Chapter 623: Transfer it to us
After leaving the ward and returning to the doctor's office, Yang Ping washed and dried his hands, and everyone sat down to discuss the treatment plan.
In fact, for patients with metal allergies, there are still certain ways to perform artificial joint replacement.
If treated simply, the problem is easy: severe metal allergy, treated conservatively.
This way of handling the problem will not cause any trouble to any doctor, but will get rid of the trouble.
For a provincial hospital like Sanbo Hospital, the director of joint surgery can perform hundreds of artificial joint replacement surgeries without too much effort. Is this one surgery still missing?
When bilateral knee osteoarthritis reaches this severe stage, conservative treatment is synonymous with giving up treatment, which is not in line with Yang Ping's philosophy of going all out.
Therefore, he did not intend to end the consultation hastily, and then give a sound and watertight opinion according to the formula: he agreed with Guike's diagnosis. The patient was allergic to various metals, and conservative treatment was recommended.
Before seeing a patient, go through the medical record, and after seeing the patient, review the medical record again. This is a consultation habit.
Review the past and learn the new. Sometimes reviewing medical records will lead to unexpected discoveries.
Yang Ping controlled the mouse himself and quickly browsed the entire medical record. Reading medical records quickly is also a basic skill for doctors.
After reading it, he was not in a hurry to speak.
Now as a superior doctor, Yang Ping needs to give his subordinate doctors a chance to think.
He has countless cases to practice in the system space, but Song Zimo and Xu Zhiliang can only rely on real-life cases to practice, so Yang Ping will not deprive them of the opportunity to practice.
"Metal allergy, allergic reaction is quite serious."
Yang Ping looked away from the computer screen and narrowed his eyes slightly.
Director Chang was on the side, leaning very close, holding the back of Yang Ping's chair with one hand and saying, "That's right, because his family members said he has a history of metal allergies, we are more cautious and conduct tests on several metals involved in artificial prostheses. Allergy tests show strong positive reactions, and I have never seen a patient who is allergic to these metals.”
There are only a few patients with metal allergies, and even fewer are allergic to several metals at the same time.
But doctors cannot ask patients to follow their own wishes. There is no problem with this kind of ordinary diagnosis, but at best they can't be cured. If you encounter an emergency rescue, the doctor can't say: This is too rare, I'm not ready yet, push it back and move on to the next one.
Director Chang's words actually have a profound meaning: It's not that we are incompetent, but that the patient's condition is too complicated and no one can do anything about it.
To reinforce this profound meaning, Director Chang continued: "We also considered using gold joint prostheses, but this allergy test was strongly positive, and we are also worried that a small amount of metal ions can also cause severe allergies."
Gold joints are not actually joints made of gold, but the prosthesis has certain specialties in technology. The physical vapor deposition process is used to deposit titanium niobium nitrogen onto a cobalt-chromium-molybdenum matrix, and then performs high-precision polishing to obtain the prosthesis.
Titanium niobium nitrogen (TiNbN) can effectively reduce the release of cobalt, chromium and molybdenum metal ions in the matrix, has better biocompatibility, and can also prevent metal allergies, providing a more reliable solution for patients with metal allergies, and its bonding, strength, Wear resistance, biocompatibility, fatigue resistance and safety are all better than ordinary artificial knee joints.
Because the color of the surface of the prosthesis is golden, it is often called the "golden joint" by doctors.
This kind of prosthesis can be used for patients with metal allergies, but doctors still dare not use it for patients with severe allergic reactions.
Titanium niobium nitrogen can reduce the release of cobalt, chromium and molybdenum metal ions, but it cannot completely prevent the release of metal ions.
As long as metal ions are released, there is a possibility of allergies.
If the prosthesis loosens due to allergies, severe inflammation occurs in the surrounding soft tissue, and the surgical incision does not heal, the consequences will be catastrophic.
One less operation would be fine for Director Chang, but if it were to have a disastrous operation, Director Chang would probably have trouble sleeping and eating.
Therefore, the "golden joint" was ruthlessly excluded!
Director Chang is also experienced as the chief physician of joint surgery, and he should have thought of all the ways he can think of.
"What if there were all-ceramic knee prostheses?" Xu Zhiliang said regretfully.
Ceramic artificial joints are widely used in hip joints, whether ceramic on ceramic or ceramic on highly cross-linked polyethylene. Because of their low wear, ceramic prostheses are often used as high-end prostheses.
