0307 Chapter too handsome (pulling the sled for the silver wolf
"Let's talk again in the next segment!" Director Qin is the chief surgeon, so he will naturally show courage at critical moments.
If you are wrong, it won’t be too far wrong. It should be one section off. If there is an error, it won’t go up. It should be going down.
After removing the lens and working cannula, Director Qin made another small opening on the left side of the next segment, punctured the path, expanded the channel, inserted the working cannula, then inserted the lens, and the plasma knife cleared the field of view and gradually entered the spinal canal. There is nothing, everything is so normal that it makes people panic!
Just now I could still see the ruptured annulus fibrosus, but now I can see the normal structure in my field of vision. Director Qin’s hope was shattered like a soap bubble. It’s impossible to blindly punch two rows of holes in the patient’s waist.
In desperation, Director Qin caught a glimpse of Yang Ping out of the corner of his eye. This guy said that he didn't know how spinal surgery was, so he wanted to give it a try: "Xiao Yang, look, it still doesn't work, what should I do?"
At this time, for the sake of the patient, Face had already been forced to sell at a reduced price. Although Director Qin was embarrassed, he still had to speak out.
Although Director Qin knew that he was left here just to wait for this moment to speak, but when it came time to speak, he still felt a little uncomfortable.
Face is a wonderful thing. Even if you know it is worthless, you have no choice but to take good care of it all the time, for fear of scratching your skin.
Yang Ping is looking at the MRI film carefully: "Prescribe an Onipex and perform intraoperative myelography!"
This sentence is enlightening. Why didn't I think of this? Since the popularization of magnetic resonance, myelography has almost disappeared from the brains of orthopedic surgeons. In this era, who still does myelography.
However, at this moment, myelography is the best method. If you see such a big thing on the magnetic resonance imaging, it can disappear out of thin air. You can understand everything by doing an imaging, and then locate it based on the imaging.
"Wipe the sweat for me." Director Qin moved his head away from the sterile area and printed it on the tissue of the circulating nurse.
There is no need for a heavy hammer when playing drums. They are all experts. They can point out the ideas for solving problems in one sentence. This guy also has two brushes in spinal surgery.
Director Qin felt much more relaxed and immediately regained his confidence: "Onipex, bring me a 100ml bottle. Anything less is useless."
Director Qin is still familiar with Onipex and iohexol injection, an iodine-based X-ray contrast agent. He often uses it for vertebral angiography when performing percutaneous kyphoplasty, but intraspinal angiography,
I have never used this method before, so I can’t think of it.
"Isn't it sterile?" a doctor in the audience asked.
Director Qin was furious: "I usually use the brain for many purposes. Injections can enter the blood vessels of the human body. Do you think it is sterile?"
The doctor who asked the question blushed. Indeed, injections can be injected into human blood vessels. How could they not be sterile? Such an idiotic question must have confused his head just now.
The circulating nurse opened a 100ml bottle of Onipex, and the equipment nurse used a large 50ml syringe to draw out two full tubes and put them away for later use.
The patient is lying on his stomach and is now a little tilted. Director Qin returns to the first approach, establishes the working cannula, inserts the lens, injects Onipex into the spinal canal, and waits for a while to allow it to spread evenly. "Perspective, look at the situation."
The G-arm machine was pushed in. The transmitter and receiver near the surgical area were covered with sterile protective films. Dr. Wen directed the operator to adjust the position.
"Hurry up, avoid it!" Dr. Wen drove people away.
The operator stepped on the foot pedal at the door, and everyone filed in again. The contrast image on the screen was clear, and the intervertebral disc appeared on the right rear side of the lumbar 45 gap.
"Today was unlucky. I have been doing this kind of surgery for ten years and I have never encountered anything like this. The intervertebral disc moved in the spinal canal. During the examination, it moved to the lumbar 12 position. During the operation, it moved to the right back side of lumbar 45.
"Director Qin couldn't laugh or cry.
If it weren't for Yang Ping's prompting today, I would really have fallen into a fixed mindset. In the end, the surgery was forced to be a switch surgery. I wanted to save face, but in the end, all the face was lost.
"Dr. Yang, you are so open-minded, we were almost fooled by this guy." Director Qin is also a sweet-tempered person.
Yang Ping reminded him: "This situation is indeed rare. Such a large thing can be moved freely inside, so be careful, lest it escape again later."
The nerves that had just been relaxed were tightened again by Yang Ping's words. Director Qin was now frightened and became a frightened bird.
The patient's upper body was not anesthetized and could move. Maybe he had been lying down for a long time. The patient moved a little, and the anesthetist immediately shouted: "Don't move around. If you feel any discomfort, tell me."
"Puncture and open the path from the right side of waist 45. This is not a high iliac crest, so it should be easier to open the path." Director Qin wanted to take a break and let Dr. Wen perform the puncture.
After thinking about it, he decided to do it himself: "Wait, I'll do it." Director Qin took the puncture tool.
Fluoroscopic positioning, puncture, after several fluoroscopy, the position is correct, then the hole is opened, the working channel is established, and the lens is inserted into the spinal canal.
No free intervertebral disc was seen! The spinal canal imaging just now clearly showed it here.
I stepped on dog poop today. Director Qin's hand was a little stiff: "The contrast agent is still in it, let's see it through again!"
