godfather of surgery

Chapter 104 Turning the war into jade
"Let's talk about this patient." Yang Ping felt that the time was right.

Director Zeng was very sincere: "Well, I'll go and get the patient's information."

There are a lot of patient's films, several bags are bulging, from Nanqiao People's Hospital to Shipo People's Hospital, and then to hospitals in the provincial capital, every hospital has done a full set.

Yang Ping simply classified these films into three parts, X-film, CT, and MRI, and arranged each part in order of date, with the earlier date on the top and the later one on the bottom.

Otherwise, there are a bunch of films, and it is not clear which one was taken where and when.

Facing the reading light, the two people hung up the films one by one, looked at one and then changed another.

Yang Ping pointed to the most recent MRI film and said: "Look at the left femoral shaft. The local signal here is still different from the signal in other parts. Then look at the CT."

He took out the CT of the same period, verified the date, and then hung it up: "Similarly, the density of this part is also different from other parts. You can see that there is slight sequestrum formation and local hyperplasia here, but there is no such thing in other places." The phenomenon is just the uneven reduction of bone tissue density, with pits and hollows."

Then hang up the X-ray: "The bone trabeculae are unevenly reduced, and there is no gap in the cortex for the time being."

Having said so much, Director Zeng didn't understand what Yang Ping wanted to express?
Yang Ping also saw his bewilderment, and said, "I suspect that this patient is not infected with the entire femur, but only with a partial infection here!"

Director Zeng was attracted by his novel point of view. Why is this patient so difficult? Why is the provincial hospital unwilling to operate on him? It is because the whole femur is infected and there is no way to operate.

"This patient has been hospitalized in the Provincial People's Hospital. He originally planned to undergo resection of the infected bone segment and bone lengthening, but even both ends were infected. It is impossible to cut the entire femur. If they are all cut, how can we extend it? So the doctor The operation was given up, and it was suggested to return to the local hospital for anti-infection treatment."

The so-called going back to the local hospital for anti-infection treatment is just an excuse, and they are unwilling to take over.

Yang Ping said: "If the judgment is correct and there is only focal osteomyelitis, it will be much easier to handle. The infected bone tissue can be completely removed, filled with calcium sulfate containing antibiotics, and then a myocutaneous flap can be used to cover the defect. , the problem is solved.

Bone lengthening technology, also called bone transporting technology, uses the distraction osteogenesis technique of former Soviet doctor Ilizarov to lengthen bone tissue.

In the past, this technology was very popular, and many hospitals used it to perform height-enhancing surgery. That's right, it was Lei Guaner's broken bone heightening.

Broken bones and heightening led to the abuse of technology, and many accidents occurred. Later, the Ministry of Health issued an order to prohibit the use of this technology for heightening, and it was only used to treat diseases and correct deformities.

"Director Yang, if it is focal osteomyelitis, then the image changes in other parts are bumpy, how to explain it?"

Director Zeng is very interested in following Yang Ping's ideas, not only in solving problems, but also in the fun and sense of accomplishment brought by such rigorous logical reasoning.

Doctors can do that too!I feel that my clinical thinking has improved several levels after discussing with Yang Ping in this way.

Yang Ping went straight to the point: "The changes in other parts are caused by hyperthyroid bone mineral disease, which happens to overlap with osteomyelitis, making people think without hesitation that the entire femur is infected and hopeless."

Thyroid examination is not a routine examination in hospital. Orthopedic patients are hospitalized. Without special circumstances, thyroid hormones are generally not checked unless there are symptoms, such as thyroid enlargement.

"Then what should we do?" Director Zeng was straightforward and straightforward.

Knowledge is a bit super-class, brain-burning!
Yang Ping said: "I just speculate that further tests are needed at present, such as blood tests for thyroid hormones, and multiple bone punctures to take bone tissue for bacterial culture."

Medicine is a rigorous science, and decisions must not be made arbitrarily based on feelings. This will not only fail to cure the disease, but may easily cause harm to the patient.

"We perform multiple punctures, do bacterial culture, and look at the results. If bacteria are cultured at every puncture point, it means that the femur is extensively infected. If bacteria are only cultured at this point and no bacteria are found at other points, then support me If the diagnosis is confirmed, we will perform surgery to remove the infected bone tissue and make a musculocutaneous flap to cover the defect." Yang Ping explained in detail.

Director Zeng said, "I'll make arrangements now to draw blood for him on an empty stomach tomorrow morning?"

"Tomorrow morning, I will draw blood on an empty stomach, and now I will do bone puncture at the bedside to take bone tissue to culture bacteria." Yang Ping agreed.

Don't be too late, think clearly, and start early.Two weeks, procrastination, nothing can be done.

Director Zeng immediately went to the doctor's office, grabbed a doctor at random, and issued a doctor's order to draw blood on an empty stomach tomorrow morning, check thyroid hormones, and do a color Doppler ultrasound to see if there are no nodules in the thyroid gland.

