9 In the operating room, Professor Ye, Director Guan and Chen Ge were undergoing surgery.
This surgery was also a quadruple reconstruction, and the intercondylar fossa was deformed. When the femoral tunnel was opened, the medial femoral condyle was split, which caused trouble.
Let Professor Ye do it, this problem will not occur at all. The operation lasted half an hour and the rear fork was reconstructed. Chen Ge wanted to try it. Chen Ge is Director Guan’s doctorate, and he can be considered Professor Ye’s nephew, not to mention that he is in the third hospital.
I also studied with Professor Ye for a year, so it doesn’t matter if I let him try.
Because the posterior fork reconstruction is also double-bundled, there are two tunnels on the medial condyle of the femur, so the tunnel location is quite crowded. Chen Ge was inexperienced, and Professor Ye was a little careless. Once the tunnel was opened, it collapsed and the medial condyle was split into three.
block, and cut the drill bit inside.
Now the broken drill bit needs to be taken out from the bone. When Yang Ping and Su Nanchen went in, Professor Ye had just finished the fluoroscopy and determined the position and direction of the drill bit.
Professor Ye didn't speak, and Chen Ge and Director Guan didn't speak either. They both frowned. There were many people surrounding the operating room, observing.
Su Nanchen pointed to the patient, and the anesthesiologist said, "He's under general anesthesia!" It was much easier to speak this way.
Professor Ye looked at the image on the C-arm X-ray machine screen and wondered how to remove the drill bit. He wanted to remove it minimally invasively, that is, without incision, but under arthroscopy, which was very difficult.
How did you get this drill? Professor Ye was scolding his mother in his heart, and now he has the urge to vomit blood. If this were in the Third Hospital, he would probably scold Chen Ge like a bastard when he stepped down.
Removing the drill bit is still the first step. After removing the drill bit, you need to fix the fracture. After fixing the fracture, you need to open the tunnel again. Generally speaking, only the posterior part of the condyle is split, which does not affect the suspension fixation. Now the entire condyle is broken.
Oh, it’s so troublesome.
Su Nanchen looked at the screen and was speechless. This patient did not have osteoporosis, let alone tumors and other pathological factors. The medial condyle was shattered into three pieces.
In this case, each step can be regarded as an independent and difficult operation. The combination of several steps is very difficult and daunting.
If it weren't for Professor Ye, who is one of the best in the country, he would probably have given up on the surgery. He would just cut open, take out the drill bit, fix the fracture, and wait for a few months, at least three months, for the fracture to heal well before doing the surgery.<
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Professor Ye is worthy of being one of the top players in the country. He is unhurried and calm. He reaches into the joint cavity with a nucleus pulposus forceps, takes a little bit from the bone, and hands it to the nurse, who takes it with saline gauze.
Professor Ye confessed: "Send to pathology!"
This kind of unexpected fracture should not have occurred. Once it occurs, as a rigorous professor, he must consider pathological factors, especially tumors. Although visual inspection is not correct, there are many things that cannot be calculated by visual inspection. For the sake of caution, Professor Ye took a little
Bone tissue undergoes pathological examination to rule out tumors.
Removing the drill bit under arthroscopy is a difficult technical task. Most doctors cannot do it. They have to make an incision to take it out. However, Professor Ye seems not to be prepared to make an incision. He plans to use arthroscopy to remove it.
The camera found the best angle, and saw that the drill bit was stuck in the bone tissue, and a little bit was exposed. The intercondylar fossa was like a hole. What was buried in the wall of the hole could not be taken out if you wanted to, and the instruments could not reach it.
It can't be used, it's stuck in the bone.
This drill bit is hollow. Professor Ye took a guide pin and passed it through the hollow hole in the middle of the broken drill bit under the surveillance of the arthroscope, to the inside of the lower end of the thigh, through the skin, and poked it out.
"The thinnest drill bit!"
Professor Ye inserted the thinnest drill bit along the exposed guide pin on the inner thigh, made contact with the broken drill bit, held the tip of the broken drill bit, then removed the electric drill and pushed the guide pin flush with the tail of the thin drill. p>
"Hammer!"
Professor Ye tapped it gently with a hammer and slowly broke off the drill bit to get it out.
As expected, he is a master. In other hospitals, this kind of drill would either not be removed, or it would take a long time to remove it by incision.
Using this method is very clever, but it requires rich experience and feel, otherwise not only will it not be taken out, but it will also cause new fractures.
It only took a few minutes for Professor Ye to easily take out the drill bit and hand it to the nurse: "Align it with the other half and see if it can be aligned? Prepare the C-arm machine for fluoroscopy."
When the two halves are put together, if they can match up, it means there is no residue. If they don't match up, it means there is still residue.
Sure enough, the operation was performed carefully and meticulously. After taking it out, the broken end was also examined through fluoroscopy to ensure everything was perfect.
