Three days later, Yang Ping saw Qin Xiaowei again at the entrance of the ICU. His skin was obviously darker, with traces of sunburn, and all the tape on his hands had been replaced, and his hair was cut shorter, making him look more energetic.
Still wearing a fanny pack.
Li Jun has not woken up yet. He was only agitated when he first entered the ICU and had a tendency to wake up. Since then, there has been no movement. ECMO costs more than 20,000 yuan a day, bedside hemofiltration machines cost 7,000 to 8,000 yuan a day, and various expensive imported equipment.
Medicines, various examinations, etc., cost 70,000 to 80,000 yuan a day to maintain Li Jun's life. As long as one of these life-saving treatments is stopped, Li Jun's life will collapse.
His life is maintained persistently by expensive drugs and machines.
Every time Yang Ping comes for ward rounds, the ICU director will accompany him. He still respects this young professor very much.
"Li Jun suffers from severe anemia, which is renal anemia. He currently relies on blood transfusions to maintain hemoglobin concentration and the number of red blood cells, but this is not a solution. In order to increase hemoglobin and red blood cells, we inject Arendrol (Rosa) through the stomach tube.
(Sita), yesterday we did an electroencephalogram again, and the brain waves are present and moving very well, and the cranial nerve reflexes such as the foramen reflex are present."
From this point of view, in theory, you can definitely wake up.
"As long as the brain waves are normal and cranial nerve reflexes exist, it means there is no necrosis in the brain tissue, and there is no anatomical evidence that one cannot wake up."
Yang Ping used the light of a flashlight to check the boy's hole, and found that the boy's hole was indeed more reflective.
The nurse is turning Li Jun over, doing body care, checking the skin condition of some bony protrusions, and replacing protective pads on these bony protrusions to prevent the formation of pressure ulcers.
Bedridden patients can easily develop pressure ulcers if they are not properly cared for.
The director of the ICU was quite emotional: "Hope is not completely lost. Even if you wake up, you still face the problem of whether you can go offline. These two life-and-death hurdles must be passed. We here have people who have successfully taken offline for more than three months, but the cost is huge.
The self-funded portion alone is more than two million. Even if his family has such a heart, money is still a problem."
As a doctor, the ICU director knows very well how many people lose money. At this time, betting on the slim chance of life is just throwing away money.
Ordinary people sell their houses and sell iron and steel. In the end, they lose their lives and money, which no one can accept.
Many problems eventually turn into economic problems.
"What about the one next door? Are you still holding on?" Yang Ping asked by the way.
The director of the ICU smiled bitterly: "How is it possible? He died of brain death a few days ago. The patient actually wanted to be older than Li Jun. He also relied on ECMO to survive. After more than 20 days, the family really couldn't support it, so the family members signed to give up." p>
Yang Ping remained silent.
After watching Li Jun and Yang Ping come out of the ICU, Qin Xiaowei is talking to Dr. An, the doctor in charge of the bed. He will be away for a while, which will be a long time.
Qin Xiaowei told Dr. An to call him once Li Jun wakes up.
And I also left another emergency backup phone number, which belongs to my friend Alon.
Before officially climbing, he would climb with ropes dozens of times to select the best route, study the difficulties in the route, and design countermeasures in advance.
You also need to carry out various professional trainings, including physical training, etc., just like athletes training before a competition. This kind of high-risk outdoor extreme sports is very professional and is by no means a passion.
Only when every detail is in place can you succeed.
——
August has basically mastered the scoliosis correction technology and has a deep understanding of the technology.
As a great figure in spine surgery, his understanding of spine surgery is by no means comparable to that of ordinary doctors.
Yang Ping's technique makes full use of Yinlizalov's theory to correct ridge scoliosis. The difficulty lies in fully understanding the ridge deformity, and then knowing where distraction osteogenesis can help correct the deformity. p>
August understood these core theories bit by bit, and asked Yang Ping for advice if he didn't understand anything.
In order to have a deeper and more comprehensive understanding of the case, he personally changed the dressing and rotated the knob of the spinal external fixator every day.
The work August does now at Sanbo Hospital is all the work of a resident doctor, and he never tires of it.
"Why is my pen missing again?"
In the doctor's office, August hung his badge as a trainee doctor. He sat down to rest for a while and took a pen from his chest pocket to record something, but found that the pen was gone.
And Robert was sitting at his desk, counting his pens proudly. There were more than a dozen, including blue and black ink pens, surgical marker pens, etc., and the two pen sleeves were inserted slowly.
Robert labels each pen with his name, declaring his ownership.
August said angrily: "Classmate Luo, will you take my pen away?"
Robert protected his pen with both hands: "I followed Teacher Zhang's consultation and got these from other departments. Every pen has my name."
For doctors, these pens are a valuable asset, how could they be taken away by others?
No matter how many pens there are, doctors often can't find them.
Not wanting to hurt the relationship between his roommates just for a pen, Takahashi handed August a pen: "Use it first, I still have it here."
