Chapter 373: Sweating even during surgery
Except for Wen Rentao, Song Yun of Xiehe didn't think anyone would be his opponent.
Even if he is facing off against Wen Rentao, Song Yun is very confident.
Some hospitals are better than Xiehe in certain specialties, but in terms of overall strength, Xiehe is the well-deserved overlord. Its fine tradition has allowed generations of Xiehe people to work tirelessly and strive for excellence.
Now, Song Yun is facing off against Yang Ping, and Yang Ping, who has never played in previous competitions, uses this Everest-level case when he plays. To be honest, even his director would not dare to take over this kind of case in Xiehe Union Medical College. .
Medicine is not a place for competition, and there is no shame in not being able to take over. It is a responsibility to the patient.
The more skilled a doctor is, the more he knows where the boundaries of medicine are.
But what makes Yang Ping so arrogant that he accepts this kind of case and puts it into competition.
From the analysis of the surgical video of Sanbo Hospital, Song Yun had to admit that in a single round of basic surgery, Yishu's strength was already at the same level as his own. The new method of multi-ligament reconstruction of the knee joint pioneered by Yang Ping, the surgeon, was simply a work of genius. It is misleading that it comes from the Hospital for Special Surgery in New York, USA.
If the inspection team hadn't announced the truth, Song Yun wouldn't have believed that it was Sanbo Yang Ping who pioneered this surgical method. In addition to talent, it also requires a large number of cases, which Sanbo does not have in any case.
Yang Ping's mystery put Song Yun under great pressure. Can he really complete this operation?
If it can't be done, why do it? People who can create new techniques must not be treated simply.
As for the comments shouted online, they are crazy, exaggerated and forgetful.
How is it possible? Song Yun doesn't believe these remarks at all. From the quality shown by the first assistant during the operation, it can be inferred that the surgeon must be a calm and experienced person, and his surgical quality is very good.
However, Song Yun didn't understand why Yang Ping could perform such a difficult and impossible operation.
Why?
Not only Song Yun has such doubts, but orthopedic surgeons across the country are also doubtful, the judges are also doubtful, and several spine experts are also doubtful.
By the time the second season started, Yang Ping was fully prepared. His condition could change at any time. The sooner he could use the experience accumulated in simulated surgeries, the better.
Yang Ping did not intend to wait for anyone, nor did he deliberately want to be the first to open the surgery. In short, for the sake of the patient and the safety of the operation, he wanted to open the surgery as soon as possible.
Before the operation, Yang Ping once again had a pre-operative conversation with Lu Gang and his mother.
The risks of surgery are very high, including the possibility of death, paralysis, infection, etc. Doctors can only go all out to reduce risks, but they cannot completely avoid them.
"No matter how big the risk is, you have to take it. Now he has to suffer a little, and it's okay to take some risks. When I get old, who will take care of him? He went from elementary school to college. You don't know how hard it is. He worked hard, and so did I. They had to use a wheelchair to push him to school and pick him up every day. The university had to rent a house next to the school and pick him up and drop him off every day. He even had to pick him up for lunch and dinner at home," Lu Gang's mother said while wiping her tears.
Lu Gang just stood silently, even if it was a common thing, it was very difficult for him to do it.
For example, eating is an ordinary thing for ordinary people, but it is extremely difficult for Lu Gang.
Without a mother, even survival is a problem, let alone going to college.
For more than ten years, his mother has taken him everywhere to seek medical treatment, spending a lot of money on travel expenses alone, but no hospital dared to perform surgery. Now Dr. Yang is willing to perform surgery, even if he takes risks.
Until Yang Ping asked again: Are there any other questions?
Lu Gang and his mother really couldn't think of any other questions. What needed to be explained had been explained repeatedly and clearly. Both Lu Gang and his mother signed solemnly.
Informed consent form for surgery, informed consent form for blood transfusion, informed consent form for anesthesia, and authorization letter.
In this kind of complex and high-risk surgery, unplanned things may happen during the operation. Once such things happen, the patient is under anesthesia and has no independent ability. A person needs to act on his behalf. Lu Gang uses a power of attorney to entrust this right. To his mother.
The operation was unpredictable. Yang Ping was confident that the blood loss would be controlled within 200 milliliters, but he still prepared autologous and allogeneic blood transfusions. The more prepared the better, even if it was not needed.
Director Han and Professor Zhang were sitting beside them while Lu Gang was pushed into the operating room on a flat cart.
Xiao Wu and Zhang Lin had practiced crossing the bed many times and were familiar with it. Together with Gui Peisheng, they passed Lu Gang onto the operating bed.
