godfather of surgery

Chapter 51 I really don't understand
"The traction abduction position, the fracture has not been reset, so the stage is opened?"

"Wait for trouble, the intramedullary nail can't be inserted."

"Is this kind of fracture done rarely?"

"Look, I don't know either."

"I heard that I will be able to walk normally the next day after the operation. It is still unknown whether the operation can be completed or not."

"If the cowhide is blown up, it will break."

There was a discussion in the classroom next door, and everyone was disappointed with the opening.

Just like a movie, before it was released, it was so popular that everyone was eager to watch it.On the day of the release, there were empty crowds, crowded into the theater in a frenzy, finally bought a ticket, and after watching it - a utterly bad film, there was nothing, not even a single attractive scene.

Yang Ping's tall image is also naturally discounted in the hearts of these young people. Qian's donkey skills are poor, Jiang Lang's talents are exhausted, and everyone sighs in their hearts.

Fractures of the greater trochanter are generally treated with minimally invasive methods, and PFNA intramedullary nails are the first choice for internal fixation in the elderly because of osteoporosis.For this type of surgery, the body position is very important, either the adducted position or the neutral position can be used, but it must not be performed in the abduction position, and the intramedullary nail cannot be inserted in the abduction position.Fracture reduction is equally important. The fracture must be reduced first, otherwise, the following steps will not go on.Correct positioning and good reduction of the fracture are necessary conditions for surgery.

Now that the two necessary conditions are not met, how can the operation be successful?

In the classroom next door, the senior doctors include Dr. Jin, and the director-level directors include Director Ouyang and Director Bai. They all want to see Yang Ping for surgery. After all, it is said that Yang Ping is magical.

Most of the young doctors, except for some Rotary doctors and Gu Pearson, are orthopedic professionals, and they still have a certain understanding of these routine operations.I couldn't help but say a few words about this kind of posture reset before the stage was set.

"Isn't this boy's lower limb fractured with little contact? He hastily entered the battle?" Fat Boy, the attending physician under Director Bai, asked Dr. Jin.

Dr. Jin shook his head: "I don't understand!"

Fat Boy said, "How can Director Han let him do it without worrying about it? The hand surgery is well done, but other surgeries are a mess. There are many."

"Director Han was on a flight, I guess he didn't explain clearly?" said another doctor.

"No, I heard that old man Zhang asked him to do it by name." An informed explanation.

"It's embarrassing now, but it's alright, Tian Yuan will definitely come later, not in Tian Yuan, it's a matter of minutes." Someone from the spinal surgery department spoke up.

"This operation is actually simple. I heard that the inner bone block is inserted into the muscle, and it cannot be reset without incision. If it is minimally invasive, this kind of bone block does not need to be managed. Insert, or it will be over, he has not even reset the main body bone now, how will it end later."

"What reset, the body position is wrong."

Everyone is more and more dare to speak.

At this time, Tian Yuan also came in. He saw that Song Zimo was there, and there was no shortage of manpower. He was afraid that if he stayed in the operating room, old man Zhang would think that there were too many people and his concept of sterility was not strong. He simply came next door to watch the screen with everyone.

Although Su Yixuan is a nurse, she is an orthopaedic specialist instrument nurse, and she is very knowledgeable about surgery. She has followed countless operations for this type of surgery, and she naturally knows this. This position and repositioning are indeed not good.

She was sweating in her heart. This is a piece of wood. Usually, she strives for perfection even when laying out a single sheet. Today, I performed an operation on Professor Zhang. Why did the position reset fail, so I hurriedly set up the stage. I won't be nervous and make mistakes.

Yang Ping and Song Zimo went to wash their hands.

Through the glass, Song Zimo saw the expressions of everyone next door and knew what everyone was thinking.

By the sink, Song Zimo said, "Everyone is worried, why don't you explain?"

Yang Ping said while washing his hands, "What to explain? You won't know after two steps."

The words are not rough, the boxer, before the match, shouting [-] times I want to win, it is not as realistic as KO the opponent with one punch.

After washing his hands, Song Zimo disinfected, Yang Ping began to wear surgical gowns and gloves, his face was calm, and he did not react too much to everyone's doubts.

Su Yixuan looked over several times, with a little anxiety in her eyes, Yang Ping smiled at her and signaled her not to worry, she knew what she knew.

As if she had a good heart, Su Yixuan immediately calmed down and started to organize the equipment, checking the PFNA intramedullary nail, screw blade, locking nail, steel cable, and supporting equipment.

The engineer from the equipment dealer was on the side, checking with Su Yixuan with a laser pointer. If there was a mistake, and if he met a bad-tempered chief knife, he would be scolded, so he didn't dare to be sloppy.

After the sterilization is completed, the electrosurgical knife and suction device are connected, and the ritual-like preoperative check is started!
Yang Ping made an incision of three centimeters above and below the greater trochanter, took the bone hook handed over by Su Yixuan, and gently probed into the bone hook from the incision under the greater trochanter.

"He wouldn't want to reduce the fracture on the inside, it should be inserted into the muscle, and there is no way to reduce it."

"When I was studying in the imperial capital, there was a big guy who wanted to show off and micro-invasively restore the bone that inserted the muscle inside. It didn't work, and finally gave up."

"Once it's inserted into the muscle, you either give up or open up."

"Yeah, open reduction of fracture fragments inserted into muscles is sometimes laborious. How can closed reduction come out?"

