Chapter 593 Back
Three days later, Yang Ping saw Qin Xiaowei again at the entrance of the ICU. His skin was obviously darker, with traces of sunburn, and all the tape on his hands had been replaced, and his hair was cut shorter. He looked more energetic, and his waist was still swollen. Wear a fanny pack.
Li Jun has not woken up yet. He was only agitated when he first entered the ICU and had a tendency to wake up. Since then, there has been no movement. ECMO costs more than 20,000 yuan a day, bedside hemofiltration machines cost 7,000 to 8,000 yuan a day, and various expensive imported equipment. Medicines, various examinations, etc. cost 70,000 to 80,000 yuan a day to maintain Li Jun's life. As long as one of these life-saving treatments is stopped, Li Jun's life will collapse.
His life is maintained persistently by expensive drugs and machines.
Every time Yang Ping comes for ward rounds, the ICU director will accompany him. He still respects this young professor very much.
"Li Jun has severe anemia. This anemia is renal anemia. He currently relies on blood transfusions to maintain hemoglobin concentration and the number of red blood cells, but this is not a solution. In order to increase hemoglobin and red blood cells, we inject Aridrome (Rosa) through the gastric tube. (Sita), we did an electroencephalogram yesterday, and the brain waves are present, and the activity is very good, and the pupillary reflex and other cranial nerve reflexes are present.”
From this point of view, theoretically, he would be able to wake up.
"As long as the brain waves are normal and cranial nerve reflexes exist, it means there is no necrosis in the brain tissue, and there is no anatomical evidence that one cannot wake up."
Yang Ping used the light of a flashlight to check his pupils, and found that the pupil reflex was indeed relatively sensitive.
The nurse is turning Li Jun over, doing body care, checking the skin condition of some bony protrusions, and replacing protective pads on these bony protrusions to prevent the formation of pressure sores.
Bedridden patients are prone to pressure ulcers if they are not well cared for.
The director of the ICU expressed emotion: "Hope is not completely lost. Even if you wake up, you still face the problem of whether you can go offline. These two life-and-death hurdles must be passed. We here have people who have successfully taken offline for more than three months, but the cost is huge. The self-expense alone is more than two million. Even if his family has the heart, money is still a problem.”
As a doctor, the ICU director knows very well how many people lose money because of the issue. At this time, betting on the slim chance of life is just throwing away money.
Ordinary people sell their houses and lose everything, and no one can accept it.
Many problems eventually become economic problems.
"What about the one next door? Are you still holding on?" Yang Ping asked in passing.
The director of the ICU smiled bitterly: "How is it possible? He was brain-dead a few days ago. The patient actually had greater hope than Li Jun. He was also maintained on ECMO. After more than 20 days, the family really couldn't support it, and the family members signed a waiver."
Yang Ping remained silent.
After watching Li Jun and Yang Ping come out of the ICU, Qin Xiaowei is talking to Dr. An, the doctor in charge of the bed. He will be away for a while, which will be a long time.
Qin Xiaowei told Dr. An to call him as soon as Li Jun woke up.
And I also left another emergency backup phone number, that of my friend Alon.
Before officially climbing, he had to climb with ropes dozens of times to select the best route, study the difficulties in the route, and design countermeasures in advance.
They also need to carry out various professional trainings, including physical training, etc., just like athletes training before a competition. This kind of high-risk outdoor extreme sports is very professional and is by no means a passion.
Only when every detail is in place can success be achieved.
——
August has basically mastered scoliosis correction technology and has a deep understanding of the technology.
As a great figure in spine surgery, his understanding of the spine is by no means comparable to that of ordinary doctors.
Yang Ping's technology makes full use of Ilizalov's theory to correct scoliosis. The difficulty lies in fully understanding the spinal deformity, and then knowing where distraction osteogenesis can help correct the deformity.
August understood these core theories bit by bit, and asked Yang Ping for advice if he didn't understand anything.
In order to have a deeper and more comprehensive understanding of the case, he personally changed the dressing and rotated the knob of the spinal external fixator every day.
The work August does now at Sanbo Hospital is all the work of a resident doctor, and he never tires of it.
"Why is my pen missing again?"
In the doctor's office, August hung his badge as a training doctor. He sat down to rest for a while and took a pen from his chest pocket to record something, but found that the pen was gone.
And Robert was sitting at the desk, counting his pens proudly. There were more than a dozen, including blue and black ink pens, surgical marker pens, etc., and the two pen sleeves were inserted slowly.
On each pen, Robert labeled it with his name, declaring his ownership.
August said angrily: "Classmate Luo, will you take my pen away?"
Robert protected his pen with both hands: "I followed Teacher Zhang's consultation and got these from other departments. Every pen has my name."
For doctors, these pens are a valuable asset, so how could they be taken away by others?
No matter how many pens there are, the doctor will always be unable to find them.
Not wanting to hurt the feelings between roommates just for a pen, Takahashi handed August a pen: "Use it first, I still have it here."