The fat man began to intubate his trachea. Although he had practiced on Lu Gang's model for a long time and practiced on a rabbit for a long time, he was still not completely sure.
The fat man slowly inserted the bronchoscope, and the mouth, throat and trachea were slowly revealed from the first view, and then he focused his field of view on the glottis cleft.
The laryngoscope was inserted gently, and the endotracheal tube was inserted. The fat man's hands were very steady, and the tube crossed the glottis. The fat man held the tube with one hand, and held the stethoscope earpiece in the other hand to auscultate both lungs, and then made an OK gesture.
It went smoothly, the intubation was successful, everyone applauded, and the first hurdle was passed.
Zhang Lin Xiaowu inserted various positions into the gaps around Lu Gang's body and assumed a strange position.
Yang Ping plans to perform hip and knee joint release and joint replacement first, so that the hips can move freely and facilitate the next step of posture placement.
It is very difficult to complete bilateral hip and knee replacement in this hunched position.
Even in normal position, performing bilateral hip and knee replacement at the same time is a challenging operation.
It is very difficult to complete the operation in this extreme position.
Even Professor Zhang and Director Han had to wonder how he could quickly complete the replacement of these four joints.
Yang Ping was so proficient in how to operate that he had formed muscle memory. He performed nearly a hundred operations on the systematic Lu Gang, and also conducted many research pathological dissections.
Song Zimo disinfected the sheets very quickly.
After the last check before the operation, Yang Ping made a minimally invasive hip replacement incision. In just a few minutes, the deep hip joint was exposed. Several acetabular retractors were put in place, and Zhang Lin Xiaowu was supported.
Zhang Lin Xiaowu had no idea where the hook was placed and what was inside, but they only needed to hold the hook steady. They were fully qualified for this job. According to Yang Ping's request, they held Lagou steadily.
The femoral neck osteotomy is in place at one time, and the deformed femoral head is easily removed with the head remover.
Director Han was just worried that it would be difficult to remove the severed femoral head, but Xiao Su had already taken over the femoral head and placed it in a metal basin.
Usually, you need to use a caliper to measure the diameter of the femoral head to guide the selection of the model of artificial joint prosthesis. Now because the femoral head has been deformed, it has no guiding significance at all.
Where is Lu Gang’s acetabulum?
In the pelvic acetabular area on the CT three-dimensional reconstruction, there is no real acetabulum, and the shallow indentation is meaningless.
His hip joint has been in dislocation for more than a decade, and the femoral head has floated in the soft tissue without an acetabular socket to accommodate it.
When joint surgeons usually deal with the acetabulum, in order to make the direction of the acetabulum correct, they use the patient lying down as a reference to find the angle.
Now Yang Ping needs to make a new acetabulum for Lu Gang. The position, direction and depth of this acetabulum must meet the anatomical requirements. Lu Gang's posture is extremely irregular. Finding the angle in this posture requires the doctor to have strong spatial imagination. .
"Xiao Yang——" Professor Zhang just wanted to give him some advice.
The acetabular file has been inserted, making a rustling sound, and blood mist rises through the goggles.
Before the high-speed electric drill and acetabular file completed the work, Yang Ping directly reported the model parameters of the acetabular prosthesis.
Huang Jiahui immediately opened the package and placed the prosthesis on the instrument table.
The steps of the competition require a mold trial, otherwise Yang Ping wouldn't need a mold trial at all. After a hundred surgeries, it would still be a mold trial, which is a complete waste of time.
After Yang Ping completed the mold trial process, he asked Xiao Su to open the prosthesis.
Due to insufficient activity and osteoporosis, Lu Gang's biological prosthesis was not suitable, so he used a bone cement prosthesis.
The bone cement is unpacked and mixed with the special dissolving solution. The fragrant smell fills the entire operating room.
The acetabulum is rinsed, the gauze is soaked and dried, and the acetabular prosthesis is accurately implanted into the artificially dug acetabular socket with bone cement in the dough stage and pressed tightly.
Immediately afterwards, the femoral end is reamed, the medullary cavity is flushed, and the trial mold is also walked through. The bone cement gun drives the bone cement into the femoral medullary cavity, and then the real femoral prosthesis is implanted into the medullary cavity and compressed.
A little excess bone cement has been completely removed, and the artificial prostheses of the joint head and socket have been installed. All that is left is to completely stop the bleeding. There is no bleeding at all, and there is no need to put in drainage.
After observing for a few minutes with a close-up lens, there was no obvious bleeding.
