The Godfather of Surgery

Sisi's father's examination results came out. The right ankle was fractured, supination and external rotation were four degrees, and four points were damaged. The medial malleolus, lateral malleolus, and posterior malleolus were fractured. Wide, lateral displacement of the talus, subluxation of the ankle joint, this kind of fracture must be operated and reduced by manual operation. Even if the reduction is satisfactory, it cannot be well fixed.

Every treatment method has indications, and it is against scientific principles to deviate from the indications and myth of any treatment method.

Lange-Hanson classification - four degrees of supination and external rotation, AO classification - C!

Song Zimo turned on the electronic reading screen, and Sisi's father's X-ray and CT were displayed on the screen. Several trainees and interns gathered around, and Song Zimo explained the knowledge of ankle fractures to everyone.

The classification of ankle fractures is the most complicated in the classification of extremity fractures, especially the Lange-Hanson classification. Many senior orthopedic surgeons are confused and do not understand.

In this classification, what is pronation and supination, and what state is it; what is external pronation and internal pronation, what state is it, and why it is combined in this way, Song Zimo will explain it to you in detail.

He also drew a piece of A4 paper, explained and drew pictures. In order to make it easier for everyone to understand, Song Zimo drew a picture of a hinge to simulate the mechanism of ankle injury.

Most of the students are highly motivated to study. Especially at the academic meeting, Yang Ping brought Song Zimo to show his ingenious surgical skills, pressing the two heroes of trauma surgery in Japan, making these young people full of enthusiasm and admiration, which made these students even more determined. The belief of a good doctor.

The power of idols should not be underestimated. It is a kind of spiritual pillar, like a lighthouse, giving you hope, giving you direction, and giving you the confidence to move forward in the distance.

It is a supreme honor to be able to study in the comprehensive orthopedics for a period of time; it is also a supreme honor to be strictly required by the teachers here, they all think so.

In teaching, Yang Ping advocates learning with clinical cases as the center, using a case to get all the relevant knowledge thoroughly. Even an intern who leaves the Department of Comprehensive Orthopedics must have a thorough understanding and firm grasp of the knowledge that should be mastered.

Usually, the interns and the training students are both managed by Zhang Lin, and some basic knowledge is taught by Zhang Lin, and the more complex professional knowledge is taught by Song Zimo.

Yang Ping usually gives lectures to Song Zimo, Zhang Lin and Xiaowu. He also explains cases to regular trainees and interns during the teaching rounds, asks some questions, and checks the practical effect of clinical teaching in the department.

Treat the swelling first, and then arrange for surgery. Yang Ping instructed Song Zimo.

This kind of fracture cannot be operated during the swelling period, otherwise it is easy to cause incision complications, such as inability to suture, necrosis, infection, etc., and it is necessary to wait for the swelling to subside before surgery.

Song Zimo's cell phone vibrated, and it was Duan Xiaoming, the director of Haifudao's operating room: Master Song, is your surgery tomorrow for a liver tumor? Yes!

The medical department just called to say that you have overstepped your authority. The authority for this operation is limited to the general surgery department, the oncology department and our department. Your orthopaedic department has no authority.

Sisi's operation, tomorrow we will have liver metastases. This operation is not within the scope of our orthopaedic department, but in general surgery and tumor surgery. Brother Ming just called to say that we were monitored by the medical department and we would cancel the operation. Song Zimo hung up and said.

Yang Ping and Song Zimo have been focusing on the treatment of Sisi's disease, but Yang Ping and Song Zimo didn't care. Indeed, this operation overstepped their authority.

How about we deal with the primary tumor of the left femur first? Song Zimo suggested.

Yang Ping shook his head: The current treatment is all palliative, and the most painful part should be dealt with first. You also saw the painful expression of Sisi lying on the bed during the ward round.

Can you put Brother Ming's name on it and do it for you? Song Zimo thought for a while.

The matter of surgical permission is very serious, just like asking for a driver's license to drive a car.

Brother Ming, whose real name is Duan Xiaoming, is the director of the Haifu Knife Department. No matter what kind of tumor in the body, as long as there are indications for Haifu Knife, he can do it.

This is a good way, but people don't necessarily agree to be named, because they have to take risks.

I told him that he would definitely agree. Song Zimo was very confident.

Song Zimo helped to solve Duan Xiaoming's child's degree study. It should be no problem to ask him to help put up a name for this friendship.

Based on Yang Ping's trust value in Sanbo, since he dares to perform this operation, he must be very sure, and Duan Xiaoming will not have too much worry.

Don't worry, I'll tell Director Han! Yang Ping called and explained the situation to Director Han.

It didn't take long for Director Han to call: Xiao Yang, you do it, I just communicated with the medical department and I will give you a one-time temporary authorization. President Xia and I will sign and endorse, and I will call the general surgery department and the oncology department. Greeted and explained, this is a special case, this patient is a charitable funded object of our department and belongs to a scientific research case, so they will not have any opinion.

After a few words and not asking Yang Ping too much, Lao Han settled the matter.

Lao Han's idea is very simple, since you have to do it, just do it, I will remove the obstacles, and I will take the risks.

Director Han has already sorted everything out. Yang Ping put down his phone so that Song Zimo didn't have to deal with it.

