Although patients with metal allergies are rare, Yang Ping has encountered two at Sanbo Hospital.
When he first came to Sanbo Hospital, Yang Ping encountered a case. The patient was a fourteen-year-old boy. He underwent surgery for an old fracture of the left carpal scaphoid and implanted two metal countersunk screws.
Multiple manifestations of synovitis occur.
Later it was diagnosed as "metal ion reactive arthritis". After the two screws were removed, the symptoms of synovitis in each joint gradually eased.
The two screws of this little boy have no friction between metal and metal or metal and other materials. In fact, the ions released are very few, but the allergic reaction has nothing to do with the dose. Even a little bit can trigger an allergic reaction.
For example, if you are allergic to penicillin, some sensitive patients will suffer from anaphylactic shock even if they smell the smell of penicillin.
Now Mr. Wu is allergic to so many metals. This kind of thing can be written and published.
Zhang Lin and Xiao Wu heard that the transferred patient was a metal allergy patient. They hurriedly checked the medical records in advance and found out that the patient had been allergic to metals for so many years. They felt like they had discovered a treasure.
Song Zimo and Xu Zhiliang are probably not interested in this kind of personal report. They want to follow the professor to do big things. Zhang Lin and Xiao Wu can use this case to write an article as the first author and choose a better magazine to publish it.
Corey usually published articles with their names trailing behind them, so the two worked hard to make some noise. Monographs on La Gou Xue alone were not enough to determine their academic status, so the two came up with the idea of these personal reports.<
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In short, I have to pick up some things that Song Zimo and Xu Zhiliang are not interested in and write articles.
After dinner, Yang Ping and Xiao Su went to play tennis.
Song Zimo, Xu Zhiliang, August and Robert all ran to the hospital library to read books and information.
The library of Sanbo Hospital is very good. There is basically no shortage of medical monographs and periodicals. The library is open from 8 a.m. to 10 p.m. with no breaks in between. It is also open on Saturdays and Sundays, so it is very convenient to read books and check information. The four of them met Director Gao in the library. Director Gao was immersed in reading and taking notes from time to time.
Anyway, Song Zimo often ran into Director Gao when he came to the library. Since he was immersed in reading, he didn't say hello.
In the past, Song Zimo hated Director Gao. He felt that it was too much for him to be thick-skinned, pretending to study diligently, and showing courtesy to Yang Ping. Later, he felt that this person was really not pretending, but was really dedicated to studying.
The four of them stayed together until the library closed. Song Zimo consulted a large amount of information to understand how patients with metal allergies deal with severe knee arthritis.
However, there are very few papers in this area. Probably when encountering patients with severe metal ions, most doctors give up joint replacement.
———
Mr. Wu's MRI examination was scheduled for the afternoon of the next day.
Yang Ping took the time to personally participate in the magnetic resonance examination. He specializes in understanding the magnetic resonance of articular cartilage and the magnetic resonance of ordinary joints. There is a big difference in parameter setting and technical application during the examination. Some special technologies need to be used to observe and evaluate the cartilage.
Quantitative evaluation is also needed.
Personalized treatment for each patient must rely on familiarity with the patient's condition, a comprehensive and in-depth grasp of relevant medical knowledge, and rich experience in the treatment of this type of disease, all three of which are indispensable.
Lao Du in the Radiology Department, named Du Haibin, is an attending doctor in his thirties. Because he is a bit fat, especially with an obvious beer belly, and looks rather mature, with the demeanor of a director, everyone affectionately calls him Lao Du.
When Lao Du heard that Yang Ping was coming to the magnetic resonance room, he immediately put aside all the work at hand. He had long wanted to have a relationship with Yang Ping.
Yang Ping's reputation in the hospital is known to everyone, and there are many legends about him.
I heard that Director Gao is a non-staff trainee in general surgery and Yang Ping's disciple. He has learned some real things and now makes the sports medicine center prosperous, almost as good as the sports medicine center attached to the first branch.
Duan Guangtou from the Department of Hai Fu Knife got a little bit of information from Yang Ping. This three-way stock god who lost money every year suddenly turned into a uterine fibroid expert, and his reputation became more and more famous. I heard that the flying knife in the city is lower than three
Qian Buqian, any hospital that has Haifu knife is begging to hire Duan Guangtou. Haifu knife company also attaches great importance to Duan Guangtou and promotes Duan Guangtou as a gold medal surgeon. Hai goes everywhere to help him make appointments.
Since Xu Zhiba from the emergency department entered the general surgery department, his professional skills have improved dramatically. He has also started to perform scoliosis surgery himself, and he has also found a beautiful civil servant girlfriend.
Lao Du felt itchy and was waiting in the MRI room very early.
Lao Du went out to take a look from time to time and asked the nurse: "The patients from the general surgery department haven't arrived yet?"
"We're here!" The nurse was also very busy, pointing to the old man in a wheelchair in the hall.
