Chapter 536 Cases are issues
Anyway, it wasn't the first time that Xu Zhiliang was yelling at him. Zhang Lin was used to it.
These two people are from the same medical team. Zhang Lin usually likes to pretend to be a big boss and has a good handle on graduate students, trainees, interns, and even doctors who come from outside for further training.
But Xu Zhiliang kept him under control. When Xu Zhiliang took him for ward rounds, he was basically sweating profusely and trembling.
Xiao Wu has never seen this kind of disease and can't tell anything.
Song Zimo and Xu Zhiliang are well-read and read various journals every day. Although he is unfamiliar with this kind of case, he can at least have a preliminary understanding.
"I have read the literature about this. The first case appeared in 1800, and several cases appeared sporadically later. In the cases recorded in the literature, although the knee joint is recurved, there is no anatomical inversion. Those cases are all Various reasons lead to ligament laxity, and the knee joint evolves into excessive forward bending. Finally, both the patellofemoral joint and tibiofemoral joint are dislocated or subluxed, and the knee joint becomes stiff in a deformed position of recurvature. This knee joint is different, its recurvature It’s not that the ligaments are loose, but it’s completely anatomically reversed. You see, the patella is actually at the back.”
"Is this an atavism? The knees of mammals, such as dogs, point backwards." Zhang Lin asked again. He did not give up and wanted to show off, because he had recently read Professor Qin Sihe's article and tried to imitate Professor Qin. Use a higher perspective to look at some issues in orthopedics from the perspective of human evolution.
Teacher Zhang is awesome!
As soon as such high-end remarks came out, the graduate students and graduate students next to him cast admiring glances.
When Zhang Lin saw everyone's reactions, he immediately sat up straight, very scholarly.
It seems that if you want to show off, you still need to read more books. The failure rate of showing off without education is too high. Even if you succeed, the grade will not be high.
Xu Zhiliang took over: "Does your dog's knees face backward? The knees of mammals are the same as those of humans. They also face forward, with the patella in the front. In this case, the patella is in the back. How can it be atavistic? Strictly speaking, this kind of The case is more appropriately called anteroposterior anatomical inversion deformity of the knee joint.”
Zhang Lin failed to show off again, but there was nothing he could do. This was a case discussion, and everyone expressed their opinions. Dogs' knee joints face backwards. He also learned this knowledge from the Internet. It seems that the knowledge on the Internet is too unreliable. He will need to read more academic journals in the future.
Song Zimo enlarged the picture and looked at it again: "Lao Xu's idea is very good, and it is very consistent with the actual situation of this disease. When writing the paper, we can name this disease as knee joint anteroposterior anatomical inversion deformity syndrome. You It seems that the hip joint is severely underdeveloped and in a state of deformity and dislocation, and the ankle joint and foot are also varus deformed. Professor! You don’t want to make her stand up through surgery?”
Song Zimo looked at Yang Ping and thought he was a demigod, with his mind full of crazy ideas and always able to realize them.
Now Song Zimo really hopes that Yang Ping can lead a postdoc in the future and he can become a postdoc with him.
Let's talk about surgery. Many seemingly impossible surgeries were completed in his hands as surely as an expert.
Let's talk about scientific research. Spinal external fixators treat scoliosis. This guy just got it right in one step and succeeded in such a complicated thing.
Now I am planning to start a project on stem cell culture of muscle. If this project is completed, it will be Nobel Prize-level.
Song Zimo had no doubt at this time that this guy could really do it.
Song Zimo was excited just thinking about studying with such a person.
"After this patient came, we treated the whole process as a new subject. If we handle this case well, no matter how difficult the lower limb orthopedic surgery is in the future, it will not be a problem. This case uses almost all the knowledge of lower limb anatomy and biomechanics, and there is no one step. If treated well, the postoperative effect will be very poor. If the postoperative effect is too poor, it will be counterproductive. Originally, others can crawl, but after the operation, they can neither walk nor crawl, and end up in a wheelchair. "Yang Ping hopes that the team will pay attention to this case. Since you are a professor, you should look like a professor.
Xiao Wu said with a smile: "If the operation is not done well, not only will we not be able to regain a new life, but we will also ruin our current circus job."
That’s indeed what happened!
"I contacted Ruixing's laboratory to conduct computer 3D modeling, then simulated osteotomy and soft tissue balance adjustment to find the best force line, and then designed hip and knee prostheses. Xiao Wu was responsible for the reception of patients. At work, Zhang Lin was responsible for collecting information, and Lao Xu was responsible for checking the information. The relevant knowledge was compiled into a booklet for everyone to learn." Song Zimo divided the work for everyone on the spot.
After discussing the case, Yang Ping led everyone in ward rounds.
One patient named Yang Ping for surgery, saying that he knew Yang Ping, and held a small note written by Yang Ping in his hand.
Yang Ping felt strange that he had ever written a small note to someone.
During ward rounds, I saw this patient.
Yang Ping had a good memory and recognized this young man in his twenties at a glance.
When I went to the countryside in Nanqiao County, I saw a patient at a free clinic whose lower limbs were unequal in length. He fell from a tree when he was a child. Without formal treatment, he asked the rural osteopath to spit a few mouthfuls of cold water on his legs and then pull them hard. After a few clicks, it turned out that the left leg was a full five centimeters shorter than the right leg, and the left ankle and left foot were also deformed, and I walked with a limp.
