godfather of surgery

After the bleeding was successfully stopped, the boy had passed the first gate of hell.

Next, he will be transferred to the trauma ICU for further treatment. After his condition stabilizes, he will undergo the second-stage operation.

The second-stage surgery involves a lot of content. In addition to fixing the head and neck, it also requires surgical treatment of pelvic fractures and multiple fractures throughout the body.

"Get ready for bed, everyone take their places!"

Song Zimo commanded everyone to start moving the boy from the operating bed to the transfer flat car.

Because of the weakened muscles, the boy had to rely on a ventilator to assist his breathing. The cannula placed through the tracheotomy was connected to the ventilator, making rhythmic wheezing and wheezing sounds.

"1, 2, 3, start!"

Following Song Zimo's order, everyone worked together to transfer the boy to Pingche smoothly.

Normally, only two or three people are needed to complete the bed transfer for ordinary surgery patients, but this time is different. In order to safely carry the patient, seven experienced and strong doctors went into battle together.

Because the spinal canal at the atlanto-occipital joint plane is the starting part of the cervical spinal cord, adjacent to the medullary respiratory center, a little carelessness may cause secondary damage to the spinal cord, and the result of the secondary damage is respiratory arrest.

"Blood oxygen is dropping?" the anesthesiologist reminded immediately.

On the screen of the monitoring instrument, the blood oxygen saturation has been dropping from 100% to 80%. Just one handling caused this fatal fluctuation.

Everyone turned their attention to Yang Ping, hoping to get some kind of rescue instructions from him.

Yang Ping looked at the values ​​on the monitoring screen, and spoke after a while: "No matter how careful you are, there is no guarantee that there will be no rotation and translation of the cervical spine. Even a small rotation and translation will interfere with the edema of the cervical spinal cord and affect the respiratory center. , thus causing a drop in blood oxygen, which is a transient blood oxygen fluctuation, let’s wait and see.”

The blood oxygen saturation remained at 80% for less than 30 seconds, and then began to rise until it reached above 95%. Everyone breathed a sigh of relief.

If the blood oxygen saturation does not rise but continues to drop, it means that the cervical cord has been fatally injured twice, and the boy may not have a chance to survive. Fortunately, the blood oxygen saturation returned to normal, thanks to the good fixation of the brace and Everyone's professional cooperation during the move.

Yang Ping approached the transfer car and touched the brace. Director Wei hurriedly followed and looked at Yang Ping worriedly. The blood oxygen fluctuation just now indicated that the cervical spine was still unstable, which meant that the respiratory center was disturbed in some way.

Director Wei also stretched out his hand and stroked the surface of the brace to judge whether it fits snugly, especially at the corners, whether it is supple. Along the edge of the brace, he explored the gap between the brace and the skin to see if it was too wide.

After some groping, Director Wei said suspiciously: "The fixation is very reliable, what's the matter?"

Yang Ping said flatly: "The brace is perfect, it's not a problem with the brace, any external fixation is elastic and cannot be absolutely stable, as long as the fretting is within the safe range, don't worry, you can send it to the ICU now, If blood oxygen fluctuations occur again, stop to rest and stabilize before transporting."

Director Wei felt relieved, he was still very confident in his brace, and he thought he had achieved the ultimate in doing this thing in his life.

About 15 minutes after the blood oxygen was stable, everyone pushed the flat cart and began to send the boy to the trauma ICU.
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General Surgeon's Office.

It's already off-duty time, but the doctor's life has never had the concept of "normal commuting".

Scattered lunch boxes are placed on the desk. These are all empty boxes, no matter whether they are dishes or rice, they have been swept away, and there is nothing left.

Xiao Su and Tang Fei helped clear the table, and Yang Ping, Song Zimo, Xu Zhiliang, August, Robert and others began to discuss the case again.

"There is edema in the spinal cord and no transection, which means it's just a contusion. The muscle strength of the limbs is now at the first level. As long as the operation is performed in time, it is very likely to be able to recover. Traumatic atlanto-occipital joint dislocation--I have undergone similar operations, but there are only a few cases. There are not many cases of similar surgery reported in Europe, but this wounded patient had a comminuted fracture of the atlas, which I have never encountered."

August is a top spine surgeon and experience is very important. He wiped the corners of his mouth with a tissue while speaking.

Trauma causes the joints between the head and cervical vertebrae to separate. The head and neck lose reliable bone and ligament connections, and only rely on soft tissue to maintain the connection.

In fact, there are not many such traumas, but there are very few cases that doctors can see.

In the cases of death caused by cervical spine trauma, about 1/3 is caused by the dislocation of the atlanto-occipital joint, which is very unstable. Further dislocation of the occipital joint causes compression or pulling on the vital centers in the spinal cord, resulting in death due to cessation of breathing.

Therefore, cases where you can or see a doctor are very rare, and this is also the case around the world.