Because of the minimally invasive approach, various important structures, such as the piriformis muscle, were not damaged. The bleeding on the bone surface had long been stopped by the compression of the joint prosthesis and bone cement, so there was no bleeding.
Rinse, sew layer by layer, and replace one hip joint.
Young man, your surgery is like playing a game. Professor Zhang doesn't dare to blink. The skill of your hands is still inhuman.
They originally wanted to communicate a few words with Yang Ping, but the hip joint on the other side started moving too fast, and their brains couldn't keep up with Yang Ping's rhythm. Professor Zhang and Director Han were running with Yang Ping in their hearts.
After replacing both hip joints without stopping, the knee joints were replaced.
Song Zimo felt it was difficult for him as an assistant for the first time, but he could barely keep up with the rhythm. Zhang Lin Xiaowu didn't see clearly how the surgery was done. Every time Yang Ping put the retractor in place, they just supported it mechanically. But fortunately, after so long training, the two brothers are very good at pulling the hook. They pulled the hook appropriately and the thread did not move.
Knee replacement tests the techniques of osteotomy and soft tissue balancing. Yang Ping's movements were too fast. Whether it was the members participating in the operation or Professor Zhang and Director Han who were observing the operation, no one dared to even relax a little. How could they talk? If you hesitate a little, you will be thrown off by the rhythm.
Exposing and cleaning the synovial membrane of the knee joint, releasing the ligaments and joint capsule, and osteotomizing the tibia and femur ends are also requirements of the surgical procedures. Otherwise, Yang Ping would need an osteotomy template. He can directly cut the bones with his bare hands, which can be accurate to the millimeter. below level.
The positioner is installed, the tibial osteotomy template is assembled, and the osteotomy is completed in a few steps. The femoral osteotomy is also completed in a few steps. After the osteotomy is completed, the tibial end prosthesis and femoral end prosthesis are implanted one after another, and the bone ends are firmly fixed with bone cement.
The fragrant bone cement smell became stronger and stronger, and the bilateral knee joint replacements were completed, sutured, and dressings covering the incisions.
Reposition, sterilize and drape, and perform osteotomy and correction of the cervical spine. This is the most dangerous step, especially the treatment of skull base deformity of the upper cervical spine.
"Xiao Yang, don't be in a hurry. Slow down. If it doesn't work, you can do it in installments." Director Han almost held his heart in his hands.
Professor Zhang was also worried. For an eighty-year-old man, seeing a young man doing this kind of surgery means he has a good heart. Otherwise, he would probably be frightened to the point of myocardial ischemia.
"Slow down, slow down -" Professor Zhang was choked when he spoke.
However, Yang Ping was completely immersed in the operation. He had to walk at his own pace, just like a running athlete who could not be stopped suddenly by others.
The sooner the surgery is completed, the lower the risk.
After the incision and exposure are completed, nailing is done first and then the osteotomy is performed.
If Yang Ping had not used 3D models before surgery and led everyone to train repeatedly, no one would have been able to keep up with his pace.
The lateral mass screws of the atlas and the pedicle screws of other cervical vertebrae. These are the pedicle screws of the cervical vertebra. If they fail to damage the vertebral artery, the arterial blood will surge to the ceiling.
There are vertebral arteries around the cervical vertebrae, and the vertebral pedicles are small and not as thick as the thoracolumbar vertebrae. Performing cervical pedicle screws is a high-risk operation. Only senior experts dare to do it, and most spine surgery directors do not dare to do it.
Now Yang Ping is like digging soil to plant beans, planting screws one by one, completely ignoring the risks.
My little master, can you please slow down? Director Han stood looking at the screen, his body felt a little uneasy, his legs were uncomfortable, he kept shouting in his heart, and he swallowed his saliva again and again.
Professor Zhang simply moved a stool in front of the screen. Standing to watch it took too much energy, and watching the surgery was also a laborious task.
This speed is really too fast, just like on the street, there are people everywhere, you perform Fast and Furious, and whoever sees it is not beating the heart.
Several cameras, with different focal lengths and different directions, captured the surgery clearly.
Another osteotomy, ultrasonic water jet osteotomy, was like playing.
Oh my God, young people, slow down, slow down, slow down. One is in his eighties and the other is in his fifties. I have never seen anyone do this kind of surgery. You are doing somersaults on a tightrope.
It’s not up to you, the surgeon will now follow the rhythm of his heart!
The osteotomy is completed, and now the cervical spine needs to be reassembled. This step has the highest risk of the entire operation. If you are not careful, the upper cervical spinal cord will be damaged, and the patient will die directly on the operating table.