However, it is very rare for ceramic prostheses to be used in knee joints, and all-ceramic prostheses without any metal cannot be found in hip joints, not to mention knee joints, because the femoral stem of the prosthesis is still metal.
Ceramics are generally alumina and zirconia, or a combination of the two. Alumina has been used in artificial joints for more than 40 years, and zirconia has been used for more than 30 years. It is hard, smooth, wear-resistant, and has little wear. A good material for artificial joint prostheses.
However, it also has its disadvantages, that is, it is highly brittle and will easily break if damaged. However, the possibility of chipping of implanted ceramics is now very small, less than one in 10,000.
Currently, Germany's CeramTec is the best manufacturer of medical implantable ceramics on the market. Almost all artificial joint manufacturers, whether American, British or Chinese, purchase its ceramic blanks for artificial joint manufacturing. .
There is no way other countries can produce such qualified ceramics.
CeramTec medical implantable ceramics occupy 95% of the global market, a well-deserved monopoly.
"Tao Tao's all-ceramic knee prosthesis is definitely not available on the market at present. It is a ceramic-on-highly cross-linked polyethylene knee prosthesis, and the tibial end also has a metal bracket." Song Zimo responded to Xu Zhiliang's regret.
Because the way the knee joint moves is completely different from the way the hip joint moves, ceramics are used more in the hip joint and less in the knee joint.
The hip joint is a ball-and-socket joint, and the femoral head rotates in the acetabular socket, so movement is more about friction between the ball and the socket.
The knee joint is a complex joint dominated by the flexor and pentaphyseal joints. Its movements include flexion, extension, rotation, and micro-movement in and out. This micro-movement in and out will cause impact on the articular surface. Such frequent impacts cannot be achieved with ceramics. It is tolerable because it hits its weak point - it is highly brittle. Once the impact causes slight damage, it will also cause the ceramic to crack.
The technology of implantable ceramics is constantly improving and will solve this problem, but at least there are no all-ceramic knee joints on the market yet.
"We have also considered ceramics. There are no all-ceramic knee prostheses on the market. What about it? Are there any other methods?" Director Chang asked indifferently, indicating that he had considered everything and there were no loopholes.
You, Professor Yang, must think of ways within the rules. Director Chang has already thought of these ways. Director Han is very satisfied with the Department of Traumatology and Orthopedics and Sports Medicine recently, but not very satisfied with the Department of Spine and Joints.
Director Chang was a little unconvinced. Anyway, I do this every day during surgeries. I, Director Chang, am not bad at it, so I can still do some tricks.
Yang Ping remained silent, allowing them to continue speaking freely.
If there is a completely metal-free knee joint prosthesis, the only way is to go to Germany to find it. The Germans are sitting next to you. Just make a few phone calls and the Germans will deliver the ceramic joint.
The problem is that it is not available now. Even if it is available, it is still an experimental product and cannot be used. This will involve some medical regulatory issues.
It is possible to discuss using all-ceramic joints, but in practice it is not possible. This road will not work. Yang Ping looked at the X-rays repeatedly and pondered in his mind.
"Professor, I'm familiar with CeramTec and Link. May I ask if they currently have any products in this field?" August was able to keep up with Yang Ping's thinking. Linke is a German manufacturer of artificial joints.
Robert didn't say anything because he knew that the major artificial joint manufacturers in the United States, whether Johnson & Johnson, Depuy, Zimmer Biomet, or Stryker, all imported ceramic blanks from CeramTec for processing. The research and development would definitely not be faster than CeramTec.
Dr. Ao's casual words attracted everyone's attention. Whether it was Director Chang or other joint surgeons, they were envious. For manufacturers like CeramTec and Link, the foreigner said to just call and ask. The noodles are quite large.
"Ask!" Yang Ping agreed.
It doesn’t hurt to ask, at least to learn about the latest developments in ceramic artificial joints.
Professor Zhang has a famous saying - even if you don't buy a plane ticket, you still have to find a way to get to the Imperial Capital. Yang Ping is thinking now, how to get to the Imperial Capital, you can't walk.
Facing this patient, everyone feels a little helpless.
Yang Ping also called up the magnetic resonance imaging of the patient's bilateral knees and ankles and checked them repeatedly.
"How about transferring this patient to us? Let's take our time and figure it out?" Yang Ping did not intend to continue the discussion here. He was not looking for joint surgery patients.
If you transfer to general surgery, it will be much easier to do many things, such as communicating with family members, discussing treatment plans, and consulting in other departments. After all, you will be the one who advises.