The drill bit was taken out. It seems that nothing happened to Yang Ping. Su Nanchen thought that Professor Su asked Yang Ping to come to the rescue. Now it seems that nothing is wrong, so I won’t waste his time.
"Professor Su, if nothing happens, I will send Dr. Yang back." Su Nanchen asked carefully.
Professor Su said: "Wait!"
Then he turned to Yang Ping and said, "Xiao Yang, please wait a little longer. Is the surgery at home urgent? What kind of surgery? Can Nan Chen go over and help?"
Professor Su has said so. It seems that there must be other things to keep him here. Yang Ping is not in a good position to leave: "It's okay. They can do the surgery. They just want me to check it. It won't be a problem if it's late."
"Professor Su?" Su Nanchen meant, nothing happened, let him go back.
Professor Su waved his hand, no longer explaining, and ignored Su Nanchen.
"Watch carefully! See how Professor Ye adapts to the situation and handles this situation."
Is it possible that Yang Ping was kept here just to let him learn from Professor Ye? How to deal with this rare accidental crushing fracture of the medial or lateral condyle during quadruple reconstruction?
"Xiao Yang, please arrange things at home." Professor Su ordered again.
Yang Ping responded, "Professor Su has spoken, what else can you say? Just follow the instructions.
"How about it? Keep doing it? Or wait three months?" Director Guan took the opportunity to ask.
In this case, it is usually treated as a fracture operation, and the fracture is fixed. After three months, the fracture is healed, and then ligament reconstruction is performed. If it continues, the difficulty of the operation will not only increase, but there will not be much space for tunneling in the remaining bone.
, and even if there is space, many of them are operating dead ends, and a good tunnel cannot be made at all, so the operation will not be effective.
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This kind of surgery is not just about rebuilding the ligaments, it also needs to ensure the effect. It's like doing a test paper. You don't pursue the score, just fill up the test paper. How easy it is. If you pursue the final high score, you are not pursuing the final high score.
Just fill out the test paper.
"Continue! Is the patient under general anesthesia?" Professor Ye confirmed again.
"He's under general anesthesia!" the anesthesiologist replied.
Professor Ye took a short break. The doctor in the audience was pushing the C-arm machine for fluoroscopy. Everyone moved away to make room.
"I always say that there is no big or small operation, and you must be careful every step. We surgeons are walking on thin ice every step. You see, if you are a little careless, something will go wrong. If the operation is stopped like this, and the patient comes off the stage with a fracture, how will you explain it?
?How do you explain it? It will delay the recovery time, affect the season, and leave new problems." Professor Ye's tone was quite good, he just reprimanded, not scolded.
"C-arm machine, push hard, go higher, come in this way!" Chen Ge had a bad temper. He was holding his anger in his heart and vented his anger on the little doctor who was pushing the C-arm.
Although Professor Ye has a big temper, he doesn't lose his temper randomly. He is a rather harsh type. If you don't do well or don't get what he wants, he will scold you.
"Chen Ge, what are you doing?" Director Guan saw that Professor Ye looked wrong and stopped Chen Ge.
Sure enough, Professor Ye got angry and glared at Chen Ge, saying that he had caused trouble. Everyone helped him wipe his butt, and he even cursed at the doctor below.
If Professor Su hadn't been around, Professor Ye would have cursed, but Professor Su was around. Although he was Chen Ge's uncle, he was also a foreign guest, so it would be inappropriate to scold the doctors under him in front of Professor Su.
Everyone came out of the operating room, finished the fluoroscopy, and went in to see that the drill bit had been completely taken out without any residue.
"Prepare cannulated screws, which are usually used for fractures of the internal and external femoral condyle to fix the fracture."
The C-arm machine exited, Professor Ye returned to the position of surgeon, and everyone returned to their positions.
This kind of fracture through the articular surface, some of which still have cartilage, requires a lot of skill in fixing it. Not only must it be fixed well, but the position of the nail must not affect the next step of ligament reconstruction and tunneling. The nail head or nail tip must also be countersunk and cannot be exposed.
.
This step of minimally invasive arthroscopic reduction and fixation of fractures is also very difficult. Professor Ye used grasping forceps to grab a bone fragment. The grasping forceps were very small. Generally, he was not very skilled in using them. He could not grasp such a large bone fragment at one time.
He grasped it firmly and put it in its original position. The forceps were loosened. Before the bone fragment could loosen and fall off, Professor Ye used the end of the closed grasping forceps to hold the fracture in an instant. The operation was like performing acrobatics. p>
"Guide pin electric drill!"
When fixing this bone block, you cannot drive the guide pin from the inside, because the intercondylar fossa is an arched fossa, which is equivalent to a hole. There are some dead ends from the inside to the outside. This bone block is in a dead corner, and you can only go in from the outside.
Type in.
When you penetrate from the outside in, you encounter the same problem as Yang Ping's tibial tunnel. You have to snipe the target behind the wall through a thick wall.
