godfather of surgery

Chapter 135 Irizalov

Hermes' surgery is scheduled for next week and needs to be discussed in the afternoon.

This operation is very large, and most of the tibia should be amputated and discarded. Except for the proximal and distal healthy parts, all the infected bone tissue in the middle must be amputated.

Then use the Irizarov technique, using external fixators to extend the healthy bone tissue at both ends, from both ends to the middle, and finally meet.

In order to complete the task of bone elongation, an external fixator is installed on the calf. There are screws on the external fixator. When the screw is turned, the external fixator will move with the bone tissue.

Two weeks after the operation, it will be extended by one millimeter every day. Hermes needs to be extended by more than 30 centimeters, which will take about a year.

This is just an ideal state. If there is an abnormal bone formation in the middle, it needs to be stopped and extended.

Yang Ping finished Luo Xiaohu's operation in the morning, and had nothing to do in the afternoon. He slept in the duty room, entered the system space, read a long time, dissected dozens of experimental subjects, and trained his ability to compose pictures.

He also spent [-] points to purchase [-] cases of special surgery for external fixators for training.

Director Tian returned to the ward from the first floor. He had translated Tan Boyun's opening speech into English and handed it to Zhang Lin.

Zhang Lin's posters are almost finished. Sitting in front of the computer, he went through them one by one and repeated them several times.

"Is this really a Japanese doctor? Are you sure you didn't steal the picture?" Xiao Wu sat next to Zhang Lin, still struggling with this question.

Zhang Lin ignored him. Xiao Wu remembered that Director Tian was familiar with the guests and had been to Japan, so he asked him if he was right, pointing to the photo on the computer: "Is this really a Japanese doctor?"

Director Tian said with a smile: "Really, she is a guest at the meeting, a doctor at the Affiliated Hospital of the University of Tokyo, Fujiwara, who is very good at sports medicine."

"Have you seen her in person?" Fatty Liang was also very interested.

"When I was a visiting scholar there, I met her in person." Director Tian had indeed met her.

"Am I so beautiful?" Xiao Wu still didn't believe the photos.

Director Tian smiled: "I am more beautiful than this one, do you know how tall she is?"

"How much?" Zhang Lin asked, because the information provided would not include height.

"1.7 meters eight!" Director Tian reported the figure.

"So tall? As tall as me! Then only Song Zimo can hold it down, and the senior brother can barely hold it down!" Zhang Lin was surprised.

After talking so much, Director Tian became impatient: "Let me say, pour a glass of water, don't say it's dry."

Xiao Wu immediately offered a glass of water with a smile on her face, and then Director Tian continued: "It's not a big deal, what surprised you even more, what is her part-time job, do you want to know?"

What?Everyone is very interested, this is expected, could it be--
Island country!It always makes people think about it, who has never been young, and some people have already popped two letters in their minds.

Director Tian took a sip of water: "Fatty, take out your weight loss meal replacement and give me some. You need energy to talk, and your ATP is seriously insufficient."

Fatty took out a few chocolate balls from the bag in pain and sent them over. Director Tian peeled off one and threw it into his mouth.

Everyone watched him eat eagerly, waiting for him to tell what the part-time job was?

Director Tian took a sip of water and said, "She is a part-time model, a Japanese supermodel, top ten in the world's elite model competition, and participated in the Victoria's Secret Fashion Show in Paris."

"With such a person, don't hold the academic meeting, just watch her show." Fatty Liang said.

Zhang Lin snorted: "Fatty, do you think everyone is as vulgar as you? Be more elegant."

Director Tian went on to say: "She is a rookie in the field of sports medicine in Japan. Her brother is good at trauma orthopedics. This time I guess she came out with his brother. Although her situation is rare, there are also cases. Norio Ohga, chairman of Sony's board of directors , is the conductor of the Tokyo Philharmonic Orchestra; Heidi Lamarr, the inventor of CDMA telecommunications technology in the United States, is a generation of Hollywood movie stars, the world's first naked actress; everyone knows Bohr? Bohr's law, high He was educated in middle school, he is not only a physicist, a Nobel laureate, but also the goalkeeper of the Danish football national team; let me tell you, several gold medalists in the history of the Olympic Games have been doctors by profession! Treat me to dinner when you have time , I will tell you slowly.”

