godfather of surgery

Chapter 373 Sweat after seeing surgery
Song Yun of Xiehe, except for Wen Rentao, he didn't think anyone would be his opponent.

Even in a duel with Wen Rentao, Song Yun was very confident.

Some hospitals are better than Xiehe in certain specialties, but in terms of comprehensive strength, Xiehe is a well-deserved overlord. Its fine traditions have made generations of Xiehe people work tirelessly and strive for excellence.

Now, Song Yun is facing Yang Ping, and Yang Ping, who has never played in the previous competition, uses this kind of Everest-level case. To be honest, even his director dare not take over this kind of case in Xiehe .

Medicine is not a place to be competitive, and it is not shameful not to dare to take over, but a responsibility to patients.

The more skilled a doctor is, the more he knows where the boundaries of medicine lie.

But what did Yang Ping rely on, so arrogant, to accept this kind of case, but also to put it in the competition.

From the analysis of the operation video of Sanbo Hospital, Song Yun had to admit that Yizhu’s strength was already at the same level as his own in a single round of basic surgery. People are misunderstood from the Hospital for Special Surgery in New York, USA.

If the inspection team hadn't announced the truth, Song Yun would not have believed that Sanbo Yang Ping was the first to create this surgical method. In addition to talent, a large number of cases were needed, which Sanbo did not have anyway.

Yang Ping's mystery put Song Yun under great pressure. Can he really complete this operation?

If it can't be done, why do it?People who can create new techniques must not be treated simply.

As for the remarks shouted out on the Internet, what is crazy, what is inflated, what is carried away.

How could it be possible? Song Yun didn't believe these remarks at all. Judging from the quality of the first assistant in the operation, it can be inferred that the chief surgeon must be a calm and experienced person, and the surgical quality is very good.

However, Song Yun didn't understand why Yang Ping won such a difficult operation, which was simply impossible.

Why?
Not only Song Yun had such doubts, but also orthopedic surgeons all over the country, the judges were also puzzled, and several spine experts were also puzzled.

When the second season started, Yang Ping was fully prepared, and his condition could change at any time. The experience accumulated in the simulated surgery should be used as soon as possible.

Yang Ping didn't intend to wait for anyone, and he didn't deliberately want to be the first to open the stage. In short, for the sake of the patient and the safety of the operation, he wanted to open the stage as soon as possible.

Before the operation, Yang Ping had a preoperative talk with Lu Gang and his mother again.

The risk of surgery is very high, and there are possibilities of death, paralysis, infection, etc. Doctors can only do their best to reduce the risk, but they cannot completely avoid it.

"No matter how big the risk is, you have to take it. Now he suffers a little bit, and it's okay to take a little risk. When I get old, who will take care of him? He went from elementary school to university. You don't know how hard it is. He worked hard, and I worked hard too. Every day I have to use a wheelchair to push him to school and pick him up, and the university can only rent a house next to the school, pick him up every day, even pick him up for lunch and dinner, and eat at home.” Lu Gang’s mother said while wiping away tears.

Lu Gang just kept silent, even for an ordinary thing, it was very difficult for him to do it.

For example, eating, for ordinary people, it is extremely difficult for Lu Gang.

Without a mother, let alone going to college, even survival is a problem.

For more than ten years, his mother took him everywhere to seek medical treatment, which cost a lot of travel expenses, but no hospital dared to perform surgery. Now Dr. Yang is willing to perform surgery, even if he takes risks.

Until Yang Ping asked again: Are there any other questions?
Lu Gang's mother and son really couldn't think of any other problems. What should be explained has been explained repeatedly, and it is already clear. Both Lu Gang and his mother solemnly signed.

Informed consent for surgery, informed consent for blood transfusion, informed consent for anesthesia, power of attorney.

This kind of complicated and high-risk surgery may have unplanned things during the operation. Once such things happen, the patient is under anesthesia and has no autonomy, so a person needs to act on his behalf. Lu Gang entrusted this right with a power of attorney. to his mother.

Surgical situation is unpredictable, Yang Ping is confident to control the amount of bleeding within [-]ml, but still prepared autologous and allogeneic blood transfusion, the more prepared the better, even if it is not needed.

Director Han and Professor Zhang sat on the side, pushing Lu Gang into the operating room on a flat cart.

Passing over the bed, Xiaowu Zhang Lin had practiced many times and was familiar with the road. They took Gui Peisheng together and carried Lu Gang to the operating bed.

