"With traction and abduction, the fracture has not been reduced well, so the stage is opened?"
"It will be troublesome later, the intramedullary nail cannot be inserted."
"Isn't this kind of fracture done very rarely?"
"Let's see, I don't know either."
"I heard that I will be able to walk normally the next day after the operation. It is still unknown whether the operation can be completed."
"If the cowhide is blown too much, it will break."
There was a discussion in the classroom next door. Everyone was very disappointed with the start.
Just like a movie, it was so hyped before it was released that everyone was so excited to see it. On the day of the release, the streets were packed with people and they crowded into the theater like crazy. They finally bought a ticket. After watching it, it was a complete bad movie.
, nothing, not even an attractive shot.
Yang Ping's tall image was naturally discounted in the minds of these young people. The Guizhou donkey had no skills and the Jiang man had exhausted all his talents, and everyone sighed in their hearts.
Fractures of the greater trochanter of the femur are now generally treated with minimally invasive methods. For the elderly due to osteoporosis, PFNA intramedullary nails are the first choice for internal fixation. For this type of surgery, body position is very important. It can be in the adducted or neutral position, and it must not be external.
The intramedullary nail cannot be inserted in the abduction position. Fracture reduction is equally important. The fracture must be reduced first, otherwise, the following steps will not be possible. Correct posture and good reduction of the fracture are surgical.
Necessary conditions.
Now that the two necessary conditions are not met, how can the operation be successful?
In the demonstration classroom next door, senior doctors include Dr. Jin, and director-level doctors include Director Ouyang and Director Bai. They all want to come and see Yang Ping perform surgery. After all, everyone says that Yang Ping is a miraculous person.
Most of the young doctors, except for some rotation doctors and trainees, are orthopedics majors and have a certain understanding of these routine surgeries. They can't help but start this kind of surgery without properly repositioning them.
I want to say a few words.
"This guy didn't have much contact with the broken lower limbs, so he went into battle in a hurry?" Fatty, the attending physician under Director Bai, asked Dr. Jin.
Dr. Jin shook his head: "I don't understand!"
Fatty said: "Why did Director Han just let him do it without any hesitation? Hand surgery is good, but other surgeries are a mess. There are too many."
"Director Han had a flight to catch, so he probably didn't explain it clearly?" another doctor said.
"No, I heard that Old Man Zhang asked him to do it by name." An informed explanation.
"I'm embarrassed now, but it's okay. I'll definitely come to Tianyuan later. If I can't go to Tianyuan, it'll only take a minute." Someone from the spinal surgery department spoke to me.
"This operation is actually simple. I heard that the bone on the inner side is inserted into the muscle. It will definitely not be able to be reduced without incision. If it is done minimally invasively, this kind of bone will not need to be treated. The main bone will be aligned in the front and side, and the nail will
If it’s inserted, it’s over. He hasn’t even reset the main bone. How will it end later?”
"What kind of reset, the posture is wrong."
Everyone is becoming more and more courageous to speak.
Tian Yuan also came in at this time. He saw that Song Zimo was there and there was no shortage of manpower. He was afraid that staying in the operating room would make old man Zhang feel that there were too many people and he did not have a strong concept of sterility, so he simply came next door to watch the screen with everyone.
Although Su Yixuan is a nurse, she is an orthopedic specialist nurse and also knows a lot about surgery. She has done countless surgeries of this kind, so she naturally knows this. This position and reduction are really not good, and the next surgery will be very embarrassing.
She was sweating in her heart, this piece of wood, she usually strives to be perfect even if she lays down a sheet during surgery. Today, she performed surgery on Professor Zhang, but why the positioning was not corrected, so she started the operation in a hurry, so she would not be nervous and make mistakes.
Yang Ping and Song Zimo went to wash their hands.
Through the glass, Song Zimo looked at the expressions of everyone next door and knew what everyone was thinking.
At the sink, Song Zimo said: "Everyone is worried, why don't you explain it?"
Yang Ping said while washing his hands: "Explain what? You will know after you take two steps."
Rough talk but not rough reasoning, boxers, if you shout 10,000 times before the game that I want to win, it is not as practical as going on stage and KOing your opponent with a punch.
After washing his hands, Song Zimo disinfected, and Yang Ping began to put on surgical clothes and gloves. His face was calm and he did not react too much to everyone's questions.
Su Yixuan looked over several times, with a bit of anxiety in her eyes. Yang Ping smiled at her and told her not to worry, as he knew it well.
As if she had a clear understanding, Su Yixuan immediately calmed down and began to sort out the instruments, checking the PFNA intramedullary nails, spiral blades, locking nails, steel cables, and supporting instruments.
The engineer from the equipment manufacturer was standing by, using a laser pointer to check with Su Yixuan. If there were any mistakes, he would be scolded if he encountered a bad-tempered surgeon, so he did not dare to be careless at all.
After the disinfection and draping is completed, the electrosurgical knife and suction device are connected, and the ritual preoperative check is performed, and the stage is started!
Yang Ping made a three-centimeter incision above and below the greater trochanter, took the bone hook from Su Yixuan, and gently inserted the bone hook through the incision under the greater trochanter.
"He doesn't want to reset the fracture on the medial side. He should insert muscles there, and there's no way to reset it."
"When I was studying in the imperial capital, there was a big boss who wanted to show off his skills by minimally invasively resetting the bone that inserts the muscles on the inside, but he failed and finally gave up."
"Once you insert a muscle, you either give up or open it up."
"Yes, open reduction of the fracture fragment inserted into the muscle is sometimes laborious. How can it be achieved with closed reduction?"
"This way you don't have to reset all the bones."
The bone hook goes in, and there is almost no testing, and the hook is pulled back.