August took over the pen, his dislike of the Japanese slightly lessened.
"Doctor Ao! The professor is looking for you and asks you to go to his office."
Young doctors all call them Dr. Ao, Dr. Luo, and Dr. Gao.
The professor is looking for me? August temporarily put aside his hatred, straightened his white coat, cheered up, and came to Yang Ping's office.
The door was ajar, he pushed it open gently, poked his head in, and asked in a low voice:
"Professor, are you looking for me?"
"Come in!" Yang Ping was studying surgery and wanted to discuss it with him.
August came in and stood with his hands on the seams of his trousers and his body slightly forward.
Then he stared at the professor's pot of tea out of the corner of his eye, because he knew that if the professor poured a cup of tea from the pot to the students, it meant that the students would be recognized by the professor. It is said that this is tradition.
So far, Dr. O has not had that cup of tea.
Yang Ping pushed the 3D spine model on the table to the center: "Dr. Ao, if this case is treated with a spinal external fixator, can you tell me how to cut the bones? This is your patient."
This spine model was the spiral spine of the Duke's precious son, and August was a little excited.
Are you testing yourself? August is confident. During this period, I worked hard on new technologies. I performed surgeries during the day, changed dressings before getting off work, and returned to the dormitory to add notes and summarize the day's work.
"Professor, look!" August took out his pen: "Every vertebra must be osteotomized, and the osteotomy should be left in the posterior column as much as possible to maintain the stability of the spine and make full use of distraction osteogenesis. I started from this The vertebrae begin-——”
Auguste explained in detail the specific location, direction and depth of each osteotomy with a pen gesture.
The osteotomy site will be the site of distraction in the future. Not only orthopedics must be considered, but also the deformation tolerance of the scattered spinal cord must be considered.
He is indeed a great figure in spinal surgery, and he has such a thorough understanding of the new technology of osteotomy.
The promotion of new technologies in Europe relies on Dr. Ao in front of us.
Yang Ping expressed his approval and then made modifications to several osteotomies.
These modifications will make the operation simpler and easier. This is something August has never understood. He always feels that something is wrong, but he doesn't know how to modify it.
After Yang Ping's prompting, the ice-snow and smart August finally understood the secret.
"Professor, when can I ask you to go to Germany to perform surgery on this patient?" August took the opportunity to invite him.
Yang Ping did not refuse and asked: "Is the patient's cardiopulmonary function not very good?"
"Due to severe spinal deformity, the thoracic space is extremely narrow, causing serious compression and distortion of the heart and lungs, and the heart and lung functions are very poor. Once other problems occur, it may be life-threatening due to insufficient compensation of the heart and lung functions, so my friend hopes to give me a cure soon." His son’s surgery.”
Auguste was well aware of the professor's temper. If the patient was not operated on quickly, he might not be saved.
professor! Will you take action or not?
Yang Ping thought for a moment and nodded: "After I finish my busy work, I will go to Germany with you." "By the way, I will inspect the projects funded by the Duke Fund. I guarantee with my personality that this fund is very serious."
August swallowed, as if his throat was dry.
"Okay, let's go and have a look."
"The spinal cord injury research project that I directed by the way is to see if our hospital is qualified as a clinical trial base. For this phase three clinical trial, the Duke Fund has given 100 million euros. Patients from all over the world can enjoy free treatment in Germany, Professor ! Every spinal external fixator you use is benefiting mankind." August threw out the card he had held in his hand for a long time.
For the sake of his son, the Duke was very generous and signed an agreement with the Munich Orthopedic Hospital in Harlachen. If the third phase clinical trial is successful, he will provide a funding of 100 million euros.
This is a huge amount of money no matter where it is.
"By the way-"
Yang Ping patted August on the shoulder.
August was very disappointed that he never had the cup of tea until the end of the conversation with the professor.
August had a few patients to change dressings before getting off work, so he went to push the dressing cart, put on a mask and hat, and prepared to change dressings.
In the corridor, I saw Professor Zou from Affiliated One, standing at the door with a bag of fruit in his hand.
"Teacher——"
Professor Zou waved his hand.
August looked back, then gestured for Professor Zou to go back, and then pushed the dressing cart into the ward.
Looking at the tutor's back pushing the dressing cart, Professor Zou felt a sense of sadness welling up in his heart, stronger than last time. Tutor, my tutor! He looked like a medical trainee, pushing a dressing cart to change dressings for patients. Professor Zou almost shed tears.
When we got here, Professor Zou wanted to say hello to Yang Ping, so he went to Yang Ping's office.
Yang Ping was very surprised to see Professor Zou, carrying a bag of fruit, and paid a sudden visit without saying hello in advance.
"I'm just on my way, come and take a look, Professor Yang!" Professor Zou put down the fruit in his hand and took out a tissue to wipe his sweat, his eyes moist.
"Professor Zou, what are you doing?" Yang Ping felt that his expression was wrong.
Professor Zou sighed slightly: "August is my mentor, please take care of him! I just wanted to see him."