"Atlas, this term is taken from Atlas, the Titan giant god in Greek mythology. Just like this giant god is carrying the earth on his back, the atlas carries the entire head on his back, and the joint formed between the atlas and the head—— The atlanto-occipital joint is the only connection between the head and the cervical spine, our huge human head is connected to the cervical spine and torso through this small joint—"

August pointed to the [-]D reconstruction image of head and neck CT that rotated automatically and slowly on the screen, and spoke eloquently.

"Without Atlas, who will carry the earth? Without Atlas, I don't know how to place this head?" August shrugged.

Robert said helplessly: "The separation of the atlanto-occipital joint is really an unbearable separation in life!"

"The prosthesis can only be customized. The prosthesis supports the occipital part of the head, connects the axis below, and simulates the atlas in the middle, that is, it needs to create an artificial atlas, atlanto-occipital joint and atlanto-axis joint." Song Zimo said own opinion.

This idea is bold and easy to say, but very difficult to do.

"There are single-digit cases of simple dislocation of the atlanto-occipital joint, and there are no precedents in the world for cases of comminuted atlas fractures." Auguste was very disappointed.

"According to common sense, this case will not appear in front of us, but he happened to appear. We have to do something, right?" Xu Zhiliang was silent for a long time and began to join the discussion.

However, Zhang Lin and Xiao Wu remained silent. It was not that they were unwilling to participate in the discussion, but that the discussion was too high-end and they could not intervene at all and could only learn from it as bystanders.

"If a custom-made prosthesis is used, the shattered atlas needs to be resected, and it is difficult to completely resect the atlas, and there will be unpredictable bleeding during the operation. The supine position and the switching of body positions make it very difficult to fix the head and cervical spine, and it is impossible to fix it with a brace during the operation, and traditional skull traction and various brackets are powerless." August added a new worry.

Indeed, how to allow the patient to freely switch positions during the operation without damaging the cervical spinal cord is another huge problem.

"Using prosthesis for fixation is a good solution, but if the atlas prosthesis is used to complete the operation, how to achieve stable and long-term fixation between the occiput of the head and the prosthesis, and between the prosthesis and the axis? Of course, we can There is no need to think about such a long-term, after all, as long as we can complete the operation, no matter how long it can be stable, it is a victory in medicine."

August once participated in an academic exchange meeting between Europe and the United States. An American doctor tried to use this method to complete the operation, but in the end, due to the loosening of the screws, the connection between the headrest and the cervical spine of the patient became loose, and finally the breathing stopped.

"This method can be improved. The artificial atlas uses a mesh structure similar to titanium mesh. The mesh structure undertakes the task of temporary fixation, and the mesh structure is filled with autogenous bone, such as ribs or ilium, or the patient's existing crushed atlas. , so that the autogenous bone can complete the bony fusion with the upper headrest and the lower axis, so that two birds with one stone can be achieved." Yang Ping leaned back on the chair and expressed his opinion.

Sometimes, when faced with this kind of problem, innovative thinking is necessary to solve the problem.

Because they are difficult problems because existing knowledge has no solution, and you need to use your imagination to come up with a completely new solution.

"The hollow cage structure is filled with autogenous bone, allowing the prosthesis to undertake the dual tasks of temporary fixation and fusion of the head and neck?" August said in surprise.

"That's right!" Yang Ping said with certainty.

"Bone cyst is now only an imaging diagnosis. Pathological section examination is required during the operation to clarify the nature of the atlas tumor. If it is malignant, not only can we not use the atlas as a donor bone, but we will also face more troubles." Xu Zhiliang raised new questions.

Yang Ping said approvingly: "The thinking is very rigorous! Whether the bone cyst is a bone cyst or not is uncertain now, and a pathological examination must be performed during the operation, but no matter what, the purpose of our current operation is to complete the fixation of the head and neck. The only purpose right now."

"An imaginative plan, what can I do?" Robert snapped his fingers.

Yang Ping thought for a moment and said: "You can do many things, but I have decided to entrust you with the most important and core tasks, and I hope you will be able to do them."

Robert patted his chest excitedly: "Don't worry, trust me."

"Starting today, you join the nursing team of the Trauma ICU. They need a member who is proficient in orthopedic knowledge and has a strong physique, because turning over in nursing work is too important, and a little carelessness will lead to dislocation of the head and neck." Yang Ping said very seriously.

Robert's brows tightened, then relaxed in an instant: "Professor - I promise - to complete the task - can I have a request?"

"Please tell me!" Yang Ping replied easily.

"During the mission, the working meals are arranged for two people?"

"No problem, not only double serving standard, but also chicken legs!"

"This is a arduous and sacred task. This is the most critical and core part of the entire treatment plan. Don't make any mistakes. As a brother, I really want to fight side by side with you, but the situation does not allow it. Cheering for you, believe in yourself, you can do it, come on." August encouraged his roommate.

"The nursing team also needs an expert who is proficient in spinal surgery. If necessary, I can try my best to get it for you." Yang Ping sent August another task.

August straightened his chest and swallowed a mouthful of saliva: "Professor, I don't want to embarrass you."

"It's okay! You touched me, no matter how difficult it is, I will try my best to fight for it!" Yang Ping said calmly.