Teacher Wu and his two younger brothers were waiting for Yang Ping's reply in the general surgery patient family lounge.
She felt a little uneasy, wondering if Professor Yang could do anything.
My father's life was too hard. For the sake of the three brothers and sisters, he relied on hard work to earn money and sent the three brothers and sisters to college.
I remembered that when I was in middle school, my father would send her living expenses regularly every month, rain or shine, and he would never be late. Moreover, the monthly living expenses would never be less than those of ordinary people. Every time he sent her living expenses, his father would always ask her to go there.
In a park pavilion far away from the school, I handed the money to myself and said a few words: Studying is hard, and it’s time to grow taller. Don’t be too frugal. If you have any difficulties, tell your dad that only by reading good books can you be successful. Don’t believe it.
People say that studying is useless, but don’t put too much pressure on yourself. If you study well, it will be beneficial whether you can get into college or not.
Every time, her father would never talk about his suffering, but would always tell her some interesting things, as if there was no suffering in his life, only happiness and hope.
Sometimes my father would bring some food, watch me finish it, and then take the lunch box back.
Sometimes he would also bring some chicken legs, saying that the customer saw him working hard moving the goods and bought them for him to eat. He was full, so he brought them.
In fact, he knew that his father bought it, and he wanted his daughter to taste something that others could afford.
Sometimes I will give myself more money to buy beautiful clothes and skirts, and I will repeatedly explain: the money you earn is for spending, don’t wrong yourself too much, as long as you don’t waste it, it is normal to wear nicer clothes and skirts, not extravagance and waste.
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When I got to college, I could have taken out a student loan to complete my studies, but my father said that he had prepared the tuition fees and did not let me take out a loan.
When she was in college, her father called her every week to chat, telling her to take one step at a time, not to be poisoned by the messy thoughts in society, and to live a good life.
She understood what her father was thinking at that time, fearing that she would go astray because of poverty and low self-esteem.
As he thought about it, the corners of Teacher Wu's eyes became moist.
She just wanted her father to be happy and healthy in his later years, and she wanted to take him to travel everywhere.
"elder sister?"
The second brother saw something was wrong with his sister.
"Dad is fine. In the worst case, we can push the wheelchair and take him out to play."
The younger brother also noticed his sister's expression.
At this time, a doctor came over and asked them to go to the consultation room. Professor Yang invited them to talk to them about their condition.
Teacher Wu was very excited when he heard that Yang Ping said that knee-preserving surgery was possible. This meant that his father could stand up and walk, and he could also visit the great places of the motherland in the future.
The surgical plan is simple: cut off both fibulas, transplant the cartilage from the ankle joint to the knee joint, and fuse the ankle joints.
This operation is based on Mr. Wu's specific situation and organically combines several surgical techniques. It can not only solve the old man's problem, but also save the knee joint.
Knee-preserving surgery is compared to artificial knee replacement. Artificial joint replacement removes the original cartilage and part of the bone and replaces it with an artificial joint. The artificial joint is used to replace the original joint surface.
Knee-preserving surgery is to preserve your own knee cartilage, without using artificial joints, and to use other methods to relieve pain.
The core value of surgery for knee osteoarthritis is to eliminate pain and obtain a pain-free joint.
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Mr. Wu was lying on the operating bed while Fatty Liang prepared for anesthesia.
The fat man marveled at the old man's muscles, which were even better than those of the trainers in the gym. Moreover, coupled with his bronze skin, he showed strength and health that was clearly inconsistent with his seventy-four-year-old age.
The old man speaks Chongqing dialect, while Fatty Liang graduated from West China University of Medicine and can understand the Sichuan dialect.
"Old man, are you also lifting weights? You don't have ten years of training, can't you develop such muscles?"
In order to lose weight, Fatty Liang now goes for runs and goes to the gym to lift weights when he has time.
The old man didn’t understand the meaning of the iron pull, but he knew that he was being asked about his muscles, so he held out three fingers: “I have been working as a stickman for more than 30 years. Every day I am either carrying goods or pulling pallets, and I have to climb mountains to carry goods.
"
It turns out that these muscles are real and are shaped by labor.
"Don't just look at these muscles, the old man trained three college students with one pole." Xiao Wu said next to him.
Fatty Liang didn't expect that the old man was a ruthless character: "A top student emerges from a stick!"
However, hitting with a carrying pole is too harsh and can easily cause problems.
Zhang Lin explained: "It seems that you, fat man, were beaten a lot when you were a child. The old man used this pole not to beat people, but to make money. He used the pole to make money to send three college students."
Fatty Liang was filled with respect.
"You can't do it without studying. You must study. Only by studying can you find a way out."
The old man expressed his ideas in Chongqing dialect.
What a great father, Xiao Wu Zhang Lin's child is still young, otherwise I would really like to discuss with the old man his experience in raising children.
