There is another needle in the space between the third cervical vertebra and the fourth cervical vertebra. This thin needle is saved until the end because it is the most difficult, even harder to remove than the pericardial needle.
The structure that fills the vertebral body space is the intervertebral disc, and this needle is inserted into the intervertebral disc.
After flushing the abdominal cavity, the instrument was withdrawn, and Li Guodong sutured three small incisions in the abdomen.
Yang Ping moved the battlefield to the cervical spine. The baby's cervical spine was very small. Yang Pingyuan planned to use color ultrasound to locate it, and then remove the fine needle under an endoscope.
However, the Provincial Maternity and Children's Hospital does not have a suitable endoscopic system that can be used in the neck. The equipment usually used for minimally invasive cervical spine surgeries in adults, such as dilator tube systems, are not suitable for infants, and the endoscopic systems for children's otolaryngology are also not suitable.
Use here.
Yang Ping had no choice but to use an open small incision surgery, and the incision was not large, only one centimeter.
This needle is about 1.8 centimeters. According to logic, after inserting the needle into the human body from the front or back of the cervical spine, the ultimate state is that the needle sinks below the skin, and cannot go deeper thereafter. The needle's position will change in response to human muscle contraction.
Wait to move.
No matter how you move, how can you be able to enter the intervertebral space so cleverly?
Moreover, one end of this needle is pointed and has no abnormality, while the other end loses the roundness of the needle tail.
Could it be that a long needle was inserted into the intervertebral space, and then part of the needle broke inside?
Yang Ping thought about this needle for a long time and felt that this was the only reasonable explanation.
Dr. Jin had an all-night operation last night. He could have rested, but he wanted to observe Yang Ping's operation. Now that he was standing nearby, he had no idea of resting.
Besides, with the current situation in the Department of Traumatology and Orthopedics today, rest will definitely be wasted. Dr. Jin decided to stay here so that he could watch the surgery and take a breather.
Yang Ping planned to use a small incision, so it was difficult to avoid multiple positioning, and X-ray positioning was indispensable for this part.
Dr. Jin glanced around the operating room. Apart from himself, Fatty Liang and Zhou Can, there was no one else in the audience. The entire army of interns rushed to support the trauma emergency center.
Fatty Liang is sitting on a stool in a daze, don't expect him to do anything else.
Zhou Can is a girl, Dr. Jin thought, it is unreasonable and unreasonable for a grown man to stand here and ask Zhou Can to push the C arm.
So he quietly came to the storage room next door, and started to push the C-arm alone. He first pushed out the host screen and set it up, and then pushed out the C-shaped arm. It was still a bit laborious for one person to push the machine. Normally, those who trained
Recommended by the boy who gave birth to an intern.
In spinal surgery, segment positioning is very important and indispensable.
In the past, when there was no C-arm machine, positioning was based on experience, and sometimes the wrong section was done, and Daniel was no exception.
When everything was ready, Dr. Jin asked again: "Professor Yang, the C-arm machine is ready. Can I come on stage to help?"
"Brush your hands!"
Yang Ping was also unambiguous. Since Lao Jin was so enthusiastic, let him come on stage to participate.
However, this C-arm machine is not used at all, and Yang Ping has no intention of using the C-arm machine for positioning.
C-arm machine positioning is necessary from a procedural point of view, but Yang Ping is a very brave artist. In order to minimize Xiao Minmin's radiation, he
Cervical spine surgery cannot protect the thyroid gland, and X-ray radiation can be reduced if possible.
"No need for C-arm! I use color Doppler ultrasound for positioning." Yang Ping said as he began to disinfect the neck skin again before skin incision.
Instead of C-arm, use color Doppler ultrasound?
How to locate the segment? If the segment cannot be positioned, how to complete this operation?
Dr. Jin was very puzzled. A veteran doctor and senior attending physician could not think of how color Doppler ultrasound can locate spinal segments.
I didn't expect it to be normal, because only Yang Ping dared to do this.
Yang Ping was so familiar with anatomy that he could accurately determine the number of the corresponding cervical spinous processes simply by palpating the spinous processes of the cervical vertebrae, and then accurately positioned the vertebrae based on the distance between the spinous processes and the intervertebral space on the original X-ray.
gap.
Dr. Jin came to the stage with questions to help Yang Ping.
Yang Ping was going to use the anterolateral approach and use color ultrasound to do some positioning. He made a small incision and used microvascular forceps to separate it briefly. Then he put in a microskin retractor and asked Li Guodong to retract the skin.
"Don't imitate me. You should still use C-arm machine for fluoroscopic positioning during surgery."
Yang Ping reminded Dr. Jin and Li Guodong, especially Dr. Jin.
This reminder is necessary, just like every time a dangerous action appears on TV, the audience must be reminded: Do not imitate.
Once imitated, the consequences will be disastrous.
