godfather of surgery

Chapter 624 Immortals Pulling Hair
Although patients with metal allergies are rare, Yang Ping has encountered two in Sanbo Hospital.

When he first came to Sanbo Hospital, Yang Ping encountered a case. The patient was a 14-year-old boy who underwent surgery for an old fracture of the left scaphoid bone. Two metal countersunk screws were implanted. Multiple joint synovitis manifestations.

It was later diagnosed as "metal ion reactive arthritis". After removing the two screws, the symptoms of synovitis in each joint gradually eased.

The two screws of this little boy have no metal-to-metal or metal-to-other material friction, and actually release very few ions, but the allergic reaction has nothing to do with the dosage, and even a little bit can trigger an allergic reaction.

For example, if you are allergic to penicillin, some sensitive patients will cause anaphylactic shock even if they smell the smell of penicillin.

Now Mr. Wu is allergic to so many metals, this kind of case can write an article and publish it.

Zhang Lin and Xiao Wu heard that the patient who was transferred was a patient with metal allergy, so they hurriedly read the medical records in advance.

Song Zimo and Xu Zhiliang are probably not interested in this kind of case report. They want to follow the professor to do big things. Zhang Lin and Xiao Wu can use this case to write an article as the first author, and then choose a good magazine to publish.

Usually, when Corey publishes articles, their names drag their tails, so the two work hard to make some noise. The monographs of Lagouxue alone are not enough to secure academic status, so the two started the idea of ​​these case reports.

In short, I have to pick up some things that Song Zimo and Xu Zhiliang have no interest in writing articles.

After dinner, Yang Ping and Xiao Su went to play tennis.

Song Zimo, Xu Zhiliang, August and Robert all ran to the hospital library to read books and check information.

The library of Sanbo Hospital is very good. There is basically no shortage of medical monographs and periodicals. The library is open from [-]:[-] am to [-]:[-] pm.

The four met Director Gao in the library, who was immersed in reading and taking notes from time to time.

Anyway, Song Zimo often ran into Director Gao when he came to the library. Since he was immersed in reading, he didn't say hello.

In the past, Song Zimo hated Director Gao, thinking that he had a thick skin, pretending to study hard, and being courteous to Yang Ping was a bit too much. Later, he felt that this person was not just pretending, but was really dedicated to studying.

The four stayed together until the library was closed. Song Zimo checked a lot of information to understand how patients with metal allergies deal with severe knee arthritis.

However, there are very few papers in this area. Most doctors probably give up joint replacement when encountering patients with severe metal ions.

---

Mr. Wu's MRI examination was scheduled for the next afternoon.

Yang Ping took the time to participate in the magnetic resonance examination in person, and specialized in understanding the magnetic resonance of articular cartilage and ordinary joints. There is a big difference in parameter setting and technology application during the examination, and some special techniques are needed to realize the observation and evaluation of cartilage. Quantitative evaluation is also required.

Personalized treatment of each patient must rely on familiarity with the patient's condition, comprehensive and in-depth grasp of relevant medical knowledge, and rich experience in the treatment of such diseases, all of which are indispensable.

Lao Du in the radiology department, called Du Haibin, is an attending doctor in his 30s. Because he is a bit fat, especially with a beer belly, he looks more mature and has the demeanor of a director. Everyone calls him Lao Du affectionately.

Old Du heard that Yang Ping was coming to the MRI room, and he also came to work today on a day off. He had long wanted to have some relationship with Yang Ping.

Everyone knows Yang Ping's reputation in the hospital, and there are many legends about him.

I heard that Director Gao is a non-staffed advanced student in general surgery and Yang Ping's apprentice. He has learned some real things, and now the Sports Medicine Center is booming, almost approaching the Sports Medicine Center attached to No. [-].

In addition, the bald Duan of the Haifu Knife Department got Yang Ping's fur. Don't do it, all the hospitals that have Haifu Knife are begging to hire Duan Bald.

Xu Jieba in the emergency department has not only improved his professional level by leaps and bounds since he entered the general surgery department, but also started performing scoliosis surgery himself, and found a beautiful civil servant girlfriend.

Lao Du was itchy in his heart, and he waited in the MRI room very early.

Lao Du went out from time to time to look around and asked the nurse, "The patient from the general surgery department hasn't arrived yet?"

"It's here!" The nurse was also very busy, pointing to the old man in a wheelchair surrounded by his family members in the hall.

Not far away, Professor Yang and his party are walking towards this side.

Lao Du hurried forward to greet him, and Lao Yuan stretched out his hand: "Welcome."

"Old Du, are you in the MRI room today?" Song Zimo asked.