"This one doesn't need to reset all the bones."

The bone hook stretched in, with little probing, and hooked back.

"Four steel cables, hand them over one by one!"

Three steel cables, one after the other, against the bone surface, were sent to their respective positions on the opposite side by the guide.The fourth steel cable is intertwined with the other three, and I don't know what it means.

"Traction, retraction!"

Zhang Lin Xiaowu and two immediately helped to adjust the traction.

"Continue to add in, yes, continue, stop!"

"The lever goes back three turns."

"Okay! That's it."

Every sentence is like an order from a superior, clear and unquestionable.On the operating table, all actions are obeyed by the chief surgeon, whose authority is the guarantee of surgical discipline.

Zhang Lin Xiaowu and the two couldn't understand the steps at all, so they could only follow them mechanically.

"I underestimated you. You know the attachment of muscles in every part of your bones, the function of each muscle, and the relationship between different muscles." Song Zimo said beside him.

"It's called Senior Brother, if you don't have anything, will you be convinced?" Yang Ping said while operating.

The bone block inserted in the muscle is easily hooked out, the tip of the bone hook is fastened to the bone block, and then moved slightly, reset, the first wire is pressed in the center of the fragment, the ring is locked, and the tail of the wire is cut. .

perspective!

Everyone left the operating room again. After one exposure, they returned to the operating room. The X-ray on the C-arm screen showed that the fracture had been anatomically reduced. If you didn’t look carefully, you would think there was no fracture.

This is the direction and strength of the traction just grasped very precisely.

"Damn it! Can you still do this?"

"I don't understand."

"The position and reduction just now seemed to be intentional, but I didn't understand it. Is it related to the reduction of the bone block inserted inside the muscle?"

Dr. Jin told Director Ouyang.

I don't know what the person next door was thinking, anyway, Xiao Wu Zhanglin felt like he was being tricked.Now it is found that it is completely redundant, and even the bone pieces inserted in the muscles have come out.As for how it came out, I don't know.

The second wire rope, the third wire rope loop, lock and cut off the tail.

The tip of the greater trochanter is directly opened, the guide wire enters, and then the intramedullary nail enters, once in place, the guide wire is pulled out, and the guide needle of the helical blade is inserted.

perspective--
The guide pin of the spiral blade is just in the standard position, no more than one point, no less than one point, the midline of the lateral femoral neck, the middle and lower third of the anteroposterior femoral neck, and the tip is just a little bit away from the circular border of the femoral head .

"90mm helical blade."

After the measurement is completed, drill the hole with the electric drill and drive the screw blade into it.

The locking screw at the lower end, drilling, sounding, and screwing in the screw are all done in one go.

Steel cable!

The fourth steel cable is locked, and the tail is cut off. Now, at a glance, it is actually interwoven with the first three heels to form a whole structure. It forms a wonderful tension belt structure on the outside.

This operation is incomprehensible, and even Song Zimo is a little puzzled: "This is you?"

"If your IQ is approaching 250, you still need to ask me." Yang Ping screwed into the end cap of the intramedullary nail and switched places with Song Zimo.

Song Zimo began to rinse the suture skin, and just a few small incisions were quickly sewn up, without even draining.

Final perspective confirmation.

The whole process takes about ten minutes, like a common intertrochanteric fracture, a top hospital with a large amount of surgery, very skilled, it can be done in ten minutes, and there are many people there.However, in this case, the fracture end is inserted into the muscle, and there is no way to reduce it with minimal trauma.

Everyone is staring at the screen, and the operation is over?Do not understand you?The first three cables are easy to understand, but the last cable is really incomprehensible.

Dr. Kim sat in the crowd and kept looking at the screen, taking pictures with his phone.Director Ouyang was also beside him and said, "This operation is a bit wild. Do you understand the last cable?"

"I don't understand it for now, I should understand it tomorrow." Dr. Jin shook his head.

Song Zimo lifted the sheet, and Professor Zhang suddenly said, "Please consult an ophthalmologist tomorrow, my eyes are dying."

He really lay down and watched the whole operation.

He didn't say a word, it didn't fit his temper, at least he would give some pointers.

Yang Ping held Professor Zhang's hand: "Don't worry, I will ask the nurse to give me a walker tomorrow morning, and you can walk on the ground, won't you give me zeros?"

Professor Zhang said: "Take two steps tomorrow and talk about it."

The head nurse of the operating room came over: "Mr. Zhang, do you feel okay?"

Dean Xia also called and directly called the head nurse in the operating room on the mobile phone and asked Yang Ping to answer.

Yang Ping went to the locker room to call Director Han to report safety.

Song Zimo leaned on the bench: "Wonderful idea!"

While others were talking.

"What does the steel cable at the end mean? I really don't understand."

"You ask me, who do I ask?"

　Thank you for the reward of the humble gentleman and the humble self-shepherd!Thank you all for your votes!Thank you all for your love!New work, new work, the update is not very powerful at present, and it is working hard.I have more than [-] collections of streaking before, and I am very satisfied.Today, I started to test the water recommendation. I urge everyone to continue to support and vote for the recommendation.Surgery during the day and coding at night is really hard, but as long as there are recommended tickets and collections, it is not a problem.No matter what, I will do my best to tell the story well.If you have any comments, please feel free to mention, encourage, complain, criticize, and accept them all.Ask for a recommendation ticket again, ask for a collection!Once again, sincere thanks to everyone, bows!
　　
　
(End of this chapter)