The Godfather of Surgery

Fatty Liang, Zhang Lin, and Xiao Wu went outside to smoke.

Yang Ping edited the first day's work into WeChat and reported it to Director Tian.

I made a key report on Mr. Yan's affairs separately. When reporting the operation plan, he deliberately did not mention the partial closure during the operation.

Director Tian replied: I agree with your opinion. The operation is carried out according to the original plan. Pay attention to the use of methylprednisolone to partially seal the compressive segment of the sciatic nerve during the operation.

A good doctor requires both mentality and courage.

Without courage, you are afraid of your head and tail, and it is difficult to make a weapon; without a mind, you are brave and resourceful, and sooner or later something will happen.

In order to ensure the success of the operation, Yang Ping entered the system space and dissected several experimental subjects. In addition to the routine whole body dissection, he also paid special attention to the local dissection around the piriformis muscle.

Now he is slowly realizing the power of super-cultivation Dafa. Every anatomy training is of great help to the operation. This improvement is spiral.

Just like basic science and applied technology, if basic science is strong, only applied technology can accumulate and develop, otherwise applied technology will become rootless and stagnate.

After accumulating the anatomical knowledge of several experimental subjects, plus the master-level trauma orthopedics as the foundation, this sciatic nerve release is only a minor operation.

The next day, after the shift and rounds in the morning, Yang Ping took everyone to read the films, and then went to the operating room for surgery.

Director Zeng is very enthusiastic, and now he really wants to learn something along the way: I'll help you.

Yang Ping said: Director Zeng, how embarrassing this is, just ask Dr. Song to help me, and you have to communicate with your family members about your condition at any time.

Yang Ping was the chief knife, Song Zimo was the assistant, and Director Zeng came to the stage to take a look and move freely.

Intraoperative protection of nerves is particularly important. Once the operation is inadvertent, accidental injury or excessive traction may be caused, which will cause adverse consequences after surgery.

It was the first time I had an operation with Director Zeng, and I was not familiar with it. I was afraid that the operation would inadvertently damage the nerves. But it's not easy to ask Director Zeng not to come to power directly, so Yang Ping arranged it like this.

Under general anesthesia with endotracheal intubation, Xiao Wu Zhanglin has put the patient in a prone position.

Mr. Yang, good morning! Su Yixuan brought a nurse from the Nanqiao Hospital and was sorting out equipment when she saw Yang Ping coming in and said hello.

Yang Ping responded seriously: Head Nurse Su, I'm in trouble, I want the head nurse to provide the stage in person.

Director Yang's surgery should be done. Su Yixuan pursed her lips and smiled through the mask.

Everything is ready, wash hands and dress, sanitize and spread out, and open the stage.

The lower edge of the gluteus maximus, the incision of the gluteal fold, to avoid the formation of scars on the ischial tuberosity.

Lift the skin to reveal the gluteus maximus, which is partially fibrotic. Cut the fascia at the lower edge of the gluteus maximus without damaging the muscle fibers, and lift the gluteus maximus upwards to protect the subgluteal nerve and the posterior femoral skin. nerve.

The piriformis muscle was exposed, and sure enough, the lower third of the piriformis muscle had become fibrotic, that is, scarred, not muscle tissue at all.

The sciatic nerve does not emerge from the inferior border of the piriformis muscle, but exits the fibrotic piriformis muscle in the form of a trunk, and is compressed by the scar at the exit.

No wonder, the symptoms of the sciatic nerve are so severe, and the symptoms are worse when walking, because the piriformis muscle contracts while walking, squeezing the sciatic nerve, so the symptoms are worse.

The nerve is carefully separated from the scar tissue, and the surrounding scar tissue is excised to expose the epineurium intact.

The nerve forms a dent at the compression site, and the dent is edematous and enlarged both near and far.

Yang Ping picked out his nerves gently: Director Zeng, look!

Sure enough, with piriformis entrapment syndrome, Director Zeng felt relieved, and the preoperative judgment was correct.

Xiao Wu took a picture!

Everyone got out of the way, and Xiao Wu used his mobile phone to focus and take pictures, being careful to prevent contamination in the surgical area.

The rubber strip gently retracts the nerve. At this time, do not interfere with the sciatic nerve. Once the sciatic nerve is stretched too much, it will cause nerve damage. Although it usually recovers, it can be as short as a few days or as long as a few months, and the lower limbs will be numb and weak. , At that time, the patient will have misunderstanding, thinking that the operation failed and aggravated the symptoms.

Doctor, always walk on thin ice.

Doctor Song, protect your nerves! Yang Ping reminded.

He wasn't worried about Song Zimo. He was afraid that Director Zeng didn't pay attention to nerve protection, and casual and inadvertent actions, such as sliding the retractor, damaged the sciatic nerve, and it was not wrong to be cautious on the operating table.

Song Zimo understood, and placed one hand between Director Zeng's pull hook and the nerve, tightly protecting the nerve.

The nerve was retracted, and Yang Ping bluntly separated the normal muscle fibers around the piriformis scar. Entering from the gap, the fingers separate a gap, and then at the attachment points of the muscles at both ends, the fibrotic piriformis portion is severed. With some normal muscle fibers, the fibrotic tissue is completely excised.

In this way, the nerve will come out from the lower edge of the remaining normal piriformis muscle, the sciatic foramen magnum, and will no longer be compressed, because the just separation is separated from the natural muscle fiber gap, no damage to the normal muscle, and no scar adhesion in the future. No aftermath.