"I'm resting today. I didn't hear that Professor Yang came to the MRI room in person. I came here specially to see if I can help." Lao Du did take a rest today, but there are not many such opportunities, so he also came to rest.

If he could learn a little from Yang Ping like Bald Duan did, he might be invited to read the film.

In fact, medicine involves a wide range of things, and if any small field is studied in depth, experts can be produced.

A certain radiologist specializes in CT images of pulmonary nodules. He has read 10,000+ CT films of various pulmonary nodules and published hundreds of articles. Patients with pulmonary nodules from all over the country came to him After reading the film, people can see it accurately. Some people suspect that it is lung cancer that needs surgery. Experts look at it a few times. This one does not need surgery, and it is definitely not lung cancer.

While walking and chatting, I came to the doctor's operating room in the MRI room.

As the host, Lao Du arranged for everyone to be seated, and then went out to greet the nurses, and asked the patients of the general surgery department to arrange the check-ups on the machine.

The patient had completed the pre-examination contraindication screening and signed. The nurse checked again whether there were any metal parts on the body. After confirming that it was correct, two interns were asked to help the patient into the examination room, and the wheelchair was left outside.

Because the wheelchair has metal parts, sometimes I forget to push it out of the examination room. When the machine is turned on, the wheelchair will be attracted by the magnetic field and fly up.

When the patient entered the examination room, Dr. Ao and Dr. Luo immediately entered the examination room from the operating room and carried the patient onto the machine together.

MRI does not have ionizing radiation, but it is afraid of magnetic metals. Therefore, during MRI examinations, not only must there be no magnetic metals in the body, but all magnetic metal parts on the body must be removed to prevent danger from being moved by a huge magnetic field during the examination.

Song Zimo made a gesture, Dr. Ao and Dr. Luo came out, the door of the examination room was closed, and Lao Du remotely turned on the machine through the glass window, and the machine slowly pushed the patient into the scanning black hole.

"Professor Yang?"

Lao Du smiled and chatted a few words when he had time to get closer.

But Yang Ping was waiting to scan the pictures, he was a little absorbed in waiting, and didn't hear Lao Du's words.

Old Du couldn't help being a little embarrassed, so he had no choice but to say to Song Zimo: "Young Master Song, if you have any special patients in the future, you have to come down in person and tell me, I will be there whenever you are called."

This is not a polite word, Lao Du is really ready to be on call.

Lao Du analyzed Duan Bald's counterattack story and learned a lot from it.

The inspection speed of Philips 3.0 light-speed MRI is fast. The inspection speed of different parts is several times to more than [-] times faster than that of ordinary MRI scans.

Slowly the scan was completed, the patient was moved out, Lao Du shut down the machine, and the door of the examination room opened. Dr. Ao and Dr. Luo rushed in to remove the patient consciously.

Even foreigners work so hard, why do I, Du Haibin, have any reason to make salted fish? Lao Du immediately followed up to help carry the patients.

Yang Ping read the MRI images carefully, and it was the same as his preliminary judgment. The cartilage of the lateral condyle of both knees was fine, the medial condyle was bare, the anterior and posterior cruciate ligaments were fine, the lateral meniscus was fine, and the medial meniscus was degenerated and torn, but A few millimeters of the periphery can be preserved, and the symptoms of synovitis are also very mild.

The distal tibial and talar cartilages of the bilateral ankles were worn, but the quality of the cartilage was good in a large area around them.

The outline of the clever Song Zimo's mind is faintly visible. He has been thinking about the patient's plan, even thinking about it in a dream yesterday, and his head was hot in the morning.

Yang Ping paid so much attention to the cartilage of the patient's knees and ankles that he came down to do a new MRI in person, and used some new methods to quantitatively evaluate the cartilage.

In addition, he also attaches great importance to the line of strength of the patient's lower limbs.

If artificial joint replacement is performed, it is a routine preparation to pay attention to the line of lower limbs before operation, but it is obviously unnecessary to pay so much attention to articular cartilage. For artificial knee replacement, all articular cartilage must be amputated, and preoperative attention is meaningless.

"Do you want to perform an osteotomy on the outer fibula? Use Academician Zhang Yingze's uneven settlement theory to perform an osteotomy on the fibula? Let the tibial plateau settle evenly, and move the inner force outward?" Song Zimo finally realized Yang Ping Intention, he wants to do knee surgery.

According to the theory of Academician Zhang Yingze, the uneven or differential settlement of human bones caused by osteoporosis in the elderly plays an important role in the occurrence and development of degenerative knee joint lesions.