During the chat, Fatty Liang completed the lumbar puncture, implanted the hose, and then pushed the medicine.
The old man felt a heat sensation in his lower limbs, and gradually lost feeling in his lower limbs, as if they were not his own legs.
Wash hands and disinfect the sheets, and the operation begins in an orderly manner.
The entire operation is completed in a minimally invasive manner, and except for the fibular osteotomy, all other steps are completed under arthroscopy.
First, perform arthroscopy on both knee joints to once again confirm whether they are suitable for the surgical plan formulated before surgery.
Arthroscopy, compared with various preoperative imaging examinations, can visually observe the various structures inside the joint, whether there are lesions and injuries, and what extent the lesions and injuries are.
Both knees were explored with arthroscopy, which was completely consistent with the preoperative imaging examination. The cartilage at the medial condyle was missing, exposing the yellow subchondral bone. The probe could feel the hardness and roughness of the subchondral bone. This is the source of the pain. There is no
Due to the protection and buffering of cartilage, the subchondral bone is directly subjected to friction and pressure, and the pain nerves cannot tolerate this stimulation, so pain occurs.
The cartilage of the lateral condyle is relatively good, white and smooth, with only a very small area showing roughness, indicating mild wear.
This chapter is not over yet, please click on the next page to continue reading! There is hyperplasia of the synovium, floating like waterweed in the field of view under the microscope, but the patient has no obvious symptoms of synovitis.
Yang Ping simply cleaned both knee joints and partially removed and reshaped the torn meniscus.
The arthroscope was transferred to the ankle joint and the ankle joint was inspected, which was consistent with the preoperative judgment.
The wear of the distal tibia and the medial cartilage of the talus is lighter than that of the knee joint, but it is enough to cause chronic pain. The lateral cartilage is very good and can be used as cartilage transplantation. Both quality and quantity are qualified.
The treatment method for ankle osteoarthritis is different from that of the knee joint. It is also a severe stage. Artificial joint replacement is generally considered for the knee joint, while fusion is considered for the ankle joint, because artificial joint replacement of the ankle joint is very immature and cannot be done like the knee joint.
The average service life is 15 to 20 years.
Even if ankle replacement technology is mature, this patient cannot undergo ankle replacement because of metal allergy.
Yang Ping plans to fuse the ankle joint. The so-called joint fusion is to grow the bones of the joint into one piece, which is equivalent to "welding" and eliminating the movement of the joint. To "weld" the joint, all the cartilage must be removed and the bones
It is in tight contact with the bone so that it can fuse.
Therefore, the cartilage of the ankle joint can be reused and transplanted to the knee joint. For the knee joint, this cartilage is a priceless treasure.
Yang Ping used special instruments under the microscope to start removing cartilage from the ankle joint. Cartilage of good quality was removed for later use, while cartilage of poor quality was removed and left unused.
All operations are completed under arthroscopy. Use cartilage removal instruments to remove some cylindrical cartilage from the distal end of the tibia and talus of the ankle joint. There is cancellous bone underneath the cartilage. This cartilage-bone structure is the most vulnerable to heel pain.
Areas heal. In medicine, bone-to-bone healing is always the most reliable and strongest.
Yang Ping drilled a uniform cylindrical cavity in the missing part of the medial femoral condylar cartilage.
Then, the complex of cylindrical cartilage and bone removed from the ankle joint is inserted into the pre-drilled cylindrical hole in the medial condyle of the femur of the knee joint, and is compacted and tightly packed. Slowly, these cylindrical cartilages fill in the missing cartilage and form a normal condyle.
The shape, even the curvature is so beautiful.
If the ankle joint does not contribute so much cartilage, the cartilage loss in the knee joint cannot be filled with so much articular cartilage. The effect of allogeneic cartilage transplantation is very poor. 3D printed cartilage is far from meeting the requirements of real articular cartilage. Only autologous articular cartilage can
It is the best filling material.
After the ankle cartilage is removed, the remaining unqualified cartilage is ground away until the cancellous bone is exposed to fuse the tibiotalar joint together. Because metal cannot be used, Yang Ping uses a cylindrical artificial bone plug of the same size.
Stuff it into the cylindrical hole between the distal tibia and talus.
These cylindrical holes have been precisely designed to fit perfectly when removing cartilage.
Therefore, the bone plug is inserted into the round holes of the tibia and talus, and then squeezed and tapped on the heel. The bone plug is tightly embedded in the distal end of the tibia and talus.
This is like the mortise and tenon structure used in ancient furniture making. It does not use any metal screws or steel plates, but only uses artificial bone plugs to complete the fusion steps of the ankle joint.
In order to increase the firmness, two more absorbable screws were implanted to successfully complete the reinforcement of ankle joint fusion, and the surgery on the other side was carried out in the same manner.