If it were Song Zimo, this kind of reminder would be completely redundant. Song Zimo knew clearly what could be imitated and what could not be imitated.
Pulling the hook to retract the skin, Yang Ping's vascular forceps continued to separate, entering from the muscle space, avoiding blood vessels and nerves, and reaching the anterolateral side of the 3/4 gap of the cervical spine.
"Draw the hook deeper!"
Yang Ping reminded Li Guodong to adjust the hook immediately.
Compared with Zhang Lin Xiaowu’s gold and silver double hooks, there is a huge gap in Li Guodong’s hook-drawing technology.
"Get me a headlamp."
The light of the shadowless lamp is difficult to illuminate the small space in the small incision. You need the help of a spotlight headlight to see clearly inside.
Yang Ping removed his head from the operating area, Zhou Can helped him put on the headlight, and he returned to the operating table.
A beam of light from the headlight just shone into the small space. Yang Ping used a microvascular forceps to clamp a corner of the gauze and insert it to suck out a small amount of blood.
Dr. Jin stared into the small incision and couldn't see anything? How to get the needle?
The sharp knife just poked the anterior longitudinal ligament and the anterior ring of the intervertebral disc, then inserted a straight microvascular forceps and pulled it back. The last needle was pulled out and thrown into the curved disc.
Dr. King's knees almost gave out and he knelt down directly.
I've always heard that this guy is a half-human, half-god pervert, but I didn't expect it to be true.
A veteran doctor, senior attending, both theoretical and practical experience is also good.
I didn’t understand how the surgery was done at all. I just made a small opening, poked it in, and took out the needle.
The thirty-fourth needle is pulled out, and you're done.
Yang Ping checked the needle and found that the tail was not rounded and had old signs of breakage. It was likely that the long needle broke inside after being inserted into it.
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Looking at the densely packed needles in the curved plate, Yang Ping felt relieved, and all the little guy's needles were taken out.
"Don't imitate me!"
Yang Ping reminded again.
If he didn't want to reduce the child's X-ray radiation, Yang Ping would still be willing to follow the routine operation and use the C-arm machine for positioning, so as not to mislead others.
Xiao Su counts the number of needles again.
Yang Ping handed over the remaining finishing work to Li Guodong, and he and Dr. Jin went to the surgery center to provide support.
——
The trauma emergency center is at full capacity today, and several operating rooms are full.
The nurses delivering blood were like racing, one just came out, and the other went in again.
Yang Ping and Dr. Jin came to the operating room for counterpart support.
Two generals from the Institute of Surgery took action, and the bleeding in the pelvis and thigh was stopped, and the high school student's blood pressure was strongly stabilized.
Song Zimo looked up and saw Yang Ping. He was about to report, but Yang Ping signaled him not to be distracted and to continue the operation.
Song Zimo understood, said nothing, and continued the operation. In fact, he had nothing to say.
If you can't get this surgery, just let the professor come on stage.
If it can be removed, continue the operation and stop talking nonsense.
With a professor standing next to him, Song Zimo would not blink if the sky fell.
Obviously, with the level of the top warrior in the Institute of Surgery, it is not easy to perform this kind of surgery.
Dr. Jin has been following Yang Ping, watching Song Zimo flying needles and threading, and the operation is steady and fast. He can't help but sigh, Mr. Song, your progress is really fast.
If I hadn't been a few years older, I would have shamelessly asked Yang Ping to work under him.
Suddenly, Dr. Jin felt sad.
"Teacher Zhang!!!"
Another intern asked timidly.
"What happened?"
"Did an intern just say that Dr. Li from the obstetrics department had a caesarean section?" Zhang Lin asked Xu Zhiliang.
Xu Zhiliang thought for a while and said: "It seems so!"
"Why did Dr. Li ask us to perform a caesarean section?" Zhang Lin asked.
"Didn't you ask us to go for a consultation? No, brother, what's your wife's surname?" Xu Zhiliang seemed to have some realization.
Zhang Lin said smoothly: "My wife's surname is Li!"
Your last name is Li?
The two of them raised their heads at the same time and looked at each other!
Zhang Lin suddenly remembered, no, my wife is going to give birth? It can't be such a coincidence to push her to the operating room for a laparotomy.
"Heartbeat stopped!"
The anesthesiologist shouted.
"Compression! Prepare to open the chest!"
Song Zimo shouted.
Zhang Lin and Xu Zhiliang could think of nothing else and immediately followed Song Zimo to join the rescue.
"Professor Yang, Lao Jin, hurry up, go to the operating room next door. Lao Bai can't hold it anymore, his abdominal cavity is opened, and the blood inside is coming out and he can't stop it."
The situation, which had just stabilized a little, was once again extremely tense.
"What are you doing standing here? Why don't you go help."
The circulating nurse yelled at the intern who reported to the obstetrics department, saying that he was like a fool and was getting in the way.
