godfather of surgery

Chapter 248 The Hesitant Patient

Sisi's father's examination results came out. The right ankle joint was fractured, with four degrees of supination and external rotation. Wide, the talus moves outward, and the ankle joint is subluxed. This kind of fracture requires surgery and manual reduction. Even if it can be reduced satisfactorily, it cannot be fixed well.

Every treatment method has indications, and it is against scientific principles to make any treatment method a myth without the indications.

"Lange-Hanson classification - four degrees of supination and external rotation, AO classification - C!"

Song Zimo turned on the electronic film reading screen, and Sisi's father's X-ray and CT were displayed on the screen. Several training students and interns gathered around, and Song Zimo explained to everyone the knowledge of ankle fractures.

The classification of ankle fractures is the most complicated classification of limb fractures, especially the Lange-Hanson classification. Many senior orthopedic surgeons are confused and confused.

In this classification, what is pronation and supination, what is the state; what is external rotation and internal rotation, what is the state, and why such a combination, Song Zimo will explain it to everyone in detail.

He also took out a piece of A4 paper and drew pictures while explaining. In order to make it easier for everyone to understand, Song Zimo drew a picture of a hinge to simulate the mechanism of an ankle joint injury.

Most of the students are highly motivated to learn, especially at the academic meeting, Yang Ping led Song Zimo to demonstrate his superb surgical skills, overwhelming the Japanese trauma surgeons, which made these young people excited and admiring, and strengthened the students' determination to do so. A good doctor's beliefs.

The power of an idol cannot be underestimated. It is a kind of spiritual pillar, like a lighthouse, giving you hope, giving you direction, and giving you the confidence to move forward into the distance.

It is a supreme honor to be able to study comprehensive orthopedics for a period of time; it is also a supreme honor to be strictly required by the teachers here, they all think so.

In teaching, Yang Ping advocates learning with clinical cases as the center, using a case to thoroughly understand all relevant knowledge.Those who come out of comprehensive orthopedics, even an intern, must thoroughly understand and firmly grasp the knowledge that should be mastered.

Usually, the interns and regular trainees are all in charge of Zhang Lin, some basic knowledge is taught by Zhang Lin, and when it comes to more complicated professional knowledge, Song Zimo will teach.

Yang Ping usually gives lectures to Song Zimo, Zhang Lin, and Xiaowu. He also explains cases to regular trainees and interns during teaching rounds, asks some questions, and checks the practical effect of clinical teaching in the department.

"Treat the swelling first, and arrange surgery after the swelling is reduced." Yang Ping instructed Song Zimo.

This kind of fracture cannot be operated during the swelling period, otherwise it is easy to cause incision complications, such as inability to suture, necrosis, infection, etc., and the operation can only be performed after the swelling subsides.

Song Zimo's cell phone vibrated, and it was Duan Xiaoming, the director of Haifu Knife's operating room: "Mr. Song, your surgery tomorrow is for a liver tumor?" "Yes!"

"The medical department just called to say that you have exceeded your authority. Only the general surgery department, the oncology department and our department have the authority for this operation, and your orthopedics department has no authority."

"Sisi's operation, tomorrow we are going to do liver metastases, this operation is not in the scope of our orthopedics department, but in general surgery and oncology surgery, brother Ming just called to say that we are being monitored by the medical department, and the operation should be cancelled. "Song Zimo hung up the phone and said.

Yang Ping and Song Zimo didn't care about treating Sisi's illness all the time. Indeed, this operation has crossed the line.

"Why don't we deal with the primary tumor of the left femur first?" Song Zimo suggested.

Yang Ping shook his head: "The current treatment is all palliative, and the most painful part should be treated first. You also saw Sisi's painful expression lying on the bed during the rounds."

"Can you put Brother Ming's name on it, and you can operate it?" Song Zimo thought for a while.

The matter of surgical authority is very serious, just like driving a car with a driver's license.

Brother Ming, whose real name is Duan Xiaoming, is the director of the Haifu Knife Department. No matter what kind of tumor is in the body, as long as there are indications for Haifu Knife, he can be treated.

This is a good way, but people don't necessarily agree to name it, because there are risks.

"I told him that he would definitely agree." Song Zimo was very confident.

It was Song Zimo who helped Duan Xiaoming's child study for a degree. It should be no problem to ask him to help make a name for this friendship.

With Yang Ping's trust value in Sanbo, since he dared to perform this operation, he must be very confident, and Duan Xiaoming would not have too much worry.

"No hurry, I'll talk to Director Han!" Yang Ping called to explain the situation to Director Han.

Not long after, Director Han called: "Xiao Yang, you can do it. I just communicated with the medical office and I will give you a one-time temporary authorization. Dean Xia and I will sign and endorse. I will call the Department of General Surgery and Oncology. He said hello and explained that this is a special situation, this patient is a charity funded by our department and belongs to a scientific research case, and they will not have any objections."

With just a few words and without asking Yang Ping too much, Old Han settled the matter.

Lao Han's idea is very simple, since you want to do it, just do it, I will remove the obstacles, and I will bear the risks.

"Director Han has already straightened everything out." Yang Ping put down his phone so that Song Zimo didn't have to deal with it.

In the hospital, doctors are divided into different departments, and they each do their own work, and they cannot exceed their authority without authorization.