Ankle joint fusion originally requires the bones at both ends to be pressed together tightly to achieve good contact between the bones at both ends. With good contact, new bone can connect the two ends and complete the "welding".
Because metal cannot be used, steel plates and screws cannot be used, and compression methods cannot be used. Bone plugs are used to connect the two ends of the joint. The bone plugs not only play a biological connection role, but also induce osteogenesis. New bone will crawl along the bone plugs.
Pass through the gap at both ends of the ankle joint, connect the two ends, and complete the bone welding, so that the joint can grow into one piece without putting pressure on it.
After the ankle joint is fused, both lower limbs can still walk, and as long as they are not doing sports, it will not have a great impact on daily walking.
This fusion can eliminate previous chronic pain in the ankle joint.
In this way, the problems of the four joints are solved at once.
Finally, the fibulas were amputated at the middle and upper third of the bilateral fibulas, and 3 centimeters of the fibulas were cut off to disable the function of the top pillar on the outside of the knee joint, so that the medial and lateral sides of the tibial platform can settle evenly.
Just like a house, the foundation on one side collapsed and the house tilted. Now the foundation on the other side is also artificially collapsed, and this method is used to straighten the house.
For patients with knee osteoarthritis, Academician Zhang Yingze's uneven settlement theory will achieve good results if used properly.
The emergence of the uneven settlement theory has opened up a new idea for knee-preserving surgery. In practice, many knee joints have been saved and joint replacement has been avoided.
Yang Ping combined Academician Zhang's uneven settlement theory with autologous cartilage transplantation to successfully solve Mr. Wu's problem.
The theory of the entire operation is ready-made, and no innovative theory is applied. However, by combining the two theories and thinking about the two sets of joints, a magical plan has indeed been produced.
Coupled with the excellence of the surgical operation, the application of mortise-and-tenon thinking in ankle joint fusion, and the perfect operation of knee cartilage transplantation, the entire operation can achieve the expected goals.
If someone else performs this kind of surgery and uses the same plan, without special training, it may be difficult to achieve the desired results.
The distal end of the tibia of the ankle joint is removed from the round hole of the cartilage from the talus, and is aligned up and down without making any mistakes. Finally, an artificial bone plug is inserted to obtain a tight connection and correct the line of force. This operation requires very high surgical skills.
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This surgery is generally based on theoretical innovation, and half of it is supported by superb surgical operations.
A professor is a professor!
Robert once again witnessed the world's top level of surgery.
If nothing else, the operation of this cylindrical cartilage transplant is like art. After the round cartilage surfaces are put together, it can actually be close to a round joint surface.
It is also a cartilage transplant. Robert's surgery was much rougher and did not consider the precise reshaping of the articular surface curvature. If Yang Ping's technique is learned, young patients with cartilage injuries in the future will be able to accurately reshape the articular surface during surgery.
The effect will be multiplied.
I don't know when Director Gao appeared in the corner of the operating room again, as if he was always paying attention to the operations here. Once there was an operation related to sports medicine, he was never absent.
Video, copy surgery video, cartilage transplantation operation during surgery, you must learn it no matter what.
Director Gao took off the USB flash drive hanging around his neck and began to seize the computer.
Robert reacted and followed suit to copy the video.
After the operation, Mr. Wu walked out of the operating room, and the three siblings were waiting at the door of the operating room.
They made a good deal, and the three siblings took turns taking care of their father while he was in the hospital. After all, this was the only surgery in his life, so he was a little worried about having a caregiver.
"Dad, are you okay? Does it hurt?"
The daughter touched her father's forehead warmly, and her two younger brothers followed suit.
Mr. Wu said with a smile: "I didn't even know I was doing surgery on my legs. I was dreaming about pulling a cart uphill. Before the cart could be pulled up, the doctor woke me up and said the operation was done."
This kind of surgery uses combined spinal and epidural anesthesia, commonly known as semi-anesthesia, and then uses auxiliary sedative drugs to make the patient sleep, so he wakes up very awake, unlike general anesthesia, which sometimes makes the patient feel confused when he wakes up.
These words made the children laugh. It seems that the old man is an optimistic and interesting person with a good attitude.
"That slope is relatively long, otherwise why would it take so long?" my daughter joked.
The old man said: "It's not very long, but I feel like my legs are weak and I can't pull it up. I'm in a hurry!"
"Both lower limbs are anesthetized, so they must be weak. Do you want me to give you some more medicine to let you sleep for a while? Pull the cart up?" Fatty Liang joked along with him.
"Don't---" The old man shook his head.
"Stop shaking your head, lie down and don't move." Fatty Liang pressed his head.
"You are all busy. I can do it on my own. You don't need to accompany me. It will take up too much of your time. The second one has come so far."
"No matter how far it is, it's only these days. It'll be fine. Don't worry, we've already arranged a vacation."
The children comfort their father, and the family is happy.