The fat man began to intubate the trachea. Although he practiced on Lu Gang's model for a long time and practiced with a rabbit for a long time, he is still not fully sure.

The fat man slowly inserted the fiberoptic bronchoscope, and the mouth, throat, and trachea from the first perspective were slowly revealed, and then he stopped his vision at the glottic cleft.

The laryngoscope was gently inserted, and the endotracheal tube was inserted. The fat man's hand was very steady, and the tube passed over the glottis. The fat man held the tube with one hand, and held the stethoscope earpiece with the other hand to auscultate both lungs, and then made an OK sign.

It went well, the intubation was successful, everyone applauded, and the first hurdle was passed.

Zhang Linxiaowu stuffed various posture pads in the gaps around Lu Gang's body, and assumed a strange posture.

Yang Ping plans to do hip and knee release and joint replacement first, so as to allow free movement below the hip and facilitate the next step of body positioning.

It is very difficult to complete bilateral hip and knee replacement in this curled up position.

Performing simultaneous bilateral hip and knee replacements is a challenging procedure, even in a normal position.

It is difficult and difficult to complete the operation in such an extreme position.

Even Professor Zhang and Director Han had to wonder how he quickly completed the replacement of these four joints.

How to operate, Yang Ping is proficient enough to form muscle memory. He has performed nearly a hundred operations on the systematic Lu Gang, and has also conducted many research-style pathological anatomies.

Song Zimo disinfected the shop sheets very quickly.

After the last check before the operation, Yang Ping made a minimally invasive hip replacement incision, and the deep hip joint was exposed in a few minutes.

Where the pull hook is placed and what is inside, Zhang Lin Xiaowu has no idea at all, but they only need to hold the pull hook steady.They are fully capable of this job, and according to Yang Ping's request, they held the pull hook steadily.

The osteotomy of the femoral neck is in place at one time, and the deformed femoral head is easily removed by the head extractor.

Just now Director Han was worried that it would be difficult to remove the amputated femoral head. Xiao Su had already taken over the femoral head and put it in a metal basin.

It is usually necessary to measure the diameter of the femoral head with a caliper to guide the selection of the type of artificial joint prosthesis.Now because the femoral head has been deformed, it has no guiding significance at all.

Where is Lu Gang's acetabulum?
In the acetabular area of ​​the pelvis on the CT three-dimensional reconstruction, there is no real acetabulum, and the shallow indentation is meaningless.

For more than a decade, his hip had been dislocated, and the femoral head had been floating in the soft tissue without the acetabular socket to accommodate it.

Usually, when joint surgeons handle the acetabulum, in order to make the direction of the acetabulum correct, they use the patient lying flat as a reference to find the angle.

Now Yang Ping is going to make a new acetabular for Lu Gang. The position, direction and depth of the acetabular must meet the anatomical requirements. Lu Gang's posture is extremely irregular. Finding an angle in this posture requires the doctor to have a strong spatial imagination. .

"Xiao Yang—" Professor Zhang just wanted to give him some advice.

The acetabular rasp has been inserted, rustling, and blood mist rises through the goggles.

The high-speed electric drill and the acetabular file hadn't finished the work yet, so Yang Ping directly reported the model parameters of the acetabular prosthesis.

Huang Jiahui immediately opened the bag and put the prosthesis on the instrument table.

The procedure of the competition required a mold trial, otherwise Yang Ping would not have needed a mold trial at all. After a hundred surgeries, it was still a mold trial, a waste of time.

After Yang Ping went through the mold trial process, he asked Xiao Su to open the prosthesis directly.

Due to insufficient activity and osteoporosis, Lu Gang used a bone cement prosthesis because the biological prosthesis was not suitable.

The bone cement was opened and mixed under the stirring of the special solution, and the fragrant smell filled the entire operating room.

The acetabulum was rinsed, the gauze was soaked and dried, and the acetabular prosthesis was accurately implanted into the artificially excavated acetabular socket with the bone cement of the dough stage and pressed tightly.

Immediately afterwards, the femoral end was reamed, the medullary cavity was flushed, and the mold trial was also a walking process. The bone cement gun drove the bone cement into the femoral medullary cavity, and then the real femoral end prosthesis was implanted into the medullary cavity and compressed.

A little bit of excess bone cement was completely removed, and the artificial prosthesis of the joint head and joint fossa had been installed, and the rest was complete hemostasis. There was no bleeding at all, and no drainage was required.

Under the lens of close-up magnification, observe for a few minutes, there is no obvious bleeding.