August took over the pen, and his dislike of the Japanese diminished a little.
"Doctor Ao! The professor is looking for you and asks you to go to his office."
Young doctors all call them Dr. Ao, Dr. Luo, and Dr. Gao.
The professor is looking for me? August temporarily put aside his hatred, straightened his white coat, cheered up, and came to Yang Ping's office.
The door was ajar, so he pushed it open gently, poked his head in, and asked in a low voice:
"Professor, are you looking for me?"
"Come in!" Yang Ping was studying surgery and wanted to discuss it with him.
August came in, stood, put his hands on the seam of his trousers, and moved his body slightly forward.
Then he stared at the professor's pot of tea with his peripheral vision, because he knew that if the professor poured a cup of tea from the pot to the students, it meant that the students were recognized by the professor. It is said that this is tradition.
So far, Dr. Ao has not had that cup of tea.
Yang Ping pushed the 3D ridge column model on the table to the center: "Dr. Ao, if a ridge column external fixator is used to treat this case, can you tell me how to cut the bone? This is your patient."
This crest model is the spiral crest of the Duke's precious son, and August is a little excited.
Is this a test of himself? August is very confident. During this period, he has worked hard on new technologies. He performed surgeries during the day, changed dressings before getting off work, returned to the dormitory to supplement notes, and reviewed the day's work.
Summary.
"Professor, look!" August took out his pen: "Each vertebra must be osteotomized, and the osteotomy should be left in the posterior column as much as possible to maintain the stability of the ridge column and make full use of distraction osteogenesis. I started from
This vertebra begins---"
August gestured with a pen to explain in detail the specific location, direction and depth of each osteotomy.
The osteotomy site will be the site of distraction in the future. Not only orthopedics must be considered, but also the deformation tolerance of the scattered spinal cord.
As expected, he is a great figure in spine surgery, and he has such a thorough understanding of the new technology of osteotomy.
The promotion of new technologies in Europe depends on the doctors in front of us.
Yang Ping expressed his approval and then made modifications to several osteotomies.
These modifications will make the operation simpler and easier. This is something August has never understood. He always feels that something is wrong, but he doesn’t know how to modify it.
After Yang Ping's prompting, the ice-snow-smart August finally understood the secret.
"Professor, when can I ask you to go to Germany to perform surgery on this patient?" August took the opportunity to invite him.
Yang Ping did not refuse and asked: "Is the patient's cardiopulmonary function not very good?"
"Because of the severe ridge deformity, the thoracic space is extremely narrow, causing serious compression and distortion of the heart and lungs, and the heart and lung functions are very poor. Once other problems occur, it may be life-threatening due to insufficient compensation of the heart and lung functions, so my friend hopes to hurry up
Operate his son."
August knew the professor's temper very well, and the patient might not be saved if he didn't operate quickly.
Professor! Do you want to take action or not?
Yang Ping thought for a moment and nodded: "I will go to Germany with you after I finish my busy work."
"By the way, I'm inspecting the projects funded by the Duke's Fund. I guarantee with my personality that this fund is very serious."
August swallowed, as if his throat was dry.
"Okay, let's go and have a look."
"The spinal cord injury research project that I directed by the way is to see if our hospital is qualified as a clinical trial base. For this phase three clinical trial, the Duke Fund has given 100 million euros. Patients from all over the world can enjoy free treatment in Germany. Professor! Each of your spinal external fixators is benefiting mankind." August threw out the card he had held in his hand for a long time.
For the sake of his son, the Duke was very generous and signed an agreement with the Munich Orthopedic Hospital in Harlachen. If the third phase clinical trial is successful, he will provide a funding of 100 million euros.
No matter where it is, this is a huge amount of money.
"That's by the way---"
Yang Ping patted August on the shoulder.
August was very disappointed that he never had that cup of tea until the end of the conversation with the professor.
August had a few patients to change dressings before getting off work, so he went to push the dressing cart, put on a mask and hat, and prepared to change dressings.
In the corridor, I saw Professor Zou from Appendix 1, standing at the door with a bag of fruit in his hand.
"Teacher---"
Professor Zou waved his hand.
August looked back, then gestured for Professor Zou to go back, and then pushed the dressing cart into the ward.
Looking at the tutor's back pushing the dressing cart, Professor Zou felt a sense of sadness welling up in his heart, stronger than last time. "Teacher, my tutor!" He looked like a regular trainee pushing the dressing cart to give When the patient's dressing was changed, Professor Zou almost shed tears.
When we got here, Professor Zou wanted to say hello to Yang Ping, so he went to Yang Ping's office.
Yang Ping was very surprised to see Professor Zou, carrying a bag of fruit, and paid a sudden visit without saying hello in advance.
"I'm just on my way, come and take a look, Professor Yang!" Professor Zou put down the fruit in his hand and took out a tissue to wipe his sweat, his eyes moist.
"Professor Zou, what are you doing?" Yang Ping felt that his expression was wrong.
