The Godfather of Surgery

Yang Ping looked at the images one by one and said, Pain from the lumbar 5/sacral 1 intervertebral disc.

He put on the gloves handed by Song Zimo and examined the patient.

Wearing gloves for physical examination is Yang Ping's habit. It is not to pretend to be coercive or to dislike the patient. It is more strict hand hygiene to prevent cross infection.

After a circle of physical examinations, Yang Ping knew it.

The right groin was two centimeters away from the anterior superior iliac spine. Local tenderness and Tinels sign were positive. The symptoms were aggravated when the hip was extended, and the pelvic squeeze test was positive.

At that time, the system super training program cultivated anatomy, physical examination, instruments and laboratory examinations. The super training program laid a solid clinical foundation for Yang Ping.

Lateral femoral cutaneous neuritis! Call the ultrasound department to come and bring a bedside color ultrasound machine. Yang Ping took off his gloves.

Song Zimo immediately contacted the ultrasound department. Soon, a beautiful doctor from the ultrasound department walked over to the emergency elevator and pushed the color ultrasound machine beside the bed.

She put the color Doppler machine ready to start, Yang Ping said: I'll come?

You come to an orthopedic doctor to do a color Doppler ultrasound? Unheard of.

Yang Ping didn't say much. Under the suspicious eyes of the sonographer, he started to work, apply couplant, and probe along the lateral femoral cutaneous nerve. That method is simply a senior sonographer with decades of experience.

Dr. Yang can do a color Doppler ultrasound? The beautiful doctor stood aside and asked Song Zimo, she was very curious, she had never seen an orthopedic doctor do a color Doppler ultrasound.

It is not surprising that orthopaedic surgeons can take X-rays. A few doctors are very devoted to their business, and they also dabble in specialties. Some doctors are more proficient in X-ray projections than radiologists, but there are not very few orthopedic surgeons who can do color ultrasound. , but not.

Song Zimo stayed silent, the ultrasound probe roamed fluently, the probe stayed at the groin two centimeters from the anterior superior iliac spine, Yang Ping pointed to the image on the color ultrasound screen: Look, this is the lateral femoral cutaneous nerve, passing through the inguinal tendon. When the membrane was compressed, the nerve was edematous. There should have been contusion here before, which is the compression of scar adhesion. Arrangement of surgery, minimally invasive right lateral femoral cutaneous nerve radiofrequency ablation and release under local anesthesia, and at the same time the lumbar 5/sacral 1 Angiography and radiofrequency ablation of the intervertebral disc.”

In just ten minutes, a color ultrasound machine, the diagnosis was established, and the treatment plan was also clear.

Looking at the color Doppler image, who can understand the color Doppler?

Regarding color Doppler ultrasound, as a professor of Xiehe, Professor Hu Guolin knew some basic knowledge, but not proficient. Song Yun also knew a little about the others. Except for Song Zimo and Xu Zhiliang, who had received training from Yang Ping, no one was proficient in this stuff.

Even the doctors in the ultrasound department were surprised. To be honest, few senior doctors in the ultrasound department could see this kind of nerve compression.

Dr. Yang walked back and forth a few times and came to a conclusion.

Song Yun blushed and said, Dr. Yang, I don't know much about this color ultrasound. If you have time, you can tell me about it, starting from zero basics.

Song Zimo, take out that printed book and show them first. Yang Ping put the probe away, took out two tissues from the cart of the color ultrasound machine, and gave them to the patient. agent,

The patient pulled up his pants, and the previous scolding was completely gone: Dr. Yang, you were right. I fell on a motorcycle before and got scratched here. Is it related to this?

Relevant! Let's do a minor surgery, a minimally invasive surgery, and solve your problem in ten minutes. Yang Ping said in a non-negotiable tone.

The patient hummed and said nothing, as if he was transparent and could not hide anything in front of Dr. Yang.

As for the printed books, there are several books, but they are all Song Zimo's treasures. This is Song Zimo, according to the usual explanations Yang Ping gave him, organized and printed them and bound them into volumes.

One of them is the application of color Doppler ultrasound in orthopaedics, which is the popular musculoskeletal ultrasound today. Yang Ping's explanation is summarized.

Director Hu also opened his eyes. At Xiehe, the clinical foundation of doctors is second to none in the country.

They usually deal with the basic diseases of orthopedic patients, such as diabetes, hypertension, coronary heart disease, and generally do not need consultation, and any doctor in charge of the bed can handle them easily.

Why, with a good clinical basis.

If other hospitals, surgeons will read ECG, that is a long-standing myth.

At Concord, a surgeon who can't read an EKG is not a qualified doctor.