No wonder carrying a bag of fruit.
Yang Ping nodded: "That's right, I'll definitely take care of you. It's rare to come over. How about we get together in the evening?"
"No, I'll just come over and see the instructor. I have something to do tonight."
Professor Zou did have some entertainment in the evening. Besides, he came here in a hurry, didn't say hello, and ate in a hurry. What did he say?
"Li Guodong!"
Li Guodong happened to pass by the door of Yang Ping's office and stopped when he heard the shout.
"Go and call Dr. Ao." Yang Ping ordered.
Professor Zou shook his head: "Forget it, I'll leave now. The instructor said he doesn't want me to disturb him during the study period. I just want to come over and see if I can help."
Your expression is like this, as if this is a juvenile detention center, you are the child's parent, and the child is being disciplined here. Yang Ping cursed a few words.
"Don't tell me that I've been here. Please take care of me. My instructor was very good to me when I was in Germany." Professor Zou said emotionally.
Yang Ping thought he was weird, not meeting people when they came.
"Give this piece of fruit to him for me."
After Professor Zou finished speaking, he was about to leave.
Aren't you just like the parents of children in juvenile detention centers? This is not to see the instructor.
"That's it! Please!"
While the instructor was still changing the dressing, Professor Zou left quickly. It was obvious that the instructor did not want to see him.
this?
Carrying a bag of fruit, I threw it here and then left.
Yang Ping wanted to catch up and see off Professor Zou, but he had disappeared.
——
In the office, Yang Ping took a few sips of tea.
Summarize and reflect on the orthopedic technology of spinal external fixator.
In the system space, he reviewed some monographs and journals on orthopedics.
Most scoliosis patients are teenagers and are in the stage of growth and development. Can we grasp the characteristics of teenagers and find a better method?
Any treatment method is subject to development. For example, the treatment of gastric ulcers started with surgery and partial gastrectomy, and later developed to selective vagus nerve block. Later, with the advancement of research on Helicobacter pylori and gastric acid secretion, there was no need for it at all. Surgery and direct triple or quadruple drug treatment can cure the disease. This is an improvement in treatment methods. No method is permanent.
Yang Ping summarized the history of the development of orthopedic surgery, especially orthopedic surgery for adolescents, and then analyzed the current cutting-edge technology and found an important piece of information: whether epiphyseal block and stimulation technology can be used to correct scoliosis.
Epiphyseal block technology has now been used sporadically in simple children with scoliosis.
The core concept of traditional orthopedic surgery is osteotomy, so osteotomy is often required to correct skeletal deformities.
As for adolescents and children, this type of minors, their bones are still in the growth and development stage.
The length of the long bones of the limbs mainly depends on the growth plates (also called epiphyseal plates) at both ends. The epiphyses are formed by the orderly superposition of layers of chondrocytes of different maturities. The chondrocytes near the backbone continue to mature. Mature chondrocytes Transform into osteocytes, along with calcification of the surrounding matrix, forming cancellous bone added to both ends of the long bones, so that the long bones continue to grow.
Under normal circumstances, the growth of this epiphyseal plate is balanced, so during the growth process, we will not have abnormal growth and distortion.
However, due to some reasons, such as trauma, infection, tumor, radiation, metabolism, developmental abnormalities and other factors, the growth mechanism of the epiphyseal plate is damaged and the growth balance is destroyed. The growth of the epiphyseal plate will be inhibited or stimulated, resulting in excessive or slow growth. Even stagnation occurs, and the limbs appear to be unequal in length or bent and deformed.
For cases where the growth plate growth is unbalanced and causes bone curvature, the skeletal deformity can be corrected by temporarily stopping the side of the epiphyseal plate that grows relatively fast and allowing the slow-growing side to fully grow.
Doctors often achieve epiphyseal block by placing a small plate and two screws across the growth plate on the convex side of the angular deformity.
In this way, the concave side grows faster than the convex side, and the curvature is corrected.
But spinal deformities are far more complex than deformities of the long bones of the limbs.
It seems simple, but to use this technology for spinal correction, several major problems must be solved.
First, we must thoroughly study the growth mechanism of the spine and understand the precise adjustment of each epiphysis, which can be adjusted from three axes. Second, we must finally master the epiphyseal stimulation technology, because currently there is only epiphyseal block technology and no epiphyseal stimulation technology.
If this technology achieves a breakthrough, then the spinal correction theory will gain two complementary surgeries, both of which can complement each other and make spinal correction very easy.
For example, in children's spinal orthopedics, a few screws can be placed minimally invasively, and you can do whatever you need to do after the surgery.
These screws regulate the growth of the spine in the body, allowing it to automatically correct itself during the growth process. If you become curved, you will grow it back.
There are so many ideas!
Yang Ping has a lot of ideas in his mind right now, so he will write them down for now and study them when he has time.
——
After changing the medicine, August was called to the professor's office again.
Let him get the bag of apples.
(End of chapter)