Chapter 333 Root of the disease
The reading light was very bright. Takahashi looked at it for a long time, but he didn't see the dead bones that Yang Ping mentioned.
Yang Ping has already pointed out that there is a slight abnormality in that part, but in Takahashi's understanding, it is a vascular indentation. How can a typical vascular indentation be regarded as a sequestrum? Obviously sequestrum and vascular indentation are two different things. The concepts of horse and cow are unrelated, and now they are put together into differential diagnosis.
After staring at the bright light for too long, Takahashi's vision began to blur, his eyes were sore, and tears were forced out. He had to look away temporarily. His eyes were looking away, and there were spots of light everywhere in his field of vision, and the people he looked at were flickering.
"This kind of high-level skill cannot be mastered in a short time. Even if Dr. Yang pointed at the mosquito and said, that is a male genital and this is a female genital, we can't tell. We will study it slowly when we have time." Song Zimo showed the film Put it away for now.
This surgery looks simple, but is actually quite difficult to perform.
The key is positioning. Without the help of a navigation system and relying solely on the doctor's operating experience, it is possible to dig out the infected dead bone by opening a window at the lower end of the right tibia and then digging out a large piece of bone tissue.
This kind of infected dead bone must be thoroughly dug out. If only a little bit is left, it means leaving the source of infection. After a period of time, the infection will recur, and the previous efforts will be in vain.
Therefore, when digging out dead bones, you need to dig out some of the surrounding normal bone tissue together to ensure thoroughness.
This surgery is like digging up sweet potatoes. A sweet potato is buried very deep in the soil. Open surgery is like digging a big hole and finally digging out the sweet potato.
Minimally invasive surgery is equivalent to using a hollow bamboo tube, inserting it into the soil, knocking it in hard, inserting it to a certain extent and then pulling it out. The bamboo tube is filled with soil, and the sweet potato is now inside the bamboo tube.
"Should we use the Tianji surgical robot and make an appointment with the operating room there in advance?" Song Zimo felt that with such a small dead bone, millimeter level, minimally invasive surgery would be difficult to complete without the assistance of navigation technology.
Tianji surgical robot comes with its own navigation equipment, and the navigation accuracy can reach 0.8 mm.
If a robot is used to perform this surgery, the child will need to undergo a new CT scan, import the CT data into the surgical robot's navigation system, and use the robot's CT scan for positioning during the operation. The child will naturally take a lot of rays.
"I've done a lot of X-rays and CT scans of my child. Forget it, if we use robot navigation again, the child will have to take rays. Try to simplify it as much as possible. It'll be in our operating room. I'll do it." Yang Ping looked at the A big bag of images and pictures. This sick child has eaten a lot of rays, so the radiation can be reduced as much as possible.
"The surgery will be scheduled today, he will be rushed to the hospital, and it will be done under local anesthesia. He will be discharged from the hospital tomorrow and will not participate in strenuous exercise for three months." Yang Ping told Song Zimo that for him, this surgery was too simple.
“So simple?”
The child's father thought he heard wrongly. In his impression, after the operation, he would have to rest at home for at least one month and use crutches for three months. He was already prepared to take a long leave.
I originally planned to bring him to see a doctor during the summer vacation. During this period, the child complained of pain every night. Especially in the past few days, the pain was so painful that he could not sleep. It was not like he was pretending.
There was no other way, so the father took the child to the community health station for treatment. The doctor at the health station suggested that he go to Sanbo Hospital for treatment.
When I arrived at Sanbo Hospital, I didn't see Dr. Yang's outpatient clinic, so I randomly called an orthopedic outpatient doctor. The doctor said that this was a difficult and complicated disease and that he needed to be hospitalized for treatment. The father designated Dr. Yang for treatment, and the child was admitted to the comprehensive orthopedics department.
Hearing the words "intractable disease", the children's parents were so frightened that it couldn't be a big deal, right?
Now I heard what Yang Ping said. I was discharged from the hospital the next day after the treatment. I didn’t need crutches and could walk normally immediately.
What I originally thought was a very troublesome thing is now simpler than circumcision, which requires me to grit my teeth and walk for several days.
After the pre-operative conversation, signatures, and a series of pre-operative preparations, the operation was scheduled to take place at the back.
"No need for navigation? OK - no?" Xu Zhiliang asked.
Song Zimo had no doubts: "You haven't been here for long, and you will gradually adapt to it. Dr. Yang is a person who continues to create miracles. He will help you expand your imagination and expand it continuously."
After the ward check, everyone except those on duty went to the operating room. After a few operations, it was the child's turn. Song Zimo took Xiao Wu to disinfect and spread the drape, and also applied local anesthesia to the surgical site according to Yang Ping's requirements.
Takahashi borrowed a magnifying glass from an unknown student, looked at the film with the magnifying glass in front of the reading lamp, his nose almost touching the magnifying glass, looked at it for a while, rubbed his eyes, and continued reading.