In the eyes of Director Zeng, Yang Ping is now a great immortal, and he quickly moved the two mountains of Keli away during the two weeks he was there.

It's not easy being the head of the department. When I sit in the office every day and drink tea, I have to see if Teacher Yan is here.

You have to take a detour to and from get off work, for fear of being blocked. Although he does not threaten personal safety, he is annoying. If a person keeps pestering you, how can you have a good life.

The patient with osteomyelitis of the femoral shaft, although the operation was not performed here, and the family members are polite, they will ask you every day, "How is it? Is the infection controlled? Is there any other way?"

The questions are so overwhelming that I can only perfunctory each time: "Change the medicine for a few days and see."

But changing the dressing every day, helpless, uncomfortable!

Without delay, Director Zeng asked a doctor to prepare a bone puncture bag for bedside bone puncture.

"Shall we go to see Teacher Yan again?" Yang Ping remembered going to see again.

Although we have full confidence, we still need to pay close attention to it. The human body is complex, and medicine itself is not perfect and cannot cope with all changes. This is the uncertainty of treatment.

After the general anesthesia, he fasted for six hours. Teacher Yan's son sat beside the bed and moistened his lips with a cotton swab.

"Father, Director Yang and Director Zeng have come to see you." said the old man's son.

Teacher Yan was sleeping on his side, facing inward, avoiding pressing on the surgical site, and when he heard Yang Ping coming, he said, "Director Yang, there is no pain at all now, and my whole body is loose, thank you very much."

He fumbled under the pillow with his backhand, and took out his notebook: "Give me the pen, wait a minute, I'll write it down, what time is it? Director Yang came in to make rounds. I want to write a letter to thank you. After such tossing, you have pulled out the root of the disease for more than ten years, and the relief in my heart is indescribable."

"Director Yang, which hospital do you belong to, can you tell me?" Teacher Yan asked.

"Sanbo Hospital in the provincial capital." Yang Ping told him.

"I made a note of it. I want to write a commendation letter to your hospital. You are young and promising, and you will be a pillar of the country." Teacher Yan closed the notebook, and his son took it and stuffed it under the pillow.

After seeing Mr. Yan, the bone puncture bag is also ready. This kind of bone puncture is best performed under the guidance of CT, so as to accurately penetrate to the center of the lesion.

But now the femoral lesions are diffuse and everywhere, as long as the puncture reaches the femur, it is considered successful, and the suspected infected bone tissue is just exposed, and the puncture is performed directly.

Therefore, this does not require CT guidance, and the puncture is performed directly at the bedside under local anesthesia.

The doctor in charge of the bed communicated well with the patient and signed the informed consent.

Yang Ping operated it himself, and the whole process was strictly aseptic to prevent inaccurate results due to contamination.

Bacterial culture takes several days, and after the bone piercing is done, the only thing left is to wait for the results.

Zhang Lin was checking the medical records of doctors and instructing them on how to write an excellent medical record. He wrapped a dressing on his finger, washed his clothes and rubbed his finger to the skin.

The hospital originally bought a washing machine for everyone to use, but many of the doctors are a bit of a clean freak. A dozen or so batches of people who went to the countryside share the washing machine, and many of them dare not use it. They wash it by themselves.

"Medical records are the most important test of a doctor's level!" Zhang Lin cadenced, and the teacher was very fanciful.

The doctors listening around him were very attentive.

"Look, brother, your medical record is very well written, and you have written abnormalities that are difficult for others to find. You are a talent!" Zhang Lin pointed to the medical record.

Everyone leaned closer to look at the medical records, and the praised brother had a long face.

"Men, the menstrual history is written so clearly, it's not easy, it's because of hard work." Zhang Lin tapped his fingers on the table.

Everyone wants to laugh, but dare not laugh.

Song Zimo took Xiao Wu to the operation. A severed finger was replanted. He originally planned to do away with the finger and sew it up casually. He called the operating room to inquire. There were microsurgical instruments, needles and threads, and an old microscope, so he decided to do it. Severed finger replanted.

At noon, I met Director Tian in the cafeteria. Director Tian said that the weather is good these days, and everyone will go to the mountain to do free clinics for the villagers.

Before leaving get off work, Yang Ping went to see Teacher Yan again, but there was still no pain.

I am most afraid of rebound. Sometimes this rebound lasts for several days. Ordinary patients can just explain a few words, but once this patient rebounds, it is easy to cause misunderstanding.

The system is also not as usual. The result is announced immediately after the operation, and it is estimated that they are still waiting for the result.

"Director Yang!" Teacher Yan said in a high tone.

"Say it!" Yang Ping said.

Teacher Yan said: "I'm thinking about writing a thank you poem!"

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(End of this chapter)