The tibial plateau is the main component of the knee joint. The differential subsidence of the medial and lateral tibial plateaus often causes the medial side to settle too quickly, increasing the force, and the pressure on the medial cartilage exceeds its load-bearing limit, so the pressure becomes thinner and degenerates. Under pressure, the grinding and degeneration of articular cartilage is aggravated, leading to knee osteoarthritis.

Just like a car, if the load on the inner side is always higher than that on the outer side, the inner tire will naturally wear faster.

Differential settlement, also known as uneven settlement, is a mechanical phenomenon that occurs when objects are affected by gravity, and it is ubiquitous in nature.

For example, if the foundation collapses and the house falls to one side, this is the phenomenon of uneven settlement.

Due to the influence of gravity, human bones will also experience uneven settlement. When osteoporosis occurs in human bones, micro-fractures may appear in the loose parts under the pressure of body weight. When these micro-fractures accumulate over time, the bones will collapse and sink , Joint deformation and other diseases.

This phenomenon is most obvious and typical in the spine and proximal tibia, which are the most stressed bones.

The inner side of the tibial platform bears two-thirds of the body's weight, and the outer platform bears one-third of the weight, and the outer platform is supported by the fibula that hardly occurs osteoporosis.

It is equivalent to having pillars on the outside of the knee joint for support and no pillars on the inside for support.

Therefore, when the medial platform is osteoporotic and unevenly subsides, the height drops below the lateral platform, the pressure distribution becomes uneven, and the medial cartilage wears out faster, causing osteoarthritis.

After Song Zimo said this, Xu Zhiliang was instantly enlightened.

Yang Ping nodded slightly: "Although this patient has end-stage osteoarthritis, judging from the medical history, physical examination and MRI, the symptoms of synovitis are not severe, and the pain symptoms are concentrated in the inner compartment. , can perform unicompartmental replacement."

Unicompartmental replacement means that instead of replacing the entire knee joint, only a part, usually the medial side, is replaced.

"However, unicompartmental replacement cannot escape the metal component, so we can only protect the knee. If we want to protect the knee, we can only use Academician Zhang's theory."

Sure enough, he is a smart guy. It is not a big deal to think about it, but thinking about it in this case shows that Song Zimo has a very deep and extensive understanding of knee joints.

"However, the cartilage of the medial condyle is completely missing. Even if the fibula is osteotomized, the varus deformity is corrected, and the stress point is moved inward, it still doesn't work. The new stress point still has no cartilage?" Xu Zhiliang asked a new question.

This is why no doctor wants to keep his knee. This case is not suitable for Academician Zhang's theory.

"After the fibular osteotomy, autologous cartilage transplantation?" Song Zimo asked tentatively.

"Re-doing MRI is to judge the distribution of cartilage wear? Because after the fibular osteotomy, both sides of the tibial plateau subside evenly, and the stress shifts outward. This requires judging how the lateral condyle cartilage can withstand this change, and the medial condyle.

Find new stress points for cartilage grafting? "

Song Zimo took advantage of the victory and pursued.

"Also, his bilateral ankle joints already have osteoarthritis, and he has chronic pain for many years, which cannot be cured. Do you want to transplant the cartilage of the ankle joints to the knee joints, and then fuse the ankle joints?"

Song Zimo finally figured out the whole plan, every theory, every operation, everyone knows, but it needs to be combined flexibly, no one can think of applying it to this case.

This requires the integration of all knowledge to achieve it, and each step must be calculated accurately, otherwise things will backfire.

Song Zimo couldn't help sighing that he regarded every case as a research object and made it a classic. Even if this case was abandoned by others, he racked his brains and used all existing technologies to complete the operation.

Academician Zhang's knee-preserving surgery combined with autologous cartilage transplantation, if the ankle joint fusion can be performed, and then the force on the foot can be adjusted to adjust the line of force of the lower limbs, then the problems of the four joints can be solved at once.

Song Zimo felt refreshed. He couldn't figure it out last night, and he always felt that something was wrong, but he figured everything out today.

Xu Zhiliang was still thinking about Song Zimo's words.

"Prepare for the operation the day after tomorrow, and talk to his family members tomorrow." Yang Ping finalized the operation plan.

After careful evaluation, this plan is feasible with great confidence.

"Professor Yang, just now, can you teach me the magnetic resonance technology for quantitative evaluation of articular cartilage? If we are all like your general surgery department, we will all have to be laid off. I don't understand. Why are you so familiar with magnetic resonance?" Old Du Said with a chubby belly.

Yang Ping said humbly: "We are amateurs. We are not as professional as you. We just read a few books and papers. Come, let's study together."

Fairy plucks hair!

Lao Du leaned over and almost fell off the chair.

　During this period of time, many friends who donated rewards, when I am free, I will thank you for opening a list of chapters.

　　
　
(End of this chapter)