"Four steel cables, hand them over one by one!"
Three steel cables, one after another, were pressed against the bone surface and sent to their respective positions on the opposite side by the guide. The fourth steel cable was intertwined with the other three, and I didn’t know what it meant.
"Traction, adduction!"
Zhang, Lin and Xiaowu immediately helped adjust the traction.
"Continue to adduct, yes, continue, stop!"
"The adjustment lever moves back three turns."
"Okay! That's it."
Every word is like an order from a superior, clear and unquestionable. On the operating table, all actions are subject to the surgeon's authority, and the authority of the surgeon is the guarantee of surgical discipline.
Zhang, Lin, and Xiaowu can't understand the steps at all now, so they can only follow them mechanically.
This chapter is not over yet, please click on the next page to continue reading!
"I underestimated you. You know the muscle attachments of every part of the skeleton, the function of each muscle, and the relationship between different muscles." Song Zimo said next to him.
"You've already called me Senior Brother, but you don't have anything to offer. Will you be convinced?" Yang Ping said while operating.
The bone fragment inserted into the muscle is easily hooked out. The tip of the bone hook catches the bone fragment, and then moves and resets gently. The first steel cable presses on the center of the fracture fragment, the ring is locked, and the tail of the steel cable is cut.
.
Perspective!
Everyone exited the operating room again. After one exposure, they returned to the operating room. The X-ray on the screen of the C-arm machine showed that the fracture had been anatomically reduced. If you didn't look carefully, you would have thought there was no fracture.
This is a very accurate grasp of the direction and strength of the traction.
"Holy crap! Is this still possible?"
"I don't understand."
"The position and reduction just now seems to be intentional, but I don't understand. Is it related to the bone inserted into the muscle on the inside of the reduction?"
Dr. Jin told Director Ouyang.
I don’t know what the person next door was thinking. Anyway, Zhang Lin, Xiaowu, felt like he was being cheated. He thought he was rushing into battle at the beginning and was worried that he wouldn’t be able to get off the stage. Now he found that it was completely unnecessary, and even the bones inserted into the muscles came out. As for
How it came out, I don’t understand.
The second steel cable, the third steel cable loop, lock, and cut off the tail.
The tip of the greater trochanter opens directly, the guide wire enters, and then the intramedullary nail follows. Once it is in place, the guide wire is withdrawn, and the guide pin of the spiral blade is inserted.
Perspective--
The guide pin of the spiral blade is exactly at the standard position, no more than one minute, no less than one minute, the midline of the femoral neck in the lateral position, the middle and lower third of the femoral neck in the normal position, and the tip is just a little away from the circular border of the femoral head.
.
"90 mm spiral blade."
After the measurement is completed, drill the hole with the electric drill and drive the spiral blade in.
The locking screw at the lower end, drilling, depth measurement, and screwing in the screws are completed in one go.
Steel cable!
The fourth steel cable is locked and the tail is cut. Now you can see that it is actually intertwined with the first three heels to form an overall structure. It forms a wonderful tension band structure on the outside.
I couldn't understand this operation, and even Song Zimo was a little confused: "What are you doing?"
"If you have an IQ close to 250, you don't need to ask me." Yang Ping screwed into the tail cap of the intramedullary nail and exchanged positions with Song Zimo.
Song Zimo started rinsing the sutured skin. There were only a few small incisions, and they were quickly sewn up without even draining them.
Final perspective confirmation.
The whole process takes about ten minutes. Like an ordinary intertrochanteric fracture, the top hospital with a large number of operations is very skilled. It takes about ten minutes to complete and there are many people there. But this kind of fracture end is inserted into the muscle, and there is no way to do minimally invasive surgery.
For reduction, it is very likely that you will eventually have to make an incision or give up on reducing the fracture.
Everyone is staring at the screen. Is the operation over like this? Don’t you understand? The first three steel cables are easy to understand, but the last steel cable is really hard to understand.
Dr. Jin sat in the crowd and kept looking at the screen and taking pictures with his mobile phone. Director Ouyang was also beside him and said, "This surgery is a bit wild. Do you understand the steel cable at the end?"
"I don't understand it yet, but I should understand it tomorrow." Dr. Jin shook his head.
Song Zimo opened the sheet and Professor Zhang suddenly said: "I will ask an ophthalmologist to consult me tomorrow. My eyes are not working anymore."
He literally watched the entire operation while lying down.
He didn't say a word, which is not in line with his temper. He should at least give some advice.
Yang Ping held Professor Zhang's hand: "Don't worry, I will ask the nurse to give you a walker tomorrow morning, so you can walk. You won't give me zero money, right?"
Professor Zhang said: "We'll talk about it tomorrow after taking two steps."
The head nurse of the operating room came over: "Teacher Zhang, do you feel okay?"
Dean Xia also called, directly to the mobile phone of the head nurse in the operating room and asked Yang Ping to pick up.
Yang Ping went to the locker room and called Director Han to check that he was safe.
Song Zimo leaned on the long chair: "Wonderful idea!"
Others were talking a lot.
"What does the steel cable at the end mean? I really don't understand."
"You ask me, who should I ask?"
***The author has something to say***
Thank you Qian Qianjunzi and Hibiscus Mu for your reward! Thank you all for your recommendation votes! Thank you all for your love! New work, new work, the update is not very powerful at the moment, and we are working hard. I have more than a thousand collections of streaking before, and I am very satisfied. Start today
I am testing the water and recommending it. I sincerely ask everyone to continue to support and continue. It is indeed hard to operate during the day and code at night, but as long as there are recommendation votes and collections, it doesn’t matter. No matter what, I will do my best to tell the story well. Yes
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