The Godfather of Surgery

Let's talk about this patient. Yang Ping felt that the time was ripe.

Director Zeng said sincerely: Well, I'll go get the patient information.

There are many patients' films, several bags are bulging, from Nanqiao People's Hospital, to Shipo People's Hospital, and then to the hospital in the provincial capital, each hospital has made a full set.

Yang Ping simply classified these films, X-ray, CT, and MRI, into three parts, each of which was arranged in order of date, with the earlier date on the top and the later on the bottom.

Otherwise, there are a lot of films, and it is not clear which one was taken when and where.

The two of them faced the reading light, hung the films one by one, looked at one and then changed them.

Yang Ping pointed to the recent MRI film and said, Look at the left femoral shaft, the local signal here is still different from the signal in other parts, and then look at the CT.

He took out the CT of the same period, checked the date, and hung it up: Similarly, the density of this part and other parts is also different, you can see that there is slight sequestrum formation and local hyperplasia here, and there is no such thing in other places. The phenomenon is just an uneven reduction in bone tissue density, with pits and pits.

Hang the X-ray again: The trabecular bone is unevenly reduced, and there is no gap in the cortex for the time being.

Having said so much, Director Zeng did not understand what Yang Ping wanted to express?

Yang Ping also saw his dazedness and said, I suspect that this patient is not infected with the entire femur, but only a local infection here!

Director Zeng was attracted by his novel ideas, why this patient was difficult, why the provincial hospital was reluctant to operate on him, because he thought that the entire femur was infected and there was no way to operate.

This patient was hospitalized in the Provincial People's Hospital. He originally planned to undergo resection of infected bone segments and bone lengthening, but even both ends were infected. It is impossible to cut the entire femur. The operation was abandoned, and it is recommended to return to the local hospital for anti-infection treatment.

The so-called returning to the local hospital for anti-infective treatment is just an excuse, and people are unwilling to take over.

Yang Ping said: If the judgment is correct and there is only focal osteomyelitis, it will be much easier to handle. The infected bone tissue can be completely removed, filled with calcium sulfate containing antibiotics, and then a muscle flap is made to cover the defect. , the problem is solved.

The bone lengthening technique, also known as the bone transport technique, uses the distraction osteogenesis technique of Dr. Ilizalov of the former Soviet Union to lengthen the bone tissue.

There was a time when this technology was very popular, and many hospitals used it for heightening surgery.

The heightening of broken bones led to the abuse of the technique, and there were many accidents. Later, the Ministry of Health ordered that this technique be prohibited from being used for heightening, but only for the treatment of diseases and correction of deformities.

Director Yang, if it is focal osteomyelitis, then the image changes in other parts are bumpy, how to explain it?

Director Zeng is very interested in following Yang Ping's ideas, not only in solving problems, but also in the fun and sense of achievement brought by such rigorous logical reasoning.

Doctors can do that too! I feel that discussing with Yang Ping like this has improved my clinical thinking by several levels.

Yang Ping went straight to the topic: The changes in other parts are caused by hyperthyroid bone mineral disease. This disease just overlaps with osteomyelitis. It makes people think without thinking that the entire femur is infected and can't be saved.

Thyroid examinations are not routine examinations in hospital. Orthopedic patients are hospitalized without special circumstances, and thyroid hormones are generally not checked unless there are symptoms, such as thyroid enlargement.

Then what should we do? Director Zeng was frank and straightforward.

The knowledge is a bit beyond the outline, burning the brain!

Yang Ping said: I just speculate that further tests are needed at present, blood is drawn to check thyroid hormones, and multiple bone punctures are used to collect bone tissue for bacterial culture.

Medicine is a rigorous science, and decisions must not be made arbitrarily based on feelings. This will not only fail to cure the disease, but will easily cause harm to the patient.

We perform multi-point puncture, do bacterial culture, and see the results. If bacteria are cultured at every puncture point, it means that the femur is extensively infected. If only this point has bacteria, and no bacteria are found in other points, then support me. If the diagnosis is confirmed, we will perform surgery to remove this piece of infected bone tissue and make a musculocutaneous flap to cover the defect. Yang Ping explained in detail.

Director Zeng said, I'll make arrangements now to give him an empty stomach tomorrow morning?

I will draw blood on an empty stomach tomorrow morning, and now I will perform a bone piercing at the bedside for bacterial culture. Yang Ping agreed.

It's not too late, think about it clearly, and start early. For two weeks, procrastinating and getting nothing done.

Director Zeng immediately went to the doctor's office, picked up a doctor at random, prescribed a doctor's order, drew blood on an empty stomach tomorrow morning, checked thyroid hormones, and did a color Doppler ultrasound to see if there were any nodules in the thyroid gland.

