Yang Ping looked at the images one by one and said: "Lumbar 5/sacral 1 discogenic pain."
He put on the gloves handed over by Song Zimo and examined the patient.
Wearing gloves for physical examination is Yang Ping's habit. This is not to show off, nor to dislike patients. It is more strict hand hygiene to prevent cross-infection.
After a round of physical examination, Yang Ping had a clear idea.
There was local tenderness in the right groin two centimeters away from the anterior superior iliac spine. Tinels' sign was positive. The symptoms worsened when the hip was extended posteriorly. The pelvic compression test was positive.
The systematic super training program at that time provided training in anatomy, physical examination, instrumentation and laboratory examination. The super training program laid a solid clinical foundation for Yang Ping.
"Lateral femoral cutaneous neuritis! Call the ultrasound department to come over 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 took the emergency elevator and pushed the bedside color Doppler ultrasound machine over.
She set up the color Doppler ultrasound machine and prepared to do it. Yang Ping said, "Shall I do it?"
You come to an orthopedic surgeon to do a color ultrasound? This is unheard of.
Yang Ping didn't say much. Under the suspicious eyes of the sonographer, he started to apply coupling agent and probe along the path of the lateral femoral cutaneous nerve. The technique was that of a senior sonographer with decades of experience.<
/p>
"Does Dr. Yang do color ultrasound?" The beautiful doctor stood aside and asked Song Zimo. She was very curious and had never seen an orthopedic surgeon perform color ultrasound.
It’s not surprising that orthopedic surgeons can take X-rays. A few doctors are very devoted to their studies and are also involved in peripheral subjects. Some doctors are better at X-rays than radiologists, but there are not a few orthopedic surgeons who can do color ultrasound.
, but not.
Song Zimo remained calm on the side, the ultrasound probe moved smoothly, and the probe stayed at the groin two centimeters away 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, which passes through the inguinal tendon.
The nerve was compressed when the nerve membrane was compressed, causing nerve edema. There should have been contusion here before, which is scar adhesion and compression. Surgery was arranged to perform minimally invasive radiofrequency ablation of the right lateral femoral cutaneous nerve under local anesthesia, and at the same time, lumbar 5/sacral 1
Intervertebral disc angiography and radiofrequency ablation."
In just ten minutes, a color ultrasound machine was used, the diagnosis was established, and the treatment plan was clear.
Looking at the colorful and flowing color ultrasound images, who can understand color ultrasound?
As for color ultrasound, as a professor at Xiehe, Professor Hu Guolin knows some basic knowledge, but is not proficient in it. Others, Song Yun, also know a little bit. Except for Song Zimo and Xu Zhiliang, who have received training from Yang Ping, no one is proficient in this stuff.
Even the doctors in the ultrasound department looked surprised. To be honest, not many senior doctors in the ultrasound department could spot this kind of nerve entrapment.
Dr. Yang wandered back and forth a few times and came to a conclusion.
Song Yun blushed and said, "Dr. Yang, I'm not very good at color Doppler ultrasound yet. If you have time, you can tell me about it, starting from scratch."
"Song Zimo, please take out the printed book and show it to them first." Yang Ping put the probe in place, took out two paper towels from the cart of the color ultrasound machine and gave them to the patient. A nurse practitioner helped the patient clean the coupling.
agent,
The patient pulled up his pants, and the previous curses were completely gone: "Dr. Yang, you were right just now. I fell down while riding a motorcycle before and I had a scratch here. Is this related to this?"
"It's related! Let's do another minor surgery. Minimally invasive surgery will 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 couldn't hide anything from Dr. Yang.
As for the printed books, there are several, but they are all Song Zimo's treasures. Song Zimo compiled, printed and bound them into volumes based on the explanations Yang Ping usually gave him.
One of them is the application of color ultrasound in orthopedics, which is the now popular musculoskeletal ultrasound, and a summary of Yang Ping's explanations.
Director Hu also opened his eyes. In Xiehe, the clinical foundation of doctors is second to none in the country.
They usually deal with basic diseases of orthopedic patients, such as diabetes, hypertension, and coronary heart disease. Generally, no consultation is required, and any bedside doctor can handle it with ease.
Why, with a good clinical foundation.
If in other hospitals, surgeons would read electrocardiograms, that would be an ancient myth.
In Union Medical College, a surgeon who cannot read an electrocardiogram is not a qualified doctor.
Comprehensive and solid clinical training enables Union Medical College doctors to handle common diseases or rare diseases with ease.