Not far away, Professor Yang and his group are walking this way.
Lao Du hurried forward to greet him and shook hands from afar: "Welcome."
"Lao Du, are you in the MRI room today?" Song Zimo asked.
"I have a day off today. I didn't hear that Professor Yang came to the MRI room in person. I came here specifically to see if I could help." Lao Du did take a day off today, but there are not many opportunities like this, so he came here to take a break.
If you can learn a little bit from Yang Ping like Duan Guangtou did, you might be able to be invited to review films.
In fact, medicine covers a wide range of things. If you study in depth any small field, you can produce experts.
There is a radiologist who specializes in studying CT images of pulmonary nodules. He has seen hundreds of thousands of CT images of various pulmonary nodules, published hundreds of articles, and has patients with pulmonary nodules from all over the country.
When he reads the film, others can tell accurately that some patients are suspected of needing surgery for lung cancer. The expert takes a few glances and concludes that this does not require surgery, so it is definitely not lung cancer.
While walking and chatting, we came to the doctor’s operating room in the MRI room.
As the host, Lao Du arranged for everyone to sit down, then went out to say hello to the nurse, and asked the patients from the general surgery department to arrange for a check-up on the machine. It seemed that he was usually popular, and the nurse was relatively cooperative, so he secretly adjusted the order.
The patient has completed the contraindication screening and signed before the examination. The nurse once again checked whether there were any metal parts on the body. After confirming that there were no metal parts, the nurse asked two interns to help the patient into the examination room. The wheelchair was left outside.
Because the wheelchair has metal parts, sometimes I forget to push it out of the examination room. When the machine is turned on, the wheelchair will be attracted by the magnetic field and fly up.
When the patient enters the examination room, Dr. Ao and Dr. Luo immediately enter the examination room from the operating room and move the patient onto the machine together.
Magnetic resonance does not have ionizing radiation, but it is afraid of magnetic metals. Therefore, during magnetic resonance examination, not only should there be no magnetic metal in the body, but all magnetic metal parts on the body must also be removed to prevent being moved by the huge magnetic field during the examination and causing danger.
Song Zimo made a gesture, Dr. Ao and Dr. Luo came out, the door of the examination room was closed, and Lao Du turned on the machine remotely through the glass window, and the machine slowly pushed the patient into the scanning black hole.
"Professor Yang?"
Lao Du smiled and chatted a few words when he had time to get closer.
But Yang Ping was so absorbed in waiting for the scanned pictures that he didn't hear what Lao Du said.
Lao Du couldn't help but feel a little embarrassed, so he had to say to Song Zimo: "Mr. Song, if you have any special patients in the future, please come down in person and tell me, I will be on call."
These are not polite words, Lao Du is really ready to be at your call.
Lao Du analyzed Duan Guangtou’s counterattack story and learned a lot from it.
The Philips 3.0 light speed magnetic resonance examination is extremely fast. The examination of different parts of the body is several to twenty times faster than the ordinary magnetic resonance scan.
Slowly the scan was completed and the patient was moved out. Lao Du shut down the machine and opened the examination room door. Dr. Ao and Dr. Luo consciously rushed in and moved the patient immediately.
Even foreigners are working so hard. Why do I, Du Haibin, have any reason to be a salted fish? Lao Du immediately followed me to help carry the patient.
Yang Ping carefully read the MRI pictures. His initial judgment was the same. The lateral condylar cartilage of both knees was fine, but the medial condyle was bare. The anterior and posterior cruciate ligaments were fine. The lateral meniscus was fine, but the medial meniscus was torn due to degenerative degeneration.
It can live a few millimeters in the periphery, and the symptoms of synovitis are also very mild.
There is wear and tear on the distal tibia and talus cartilage of the bilateral ankle joints, but the cartilage quality in a large surrounding area is very good.
The clever Song Zimo has a vague outline in his mind. He has been thinking about this patient's plan. He even thought about it in his dream yesterday, and his head felt hot in the morning.
Yang Ping paid so much attention to the cartilage of the patient's knees and ankles that he personally went down to do the magnetic resonance imaging again, and used some new methods to quantitatively evaluate the cartilage.
In addition, he also pays great attention to the patient's lower limb alignment.
If artificial joint replacement is performed, it is a routine preparation to pay attention to the alignment of the lower limbs before surgery, but it is obviously redundant to focus on the main articular cartilage. For artificial knee joint replacement, all articular cartilage must be amputated, and preoperative attention is meaningless.
"Do you want to perform an osteotomy on the lateral fibula? Use Academician Zhang Yingze's theory of uneven settlement to perform an osteotomy on the fibula? Let the tibial platform settle evenly and move the inner force outward bit by bit?" Song Zimo finally realized what Yang Ping had learned
He wanted to do knee-preserving surgery.
