The silence was short-lived, and the discussion continued, tense and intense.
Academics don't have so many twists and turns. Sometimes everyone will quarrel, slam the table, everyone's face turns red, and no one is convinced.
With Professor Su in charge of this meeting, there will naturally not be such an explosive situation, but debates are inevitable.
"Director Han, what do you think?" Director Zhao asked.
Director Han's body was upright, like a general holding a pre-war meeting: "The best way is to perform nerve root block, but to avoid leakage of anesthetic, nerve root sheath puncture and cannulation must be performed. It is very difficult, but it is still feasible.
Sex."
The problem was drawn to the nerve root block. The director of the cancer hospital slid the tablet with his fingers and held his chin with the palm of his other hand. He looked at it for a moment: "This nerve root block is really difficult. I see that the tumor tissue is very rich in blood vessels.
The patient's coagulation function is also not very good. If it is inserted by mistake and enters the tumor tissue, it will cause uncontrollable bleeding, form an intraspinal hematoma, compress the spinal cord, and also cause respiratory depression. In the end, the work will fail and the ventilator will be put on. You see, the surrounding soft tissues
They are all tumors, and the space left for puncture is too small, so it is easy to accidentally puncture and cause bleeding."
"Well, it's true. This kind of puncture is just like a sniper. It must be hit with one shot. There can be no mistakes. One mistake will have serious consequences." Director Yu, the director of the Orthopedics Department of Appendix 2, agreed with the opinion of the cancer hospital.
There is a plan in sight - nerve root block. It seems that no one can come up with other plans except this, but the difficulties are also facing us, and they are not small difficulties.
Everyone looked at Professor Su and handed the problem to Professor Su.
Professor Su held the tablet with his left hand, put his right elbow on the table, took off his glasses, raised his head and said: "Everyone has talked in detail. It seems that nerve root block is the only option, and no one has any objection. The difficulty lies in the difficulty of puncture.
, is indeed very large, but it is not impossible. We need to use the three-dimensional reconstruction of CT and MRI to find a way to choose a correct puncture approach. With the help of computer-aided navigation technology during the operation, puncture can be achieved! p>
Puncture is difficult, but it can be achieved, this is Professor Su's conclusion.
"What should I do if it fails? What are the rescue measures?" Director Yu in Appendix 2 has a different opinion.
Professor Su took a piece of lens cleaning cloth, wiped his glasses and said: "This is a very good question. There are risks in any medical operation. Faced with risks, we must try our best to prevent them and have backup rescue measures. If the puncture fails, enter
If the tumor causes bleeding, we will abandon the puncture and place a drainage tube in the puncture path, which can bring negative pressure and drain the blood to avoid the formation of hematoma and compression of the spinal cord."
Professor Su has an active and meticulous mind. He has made plan choices, risk control, and worst-case rescue methods in a short period of time. Director Yu admires him deeply.
This puncture is far from simple as imagined. How to achieve it can reveal a person's thinking ability and the accumulation of daily knowledge and experience.
Just like firing a shot with a sniper rifle, it is not as simple as pulling the trigger. Every time you pull the trigger, it is the result of hard work.
"Do you have any other opinions?" Director Zhao asked as the host.
Director Han smiled and said: "You two young men, do you have any opinions? Please speak up and say a few words, don't say anything."
Originally, it was not convenient for Professor Su to let Su Nanchen speak on this occasion, so it would be good to just sit in. Now Director Han took the initiative to suggest that it would be okay to let the young people exercise. Professor Su said to Su Nanchen next to him: "Senior gives you such a precious opportunity, you
Any good ideas?"
Su Nanchen was confident but not arrogant, and said calmly: "Thank you Professor Han for giving me the opportunity to speak! This puncture is really like a sniper attack, the enemy is still hiding in the bunker, the puncture must avoid both the tumor and the bone tissue.
The choice of puncture path is very limited. If conditions permit, you can use 3D printing technology to print out the reconstructed spine, tumor, and nerve blood vessels, and use a one-to-one accurate printed model to design the puncture approach, simulate puncture, and even temporarily design positioning
If the navigation device is used during the operation, the success rate of puncture will be greatly improved."
This young man has a really good mind and can combine cutting-edge 3D printing technology with puncture, and according to what he said, the success coefficient can indeed be doubled.
