godfather of surgery

Chapter 732

After multiple blood transfusions, Lu Jiangbei's hemoglobin has risen to 70 g/L, and has not dropped any further, indicating that hemodynamics have stabilized.

Next, preparations for Lu Jiangbei's surgery began. The implants used to fix the headrest and upper cervical spine have been successfully printed by a 3D printer, and the details of the surgery have also been finalized.

But there is still an unresolved problem --- how to change the position safely during the operation.

Lu Jiangbei’s operation requires anterior and posterior fixation. To complete the operation, an anterior and posterior approach is naturally required. The anterior approach requires a supine position, while the posterior approach requires a prone position. Because there is no reliable fixation, it is difficult to switch between the two positions, and Lu Jiangbei suffers from multiple rib fractures. , Pelvic fracture, which makes the prone position impossible to implement.

Another preoperative discussion around this issue begins.

August and Robert, who were temporarily borrowed from the trauma ICU, have returned to the organization. Lu Jiangbei was able to pass the waiting period for surgery smoothly, thanks to the two of them.

An animation is being played on the high-definition screen in the general surgery conference room, simulating the position change during the operation.

For this operation, it is very dangerous to change from supine to prone during the operation.

Some surgeons who are good at the upper cervical spine have encountered this fatal problem. After completing the posterior surgery, the patient died unexpectedly during the turning process. Therefore, many spine surgeons used to be afraid of turning over the upper cervical spine surgery. .

In order to avoid turning over, some experts boldly used the anterior transoral approach, that is, entering through the mouth, incising the posterior pharyngeal wall, exposing the upper cervical spine, and implementing firm anterior fixation.

Unfortunately, this patient not only had traumatic dislocation of the atlanto-occipital joint, but also had a comminuted fracture of the atlas. Fracture fragments may invade the spinal canal at any time. The anteroposterior approach must be used to completely resect the atlas and then fix it with an anterior-posterior combination.

"I also lack experience in this area. In the past, I relied on turning over to solve cases that required joint front and back fixation. This case is really difficult." August shrugged habitually, saying that there was no good solution for the time being.

"Is it so difficult to turn over?" A graduate student who is not afraid of tigers with newborn calves asked doubts.

This graduate student participated in several discussions, full of doubts in his head, why everyone is so cautious about turning over during the operation, and there is a special discussion.

No one laughed at him, because he was a student, and being able to ask questions showed that he was thinking deeply.

"This case must use the combined anteroposterior approach. If the conventional surgical method is followed, the first half of the operation is performed in the prone position, and the second half is performed in the supine position. Only in this way can the shattered atlas be resected and firmly fixed. During the process, we could not use braces for fixation, and conventional head immobilizers could not provide firm fixation, so we cannot guarantee that there will be no accidents during the turning process. It is estimated that the probability of turning over and dying during the operation is 50.00%. Our doctors are not Gamblers, so this problem must be solved before surgery." Yang Ping patiently explained to the student.

If the graduate student realizes something, he nods and writes it down in his notebook.

"Actually, we can use an improved bracket for fixation, redesign the existing head immobilizer, and extend the fixation point backward to the cervical spine. In this way, the fixation pins of the bracket are distributed on the head and cervical spine, and the head is fixed by the skull. The cervical spine is fixed by pedicles, and you can even find fixed points on the scapula and clavicle to create a firm fixation bracket. Of course, the design of the bracket must leave ample room for surgical operations.” Xu Zhiliang spoke very fluently.

Song Zimo nodded, agreeing with this idea, but there is another hurdle that cannot be avoided: "Lu Jiangbei has multiple rib fractures and pelvic comminuted fractures, and there is still an external fixation bracket on the front of the pelvis. This bracket must be preserved during the operation. Think about it. Thinking, even if the head and cervical spine can be fixed with a special brace, how can he do the prone position? The chest can be supported? The pelvic external fixation bracket will not block the prone position?"

"What about the lateral position? Can the problem be solved with the lateral position?" Zhang Lin boldly proposed.

Song Zimo shook his head: "The lateral position is not only difficult to implement the transoral approach, but also the posterior approach is also difficult. Besides, it is the same as the prone position, because rib fractures and pelvic external fixation cannot be implemented."

What a headache, I didn't expect this operation to be stuck in the body position.August touched his head, Robert remained silent, the discussion reached a dead end, neither this nor that.

"Can you do the surgery while sitting down?"

Yang Ping has been listening carefully to everyone's speeches, and now he starts to speak.

Everyone cast a surprised look - where to sit?

"Although the operation in the sitting position is a bit difficult, at least it can be performed. It perfectly avoids the troubles caused by rib fractures and pelvic fractures, and there is no need to turn over during the operation. If you use the sitting position, the area above the shoulders will be exposed to the operating table. Fixer fixed."

"Excellent surgical position!"

August admired that even in his previous operations, even if the anterior and posterior joints were fixed, he only used the method of changing the body position, and never considered the sitting position.

"The advantages of this position are obvious. There is no need to change the position during the operation. Because of the effect of gravity, the blood and flushing fluid in the operation area are easier to remove, and the venous return and cerebrospinal fluid return become easier."

Song Zimo had no reason not to support Yang Ping. Experience told him that whatever Yang Ping proposed could be realized.

"There are also advantages in terms of anesthesia, I can get closer to the patient's face, assess if the airway is secure, if the endotracheal tube is always in place, better monitoring of the cranial nerves, easier compressions in case of cardiac arrest, if in Cardiac arrest in the prone position is probably a lot trickier."

Fatty Liang felt that this position was indeed more beneficial for anesthesia.

August sighed: "Although the idea is good, the operation will become difficult, and the sitting operation may cause many problems, such as abnormal venous air embolism, intraoperative hypotension, symptomatic pneumocephalus, acute hard Submembranous hematoma, peripheral nerve injury, laryngeal or tongue edema and increased quadriplegia. So many neurosurgeons hate this position.”

But Yang Ping was confident: "Compared with the 50.00% uncontrollability during the turning process, the problems faced in this position are all controllable, such as intraoperative hypotension. Dr. Liang should have a way to avoid it."

Fatty Liang crossed his legs: "Intraoperative blood pressure control technology is my unique skill, don't worry."

"Venous air embolism, we operate gently during the operation, and try not to damage the vein—" Yang Ping proposed a solution for each problem.

Sit down and do the surgery!
For this case, theoretically speaking, sitting is indeed the best choice.

As a master of spine surgery, August has performed countless surgeries, but he has never used the sitting position to complete such an anterior-posterior approach. He is looking forward to seeing how Yang Ping will complete this kind of operation.

"So this problem has been solved?" Yang Ping wanted to know if everyone still had any problems.

Song Zimo murmured in his heart, everyone was discussing how to turn over and how to change positions, but Yang Ping wanted to do the operation while sitting down. Dr. Song felt that he couldn't keep up with the rhythm, and was always missing a beat.

(End of this chapter)