Academician Zhang Yingze's theory believes that the uneven or differential settlement of human bones caused by osteoporosis in the elderly plays an important role in the occurrence and development of degenerative knee joint disease.
The tibial plateau is the main component of the knee joint. The differential settlement of the medial and lateral tibial platforms often causes the medial side to settle too quickly and the force to increase. The medial cartilage is stressed beyond its load-bearing limit, so it becomes thinner and degenerates under pressure. If it is long-term
Pressure aggravates the grinding and degeneration of articular cartilage, leading to knee osteoarthritis.
Just like a car, if the load on the inside is always higher than on the outside, the tires on the inside will naturally wear faster.
Differential settlement, also called uneven settlement, is a mechanical phenomenon that occurs when objects are affected by gravity and is ubiquitous in nature.
For example, if the foundation collapses and the house collapses on one side, this is uneven settlement.
Human bones will also subside unevenly due to the influence of gravity. When human bones develop osteoporosis, the loose parts may suffer from microfractures under the pressure of body weight. When these microfractures accumulate over time, they will cause the bones to collapse and sink.
, joint deformation and other diseases.
This phenomenon is most significant and typical in the spine and proximal end of the tibia, the bones that receive the most concentrated stress.
The inner side of the tibial platform bears two-thirds of the body's weight, and the outer platform bears one-third of the weight. The outer platform is supported by the fibula, which rarely causes osteoporosis.
It is equivalent to having pillars for support on the outside of the knee joint, but no pillars for support on the inside.
Therefore, when the medial platform is osteoporotic and unevenly subsides, the height drops and is lower than the lateral platform, the pressure distribution becomes uneven, and the medial cartilage wears faster, causing osteoarthritis.
After Song Zimo said this, Xu Zhiliang was instantly enlightened.
Yang Ping nodded slightly: "Although this patient has terminal osteoarthritis, judging from the medical history, physical examination and magnetic resonance imaging, the symptoms of synovitis are not severe, and the pain symptoms are concentrated in the medial compartment. If this situation is accurately grasped,
, unicondylar replacement can be performed."
Unicondylar replacement means that the entire knee joint is not replaced, but only a part is replaced, usually on the inner side.
"But unicondylar replacement cannot escape the metal component, so we can only save the knee. If we want to save the knee, we can only use Academician Zhang's theory."
He is indeed a smart guy. Thinking of this is nothing, but thinking of this in this case shows that Song Zimo has a very profound and extensive understanding of knee joints.
"But all the medial condylar cartilage is missing. Even if the fibula is osteotomy, the varus deformity is corrected, and the stress point is moved inward, it still doesn't work. There is still no cartilage at the stress point of the heart?" Xu Zhiliang raised a new question.
This is why no doctor wants to save the knee. This case is not suitable for Academician Zhang’s theory.
"After fibula osteotomy, autologous cartilage transplantation is performed?" Song Zimo asked tentatively.
"Re-doing magnetic resonance is to determine the distribution of cartilage wear? Because after fibular osteotomy, both sides of the tibial platform settle evenly and the stress shifts outward. This requires determining whether the lateral condyle cartilage can withstand this change. It also needs to be done on the medial condyle. Find new stress points for cartilage transplantation?"
Song Zimo took advantage of the victory to pursue.
"Also, he already has osteoarthritis in both ankle joints and has suffered from chronic pain for many years, which cannot be cured. Do you want to transplant the cartilage from the ankle joint to the knee joint and then fuse the ankle joint?"
Song Zimo finally figured out the entire plan. Everyone knew every theory and every operation, but if they needed to be combined flexibly, no one would have thought of applying it to this case.
This requires a thorough integration of all knowledge, and each step must be calculated accurately, otherwise it will be counterproductive.
Song Zimo couldn't help but sigh that he regarded every case as a research object and wanted to make it a classic. Even for this case that others had given up on, he racked his brains and used all existing technologies to complete the operation.
Academician Zhang's knee-preserving surgery combined with autologous cartilage transplantation, if the ankle joint can be fused and the force on the foot can be adjusted to adjust the alignment of the lower limbs, then the problems of the four joints can be solved at once.
Song Zimo had a feeling of exhilaration. He had not thought about it all last night and always felt that something was wrong. Today he has figured it all out.
Xu Zhiliang is still thinking about Song Zimo's words.
"Prepare for surgery the day after tomorrow, and talk to his family tomorrow." Yang Ping finalized the surgery plan.
After careful evaluation, this plan is feasible and very certain.
"Professor Yang, can you teach me the magnetic resonance technology that you just used to quantitatively evaluate articular cartilage? If it were like your general surgery department, we would all have to be laid off. I don't understand why you are so familiar with magnetic resonance?" Lao Du
He said with a round belly.
Yang Ping said modestly: "We are amateurs. We are not as professional as you. We just read a few books and papers. Come here and let's study together."
The fairy has plucked his hair!
Lao Du leaned over and almost rolled off the chair.