In Director Zeng's eyes, Yang Ping is now a great immortal, and while he is here for two weeks, he will quickly move the two mountains of Keli away.

It is not easy to be the head of this department. Every day when I sit in the office and drink tea, I have to see if Teacher Yan is here.

I have to take a detour to and from get off work, for fear of being blocked. Although he does not threaten personal safety, he is troublesome. If you are always pestering you alone, how can you have a good life.

This femoral shaft osteomyelitis, although the operation was not performed here, and the family members are polite, but every three days they ask you: How is it, has the infection been controlled, is there any other way?

The question is too big, and every time I can only perfunctory: Change the medicine for a few days and see.

But changing the medicine every day is helpless and uncomfortable!

Without delay, Director Zeng called a doctor to prepare the bone piercing bag and bedside bone puncture.

Let's go to see Mr. Yan again? Yang Ping remembered to visit again.

Although we have full confidence, we still need to pay close attention. The human body is complex, and medicine itself is not perfect. It cannot cope with all changes. This is the uncertainty of treatment.

After general anesthesia, he fasted for six hours. Mr. Yan's son sat beside the bed and dipped a cotton swab with water to help Mr. Yan moisten his lips.

Dad, Director Yang and Director Zeng have come to see you, said the old man's son.

Mr. Yan slept on his side, facing inward to avoid pressing on the surgical site. Hearing Yang Ping coming, he said, Director Yang, there is no pain at all, and the whole body is relaxed. Thank you very much.

He groped under the pillow with his backhand and took out the notebook: Give me a pen, wait a minute, I'll write it down, what time is it? Director Yang came in to round the room. I want to write a letter to thank you, I didn't need to meet you earlier. After such a tossing, you have pulled out the root of the disease for more than ten years, and I feel so relieved, indescribable.

Director Yang, which hospital do you belong to, is it convenient to disclose? Teacher Yan asked.

Sanbo Hospital in the provincial capital. Yang Ping told him.

I wrote it down, I want to write a letter of praise to your hospital, young and promising, the pillar of the country. Teacher Yan closed the book, and his son took it and helped it under the pillow.

After reading Mr. Yan, the bone puncture package is also ready. This kind of bone puncture is best performed under the guidance of CT to accurately penetrate the center of the lesion.

But now the femoral lesions are diffuse and everywhere, as long as the femur is pierced, it is successful, and the bone tissue suspected of infection is just exposed, so look directly at the puncture.

Therefore, this does not require CT guidance, and direct puncture under local anesthesia at the bedside.

The doctor in charge of the bed communicates well with the patient and signs the informed consent.

Yang Ping operated it himself, and the whole process was strictly sterile to prevent inaccurate results due to contamination.

Bacterial culture takes several days, and after bone puncture, you can only wait for the results.

Zhang Lin was checking the doctors' medical records and instructing them on how to write a good medical record. He wrapped a dressing on his fingers and rubbed the skin of his fingers when washing clothes.

The hospital originally bought a washing machine for everyone to use, but many of the doctors have a little cleanliness. More than a dozen batches of people who went to the countryside shared the washing machine, and many did not dare to use it.

The medical record is the most test of a doctor's level! Zhang Lin stammered, his teacher was very enthusiastic.

The doctors who listened to him were very attentive.

Look, brother, your medical record is very well written, and you have written an abnormality that is difficult for others to find, talent! Zhang Lin pointed to the medical record.

Everyone leaned in to look at the medical records, and the brother who was praised had a long face.

Men, the menstrual history is written so clearly, it's not simple, it's hard work. Zhang Lin tapped his fingers on the table.

Everyone wants to laugh, but they dare not laugh.

Song Zimo took Xiao Wu to the operation. A severed finger was replanted. Originally, he planned not to use the finger, and just sew it up. He called the operating room and asked about the microsurgical instruments, needle and thread, and an old microscope, so he decided to do it. Replantation of severed fingers.

I met Director Tian in the cafeteria at noon. Director Tian said that the weather was good these days, and everyone would go into the mountains to do free clinics for the villagers.

Before leaving get off work, Yang Ping went to see Mr. Yan again, but there was still no pain.

The most afraid of rebound, this rebound sometimes lasts for several days, ordinary patients can explain a few words, but once this patient rebounds, it is easy to lead to misunderstanding.

The system is not as usual. The results are announced immediately after the operation. It is estimated that they are waiting for the results. It is not easy for the system to get points.

Director Yang! Teacher Yan's voice was very high.

You say it! Yang Ping said.

Teacher Yan said, I'm thinking about writing a thank you poem!

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