There are some rare diseases that doctors in other hospitals have no idea about, but even residents at Union Medical College understand them clearly.
This is the confidence that Xiehe’s comprehensive strength ranks first in the country.
This patient would usually fall into a trap in other hospitals, but for Dr. Hu from Union Medical College, neither diagnosis nor treatment is very difficult, and he will not easily fall into the trap. However, it will definitely cost a lot to make a clear diagnosis.
Time to analyze and compare.
It is absolutely impossible to be like Yang Ping, who can hit the nail on the head in just ten minutes, especially the color ultrasound operation just now, which does not reflect ordinary clinical strength.
With Yang Ping’s solid clinical skills, it’s no wonder that one operation left Professor Liang unforgettable.
If Yang Ping's knowledge is a sea, Director Hu feels that he is just a lake.
Professor Liang was so accurate in judging people that Director Hu couldn't help but sigh. He didn't understand at the time that it was just an operation, so he kept thinking about it and told himself that in addition to further studies, he must also complete another task - poaching people!
I heard that 301 has taken action, and Xiehe will also do its part. Compared with the strength of 301, Xiehe is more moderate.
Speaking of the academic atmosphere, Director Hu has more confidence in Xiehe, and a talent like Yang Ping will like Xiehe.
Back at the doctor's office, Song Zimo called up the images again, 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 can easily be mistaken for lumbar disc herniation. It has deceived many doctors, plus the lumbar disc origin
Most doctors will jump into the trap when it comes to sexual pain." Only when Yang Ping returned to the office could he speak without any scruples.
Lumbar disc herniation is a syndrome manifested by intervertebral disc degeneration, annulus fibrosus rupture, and nucleus pulposus herniation that stimulates or compresses the spinal nerve root and cauda equina nerve.
It can be seen that without symptoms of spinal nerve roots or cauda equina, lumbar disc herniation cannot be diagnosed.
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 nerve compression and stimulation.
But often a large number of patients who only have low back pain are easily diagnosed with lumbar disc herniation.
Many manifestations of spinal 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 manifestation of sciatic nerve, it does not necessarily mean lumbar disc herniation.
This patient is an example.
If the spinal cord is compared to the main gate of a circuit, the spinal nerves are the wires that come out of the main gate, and the sciatic nerve is the wire that has left the main gate and is distributed in the room.
There are several types of pain caused by lumbar intervertebral disc disease, including discogenic pain, which is pain caused by stimulation of the sinus vertebrae nerve, the nerve of the intervertebral disc itself. This pain manifests as low back pain.
Radical pain means that there is a problem with the bus area where the wires exit the main gate. It is compressed or stimulated by the lumbar intervertebral disc, causing pain in the distribution area of this nerve.
There is also referred pain. The site of pain is not in the same place as the site of onset, but because their sensory nerves are transmitted to the spinal cord at the same segment. It can be understood that the two sites are led and supervised by the same center. When a site
The nerves are stimulated, and the signals are transmitted to the spinal cord and then up to the brain. The brain will be muddled, misjudgment occurs, and it is unclear what is wrong. It sends pain signals to two parts, and the other part with no problem also hurts.
.
Pain caused by lumbar discs can be roughly divided into three types. The first type is called lumbar discogenic pain, and the second type is lumbar disc herniation.
As for sciatica, it can be caused by lumbar disc herniation, or it can be caused by its own problems. If there is a problem with the main gate and walking route, and it has nothing to do with the herniated lumbar disc, it cannot be said to be lumbar disc herniation.<
/p>
Take piriformis syndrome, for example, which is what Teacher Yan is like. He has been quarreling over it for two years, making both doctors and patients unhappy.
As Yang Ping spoke, he drew an anatomical diagram of the lumbar vertebrae on the whiteboard. It would be easy for everyone to understand it when combined with the diagram.
A casual drawing is more beautiful and detailed than an anatomical atlas.
Even if the herniated lumbar disc compresses and stimulates the nerves, there are rules that can be followed. You see, the most common lateral lumbar disc herniation affects the traveling roots.
What is a deformed root is that it passes down the intervertebral disc and exits through the next intervertebral foramen.
The extreme lateral disc herniation affects the exit root, which is the nerve root that just comes out of the corresponding intervertebral foramen.
The central type of intervertebral disc compression is cauda equina, and the symptoms of this type are the most troublesome.
"This type is what men are most afraid of!" Director Hu is quite humorous.
"Will lumbar disc herniation affect sexual function?" Some students have quick brain reactions.