Several directors looked at Su Nanchen with admiration. Even without Su Qingyun's help, he could still make great achievements in medicine.
Professor Su put on his glasses again: "Xiao Yang, what do you think."
Professor Su has a very good memory. Director Han only introduced him once and he remembered the names. Whether he was caring for young people or reciprocating kindness, he should name them and let them speak.
Director Han encouraged: "Professor Su has called your name, please say a few words."
"Xiao Yang, tell me your opinion?" Director Zhao also encouraged.
Yang Ping also said calmly: "Thank you, Professor Su, thank you all! I think that the puncture does not need to avoid the bone tissue, but passes directly through the bone tissue and through the vertebral pedicle. The bone tissue is the safest, as long as the puncture needle is in
In bone tissue, there is no risk of damaging blood vessels. You don’t need to know where the reef is, you just need to know where there is no reef.”
The pedicle is a bony tube connecting the front and back of the vertebrae. It is made of hard cortical bone on the outside and loose cancellous bone on the inside.
This point of view is very novel and breaks the convention.
"Since the enemy is hiding in the bunker, which is a blind spot for our ballistics, we accurately calculate the enemy's position in the bunker, shoot at the wall of the bunker, penetrate the wall, and then let the bullet pass through the hole in the wall to snipe the enemy. Thank you
Everyone." Yang Ping finished.
Professor Su looked at the three-dimensional reconstructed image on the tablet again. This idea is really imaginative. The entire puncture path is in the bone tissue, and the bone tissue is penetrated in the last step. In this way, the possibility of accidental puncture is not reduced, but completely solved.
There is almost no possibility, the only remaining problem is how to hit the enemy.
This chapter is not over yet, please click on the next page to continue reading!
Puncture from the pedicle is a basic technique for any spine surgeon. If you insert pedicle screws every day, the possibility of failure is extremely low. However, you cannot use the conventional pedicle approach, which requires tilting. The ultimate goal is to
Inside the tube, not inside the vertebral body.
Professor Su was very interested: "Xiao Yang, your idea is very imaginative and very feasible."
"Transosseous and transpedicular puncture, if combined with Dr. Su's 3D printing and simulated puncture, the success rate will be very high, and there will be no problem with feasibility." Director Han synthesized the opinions of the two people.
The director of the cancer hospital laughed: "Young people still have imagination. One brought out 3D printing, and the other proposed sniping through walls. It's interesting. It seems that we are getting old."
Director Yu joked: "I saw that you just drank two bottles of water for a while and had no intention of going to the bathroom. I really don't see how old you are."
Everyone laughed, which was a relief from the tense discussion.
"The puncture path is clear, and there are ways to improve the success rate of puncture. All that's left is to take action. Do you have any other opinions?" Professor Su asked everyone.
At this point in the discussion, the issue has become very clear.
"Transosseous puncture has no possibility of accidentally injuring the tumor, and the possibility of bleeding is also minimized. However, bleeding cannot be completely avoided. The puncture path is all cancellous bone, which will cause bleeding. In the end, the puncture needle does not enter the vertebral body, but breaks through at an angle.
Bone tissue enters the spinal canal, and blood may flow into the spinal canal along the puncture tube, forming a hematoma and compressing it. The possibility is rare, but it is still possible, and a plan is needed to deal with it." Director Yu discovered the loopholes in the plan. p>
"This kind of bleeding is different from bleeding from blood vessel rupture. It is bleeding from the bone surface. Use a catheter with a local balloon, calculate the distance, coat the outside of the balloon with bone wax, put the balloon part into the bone tunnel, and inflate and compress after the catheter is placed.
Stop the bleeding." Professor Su said immediately without much thought. The countermeasures he came up with on the spot showed how extensive his knowledge is.
"Wonderful!" Director Yu blurted out.
There are also unexpected remedial measures, and the plan is very complete.
"Professors, do you have any questions?" Director Zhao asked.
Everyone shook their heads and drank water.
Director Zhao finally concluded: "Then make a plan: thoracic 2 nerve root block, transosseous puncture catheterization, preoperative 3D printing simulated puncture, and intraoperative computer navigation assistance!"
"Professor Su, do you think this is okay?" Director Zhao asked Professor Su for his opinion. He was only in charge administratively, but he still made the decision professionally.
"Okay, let's use this wall sniper plan!" Professor Su made the final decision.