Because of the minimally invasive approach, various important structures, such as the piriformis muscle, were not damaged, and the bleeding on the bone surface was already stopped by the compression of the joint prosthesis and bone cement, so there was no bleeding.

Rinse, suture layer by layer, and just replace one hip.

Young man, your operation is like playing a game. Professor Zhang doesn't dare to blink. The kung fu of your hands is still not human.

At first, I wanted to communicate with Yang Ping, but the other hip started to move too fast, and my brain couldn't keep up with Yang Ping's rhythm. Professor Zhang and Director Han followed Yang Ping's running in their hearts.

The bilateral hip joints were replaced without stopping, and then the knee joints were replaced.

Song Zimo felt strenuous as an assistant for the first time, but he could barely keep up with the rhythm. Zhang Lin Xiaowu didn't see clearly how the operation was done. Every time Yang Ping put the retractor in place, they just supported it mechanically.

But fortunately, after so long of training, the two brothers are very good at pulling the hook.

Knee replacement requires osteotomy and soft tissue balance techniques. Yang Ping's movements are too fast. Whether it is the members participating in the operation, or Professor Zhang and Director Han who are observing the operation, everyone dare not even relax a little. How can they talk? If you hesitate a little, you will be thrown off by the rhythm.

Exposing and cleaning the synovium of the knee joint, loosening the ligament and joint capsule, and osteotomy of the tibial end and femoral end are also the requirements of the surgical procedure. Otherwise, what kind of osteotomy template is needed by Yang Ping, and the osteotomy can be done with bare hands, which can be accurate to millimeters below grade.

After the locator is installed and the tibial osteotomy template is assembled, the osteotomy is completed in a few strokes, and the femoral osteotomy is completed in a few steps in one go.After the osteotomy is completed, the tibial end prosthesis and the femoral end prosthesis are implanted successively, and are firmly fixed on the bone end by bone cement.

The fragrant smell of bone cement became stronger and stronger. The artificial joint replacement of both knee joints was completed, sutured, and the incisions were covered with dressings.

It is the most dangerous step to reposition the body, disinfect and lay the sheets, and perform osteotomy and correction of the cervical spine, especially for the treatment of skull base deformities of the upper cervical spine.

"Xiao Yang, don't be in a hurry, slow down, if it doesn't work, you can install it in installments." Director Han literally held his heart in his hands.

Professor Zhang was also worried. For an 80-year-old man, seeing a young man doing this surgery is considered a good heart, otherwise he might be frightened to myocardial ischemia.

"Slow down, slow down—" Professor Zhang choked on speaking.

However, Yang Ping was completely immersed in the operation, he had to walk according to his own rhythm, just like a running athlete, and he couldn't be stopped suddenly by others.

The sooner the surgery is done, the lower the risk.

After the incision and exposure are completed, nails are placed first, followed by osteotomy.

If it weren't for the 3D model used before the operation, Yang Ping led everyone to train repeatedly, and no one could keep up with his rhythm.

The lateral mass screws of the atlas and the pedicle screws of other cervical vertebrae are cervical pedicle screws. Otherwise, the vertebral artery may be damaged, and the arterial blood will soar to the ceiling.

There are vertebral arteries around the cervical spine, and the pedicles are small, not as thick as the thoracic and lumbar spine. Performing cervical pedicle screws is a high-risk operation.

Now Yang Ping is like digging soil and planting beans, planting screws one by one, completely ignoring the risks.

My young master, can you slow down, Director Han stood looking at the screen, his body was a little uneasy, his legs were uncomfortable, he kept shouting in his heart, and swallowed his saliva again and again.

Professor Zhang simply moved the stool to be in front of the screen. Standing and watching is too exhausting, and watching the operation is also a labor-intensive thing.

This speed is really too fast, just like on the street, there are people everywhere, when you stage the speed and passion, whoever sees it is not the heartbeat.

Several cameras, with different focal lengths and different directions, can clearly capture the operation.

Osteotomy again, ultrasonic water knife osteotomy, just like playing.

Oh my god, young people, slow down, slow down, slow down, one is in his [-]s and the other is in his [-]s. I have never seen such an operation. You are doing somersaults on a tightrope.

It's up to you, the chief surgeon is now walking according to the rhythm of his heart!

The osteotomy is complete, and now the cervical spine needs to be reassembled. This step is the most risky in the entire operation. If there is a slight carelessness, the upper cervical spinal cord will be damaged, and the patient will die directly on the operating table.