Comprehensive and solid clinical training, whether it is a common disease or a rare disease, allows doctors at Xiehe to handle them with ease.

There are some rare diseases that doctors in other hospitals have no concept of, but Xiehe even knows it clearly.

This is the confidence that Xiehe's comprehensive strength ranks first in the country.

This patient, in other hospitals, usually falls into a trap, but for Director Hu of Xiehe, both diagnosis and treatment are not very difficult, and they will not easily fall into the trap. time to analyze and compare.

It is absolutely impossible to be like Yang Ping, who can hit the spot in ten minutes, especially the color ultrasound operation just now, which does not reflect the general clinical strength.

With such a solid clinical foundation of Yang Ping, it is no wonder that one operation made Professor Liang unforgettable.

If Yang Ping's knowledge is a sea, Director Hu feels that he is just a lake.

Professor Liang saw people accurately, Director Hu couldn't help sighing, he didn't understand it at the time, it was just an operation, so he kept thinking about it and told himself that in addition to further studies, he had to complete another task - poaching people!

I heard that 301 has already acted, and Concord will do its part. Compared with the strength of 301, Concord is more moderate.

Speaking of the academic atmosphere, Director Hu has more confidence in Xiehe, and talents like Yang Ping will like Xiehe.

Back at the doctor's office, Song Zimo recalled the images and pictures, and Yang Ping took the opportunity to explain lumbar disc herniation to the young doctor.

This is not lumbar disc herniation, but lumbar discogenic pain and right lateral femoral cutaneous neuritis, lateral femoral cutaneous neuritis, which is very easy to be regarded as lumbar disc herniation, which has deceived many doctors, plus lumbar disc source Sexual pain, most doctors will jump into the trap. Yang Ping returned to the office and could speak without any scruples.

Lumbar intervertebral disc herniation is a syndrome manifested by disc degeneration, annulus fibrosus rupture, and nucleus pulposus herniation that stimulates or compresses the spinal nerve root and cauda equina.

It can be seen that lumbar disc herniation cannot be diagnosed when there are no symptoms of the spinal nerve root or cauda equina.

In other words, just low back pain cannot be diagnosed as lumbar disc herniation.

Lumbar disc herniation must have symptoms of spinal nerve root or cauda equina compression irritation.

But often a large number of patients with only low back pain are easily diagnosed with low lumbar disc herniation.

Many manifestations of radicular pain are symptoms of sciatica, but sciatica also has many other causes, and the two are not the same concept.

Therefore, even if there is a sciatic nerve, it is not necessarily a lumbar disc herniation.

This patient is an example.

If the spinal cord is likened to a wiring master, the spinal nerves are the wires coming out of the master switch, and the sciatic nerves are the wires that have left the master switch and are routed in the room.

There are several types of pain caused by lumbar intervertebral disc disease. There are discogenic pain, which is the pain caused by stimulation of the nerves of the intervertebral disc itself, the sinus vertebral nerve. This pain is manifested as low back pain.

Root pain means that there is a problem with the bus where the wire exits the main gate, which is compressed or stimulated by the lumbar intervertebral disc, causing pain in the distribution area of ​​this nerve.

There is also referred pain. The pain site is not in the same place as the diseased site, but because their sensory nerves are transmitted to the spinal cord, they are in the same segment. It can be understood that the two parts are led and supervised by the same center. When the nerves of one part are stimulated, the signals are transmitted to the spinal cord, and then to the brain. Send pain signals to both areas, and the other, okay area is also painful.

The pain caused by lumbar intervertebral disc can be roughly divided into three types, the first one is called lumbar discogenic pain, and the second is lumbar disc herniation.

As for sciatica, it can be caused by lumbar intervertebral disc herniation, or it can be caused by its own problems. If there is a problem in the walking route, it cannot be said to be lumbar intervertebral disc herniation.

For example, the piriformis syndrome, Mr. Yan is like this. After two years of trouble, the doctor and the patient are unhappy.

Yang Ping said, and drew the anatomical diagram of the lumbar spine on the whiteboard. It is easy for everyone to understand when talking about the diagram.

It is more beautiful and detailed than an anatomical map when you draw it casually.

Even if the herniated lumbar intervertebral disc compresses and stimulates the nerves, there are rules that can be followed. You see, the most common lateral lumbar intervertebral disc herniation affects the running root.

What is a deviated root, that is, it goes down through the intervertebral disc and goes out from the next intervertebral foramen.

The very lateral disc herniation affects the outlet root, which is the nerve root that just emerges from the corresponding intervertebral foramen.

The central type of disc compression is the cauda equina, and this type of symptoms is the most troublesome.

This type is what men are most afraid of! Director Hu was quite humorous.