Yang Ping washed his hands and dressed, thought about the film for a while, made a final position in his mind, and then took action.
He made a small longitudinal incision of 1 cm on the inner skin of the lower end of the right tibia, reaching the periosteum and bone, and separated it from the periosteum. He then used vascular forceps to open the small incision and expose a small part of the inner surface of the tibia.
Press the trephine against the bone surface, adjust the direction, then drill in slowly, stop when it reaches a certain depth, and then pull out the trephine, taking the filled bone with it.
In the irrigation area, calcium sulfate containing vancomycin is mixed into dough, filling the small tunnel just dug. Vancomycin can be slowly released locally to kill any bacteria that may remain inside.
The tunnel is packed firmly, and a small incision of 1 cm requires only one stitch. Starting from the periosteum, it is sutured in layers, and a small sterile dressing is applied to cover it, and it's done!
From taking the stage to sewing the skin, it was one minute and twenty-two seconds. Takahashi timed it, and it was settled just like that? "Do you want to see X-ray?" Yang Ping took off his surgical gown and gloves.
Fluoroscopy is only a brief exposure, and the amount of radiation is much less than the multiple or continuous exposures of navigation surgery.
After the fluoroscopy was completed, and compared with the pre-operative images, the tunnel drilled by the trephine was just at the point Yang Ping mentioned, and it just surrounded that point, no more, no less.
Song Zimo took out the cylindrical bone tissue from the trephine. Except for a small amount of cortical bone at one end, most of the cylindrical bone tissue was cancellous bone.
He carefully cut the cylinder into thin circular slices. It was not difficult to cut the cancellous bone. Sure enough, he looked at the cross-section of the lesion.
The cross-section is like a sandwich, with necrotic bone the size of a rice grain in the center, infected bone tissue surrounding the rice grain, and a ring of normal bone tissue outside.
Looking at this cross-section, Song Zimo was absolutely sure that the lesion had been completely removed. The accuracy of this positioning was even higher than that of the surgical robot.
"Do a CT scan after the operation." Yang Ping ordered.
Postoperative CT is inevitable, and evidence must be left to prove that the lesions have been completely removed.
"Keep it as a specimen and send it to the pathology department for pathological examination. I want to go to the pathology department and have a look under the microscope in person. Are you interested?" Song Zimo put a few thin slices into the specimen bag for pathological examination.
"Wait! Show me." Takahashi was still struggling just now, how Yang Ping could do it, without using the navigation system, to accurately pick up the lesion in one go.
Song Zimo had already given the specimen bag to Zhou Can: "When we go to the pathology department, we will take a slow look under the microscope and remove the sandwich lesions accurately in one go."
The child followed the doctor out of the operating room. Song Zimo told his parents that he could walk normally and that strenuous sports were prohibited for three months. He could be discharged from the hospital tomorrow and go to school as usual. The medicine would be changed every three days and the stitches would be removed every 10 days.
"This is the excavated lesion. There are dead bones and infected bone tissue. Take a look." Song Zimo showed the picture on his mobile phone to the child's father.
The father of the child cannot understand, but he can understand roughly that this is the root of the disease. Now the doctor has dug out the root of the disease with his skillful hands.
"Will it hurt if I dig out the bones?" the child's father asked worriedly.
"There are very few pain-sensing nerves in the bone tissue, so you won't feel too much pain. If it hurts, it will be wound pain. I will give you some painkillers at night." Song Zimo explained.
"Will the dug hole be filled in later?"
"Generally, it will be filled with new bone tissue after three months."
"The roots have been dug out this time. It won't relapse, right?"
"Generally not, but no one can guarantee it 100%."
"What should I pay attention to in terms of diet? What are the taboos? Or what supplements will help him grow bones? Is it okay to make bone soup?"
"Just eat a normal diet. If he likes to drink bone soup, just make it for him to drink. It has no benefit or harm to this disease."
"Can you make some Tianqi soup? Promote blood circulation and remove blood stasis!"
The child's father and Song Zimo asked and answered questions. These questions had been discussed in detail before the operation, and now the child's father asked them again.
"Tengqi is a traditional Chinese medicine. It has side effects. Don't take it casually. Just eat a normal diet. Your family has a normal diet. If you have nothing to do, take Tianqi every day?" Zhang Lin became impatient and interrupted.
"Can you send me a copy of the photo?" The child's father was embarrassed by Zhang Lin and changed the subject.
Song Zimo gave him a copy of the photo. The father was very positive and immediately posted the photo on WeChat Moments: The root cause of the child's disease was finally dug out, and he can sleep peacefully tonight.
The trouble came when the child's father posted a message in his circle of friends, and many people responded one after another, asking which hospital he was in and which doctor he was looking for.
Someone even called for consultation. The child's father glanced at Dr. Yang and whispered: "I'm busy now, let's talk later."
(End of chapter)