Chang Zhu was not happy about anything. Originally, the patient could be discharged after completing the consultation process, but the family insisted on asking for more efforts. In Sanbo Hospital, the ceiling is the general surgery department.
I can't even handle general surgery, but I'm not incompetent either.
"Okay, when will it be transferred?"
Director Chang was cheerful.
Yang Ping was also unambiguous: "Transfer now! I will communicate with his family."
The patient's daughter has been hanging around the door of the doctor's office several times, waiting for a reply. If it doesn't work, she will be discharged tomorrow, but she still hopes to find a way.
Song Zimo went to call the patient's children, and Xu Zhiliang went to the consultation room to adjust the chairs.
In the interview room, Yang Ping met the patient's daughter and two sons.
The patient's daughter is a lady in her forties and is the oldest child of the old man. Naturally, she serves as the representative. It seems that the lady is also happy to be the representative, and the two younger brothers are also happy to be represented by the elder sister.
"Who are these two?"
The lady felt a little uncomfortable seeing the two foreigners sitting next to her.
In particular, the two foreigners were sitting upright with serious expressions. This atmosphere made the lady have some thoughts.
Yang Ping explained: "These are training doctors in our department. You don't have to mind. They also study with me."
The lady looked at the two foreigners and sat down with confidence.
"We have just discussed your father's condition. Do you think this is okay? Today we will transfer to our general surgery department to complete some more examinations. The knee joints and ankle joints on both sides will need to undergo magnetic resonance imaging again. I want to see the old man's fourth son. How is the cartilage of this large joint? Only after completing this examination can I have a good idea and judge whether your father's problem can be solved. If it still can't be solved, I will be discharged from our department at that time. If there is a way, I will try again. Talk to you in detail.”
"Based on the current inspection situation, I am not sure whether I can help the elderly solve the problem."
Yang Ping added.
The patient's daughter was very happy and did not hesitate: "Of course, we are not in a hurry. We came to the hospital just to help my dad solve the problem of joint pain. It would be better if it can be solved, but there is nothing we can do if it can't be solved. Professor Yang, I know you You are famous for your recent development of a magical device to treat spinal curvature, right?”
Do all ordinary people know about this spinal external fixator?
Yang Ping nodded in agreement.
The lady said: "There is a child in our class who has scoliosis and has always wanted to make an appointment for your surgery. However, I haven't made an appointment for a long time and said that I have to wait for the third batch."
"What's your surname, teacher?" Yang Ping said with a smile.
The teacher, who was about forty years old, said: "My surname is Wu, and I teach at the Middle School Affiliated to Normal University."
The High School Affiliated to Normal University is the highlight among the highlights.
"Hello, Teacher Wu, let's settle it like this. We will arrange to transfer to another department immediately. Can we come up with a plan and wait until the inspection is completed tomorrow?" Yang Ping saw that they had no objections, so he arranged it like this.
Teacher Wu is very talkative: "Professor Yang, you are experts. Our family members will fully cooperate. Professor Yang does not need to consider the cost. Our three siblings are willing to pay no matter how much. My dad has worked hard for us all his life. Now we are all married and starting a business. This is the reward." Please tell me about my father, thank you very much.”
The teacher is always nice to talk to. It seems that he is either a Chinese teacher or a political teacher.
The patient's two sons kept watching their sister speak and did not interrupt. They just nodded and agreed with their sister's opinions. It seemed that they were often disciplined by their sister when they were young.
"Can I add you on WeChat?" Teacher Wu lost no time in asking.
No matter whether my father can solve the problem of joint pain this time, it is always a good thing to add Professor Yang's WeChat.
Just like parents of students have WeChat accounts of famous teachers across the country, they can ask for advice from time to time.
Yang Ping showed his work WeChat account, and Teacher Wu quickly took out his mobile phone.
"Do you two have any other opinions?" Yang Ping asked his two younger brothers.
Regardless of their status in the family, they are all family members of the patient at this time and need to ask.
"Professor Yang asked if you have any comments?" My sister's tone was a bit stern, completely different from the gentle tone during the conversation just now. At this time, she looked more like a teacher.
The two younger brothers looked slightly red and shook their heads at the same time: "No - no objection."
After the meeting, Song Zimo started calling the doctor on duty in the ward to accept the patient.
At the same time, he and Xu Zhiliang were also thinking about what plan Yang Ping was going to come up with. Since he proposed to transfer to another department, he must have been somewhat sure.
(End of chapter)