Can lumbar disc herniation affect sexual function? Some students responded quickly.

That's right, it's just that men are hard to talk about this issue. Even if they ask, many people are reluctant to admit it and evade, so everyone doesn't pay attention to this issue.

No wonder, if the waist is good, so is she. Zhang Lin teased.

Xu Zhiliang glared at him, Zhang Lin immediately suppressed the smile on his face, did not dare to say more, and complained in his heart: Adjust the atmosphere, this guy is so serious.

The low back pain was sorted out by Yang Ping, like a mind map of elementary school students, simple and clear

Why does this patient need a discography during the operation? Li Guodong asked very well.

If it is disc-derived low back pain, disc imaging, contrast agents can induce low-back pain, or anesthetics can eliminate low-back pain, so that lumbar disc-derived pain can be diagnosed, the responsible part of low back pain can be found, and then radiofrequency ablation can be performed to destroy the sinus vertebral nerves, causing pain. Naturally eliminated. Song Yun helped explain.

Song Yun admired Yang Ping's ability to think like a cocoon. This patient has low back pain and radiating pain in the lower extremities. It seems that the diagnosis of lumbar disc herniation is beyond doubt.

This is the source of diagnostic errors.

Dr. Song told everyone about low back pain caused by lumbar intervertebral disc. Yang Ping encouraged everyone to discuss.

Guided by Yang Ping, Song Yun opened his mind: Lumbar disc herniation and lumbar muscle strain are becoming an abusive diagnosis, and both patients and doctors will be caught in this diagnosis.

With the advancement of follow-up diagnosis technology, it is believed that the most common chronic low back pain is discogenic low back pain, which makes the diagnosis of low back pain clearer.

Dr. Yang just said, in fact, the most accurate diagnosis of this patient should be: 1. Discogenic low back pain, 2. Right lateral femoral cutaneous neuritis.

Using discography, discogenic low back pain can be divided into endplate origin and annulus fibrosus origin. The so-called origin is the source of pain.

Song Yun's professional knowledge is very good, and then when it came to comparing the MRI films, he was inexperienced and asked Yang Ping for help.

Yang Ping asked everyone to come closer and look at the picture on the electronic reading screen: Look, on this cross-section, the HIZ high signal of the lumbar intervertebral disc high signal zone (HIZ) intervertebral disc, to see this image T1-weighted image and T2-weighted image should be seen, You can’t just look at one phase, if T1 is limited to low or isointensity, and T2 is limited to high signal, it means that the annulus fibrosus of the intervertebral disc is ruptured, and granulation tissue grows into the interior, and this granulation tissue signal is a landmark image.”

Indeed, I understand. Song Yun suddenly realized.

I read a lot of books and researched things that I haven't figured out for a long time. Dr. Yang now points it out in one sentence.

Then Yang Ping told Song Yun, from the perspective of pathology, the composition of granulation tissue, the imaging principle of MRI, the principle of artifact, the signal presented by granulation tissue on MRI, why this signal appears, and how to judge the onset time of the disease from the signal , how to identify artifacts, etc.

Especially when it comes to the principle of MRI imaging, it is estimated that the MRI maker will not understand so deeply, and then speak it in such an approachable language.

This training is right!

Song Yun saw that Song Zimo kept taking notes, so he quickly took out his notebook and took notes.

Lectures here, the operating room upstairs is ready, Li Guodong sends the patient to the operating room.

Song Zimo is the chief swordsman, Yang Ping is the guide, and everyone observes.

The operation only took ten minutes, and the results were immediate. The patient was no longer in pain, and could actually get up from the operating bed and walk back to the ward by himself.

A dispute was easily resolved by Yang Ping.

When Director Qin of Spinal Surgery received the news, he breathed a sigh of relief, and quickly called Yang Ping to thank Yang Ping. He kept reminding himself that this matter of wiping his buttocks should be cautious in the future.

The patient sent a pennant to Director Qin. It is said that he was going to go back at that time. Fortunately, Yang Ping helped to resolve it.

Director Gao of the Sports Medicine Center came over to practice arthroscopic microsculpture.

When I heard about this patient in spine surgery, I shook my head.

Old Qin, this kind of patient doesn't matter if you throw it over? In any case, you have to come over in person, follow Dr. Yang's explanation from beginning to end, and listen to Dr. Yang's explanation. You need help when you come to the stage, so that you can learn something, or you will fall into the trap next time.

I heard that Dr. Yang used a new surgical technique for children's cruciate ligament reconstruction in the United States. Director Gao waited for the opportunity to learn the curved drilling technique of children's cruciate ligament reconstruction with Yang Ping.

Laptops and U disks are always with you.