The difference is that Yang Ping's goal is a point, and now Professor Ye's goal is a circle. Whether it is a point or a circle, it is very difficult!
From the outside, he pierced the guide needle through the skin and muscle, against the bone cortex, thought for a moment, and then repeatedly moved the insertion point and angle of the guide needle, sometimes looking at the electric drill and guide needle in his hand outside, and sometimes looking at another person on the screen.
A bone fragment held with a grasping forceps by one hand.
After adjusting it many times, the electric drill started to rustle, and the guide needle drilled through and hit the bone. It came out from a good position. It was amazing! Everyone was amazed and almost cheered.
This bone fragment is relatively small, so one screw will suffice. The upper screw can only be moved from the outside to the inside. After measuring, I picked a half-threaded hollow nail and screwed it in. It just fixed the fracture. I fixed it with tight pressure. The tip of the screw
It enters the subchondral bone but is not exposed.
He is well-deserved to be the first-class in the country. When encountering this kind of thing, most experts think it is a disaster, and they surrender directly and are forced to give up the operation. But he can continue easily, and judging from the level of handling, he has reached the top.
Only a few people in the country can snipe the circle behind the wall and drill into a steel needle to this level, and even fewer can do it in one go.
Senior brother is indeed very powerful. Director Guan was impressed by this operation. Chen Ge lowered his head and was glared at by Professor Ye and Professor Guan from time to time. How could he dare to lose his temper?
There were three bone fragments in total, and the other one was about the same size. Professor Ye used the same method to fix the bone fragment with a hollow nail. The last one was larger, and two screws were used, but they were guided from the outside to the inside.
The needle penetrated accurately in one go and the position was good.
"Okay! Re-open the femoral tunnel!" Professor Ye put down the screwdriver and moved his wrist.
"Do you still have double beams?" Director Guan asked.
It is already very difficult to continue to double-beam, and three problems lie ahead.
One problem is that there are four screws occupying the space of the medial femoral condyle bone tissue, and the tunnel is easily blocked by the screws.
Another problem is that all three bone fragments have been reset, but there are several fracture gaps, and the tunnel is opened into the gaps, which is not good.
There is also a third problem. Suspended steel plates require a certain thickness of leather to withstand it. There are not many such places in suitable areas now.
"Of course -" Professor Ye has no doubt.
If you switch to single-bundle reconstruction, the surgical effect will be compromised. This is a professional athlete. People seek him for surgery because they pursue high quality. If he compromises on the quality of the surgery, Professor Ye can't do it.
His professional conscience does not allow it, and he cannot do this for the sake of his own reputation.
Fluoroscopy! Another C-arm X-ray machine fluoroscopy. The purpose of fluoroscopy is to see the distribution of several screws and to prepare for tunneling to avoid the screws.
"Guide needle! Open the femoral tunnel!"
Professor Ye inserted the guide pin through the outer port and estimated the point.
I tried several times and shook my head, but no, the exit point is not in the safe zone. The exit point must be in the safe zone, otherwise there is not enough thickness of the cortical suspensory ligament, and the cortex can be easily torn.
Changing the angle again, from straightening to extreme flexion of the knee joint, will not work.
Not from the outer opening, but from other positions, piercing the skin and penetrating it. Professor Ye has tried almost everything, but it still doesn't work.
The best position for this tunnel currently only has one direction, and there is no room for adjustment. This direction is the dead corner, which is too tricky.
It seems that the only way to penetrate from the outside is to use the technique of sniping through the wall. Last time, the target of the sniper was a circle, but now the target of the sniper is a point. The difficulty has been upgraded.
I made a profit today. I saw the top experts in the country perform magic tricks, sniping through walls, or sniping at a point. This is a magical operation.
The people observing the operation were all experts, and they all waited patiently for Professor Ye's wonderful performance. The operating room was very quiet, and the circulating nurses walked very lightly.
Professor Ye reached in with a ruler, measured the medial condyle several times under the microscope, planned out several lines, and used the intersection points of the lines to find the anatomical center of the ligament footprint. He then used a plasma knife to burn dot marks at this point.<
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Song Zimo didn't press, and Yang Ping didn't call back. He just kept watching, watching the entire process that Professor Ye just performed. It was really the top level in the country.
Professor Ye held the electric drill firmly without any shaking. The way he held the electric drill was also strictly trained. The guide pin was against the medial condyle of the femur and the cortex on the inner side of the lower end of the femur. There was no trembling or shaking in his hand.
Moving, very stable.
After adjusting the position and direction of the guide pin many times and observing repeatedly, Professor Ye finally pulled the trigger.
Swish! The guide pin was driven in, and the point where it came out was about 5 mm away from that point, which means it was deviated by 5 mm. If anyone else had thought it was very successful, the tunnel could be opened.
But he is the first-class player in the country. How can he accept this 80% score? What he wants is 100%.
The guide needle exits and comes again. This time the distance is closer and the error is smaller, about 3 mm.