Director Tian is knowledgeable and eloquent.

"Brilliant!" Fatty Liang shook his head helplessly.

"Fatty, you too, anesthesiologist, part-time chairman of Sanbo Food Association." Zhang Lin said seriously.

Fatty Liang is not angry, but reminiscingly said: "Heroes don't mention the bravery of the past. To tell you the truth, when I was in college, I really formed the school's association——Gourmet Association. I was the first president of the association. Pay the price, look at my current figure, that is the price."

The fat man gestured at his waistline.

"Superb!" Zhang Lin Xiaowu gave the fat man a thumbs up.

"Look, this is a photo of her from the Victoria's Secret show in Paris!" Zhang Lin searched the Internet for a photo of the Japanese female doctor.

"Wow!" Xiao Wu and Fatty stretched their necks very long.

"Keep your distance, don't spray the nosebleed on me." Zhang Lin sideways avoided.

"This is not a retouching school. It's so beautiful. These legs can knock down 90.00% of the men in the world!" The fat man swallowed.

The photo of Fujiwara is on the catwalk, windbreaker, shorts, sunglasses, shining stars on the runway.

Suddenly, Director Tian stopped talking and coughed a few times.

Someone slapped Zhang Lin's shoulder with a palm. Without even thinking about it, Zhang Lin switched the screen immediately: "Well, this patient is really troublesome."

"Well, it's very troublesome!" Xiao Wu rubbed his chin.

"Quite troublesome!" Fatty Liang nodded and frowned.

A group of dramatists, dramatists who were delayed by studying medicine.

"You guys are doing well today, are you looking at Wang Changxin's medical records?" Professor Zhang Zongshun walked in from the door.

Wang Changxin is the name of Hermes, and the name is so rich.

"Well, let's get acquainted in advance!" Zhang Lin stood up if he gained something.

I don't know who's damn paw touched the computer keyboard, and it actually brought up the picture of Fujiwara.

Professor Zhang looked through the gaps in their bodies: "What is this?"

Zhang Lin looked back, and the picture actually jumped out, and said calmly: "Screen saver, screen saver pattern."

"Oh!" Professor Zhang didn't pursue it anymore.

"Where's Yang Ping?"

"Study in the duty room!"

Actually sleeping in the duty room.

"Where is Song Zimo?"

"Lab practice arthroscopy!"

Really practicing arthroscopy.

"Is everyone here? Let's discuss Wang Changxin's medical records later." Professor Zhang nodded slightly.

"Director Han is in the administration building and hasn't come back yet." Director Tian moved a chair for Professor Zhang to sit on.

"It's okay, you should prepare first, wait for Director Han, this case was discussed a few days ago, have you all read the book?"

"I've seen it!" Xiao Wu Zhang Lin said in unison.

Everyone went to the classroom to wait for Director Han. Director Tian called and Director Han was on his way back. Not long after, Director Han came back.

The discussion started, Xiao Wu took care of the patients, and Xiao Wu finished reporting the medical records.

"Xiao Wu, you guys have studied the medical records and read the book in advance, please talk about your views on this case." Director Tian presided over it.

Xiao Wu looked at the screen: "There is no problem with the diagnosis of this patient. Chronic osteomyelitis of the right tibia is supported by imaging examination and bacterial culture. The best method is to completely remove the infected bone tissue of the tibia, and then extend the tibia with an external fixator." , the defect was temporarily filled with vancomycin-containing calcium sulfate."

Yang Ping had told them, and he was a little bit desperate.