When the young man saw Yang Ping, he immediately got up from the bed and held Yang Ping's hand: "Doctor Yang, I finally found you. Do you still remember me?"
"Why don't you remember, you are from Nanqiao County?" Yang Ping immediately thought of him.
This guy also said at the time that today's medical men can be transformed into women, so his leg should be transformed.
"You have such a good memory. I thought you forgot things and didn't remember me. Look, Dr. Yang, I have always carried the note you wrote to me."
The young man carefully took out a notebook with a note in it. Yang Ping took it and saw that the note was actually plasticized and well-preserved. It had the address, phone number and name written by Yang Ping himself.
"It's hard to find doctors in big hospitals, so I never dared to throw away this note. I won't dare to come to you until I save enough money." The young man took the small note that Yang Ping returned to him and put it back carefully.
"Dr. Yang, to tell you the truth, I want to walk normally and find a better wife." The young man did not hide anything, and revealed the ultimate purpose of his operation.
Because of this leg, it is a bit difficult to find a better wife.
Yang Ping chatted with him for a few words. The young man's family was poor and he had few relatives and friends. He had not graduated from junior high school and went out to work, moving bricks on the construction site.
He had a relatively clear goal in life. After working bricks for several years, he saved some money and went to a chef school to learn how to be a chef. Later, he became a chef and his income was much higher.
The young man is very high-spirited and has his own standards when looking for a wife. He doesn't want just anyone.
"What do you mean by a good wife?" Xiao Wu joked with him.
The young man said seriously: "At least a junior high school diploma, a decent person, a clean history, good health, a height of more than 1.6 meters, a good figure, and good looks. I am also a skilled person, so I must not be casual about marrying a wife. , I have to be very selective. Women should be very selective when marrying, and I should be very selective when seeking a wife. Men and women are equal.”
This guy has one theory after another, including equality between men and women. His world view and outlook on life are quite correct.
This standard is neither too high nor too low.
If this leg is not cured, it will be really difficult to achieve the goal.
"What does historical innocence mean?" Zhang Lin didn't understand. In what era, they were still talking about historical innocence.
Xiaowu pulled Zhang Lin's clothes: "We are doing rounds, don't go off topic."
The young man's name was Fang Faquan, and he had completed the admission examination. Song Zimo showed Yang Ping the full-length films of his lower limbs. Yang Ping took a closer look and found that there was an old fracture of the left tibia and fibula. There should have been shortening and overlap at the time, and later malformation healed. He was already 12 or 13 years old when he was injured, and there was not much room for fracture and reshaping, so the tibia and fibula developed varus and shortening deformities, which affected the whole body. To compensate, problems also occurred in the hip joints, ankle joints, and feet. , the pelvis is tilted and the spine is scoliosis.
This kind of orthopedic surgery is relatively difficult because it has to consider restoring function as much as possible.
Three levels of surgery: resection, repair and reconstruction.
Reconstruction is the highest level, and it is also very difficult.
Even if it is a small operation, once it involves functional reconstruction, the difficulty will naturally increase.
If you do not master the relevant core knowledge of surgery, the surgery may look very beautiful, but it will not achieve the desired function.
Just like a small factory can copy the appearance and interior of a Porsche, and make it exactly the same, or even more beautiful than a Porsche, but it just can't produce its core technologies, such as engines and power, etc.
Therefore, reconstructive surgery most tests the skill of the doctor.
"The purpose of your surgery is to get a good wife?" Yang Ping asked him.
Fang Faquan didn't hide it: "Yes, Dr. Yang, if it weren't for this, I wouldn't bother. Although I'm swaying, I'm used to it, and it won't affect my current work."
"The goal is clear and good. There are two methods. One is relatively cheap and simple, and the other is relatively expensive and complicated. Of course, the risk of the latter one is also high. The former option is to shorten the normal long leg by five centimeters, and then shorten the left leg Orthopedic. The latter method is to straighten the left leg and lengthen it by five centimeters. Which one do you choose?" Yang Ping simply told him the surgical plan.
Fang Faquan did not hesitate: "The elongated kind. If the long legs are shortened, I am only 1.6 meters tall. If the short legs are lengthened, I can be 1.65 meters tall. I asked Dr. Zhang about the cost. My money Enough.”
"The latter risk is higher!" Yang Ping added.
Fang Faquan said: "Don't be afraid. At worst, you will still be lame, and the lameness will be more serious when you reach the top. What can you do without risk? There are people in the kitchen who cut vegetables and cut off their fingers. Not long ago, an aunt who was washing dishes broke her bones while walking. Doctor Yang, please help me pull it, it’s best to pull it on both sides at the same time. I have read the introduction of your department, there is a patient who has a leg stretched by 30 centimeters, please help me pull it to 1.8 meters.”
Fang Faquan became more and more excited as he talked.
Yang Ping felt that this kid was really high-spirited: "Your condition is different from others. It will be good for you to walk normally after correction. Don't think about the height of 1.8 meters."
The young man's words made everyone laugh.
He not only has his own opinions, but also has his own outlook on life.
(End of chapter)