There must be no further scarring around the released nerve, otherwise the operation will fail and the nerve will be re-compressed.

Blunt separation and sharp separation, blunt separation is used for separation with natural gaps, and sharp separation is used for separation without natural gaps.

The surgical area was flushed and the bleeding was completely stopped again.

80mg methylprednisolone in 20ml saline, syringe!

Methylprednisolone is a glucocorticoid with anti-inflammatory and edema reducing effects.

The needle of the syringe is gently slanted into the nerve sheath, and methylprednisolone is injected into the nerve sheath, and then some are sprinkled on the epineurium to partially seal the nerve, and wait for about five minutes.

Then use ropivacaine 20mg, diluted one-to-one with normal saline, infiltrate the site where the muscle scar was just cut off, and then infiltrate the incision edge in layers, which can reduce postoperative pain.

On re-examination, the release was very thorough and the bleeding was perfect. The whole operation was pleasing to the eye, there was almost no bleeding, and the gauze was useless.

Several orthopaedic surgeons who observed, discussed in private, the big hospital is different.

The rubber strip is pulled out and the nerve is put back in place.

Drainage tubes were placed, layered sutures were performed, and the operation was over.

Immediately after the operation, the sterile sheet was opened, and the patient woke up. Fatty Liang used a straw to remove the secretions from the patient's throat and trachea, and the tube was successfully extubated. The cooperation was very good.

After waking up from anesthesia and taking the patient out of the operating room, the nurse called the family, and his son came up immediately.

Yang Ping took out his mobile phone and showed him the pictures taken during the operation: Mr. Yan, look, this is the sciatic nerve, it is stuck like this, the middle becomes thinner, and the ends are swollen. The legs are gone.

Arriving at the ward, the patient is fully awake and can talk normally.

Under general anesthesia, once awake, there is no problem with limb movement.

The patient moved his right lower extremity. Hey, the pain is gone. Could it be that the anesthesia is working? No matter what, the pain is now relieved.

Pain has a very large negative impact on patients, seriously affecting their lives, such as nightmares that cannot be escaped, and some people are tortured by pain to the point of suicidal tendencies.

This mountain was removed, even temporarily, the patient felt very comfortable, a feeling of being reborn.

It doesn't hurt anymore! Teacher Yan's first words when he returned to the ward.

Go and say thank you to the doctor! Teacher Yan instructed his son.

The son said, Don't worry, I know.

After the nerve is released, some will rebound, and the symptoms are more severe than before. In order to avoid this phenomenon, Yang Ping used the hormone methylprednisolone to partially seal the nerve to eliminate inflammation, reduce nerve edema, and avoid possible rebound after surgery. , Improve the patient's postoperative experience, this experience is very important, the patient does not know whether the operation is beautiful or not, his intuitive experience is whether the problem is solved, and how much is solved.

For Mr. Yan, pain relief is success. Saying it 10,000 times can't match his own experience.

It has been more than ten years, and the first pain-free day has come.

Teacher Yan was so excited that his hands trembled and held his son: Remember, definitely remember, thank Director Yang.

Although the whole process went smoothly, Yang Ping did not relax for the time being, and the conclusion should not be too early. After all, intraoperative partial closure was used, and it still depends on whether there will be rebound symptoms in the next few days, although the probability is very low.

Yang Ping instructed the doctor in charge of the bed to pay attention to protect the stomach, use some drugs that nourish nerves, and instruct Xiao Wu to do it himself when changing the dressing for the wound.

After the operation, Yang Ping and Director Zeng rested in the office.

Teacher Yan's son came over, this time his expression was normal, not gloomy.

Thank you, Director Yang! He took the initiative to shake hands with Yang Ping.

Yang Ping said: It should be, doctors and patients are comrades in arms, and the common enemy is disease.

Director Zeng, thank you too. The old man's son saw Director Zeng beside him and expressed his thanks.

I just finished the operation, although I saw the immediate effect, but I don't know if it can be maintained like this, so the old man and the son can't talk too much, can't turn too fast, observe and see.

Dean Pan brought Director Tian down to the department and happened to come to the Department of Orthopedics. He heard Dean Pan's voice from a distance. Because he was missing an incisor, his pronunciation was leaky, so his speech was very distinctive.

Director Yang, you've worked hard! I heard that I just finished an operation. Director Pan shook hands with Yang Ping.

Director Zeng said: The one who just performed the operation is Mr. Yan, who has been with us for a year. After the operation, the pain is relieved. The patient's family just thanked him here.

Director Tian had already reported the matter to Director Pan last night. This kind of patient is a special patient, and the operation cannot be done quietly.

Dean Pan: Oh, it's too embarrassing to let you do the butt-wiping thing as soon as you settle down. It's ugly, it's ugly.

Yang Ping said: Pan Yuan's words are serious, but Director Zeng has figured out the condition. Because the two sides misunderstood deeply, so let me come forward, and I can't talk about helping.

Dean Pan turned to look at Director Zeng: Director Zeng, learn more from provincial professors and dig in depth.

Director Zeng didn't know how happy he was, although he knew that Yang Ping was lying, but the lie was not obvious, so he said: No, I pester Director Yang every day and want to squeeze more real things. Thanks to Director Yang's guidance, I figured it out.

After chatting for a while, ask about any difficulties in work, accommodation and living habits, and then recommend a few more interesting places in South Bridge.

Dean Pan and Dean Tian left to go to other departments.

The one with osteomyelitis of the left femoral shaft? Director Zeng proposed.

During the ward round yesterday, he felt that Director Yang had something to say.