"The extension of the tibial bone needs to be at least [-] centimeters. This length is very rare. Will there be neurovascular complications? Zhang Lin, tell me." Director Tian asked.

"Well, this, that—" Zhang Lin scratched his head.

Song Zimo took it over and said: "This is different from deformity, shortening, limb extension, and there is no need to consider the extension limit of nerves and blood vessels, because only the bone tissue is extended, and the blood vessels and nerves do not need to be extended. In theory, it can be extended as long as it is. There are limits."

Song Zimo has solid knowledge and was once known as the problem solver of the director's ward rounds.

"There are two types of extension devices to choose from, external fixation frame and intramedullary nail. Of these two, the external fixation frame is more suitable for this patient. Two sets of fixation pins can be placed on the preserved proximal and distal tibia. The external fixation frame is installed No problem." Director Tian added.

Most people only know that external fixators can be extended, but they don’t know that there is also a special intramedullary nail that can also be extended.

"What's Yang Ping's opinion?" Professor Zhang called the names, but Yang Ping's speeches were not always very positive.

Yang Ping calmed down and said: "Everyone has explained everything in detail, so there is nothing more to say. When inserting the needle, pay attention to choosing the intermuscular space to insert the needle, so that during the extended period, there will be the least interference with muscle strength training."

Song Zimo looked over and pierced through the gap between the muscles. It was easy to say, but it was difficult to do it completely.Everything seemed easy to him.

Director Han collected everyone's opinions, made a teaching summary, and added the finishing touch: "Ilizarov's theory of stretched tissue regeneration: slow stretching of biological tissues generates a certain tension, which can stimulate tissue regeneration and active growth, and its growth mode is similar to Fetal tissues all have the same cell division. To put it simply, slow and continuous traction is used to return the tissue to a state where it can grow during the fetal period. This technology is subversive to the traditional theory of compression fracture healing.”

Yang Ping greatly admires the pioneers of these medical theories. These people have big enough brains and rich imagination.

Professor Zhang would like to talk about the origin of this theory: "Irizalov was a rural doctor in Siberia, the former Soviet Union in the 60s and 80s of the 2006th century. This technique was born in an accident. His original purpose of designing the external fixator was to treat a fracture. The patient tightens the screws on the external fixator every day to press the broken end of the fracture tightly to promote the healing of the fracture. Once he was going on vacation, he asked the nurse to adjust the screws on the external fixator every day. The nurse is very serious , followed his doctor’s instructions strictly, but reversed the direction of the screw. When Irizarov came back, the patient’s fracture ends were separated, but he found that even though the fracture ends were separated, a callus had grown. Inspired by this phenomenon, he devoted a lot of time and energy to research, and finally proposed the law of tensile stress, which is the theory of stretched biological tissue regeneration. Later, the Soviet Union invested a lot of manpower and material resources in research and perfected this theory, and now it is a mature theory. This theory It is fully qualified to win the Nobel Prize, but at that time, the US and the Soviet Union were in a cold war, so naturally they could not win the award. China began to develop this technology in the [-]s. There was a time when this technology was abused for normal people to increase height, which brought many complications, such as skin necrosis, Muscle weakness, bone nonunion, nerve damage, etc. In October [-], the Ministry of Health ordered to prohibit the use of broken bones for "medical beauty projects", that is, it cannot be used for normal people's height, and can only be used for congenital deformities, Bone defects and unequal lengths of limbs caused by trauma, infection, tumors, etc., and limb deformities caused by diseases."

Discussion can not only make the patient's diagnosis and treatment plan more clear and perfect, but also a good opportunity for young doctors to learn. Through clinical case study and accumulation of experience, a typical case can master the knowledge of a class of diseases.

After such a discussion, everyone has a basic understanding of the magical Ilizarov technology.

When the meeting was adjourned, Yang Ping received a WeChat message from Su Nanchen asking Yang Ping to attend a consultation.

Going to a consultation? Or add one!
That's right!
(End of this chapter)