Yang Ping is very calm. He has seen and done this thing a lot, so he naturally doesn’t panic. Director Qin can only perform thousands of spinal endoscopic surgeries, which are still routine. He has 500,000 points, and he will not engage in prodigal surgeries.
Simulation is just for training surgery. No matter how you play now, you will not make yourself poor. If you have nothing to do, you can wander around the system space and perform all kinds of strange surgeries. How can you not be calm?
It's just like fighting. It's definitely different if you practice in the flames of war every day. There are shells exploding all around you, and bullets pass by your hair, but you can still smoke a cigarette calmly.
"Add some contrast agent and see for perspective!" Someone was supporting him from behind, Director Qin's center of gravity was very stable.
Looking through the X-ray, everyone just wanted to laugh. The intervertebral disc has reached the left rear side of the lumbar 45 space. Is it necessary to drill holes on the left side of this segment?
Director Qin turned to Yang Ping for help: "This problem! How to solve it?"
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"Pull it from the opposite side. The spinal canal is only that big?" Yang Ping thought this was simple.
Blind practice? Transforaminal microscopy is absolutely prohibited.
"If it's a ponytail and you pull it out, you'll be in big trouble." Director Qin was very worried.
Can’t tell the difference between the touch of the cauda equina and the nucleus pulposus of the intervertebral disc?
Yang Ping was a little confused, and suddenly he remembered that he could do it with his touch, but others certainly couldn't. He had extensive surgical training in a systematic way, and he had become proficient in everything. How could others compare with him?
"Since the range of motion is so great, it means the compression is not severe, so why are the symptoms so severe?" The doctor in the audience didn't understand.
Dr. Wen had no choice but to educate himself: "Some people sleep with each other for several years without getting pregnant, and some people get pregnant after sleeping with each other for just one time. What's the reason?"
"Don't move, brother! Anesthesiologist, give me some sedatives!"
The patient moved again and Dr. Wen shouted.
"How about I do it?"
Yang Ping took the initiative to ask for help. If we continue to do it, not to mention that if the intervertebral disc gets stuck in that corner, just by repositioning the fluoroscopy, the patient will also need more rays.
At this time, Director Qin thought about it. This operation was really difficult, and it would be nice to have an expert help him.
I can’t even get out of the operation, so what else do I need to save face?
"How about? Dr. Yang, you come." Director Qin agreed.
"Do you want me to come on stage?" Xiao Su said softly.
"It only takes a few minutes, wait for me below the stage."
At this time, Xiao Su looked at Yang Ping, who was absolutely the most handsome man in the world. No matter how difficult the operation was, he was as stable as a rock and made it a breeze.
Wash your hands and get dressed and go on stage.
This kind of surgery can be completed by just one person, no assistant is needed.
Yang Ping came on stage and slightly adjusted the working channel and lens.
I inserted a nerve stripper and fiddled with it a few times. For some unknown reason, the free intervertebral disc appeared in my field of vision.
Then switch to the nucleus pulposus forceps, and steadily, actually remove the entire piece at one time, put it into the saline gauze handed over by the nurse, rinse it, use the plasma knife to stop the bleeding, and then remove the instrument and working sheath.
Put the sheath tube into the left passage of Lumbar 12, and insert the nucleus pulposus forceps from the back of the ruptured annulus fibrosus of Lumbar 12. Use one mouthful on the left and one on the right. The mouth of the forceps is not empty, and a part of the intervertebral disc is removed, and then the annulus fibrosus is formed.
, and finally, with the thecal sac and nerve roots as the center, completely decompress their cranial, caudal, ventral, dorsal and contralateral sides.
Director Qin was a little dazzled by what he saw. Yang Ping's transforaminal microscopy technique was not only good at doing it, it was simply a few levels ahead of him.
The instrument is in the spinal canal, and you can operate it however you want. At this level, all problems in the spinal canal can be solved under the transforaminal microscope, and then combined with percutaneous pedicle screws, the intervertebral fusion device can be placed under the microscope.
What kind of surgery will be needed on the spine in the future?
"It's over!"
Yang Ping put down the equipment and solved the problem in a few minutes.
Director Qin had to accept it. Gods are gods. He can become a legend in the hospital. He still has some talent. He doesn’t have more than ten years of surgical experience in this transforaminal microscope. I’m afraid he won’t be able to practice it. Young man, how can he have so many?
Practice for him during surgery?
While Director Qin was thinking, Yang Ping had already begun to take off his clothes and gloves. Xiao Su followed to help.
So handsome!
Every time he is on the operating table, the invincible mode that Yang Ping displays is really cool.
"Rinse it again and suture it," Yang Ping warned.
Director Qin looked at the removed intervertebral disc and the nerve roots that had been fully decompressed. The level of this surgery could be regarded as his own teacher. This is not trauma orthopedics, but spine surgery and foraminal endoscopy, which he has been doing for ten years.
.
"Dr. Yang---Thank you for your hard work---"
Director Qin is sincerely grateful. If he had been allowed to take the stage earlier, he probably wouldn’t have had to go through such trouble—face kills people!
This person's handling method is not that of a newbie, it is simply the kind that will wrinkle with old age.
"I'm back to Corey---"
"Thank you!"
"I'll contact you later and let's sit down together when we have time."
Yang Ping got off the operating table and left the operating room, with Xiao Su following behind.
"Every time I see your invincible mode on the operating table, it's so handsome!" Xiao Su secretly said.