This cross-border matter can be done once, but it must not be normalized. Any surgery must be done, nonsense.

Cheng Liquan sent a message that his medical tourism group had already arrived at the hospital and asked when the surgery could be arranged. There were eighteen patients.

eighteen?
At first it said eleven, and later increased to sixteen.

Now the exact number is eighteen. There are two patients from Southeast Asia who temporarily joined the group.

Doing surgery and organizing a group?Will there be a group purchase price for the group?Yang Ping was very curious, but it was inconvenient to ask Cheng Liquan.

If this continues, it will only accumulate more and more, and we must find a time to clear them. While there are not many patients in our department, hurry up and clear these [-] patients, just Sunday.

If Professor Zhang runs at full capacity in the outpatient clinic, he can fill the ward within two weeks. At that time, it may be difficult to find time.

Mr. Zhang has a good reputation and is very responsible. Many patients from outside the province came to call him.

Some of his patients are still being followed up 30 to [-] years after surgery.

A patient with congenital hip dysplasia had an operation when the patient was two years old. Now the patient’s children are in middle school, and he is still following up the patient.

At that time, there was no WeChat, and even the telephone was not popular, and the follow-up visits were all based on letters and visits. This has persisted, and what kind of sense of responsibility is it.

The serious and rigorous attitude of the older generation makes most doctors ashamed, which is why many patients trust him and travel thousands of miles to see him.

The nurse station called the doctor on duty, and Professor Zhang came in to admit the patient, a girl in her 20s. Professor Zhang was thinking about thoracic spine tuberculosis.

Tuberculosis is now rare, but it has been on the rise in recent years because of the mutation of tuberculosis.

Zhang Lin was on duty, he went to see the patient, and Yang Ping was fine, so let's go and see together.

The patient is Fang Xiaoyun, female, 24 years old, very thin, with low back pain for 3 years, accompanied by numbness and weakness in both lower limbs for 3 days.On physical examination, the spine formed kyphosis at the 9th part of the chest, the skin sensation below the groin of both lower limbs decreased, and the muscle strength of both lower limbs was grade [-].

Professor Zhang considers that the patient has medical insurance, and the MRI can be reimbursed for hospitalization, but the reimbursement for MRI in the outpatient clinic is too low.

Therefore, Professor Zhang only made a thoracolumbar spine lateral view for the patient in the outpatient clinic, which showed that bone destruction can be seen on the upper and lower borders of the 9th thoracic vertebrae, the upper and lower intervertebral spaces have narrowed, and widened soft tissue shadows can be seen beside the vertebrae.

Professor Zhang has rich experience and made a diagnosis based on medical history, physical examination and X-rays. He called Zhang Lin who was on duty and ordered him to do a further MRI for the patient.

This is tuberculosis of the thoracic spine and paraplegia. Emergency surgery is required to relieve the compression of the spinal cord by pus, granulation tissue, caseous necrotic tissue, and sequestrum in the spinal canal, so as to restore nerve function.

At present, the oppression time is not long, and these oppressive substances can be removed in time, and the paraplegia can be completely recovered.

Judging from the X-ray, the oppressive substance has entered the front half of the spinal canal. Once the anterior artery of the spinal cord is embolized, it will cause permanent damage to the spinal cord. Even if the operation is performed perfectly, paralysis will remain in the future.

Zhang Lin arranged for Fang Xiaoyun to have an emergency MRI of the thoracolumbar spine. When the results came out, it was as expected based on the X-rays.

The oppressive substance was at the level of the 9th thoracic vertebrae and had entered the front of the spinal canal. Yang Ping immediately took Zhang Lin to find Fang Xiaoyun to talk about the condition, and emergency surgery was the best.

Fang Xiaoyun's eyes were a little red, as if he was wronged and cried secretly.

"Doctor, do I have to undergo surgery for this disease?" Fang Xiaoyun asked.

Yang Ping said affirmatively: "Surgery is necessary, otherwise the lower body will be paralyzed in the future."

"From the perspective of magnetic resonance imaging, the oppressive material has entered the front half of the spinal canal. Once the anterior artery of the spinal cord is embolized, it will cause permanent damage to the spinal cord. Even if the operation is performed perfectly, it will remain paralyzed in the future. Are you still You are so young, don't delay, we will arrange emergency surgery for you." Yang Ping was not threatening, but told the condition objectively.

Fang Xiaoyun's face was obviously hesitant, and it was difficult to make a decision: "Let me think about it, is it okay, I will give you an answer tomorrow morning, will it be okay to wait overnight?"

"Wait overnight, there will definitely be an impact. This risk cannot be determined. If you can't make a decision now, try not to delay too long, give us an answer as soon as possible, and let us know if you have any questions."

"Okay, thank you, Dr. Yang, I will give you an accurate answer at eight o'clock tomorrow morning."

"If you think about it, tell me. Don't procrastinate. If you have any difficulties, you can tell us." Zhang Lin felt that her demeanor was a little abnormal, her eyes were red, as if she had quarreled with someone or cried.

She came here for the operation on purpose, and now that the emergency department is doing it for her, she is hesitant instead. Is there some hidden secret behind it?

It's not easy for the doctor to ask questions, so he can only leave one sentence for her.

After leaving the ward, Yang Ping told Zhang Lin: "This patient should follow closely, and he can't delay for too long."

(End of this chapter)