Chapter 181 Substitution midway
Dr. Yao and Dr. He have made preparations for the operation. Not only have the various pipelines been connected, but the focus and dialogue of the lens have also been adjusted.
Yang Ping came on stage and tried the lens, and the adjustment was very suitable.
I was indeed in a hurry. Since Su Nanchen had already sent two instrument nurses and two doctors, there was no need to be polite. I tried my best not to delay while ensuring the quality of the operation.
The sharp knife opened the path and made two small openings on the anteromedial and anterolateral sides at once. Because he was so skilled, he directly used the sharp knife to penetrate the skin, joint capsule and synovial membrane. The three layers were in place in one step. Once the sharp knife broke through the synovial membrane, he stopped. Will damage any structure in the joint cavity.
Most people make one opening with a sharp knife, and after inserting the lens, they open another opening under the guidance of the syringe needle. This allows the other opening to be opened more accurately.
But Yang Ping didn't use it at all and opened the two openings directly, because he didn't need a syringe needle to guide him and could open the openings in the best position.
Lin Hao frowned, this is not according to the standards, it is a wild way.
The arthroscope goes in with a sheath. Dr. Yao has connected the inlet and outlet pipes in advance. There is no resistance when the mirror goes in. This shows that not only the opening is good, but also the surgeon is very familiar with the path through the opening and will not be confused by the layers. Relative movement is blocked, especially by the synovial membrane. This causes the lens or instrument to be slightly explored to find the direction of the path when entering.
But Yang Ping did not need to test, he entered the joint cavity in one go without any obstruction, started arthroscopic examination, thoroughly flushed the joint cavity, and Yang Ping closed the outlet pipe.
The size of the two openings is very particular. If it is too thin, it will be difficult for the instrument to enter. If it is too large, the water in the joint cavity will flow out from the gaps around the instrument, and the small amount will accumulate, making the bag that collects the running water full of water.
Yang Ping's opening was very good, and not a drop of water came out of the gap. This means that the instrument just passed through, and the surrounding gaps were properly closed by the synovial membrane. After the operation, it was clean. There was not a drop of water in the water collection bag on or off the stage. Leaking water.
After some people's arthroscopic surgery, there is water everywhere on and off the stage, and it is a mess. Not everyone can grasp these details, and they are already a higher level pursuit besides surgery.
Starting from the suprapatellar bursa, every area in the joint will not be missed. Strictly follow the sequence, one by one. Every time the mirror moves, it will be exactly in the gap, without causing wear and tear on the cartilage, and it will move to the end of the target area at one time. Optimal location for the best view.
Yang Ping holds the camera with one hand and holds the patient's calf with the other, constantly adjusting his posture, and the coordination of his hands is impeccable.
Observing different positions, different postures of the limbs are required. For example, the suprapatellar bursa needs to be in a straight position, while the medial joint space requires knee flexion of 20-40 degrees, abduction and external rotation, and the lateral joint space needs to be in a figure-4 position.
Every movement of the camera and change of body postures are performed almost simultaneously. The moving arthroscope will never be squeezed, blocked or rubbed due to changes in the limbs. Everything is very smooth, like a fish dexterously shuttling among aquatic plants without touching it. A waterweed.
"Doctor Yao, Doctor He, start braiding tendons!" Su Nanchen commanded.
Without his command, no matter how many people there were, it would be useless. These people, especially the two nurses, seemed not to realize that the pace was getting faster and faster.
"Prepare the guide pin and electric drill for the tibial tunnel in the next step! You have to report the size of the tendon!" Su Nanchen ordered the nurse and doctor.
If Su Nanchen hadn't reminded him, no one would have reacted.
"Tibial tunnel, electric drill guide pin!"
They were still cleaning the intercondylar fossa alternately with an electric planer and a plasma knife, so Yang Ping notified them in advance to avoid wasting time.
As soon as the words were finished, the intercondylar fossa had been cleaned, but the electric drill guide pin was not removed, because there were several people supporting the stage, and Yang Ping had no rhythm to take care of each other at all.
Yang Ping looked at the screen, not at the equipment table. He didn't get what he wanted with his outstretched hand, and then he moved his palm up and down a few times to signal that the thing should be moved faster and not to stretch.
When the electric drill guide pin arrived, Yang Ping immediately said: "Eight-strand double-bundle anatomical reconstruction, report the size of the two tendons to be implanted in the front fork, and then drill the tibial tunnel with an electric drill."
Even though Su Nanchen was directing just now, the two nurses didn't pay attention to it and didn't get into the mood. Now the pace is beginning to rush. They want to catch up, but it's very difficult. In this kind of cooperation, if one step is not connected well, it will affect the next step, unless the practitioner deliberately stops and waits.
faint! Just now I said I wanted something, but after I finished speaking, I really wanted something.
There is no need for a tibial locator. The guide pin directly opens the openings of the two tibial tunnels in the front fork, one for the anterolateral bundle and one for the anteromedial bundle.
Fork rebuilt! There are many types, including single-bundle, double-bundle, isometric reconstruction, and anatomical reconstruction. The most advanced is the eight-strand double-bundle anatomical reconstruction, because research shows that the front fork is functionally and anatomically divided into two bundles-the front Only the double bundles of the lateral bundle and the anteromedial bundle can be restored to maximum function if they are reconstructed in an anatomical position.
For double-bundle anatomical reconstruction, in order to ensure the strength of the ligaments, one bundle must be completed with the quadriceps tendons. Two tibial tunnels and two femoral tunnels must be opened properly, which is very difficult. They must be opened at the anatomical position without interfering with each other.
