Dr. Yao and Dr. He have made preparations for surgery. Not only have the various pipelines been connected, but the focus and dialogue of the lens have also been adjusted.
Yang Ping came on stage and tried the lens, and the adjustment was very suitable.
I am indeed in a hurry. Since Su Nanchen has sent two instrument nurses and two doctors, there is no need to be polite. I will try my best to ensure the quality of the operation without delay.
The sharp knife opened the path and made two small openings on the anteromedial and anterolateral sides at once. Because he was so skilled, he directly used the sharp knife to penetrate the skin, joint capsule and synovial membrane. The three layers were in place in one step. As soon as the sharp knife broke through the synovial membrane, he stopped.
It will damage any structure in the joint cavity.
Most people use a sharp knife to open one opening, and after inserting the lens, they open another opening under the guidance of the syringe needle, so that the other opening can be opened more accurately.
But Yang Ping didn't use it at all and opened the two openings directly, because he didn't need a syringe needle to guide him and could open the opening in the best position.
Lin Hao frowned, this is not according to the regulations, it is a wild way.
The arthroscope goes in with a sheath. Dr. Yao has connected the inlet and outlet pipes in advance. There is no resistance when the mirror goes in. This shows that not only the opening is good, but also the surgeon is very familiar with the path through the opening and will not be confused by the layers.
Relative movement is blocked, especially by the synovial membrane. This causes the lens or instrument to be probed a little to find the direction of the path.
But Yang Ping did not need to test, he entered the joint cavity in one go without any obstruction, started arthroscopic examination, thoroughly flushed the joint cavity, and Yang Ping closed the outlet pipe.
The size of the two openings is very particular. If it is too thin, it will be difficult for the instrument to enter. If it is too large, the water in the joint cavity will flow out from the gaps around the instrument, and the small amount will accumulate, making the bag that collects the running water full of water. p>
Yang Ping's opening was very good, and not a drop of water came out of the gap. This means that the instrument just passed through, and the surrounding gap was properly closed by the synovial membrane. After the operation, it was clean, and there was no drop of water in the water collection bag on or off the stage.
Leaking water.
After some people's arthroscopic surgery, there is water everywhere on and off the stage, and it is a mess. Not everyone can grasp these details, and they are already a higher level pursuit besides surgery.
Starting from the suprapatellar bursa, every area in the joint will not be missed. Strictly follow the sequence, one by one. Every time the mirror moves, it will be exactly in the gap, without causing wear and tear on the cartilage, and it will move to the end of the target area at one time.
Optimal location to get the best view.
Yang Ping holds the camera with one hand and holds the patient's calf with the other, constantly adjusting his posture, and the coordination of his hands is impeccable.
Observing different positions requires different postures of the limbs. For example, the suprapatellar bursa needs to be in a straight position, while the medial joint space needs to flex the knee 20-40 degrees, abduct and externally rotate, and the lateral joint space needs to be in a figure-4 position.
Every time the camera is moved and the body posture is changed almost at the same time, the moving arthroscope will never be squeezed, blocked or rubbed due to changes in the limbs. Everything is very smooth, like a fish nimbly shuttling through aquatic plants without touching it.
A waterweed.
"Doctor Yao, Doctor He, start braiding tendons!" Su Nanchen directed.
Without his command, no matter how many people there are, they can't make a difference. These people, especially the two nurses, don't seem to realize that the pace is getting faster and faster.
"Prepare the guide pin and electric drill for the tibial tunnel in the next step! You have to report the size of the tendon!" Su Nanchen ordered the nurse and doctor.
If Su Nanchen hadn’t reminded us, no one would have reacted.
"Tibial tunnel, electric drill guide pin!"
Here, the intercondylar fossa was being cleaned alternately with an electric planer and a plasma knife, so Yang Ping notified them in advance to avoid wasting time.
As soon as the words were finished, the intercondylar fossa had been cleaned, but the electric drill guide pin was still in hand, because there were several people supporting the stage, and Yang Ping was completely out of tune to take care of each other.
Yang Ping looked at the screen, not at the equipment table. He didn't get what he wanted with his outstretched hand, and then he moved his palm up and down a few times to signal that the thing should be moved faster and not to hold it back.
When the electric drill guide pin arrived, Yang Ping immediately said: "Eight-strand double-bundle anatomical reconstruction, report the size of the two tendons to be implanted in the front fork, and then use the electric drill to drill the tibial tunnel."
Although Su Nanchen was directing just now, the two nurses did not pay attention to it and did not get into the state. Now the rhythm has begun to rush and they want to catch up, but it is very difficult. In this kind of cooperation, if one step is not connected well, it will affect the next step, unless the surgeon deliberately
Stop and wait.
Wow! I just said I wanted something, but after I finished my words, I really want something.
There is no need for a tibial locator. The guide pin directly opens the openings of the two tibial tunnels in the front fork, one for the anterolateral bundle and one for the anteromedial bundle.
Front fork reconstruction! There are many types, including single-bundle, double-bundle, isometric reconstruction, and anatomical reconstruction. The most advanced is the eight-strand double-bundle anatomical reconstruction, because research shows that the front fork is functionally and anatomically divided into two
Bundles - the anterolateral bundle and the anteromedial bundle, only the double bundles, reconstructed in an anatomical position, can restore function to the maximum extent.