Professor Zou sighed slightly: "August is my tutor, please take care of him! I just wanted to see him."
No wonder he is carrying a bag of fruit.
Yang Ping nodded: "That's right, I will definitely take care of you. It's rare to come over. How about we get together in the evening?"
"No, I'll just come over and see the instructor. I have something to do tonight."
Professor Zou did have some entertainment in the evening. Besides, he came here in a hurry, didn’t say hello, and had a meal in a hurry.
"Li Guodong!"
Li Guodong happened to pass by the door of Yang Ping's office and stopped when he heard the shout.
"Go and call Dr. Ao." Yang Ping ordered.
Professor Zou shook his head: "Forget it, I'll leave now. The instructor said he doesn't want me to disturb him during the study period. I just want to come over and see if I can help."
Your expression is like this, as if this is a juvenile detention center, you are the child's parent, and the child is being disciplined here. Yang Ping made a few remarks.
"Don't tell me that I've been here. Please take care of me. When I was in Germany, my tutor was very good to me." Professor Zou said emotionally.
Yang Ping thought he was weird, he didn't meet people when they came.
"Give this piece of fruit to him for me."
After Professor Zou finished speaking, he was about to leave.
Aren't you just looking at the parents of children in a juvenile detention center? You're not here to see a tutor.
"That's it! Please!"
While the instructor was still changing the dressing, Professor Zou left quickly. It was obvious that the instructor did not want to see him.
This?
Carrying a bag of fruit, I threw it here and then left.
Yang Ping wanted to catch up and see off Professor Zou, but he had disappeared.
---
In the office, Yang Ping drank a few sips of tea.
Summarize and think about the crestal external fixator orthopedic technology.
In the system space, he reviewed some monographs and journals on orthopedics.
Most patients with scoliosis are teenagers, who are in the stage of growth and development. Can we grasp the characteristics of teenagers and find a better method?
Any treatment method is subject to development. For example, the treatment of gastric ulcers started with surgery and partial gastrectomy, and later developed to selective vagus nerve block. Later, with the advancement of research on Helicobacter pylori and gastric acid secretion, there was no need for it at all.
Surgery and direct triple and quadruple drug treatment can cure the disease. This is an improvement in treatment methods. No method is permanent.
Yang Ping summarized the history of the development of orthopedic surgery, especially orthopedic surgery for adolescents, and then analyzed the current cutting-edge technology and found an important piece of information: whether epiphyseal block and stimulation technology can be used in crestal scoliosis correction.
Epiphyseal block technology has now been used sporadically in simple children with scoliosis.
The core concept of traditional orthopedic surgery is osteotomy, so osteotomy is often required to correct skeletal deformities.
As for adolescents and children, this type of minors, their bones are still in the growth and development stage.
The length of the long bones of the limbs mainly depends on the growth plates (also called epiphyseal plates) at both ends. The epiphyses are formed by the orderly superposition of layers of chondrocytes of different maturities. The chondrocytes near the backbone continue to mature. Mature chondrocytes
Transform into osteocytes, and along with the calcification of the surrounding matrix, cancellous bone is formed and added to both ends of the long bones, so that the long bones continue to grow.
Under normal circumstances, the growth of this epiphyseal plate is balanced, so during the growth process, we will not have abnormal growth.
However, due to some reasons, such as trauma, infection, tumor, radiation, metabolism, developmental abnormalities and other factors, the growth mechanism of the epiphyseal plate is damaged and the growth balance is destroyed. The growth of the epiphyseal plate will be inhibited or stimulated, resulting in excessive or slow growth.
Even stagnation occurs, and the limbs appear to be unequal in length or bent and deformed.
For situations where the growth plate growth is unbalanced and leads to bone curvature, the skeletal deformity can be corrected by temporarily stopping the side of the epiphyseal plate that grows relatively quickly, allowing the side that grows slowly to fully grow.
Doctors often achieve epiphyseal block by placing a small plate and two screws across the growth plate on the convex side of the angular deformity.
In this way, the concave side grows faster than the convex side, and the bend is corrected.
However, ridge deformity is far more complicated than long bone deformity of the limbs.
It seems simple, but to use this technology for ridge correction, several major problems must be solved.
First, we must thoroughly study the growth mechanism of the ridge column and understand the precise adjustment of each epiphysis, which can be adjusted from three axes. Second, we must finally master the epiphyseal stimulation technology, because currently there is only epiphyseal block technology and no epiphyseal stimulation technology.<
/p>
If this technology achieves a breakthrough, then the theory of ridge correction will have two complementary surgeries, both of which will complement each other and make ridge correction very easy.
For example, in children's spine orthopedics, a few screws are minimally invasive, and you can do whatever you need to do after the surgery.
These screws regulate the growth of the ridge column in the body, allowing it to automatically correct itself during the growth process. I will grow it back as long as you want.
There are so many ideas!
Yang Ping has a lot of ideas in his mind right now, so I’ll write them down for now and study them later when I have time.
---
After changing the medicine, August was called to the professor's office again.