Dr. Yao and Dr. He had sweat on their foreheads. They were mentally prepared and a little better, but neither of them had ever been on Yang Ping's stage. They just heard Su Nanchen repeatedly say that they had to keep up with the rhythm. He operated very quickly.
I have no experience of how fast it is. Now that the speed is so terrifying, I naturally feel stressed. After all, so many people are watching, and it is so embarrassing for two people to not be able to keep up with the speed.
Measure, measure quickly! Two people knitted and sewed the two bundles of tendons at the same time, and finally managed to finish the knitting. It was better to prepare in advance and start as soon as the stage was opened. The next step of knitting the tendons would not be so fast. Dr. Yao and Dr. He reported the measurements respectively. They didn't dare to rest or say another word. Su Nanchen had already put the tendons he wanted next in front of them and immediately started working hard again.
A row of large and small drill bits were spread out on the instrument table. The nurse started to look for the drill bit of the required size, and finally realized the pain of not being able to keep up.
The last two people greeted her several times in advance but didn't take it seriously. Su Nanchen was a little angry. He was well-educated and wouldn't lose his temper with a nurse, but at least he was dissatisfied in his heart.
"Prepare the electric drill guide needle for the femur!" Su Nanchen ordered another nurse.
Today I prepared more surgical instruments than usual, including several electric drills and two instrument tables.
Finally, the nurse fixed the drill and handed it to Yang Ping. Yang Ping directly opened the two tunnels on the tibia, and was about to open the two tunnels on the femur. Because Su Nanchen commanded in advance, the guide needles for the femur were more timely this time. .
Yang Ping held the entry point of the femur, drilled in and out, drilled in and pulled out again, just two clicks, a few seconds, two tunnel paths were opened, and nothing was used, the locator! What? Not at all now.
"Depth sounding!"
After Yang Ping measured the depth of the femoral tunnel, he determined the length of the two femoral tunnels based on the tendon dimensions they reported.
"Rough drill! Fine drill!--"
It's out of joint again. Two nurses prepare at the same time, one prepares the thick one, and the other prepares the thin one. The femur and tibia are different. The front part of each tunnel is thick to accommodate the tendon; the back part is thin and used to pass through the suspension. Suspended steel plates and wires.
"Give me both sets of drill bits?" Yang Ping stretched out his hand for too long and the things hadn't arrived yet. He put down his hand and took a rest.
I didn’t look here just now. It turns out that it’s not done yet. If people don’t do it well and they keep urging me, it will be bad. Su Nanchen will be embarrassed. He comforted: “It’s okay, take your time, don’t be in a hurry.”
Two tunnels and two sets of drill bits, one set thick and one set fine, are prepared at one time. Four electric drills are required.
What Su Nanchen was worried about happened. It seems that when I was in Liquan Hospital, I was already controlling the speed of surgery, and now I am still controlling the speed. It is not at full speed, and even several people working with tables can't keep up. This is Annex 1, not Liquan Hospital, which is a bit embarrassing. .
At this time, the head nurse came in, like a gust of wind: "Nan Chen, can you change the equipment and nurse, and transfer the one from Professor Ye over here, and the one from here?"
What's the meaning?
Although Su Nanchen was well-educated and good-tempered, he was still a human being. He couldn't keep up with the pace here and the operation was delayed. He was a little dissatisfied. Now he wanted to replace him.
Su Nanchen said solemnly: "We are still short of people here. Do you want to replace our people?"
In the head nurse's stand, the chief surgeon was waiting. The doctors and nurses on the stage were busy, and they could see that the person handling the stage had not kept up. How many people were there? Still can’t keep up? What's going on.
If it were anyone else, she would be showing off the authority of the head nurse at this time. The head nurses in the operating room are all very powerful. They have the power to schedule surgeries in the operating room. Not to mention young doctors, ordinary directors who are not very tough have to give in. .
But getting angry with Su Nanchen?
I can't, I don't dare, my parents are the dean and the director of the nursing department.
Not to mention his father, the dean, he couldn't afford to offend his mother even with the three blue stripes on her hat.
The head nurse whispered: "Professor Ye is very angry now, saying that the nurse is not cooperating well, and asking for another one, Nan Chen?"
Some professors have good tempers, some have bad tempers, and if they meet with bad tempers, it’s okay if the surgery goes well, but if the surgery doesn’t go well, the doctors and nurses on the stage are miserable. If the surgery doesn’t go well, it’s all because you didn’t pull the retractor properly and didn’t support the leg. Okay, the nurse didn't prepare the table properly.
"What's the key step here!" Su Nanchen said angrily.
"There's no need to change, just transfer one over. We only need one nurse. It's still early." Yang Ping saw that the atmosphere was a bit tense, so he tried to mediate it. Originally, there were two nurses here, so he was a little embarrassed.
If she hadn't had no choice, the head nurse would not have come over and made this request to Su Nanchen. When she spoke, her face was always red, her voice was still low, and she kept asking for advice.
These nurses are the most familiar with arthroscopic surgery. They will get scolded on the stage if they ask others. In fact, the person who arranges the stage for Professor Ye is already the best at the job, better than these two.
"Okay, you make arrangements!" Su Nanchen nodded.
It was hard to offend both sides, and they were in a dilemma. When Su Nanchen agreed, the head nurse breathed a sigh of relief.
(End of chapter)