For double-bundle anatomical reconstruction, in order to ensure the strength of the ligaments, one bundle must be completed with the quadriceps tendons. Two tibial tunnels and two femoral tunnels must be opened properly, which is very difficult. They must be opened at the anatomical position without interfering with each other. Dr. Yao and Dr. He were sweating on their foreheads. They were mentally prepared and a little better, but neither of them had ever been on Yang Ping's stage. They just heard Su Nanchen repeatedly say that they had to keep up with the rhythm. He operated very quickly. I have no experience of how fast it is. Now that the speed is so terrifying, I naturally feel stressed. After all, there are so many people watching, and it is so embarrassing for two people to not be able to keep up.
Measure, measure quickly! Two people knitted and sutured the two bundles of tendons at the same time, and finally managed to finish the knitting. It was better to prepare in advance and start as soon as the stage is opened. The next step of knitting the tendons will not be so fast.
Dr. Yao and Dr. He reported their measurements respectively. They didn't dare to rest or say another word. Su Nanchen had already put the tendons he wanted next in front of them and immediately immersed himself in hard work.
A row of large and small drill bits were spread out on the instrument table. The nurse started to look for the drill bit of the required size, and finally realized the pain of not being able to keep up.
The last two people greeted each other several times in advance but didn't take it seriously. Su Nanchen was a little angry. He was well-educated and wouldn't lose his temper with a nurse, but at least he was dissatisfied in his heart.
"Prepare the electric drill guide needle for the femur!" Su Nanchen ordered another nurse.
Today I prepared more surgical instruments than usual, including several electric drills and two instrument tables.
Finally, the nurse fixed the drill and handed it over to Yang Ping. Yang Ping directly opened the two tunnels on the tibia, and was about to open the two tunnels on the femur. Because Su Nanchen commanded in advance, the guide needles for the femur were more timely this time.
.
Yang Ping held the entry point of the femur, drilled in and out, drilled in and out again, just two times, in a few seconds, two tunnel paths were opened. Nothing was used, a locator! What is it? It is not used at all now.<
/p>
"Depth sounding!"
After Yang Ping measured the depth of the femoral tunnel, he determined the length of the two femoral tunnels based on the tendon size reported by them.
"Rough drill! Fine drill!--"
It's out of joint again. Two nurses prepare at the same time, one prepares the thick one, and the other prepares the thin one. The femur and tibia are different. The front part of each tunnel is thick to accommodate tendons; the back part is thin to pass through the suspension.
Hanging steel plates and hanging wires.
"Give me both sets of drill bits?" Yang Ping stretched out his hand for too long and the things hadn't arrived yet, so he put down his hand and took a rest.
I didn't look here just now. It turns out that it's not done yet. People haven't done it yet and they are urging me to do it. It will be bad. Su Nanchen will be embarrassed. He comforted: "It's okay. Take your time, don't be in a hurry."
Two tunnels and two sets of drill bits, one set thick and one set fine, are prepared at one time. Four electric drills are required.
What Su Nanchen was worried about has happened. It seems that when he was in Liquan Hospital, he had already controlled the speed of the operation, and now he still controls the speed. It is not at full speed. Even if several people are equipped with a table, they can't keep up. This is Appendix 1.
, it’s not Liquan Hospital, which is a bit embarrassing.
At this time, the head nurse came in, like a gust of wind: "Nan Chen, could you please change the equipment to another nurse, and transfer the one from Professor Ye over here, and the one from here?"
What does it mean?
Although Su Nanchen is well-educated and has a good temper, he is still a human being. Originally, he could not keep up with the pace here and the operation was delayed. He was a little dissatisfied and now he wants to be replaced.
Su Nanchen said solemnly: "We are still short of people here. Do you want to replace our people?"
In the head nurse's stand, the chief surgeon was waiting, and the doctors and nurses on the stage were busy. They could also see that the ones manning the table had not kept up with the pace. How many people were manning the table? Can't keep up with the pace? What's going on.
If it were anyone else, she would be showing the authority of the head nurse at this time. The head nurses in the operating room are all very good. They have the power to schedule surgeries in the operating room. Not to mention young doctors, ordinary directors who are not very tough have to give in a few points.
.
But getting angry with Su Nanchen?
I can't, I don't dare, my parents are the dean and the director of the nursing department.
Not to mention his father, the dean, he can't afford to offend his mother even with the three blue stripes on her hat.
The head nurse whispered: "Professor Ye is very angry now, saying that the nurse is not cooperating well, and asking for another one, Nan Chen?"
Some professors have good tempers, some have bad tempers, and some have bad tempers. If the surgery goes well, it's okay, but if the surgery doesn't go well, the doctors and nurses on the stage are miserable. If the surgery doesn't go well, it's all because you didn't pull the retractor properly and didn't support the leg.
Okay, the nurse did not set up the table properly.
"What are the key steps here!" Su Nanchen said angrily.
"There's no need to change, just transfer one over. We only need one nurse. It's still early." Yang Ping saw that the atmosphere was a bit tense, so he tried to mediate it. Originally, there were two nurses here, so he was a little embarrassed. If she hadn't had no choice, the head nurse wouldn't have come over and made this request to Su Nanchen. When she spoke, her face was always red, her voice was still low, and she kept asking for advice.
These nurses are all the most familiar with arthroscopic surgery. If they ask others, they will be scolded on the stage. In fact, the person who arranges the stage for Professor Ye is already the best at the business, better than these two. "Okay, you make arrangements!" Su Nanchen nodded.
It was hard to offend both sides, and they were in a dilemma. When Su Nanchen agreed, the head nurse breathed a sigh of relief.