"Song Zimo, take off the surgical gown and adjust the cranial immobilizer, Zhang Lin Xiaowu, pay attention to the position of the automatic hook, and the anesthesiologist pays attention to the patient's vital signs."
At this step, Yang Ping slowed down his pace.
Before the operation, they rehearsed every step with a model, especially this step. Yang Ping broke down Song Zimo's movements into more than a dozen steps, how to adjust them, and how much to adjust. They were very precise.
Song Zimo took off his surgical gown and gloves and put on new ones. Everyone performs their duties and concentrates their attention.
"Are you ready?"
"Ready!"
"1, 2, 3, start adjusting."
Yang Ping didn't need to see how Song Zimo adjusted it. He only needed to see the movement of each segment of the cervical spine. Song Zimo adjusted the cranial immobilizer, and Yang Ping began to correct the cervical spine. The two of them cooperated tacitly.
The truncated cervical vertebrae began to shift spatially on the three axes, and the cervical spinal cord in the spinal canal also began to be affected. However, Yang Ping had planned the trajectory of this spatial displacement to be optimal, with the least impact on the cervical spinal cord.
No one dared to let up on the precise displacement on the predetermined trajectory. Lu Gang's life was in the hands of Yang Ping and Song Zimo. With a small mistake, Lu Gang would never be able to get off the operating table.
"Stop!"
The correction of the cervical spine is completed, the physiological curvature is formed, the rod is applied, and the internal fixation is firmly locked. The cervical spine correction is successfully completed.
A large piece of Han's back was already wet, and he let out a long breath that he had held in his chest.
Professor Zhang rubbed his eyes. There was a large piece of sweat on the stool.
They also sweated during the operation, which the two of them did not expect.
The correction of the cervical spine was completed, and after a short slow-paced period, the fast-paced surgery began again.
It is necessary to adjust the position and re-sterilize and spread the sheets.
In thoracolumbar spine correction, the twist will be released and reshaped to restore the physiological curvature of the spine before and after.
At this time, it will not only affect the spinal cord, but also the organs in the chest and abdomen. Although it is much better than the correction of the cervical spine, the risk is still very high.
Professor Zhang wanted to take a rest. He was exhausted mentally and physically. Director Han couldn't bear it anymore and moved a stool to sit next to Professor Zhang.
The two just looked at each other without speaking.
It was revealed that the pedicle screws were like sowing beans again. Song Zimo followed Yang Ping's rhythm. Although he was pulled by Yang Ping, he was already doing a good job. If someone else had done it, he probably wouldn't be able to keep up and even pull him up.
Dozens of screws were implanted into the vertebral pedicles, and another osteotomy was performed. This time, Professor Zhang and Director Han felt much more comfortable and less worried. After all, the most dangerous hurdle had been overcome.
This time, Song Zimo still needed assistance. Every time Yang Ping corrected a point, Song Zimo tightened the internal fixation device and used the internal fixation device to fix the severed spine in a new position. Step by step, without any unnecessary steps, the thoracolumbar vertebrae were reassembled. .
When the last screw is tightened.
"Perspective!"
"Will you do a three-dimensional CT scan reconstruction later?" Director Han reminded.
This was the first time Yang Ping heard Director Han speak since the beginning of the operation, and suddenly remembered that Director Han and Professor Zhang were beside him.
"Okay!"
The surgical procedure requires that C-arm or G-arm fluoroscopy must be performed in the operating room after the operation; as for the CT scan, if conditions permit, it can be completed in the operating room. If conditions are not met, it can be returned to the ward after the operation and then done in the radiology department.
On the spinal cord electrogeneration monitoring screen, the amplitude has been stable with no abnormal changes.
After fluoroscopy, three-dimensional CT reconstruction is performed.
pretty!
Others generally pursue moderate correction, but this surgery restores the normal S physiological curvature and maximizes the surgical effect.
Each screw is in the best position, with the right length and thickness.
"Awakening test!"
Fatty Liang was very particular about the amount of anesthesia. Yang Ping told him four hours, that was four hours, three hours for the operation, and an hour for disinfection and draping several times in the middle.
Slowly, Lu Gang woke up, and Lu Gang was repeatedly trained in this area before the operation.
"Move your toes, yes, up, down, very good!"
The operation was successful, quite successful!
This surgery was originally planned to be two chapters, but after thinking about it, I decided to solve it in one big chapter to make it smoother! This chapter has more than 5,000 words. Brothers, please give me some encouragement!
(End of chapter)