, the knee joint is so swollen that I can't move anymore. How long has it been?" The aunt was very enthusiastic.
The patient said: "It has been swollen for several years. It often gets stuck suddenly and can be moved after a little movement. This time it has been stuck for a month and I can't move at all."
"Have you seen a doctor?" Yang Ping asked.
"No!" The patient touched his left knee.
"You guys are busy, I have something else to do." Director Han stood up and left. Yang Ping continued to see the doctor. He asked about the medical history in detail and did a physical examination.
"This is most likely synovial chondromatosis. There are a lot of peanut-like things growing in the joints. Let's check to confirm the diagnosis. Do an X-ray and magnetic resonance imaging. Xiao Wu, please make arrangements." Yang Ping said after the examination.
Xiaowu explained to the patient's family how to apply for a medical card, and then come back and issue a check-up sheet.
After understanding this, the patient's family members pushed the patient to apply for the card.
They had no doubts and trusted Yang Ping.
This is the power of word of mouth, nothing is more convincing than word of mouth.
(End of chapter)