In the hospital, doctors are divided into different departments, each doing things in their own fields, and they cannot overstep their authority without authorization.

This cross-border thing can be done at one time, but it must not be normalized. Every operation needs to be done, which is nonsense.

Cheng Liquan sent a message that his medical tour group had arrived at the hospital and asked when the operation could be arranged. There were eighteen patients.

Eighteen?

At first it said eleven, and then it increased to sixteen.

Now the exact number is 18, and there are two patients from Southeast Asia who have temporarily joined the group.

Surgery or group? Will there be a group purchase price for the group? Yang Ping was very curious, but it was inconvenient to ask Cheng Liquan.

If this goes on, it will only accumulate more and more, and we must find a time to clear it out. While there are not many patients in my department, hurry up and clear these 18 patients, let's go on Sunday.

If Professor Zhang was at full capacity in the outpatient clinic, he could fill the ward within two weeks. At that time, it would be difficult to find time.

Zhang Lao has a good reputation and is very responsible. Many patients from outside the province came to call him.

Some of his patients, some twenty or thirty years after surgery, are still being followed up.

A patient with congenital hip dysplasia, the patient underwent surgery when he was two years old, and now the patient's children are in middle school, and he is still following up on the patient.

At that time, there was no WeChat, and even phone calls were not popular, and follow-up was entirely by writing letters.

The serious and rigorous attitude of the older generation makes most doctors ashamed, which is why many patients trust him and come to see him from far away.

The nurse station called the doctor on duty. Professor Zhang admitted the patient, a girl in her twenties. Professor Zhang considered thoracic vertebral tuberculosis.

Tuberculosis is rare now, but it has been on the rise in recent years because of the mutation of tuberculosis bacteria.

Zhang Lin was on duty, he went to see the patient, and Yang Ping had nothing to do, so let's go and see.

The patient is named Fang Xiaoyun, female, 24 years old, very thin, with low back pain for 3 years, and numbness and weakness of both lower limbs for 3 days. On physical examination, the spine formed kyphosis in the 9th part of the chest, the skin of both lower extremities below the abdomen and femur was hypoesthesia, and the muscle strength of both lower extremities was grade 4.

Professor Zhang considered that the patient has medical insurance, and MRI can be reimbursed in hospital, but the reimbursement for MRI in outpatient is too low.

Therefore, Professor Zhang only performed a frontal and lateral X-ray of the thoracic and lumbar vertebrae in the outpatient clinic, showing that bone destruction can be seen at the upper and lower edges of the 9th thoracic vertebra, the upper and lower intervertebral spaces are narrowed, and widened soft tissue shadows can be seen in the paravertebral body.

Professor Zhang has rich experience and made a diagnosis based on medical history, physical examination and X-ray. He called Zhang Lin, who was on duty, and ordered him to perform an MRI on the patient.

This is thoracic vertebral tuberculosis and paraplegia. Emergency surgery is required to relieve the compression of the spinal cord by the pus, granulation tissue, caseous necrotic tissue and sequestrum in the spinal canal, so that the nerve function can be restored.

At present, the oppression time is not long, and if these oppressive substances are removed in time, the paraplegia can be completely recovered.

Judging from the X-ray, the compression material has entered the front half of the spinal canal. Once the anterior artery of the spinal cord is embolized, it will cause permanent damage to the spinal cord. Even if the operation is done perfectly, paralysis will be left in the future.

Zhang Lin arranged an emergency MRI of the thoracolumbar spine for Fang Xiaoyun. After the results came out, sure enough, it was the same as the speculation based on the X-ray.

The compressive substance was at the level of the thoracic 9 vertebral body and had entered the front of the spinal canal. Yang Ping immediately took Zhang Lin to find Fang Xiaoyun to talk about his condition. Emergency surgery was the best option.

Fang Xiaoyun's eyes were a little red, as if he was aggrieved and secretly cried.

Doctor, do I have to have surgery for this disease? Fang Xiaoyun asked.

Yang Ping said affirmatively: Surgery is necessary, or the lower body will be paralyzed in the future.

From the MRI point of view, the compression material has entered the front half of the spinal canal. Once the anterior artery of the spinal cord is embolized, it will cause permanent damage to the spinal cord. Even if the operation is done perfectly, it will leave paralysis in the future. You also You are so young, don't delay, we will arrange emergency surgery for you. Yang Ping did not scare, but objectively informed the condition.

Fang Xiaoyun's face is obviously hesitant, and it is difficult to make a decision: I think about it, can I give you an answer tomorrow morning, will it be alright to wait a night?

Wait one night, the impact will definitely be there, and this risk cannot be determined. If you can't make a decision now, try not to delay it for too long, give us an answer as soon as possible, and let us know if you have any questions.

Okay, thank you Dr. Yang, I will give you an accurate answer at 8 o'clock tomorrow morning.

Tell me after you think about it. Don't delay. If you have any difficulties, you can tell us. Zhang Lin felt that her demeanor was a little abnormal, her eyes were red, as if she had quarreled with someone and cried.

She came here on purpose for surgery, and now the emergency department is doing it for her, but she is hesitant to decide whether there is any secret behind it.

The doctor is not easy to ask questions, and can only leave a sentence for her.

After leaving the ward, Yang Ping told Zhang Lin: This patient should follow closely, it can't be delayed for too long.