That's right, it's just that men find it difficult to talk about this issue. Even if asked, many people are unwilling to admit it and are evasive, so people don't pay attention to this issue.
"No wonder, with a good waist, she is also good." Zhang Lin joked.
Xu Zhiliang glared at him, and Zhang Lin immediately suppressed the smile on his face, not daring to say more, complaining in his heart: To adjust the atmosphere, this guy is so serious.
Yang Ping has sorted out low back pain in a clear and logical way, like a primary school student’s mind map, simple and clear
"Why does this patient need to undergo discography during the operation?" Li Guodong was very studious and asked.
"If it is discogenic low back pain, discography and contrast agents can induce low back pain, or anesthetics can eliminate low back pain. In this way, the lumbar discogenic pain can be diagnosed, the responsible part of the low back pain can be found, and radiofrequency ablation can be performed to destroy the sinus and vertebrae nerves and cause pain.
Eliminate naturally." Song Yun helped explain.
Song Yun admired Yang Ping's ability to think like a cocoon. This patient had low back pain and radiating pain in his lower limbs. There seemed to be no doubt in the diagnosis of lumbar disc herniation.
This is the source of diagnostic errors.
"Dr. Song will tell you about lumbar discogenic low back pain." Yang Ping encouraged everyone to discuss academic things, and the more they debate, the clearer they will become.
Song Yun was guided by Yang Ping, and his thoughts opened up: "Lumbar disc herniation and lumbar muscle strain are becoming an abused diagnosis, causing both patients and doctors to fail in this diagnosis."
"With the advancement of follow-up diagnosis technology, it is believed that the most common form of chronic low back pain is discogenic low back pain, which makes the diagnosis of low back pain clearer."
"Dr. Yang just said that in fact, the most accurate diagnosis for this patient should be: first, discogenic low back pain, and second, 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 refers to the source of pain."
Song Yun's professional knowledge was very good, but when it came time to compare MRI films, he lacked experience and asked Yang Ping for help.
Yang Ping asked everyone to get closer and look at the pictures on the electronic reading screen: "Look, on this cross-section, the lumbar disc high signal zone (HIZ) is the intervertebral disc HIZ high signal. When you look at this image, you need to look at both the T1-weighted image and the T2-weighted image.
You cannot just look at one phase. If T1 is locally low or isointense and T2 is locally high, it means that the annulus fibrosus of the intervertebral disc has ruptured and granulation tissue has grown into the interior. This granulation tissue signal is a landmark image." p>
"Indeed, I understand." Song Yun suddenly realized.
I have read a lot of books and studied things that I have not understood thoroughly for a long time. Dr. Yang now points it out in one sentence.
Then Yang Ping told Song Yun, pathologically, the composition of granulation tissue, the imaging principle of MRI, the principle of artifacts, the signal displayed by granulation tissue on MRI, why this signal is displayed, and how to judge the onset time of the disease from the signal
, how to identify artifacts, etc.
Especially when it comes to the principles of MRI imaging, I don’t think anyone who creates magnetic resonance would understand it so deeply and explain it in such an approachable language.
This training trip is right!
Seeing that Song Zimo kept taking notes, Song Yun quickly took out his notebook and took notes quickly.
There are lectures here, the operating room upstairs is ready, and Li Guodong sends the patient to the operating room.
Song Zimo is the surgeon, Yang Ping is the guide, and everyone is observing.
The operation only took ten minutes, and the effect was immediate. The patient no longer felt any 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 the Spine Surgery Department received the news, he breathed a sigh of relief and quickly called Yang Ping to thank him. He kept reminding himself that he should be cautious about wiping his butt in the future.
The patient sent a banner to Director Qin. It is said that he was planning to go back at that time. Fortunately, Yang Ping helped to resolve the issue. Otherwise, where would he put his face if there was a real commotion?
Director Gao of the Sports Medicine Center rushed over to practice arthroscopic micro-sculpture.
When I heard about this patient from spine surgery, I shook my head.
Lao Qin, this kind of patient is just thrown away and ignored? No matter what, you must come here in person, follow it from beginning to end, and listen to Dr. Yang's explanation. You must help during the operation, so that you can learn something, otherwise you will fall into the trap next time. p>
Hearing that Dr. Yang was using a new technique to reconstruct cruciate ligaments in children in the United States, Director Gao was waiting for the opportunity to learn the curved drilling technique for cruciate ligament reconstruction in children from Yang Ping.
I carry my laptop and USB flash drive with me at all times.