"Song Zimo, take off the surgical gown, and adjust the head immobilizer. Zhang Lin Xiaowu, pay attention to the position of the automatic pull hook. The anesthesiologist pays attention to the patient's vital signs."

At this step, Yang Ping slowed down the pace.

Before the operation, they used the model to rehearse every step, especially this step. Yang Ping broke down Song Zimo's movements into more than a dozen steps, how to adjust, how much to adjust, very precise.

Song Zimo took off the surgical gown and gloves, and put on new gloves.Everyone performs their duties and concentrates.

"Are you ready?"

"Ready!"

"1, 2, 3, start adjusting."

Yang Ping doesn't need to watch how Song Zimo adjusts, he just needs to watch the movement of each segment of the cervical spine. Song Zimo adjusts the head immobilizer, and Yang Ping starts to correct the cervical spine. The two cooperate tacitly.

The truncated cervical vertebrae began to shift in space on the three axes, and the cervical spinal cord in the spinal canal also began to be affected. However, Yang Ping had planned the trajectory of this spatial shift to the best, with the least impact on the cervical cord.

Carry out precise shifting on the predetermined trajectory, no one dares to relax, Lu Gang's life is in the hands of Yang Ping and Song Zimo, a small mistake, Lu Gang will never get off the operating table.

"stop!"

The correction of the cervical spine is completed, the physiological curvature is formed, the rod is mounted, the internal fixation is firmly locked, and the cervical spine correction is successfully completed.

A big piece was already wet on Lao Han's back, and he let out a long sigh of relief.

Professor Zhang rubbed his eyes, a large piece of the stool was wet, it was sweat.

Watching the operation also sweated, which was unexpected by the two of them.

The correction of the cervical spine was completed, and after a brief slow-paced operation, the fast-paced operation began again.

It is necessary to adjust the body position and re-disinfect the sheet.

For thoracolumbar orthopedics, twists will be released and reshaped to restore the S-physiological curvature of the spine.

At this time, it will not only affect the spinal cord, but also affect the organs of the thoracic and abdominal cavity. Although it is much better than the correction of the cervical spine, the risk is still very high.

Professor Zhang wanted to take a rest, exhausting his mental and physical strength, Director Han couldn't bear it, so he moved a stool and sat next to Professor Zhang.

The two just looked at each other without speaking.

It was revealed that the pedicle screw was like planting beans. Song Zimo followed Yang Ping's rhythm. Although he was pulled away by Yang Ping, it was already very good. Another person might not be able to keep up at all.

Dozens of screws were implanted into the pedicle, and another osteotomy was performed. This time, Professor Zhang and Director Han felt much more comfortable, and they were not so worried. After all, they had passed the most dangerous level.

This time, Song Zimo’s assistance is still needed. Every time Yang Ping corrects a part, Song Zimo tightens the internal fixation device, and fixes the truncated spine in a new position with the internal fixation device. Step by step, there is no redundant step, and the thoracolumbar spine is reassembled. .

When the last screw is locked.

"perspective!"

"Do a [-]D CT scan and reconstruction later?" Director Han reminded.

This was the first time Yang Ping heard Director Han speak from the beginning of the operation, and suddenly remembered that Director Han and Professor Zhang were beside him.

"Row!"

Surgical procedures require that C-arm or G-arm fluoroscopy must be performed in the operating room after the operation; CT scans can be completed in the operating room if conditions permit, and can be returned to the ward after the operation if conditions are not met, and then go to the radiology department to do it later.

On the screen of the spinal cord electricity monitoring, the amplitude has been stable, and there has been no abnormal change.

After fluoroscopy, CT three-dimensional reconstruction is performed.

Pretty!

Others generally pursue moderate orthopedic surgery, but this surgery has restored the normal S physiological curvature and maximized the surgical effect.

Each screw is in the best position, and the length and thickness are very suitable.

"Wake up test!"

Fatty Liang's anesthesia dosage is very particular. Yang Ping told him four hours, that is four hours, three hours for surgery, and one hour for several disinfection shops in the middle.

Slowly, Lu Gang woke up. Before the operation, Lu Gang had been trained in this aspect repeatedly.

"Wiggle your toes, yes, up, down, very good!"

The operation was a success, quite a success!

　This operation was originally planned to be done in two chapters, but think about it, let's solve it in one big chapter, let it flow more smoothly!This chapter is more than 5000 words, brothers, please give some encouragement!

　　
　
(End of this chapter)