After the bleeding was successfully stopped, the boy passed through the first gate of hell.
Next, he will be transferred to the trauma ICU for continued treatment. After his condition stabilizes, he will undergo second-stage surgery.
The second-stage surgery involves a lot of content. In addition to fixing the head and neck, it also requires surgical treatment of pelvic fractures and multiple fractures throughout the body.
"Get ready to go to bed, everyone in your places!"
Song Zimo directed everyone to move the boy from the operating bed to the transfer truck.
Because of the weakening of muscle strength, the boy had to rely on a ventilator to assist breathing. The cannula inserted through the tracheotomy was connected to the ventilator, making a rhythmic wheezing sound.
"1,2,3, get up!"
Following Song Zimo's order, everyone worked together to successfully transfer the boy to the flat car.
Usually, only two or three people are needed to complete the bed transfer for ordinary surgical patients, but this time it was different. In order to safely move the patient, seven experienced and strong doctors worked together.
Because the spinal canal at the atlanto-occipital joint level is the starting point of the cervical spinal cord and adjacent to the respiratory center of the medulla oblongata, if you are not careful, it may cause secondary damage to the spinal cord, and the outcome of the secondary damage is respiratory arrest.
"Blood oxygen is dropping?" the anesthesiologist immediately reminded.
On the screen of the monitoring instrument, the blood oxygen saturation dropped from 100% to 80%. Just one move caused this fatal fluctuation.
Everyone turned their attention to Yang Ping, hoping to get some kind of rescue instructions from him.
Yang Ping looked at the values on the monitoring screen and spoke after a moment: "No matter how careful you are, you cannot guarantee that the cervical spine will not rotate and translate. Even small rotations and translations will interfere with the edema of the cervical spinal cord and affect the respiratory center.
, thus causing a drop in blood oxygen. This is a transient blood oxygen fluctuation, please observe it for a while and then talk about it.”
The blood oxygen saturation remained at 80% for less than 30 seconds, then began to rise, climbing to over 95%. Everyone breathed a sigh of relief.
If the blood oxygen saturation cannot rise but continues to fall, it means that the cervical spinal cord has suffered a fatal secondary injury, and the boy may not have a chance to survive. Fortunately, the blood oxygen saturation returned to normal, thanks to the good fixation of the brace and the
Everyone's professional cooperation during the move.
Yang Ping approached the transfer car and reached out to touch the brace. Director Wei hurriedly followed and looked at Yang Ping worriedly. The fluctuation in blood oxygen just now showed that the cervical spine was still unstable, indicating that the respiratory center was interfered with in some way.
Director Wei also stretched out his hand and stroked the surface of the brace to determine whether it fit snugly, especially at the corners, and whether it was pliable. Along the edge of the brace, he explored the gap between the brace and the skin to see if it was too wide.
After some groping, Director Wei said doubtfully: "The fixation is very reliable, what's going on?"
Yang Ping said calmly: "The brace is perfect. It's not a problem with the brace. Any external fixation is elastic and cannot be absolutely stable. Micro-movement is fine as long as it is within a safe range. Don't worry. You can send it to the ICU now."
If blood oxygen fluctuations occur again, stop and rest to stabilize before transporting."
Director Wei was relieved. He was still very confident in his brace. He had been doing this for the rest of his life, and he thought he had done it to the best of his ability.
About fifteen minutes after the blood oxygen stabilized, everyone pushed the flat cart and began to take the boy to the trauma ICU.
---
General Surgeon's Office.
It's already time to get off work, but there is never a concept of "normal commuting" in a doctor's life.
Scattered lunch boxes are placed on the desk. These are all empty boxes. Whether they are vegetables or rice, they have been swept away without any leftover.
Xiao Su and Tang Fei helped clear the table, and Yang Ping, Song Zimo, Xu Zhiliang, August, Robert and others began to discuss the case again.
"There is edema in the spinal cord and there is no transection, which means it is just a contusion. The muscle strength of the limbs is now at level one. As long as the surgery is timely, it is likely to be able to recover. Traumatic atlanto-occipital joint dislocation---I have done similar surgeries, but there are only a few cases.
There are not many cases of similar surgeries reported throughout Europe, and this injured patient had a comminuted fracture of the atlas, and I have never encountered such a case."
August is a top spinal surgeon, and experience is very important. He wiped the corners of his mouth with a tissue while speaking.
Trauma causes the joints between the head and cervical vertebrae to separate. The head and neck lose reliable bone and ligament connections, and only rely on soft tissue to maintain the connection.
There are actually not many such injuries, but doctors can see very few cases.
Among the cases of death caused by cervical spine trauma, about 1/3 are caused by the dislocation of the atlanto-occipital joint. The dislocation of the atlanto-occipital joint is very unstable. The vast majority of such patients either die on the spot after being injured, or the atlanto-occipital joint dislocates during transportation.
Further dislocation of the occipital joints may cause compression or pulling on the life center in the spinal cord, leading to respiratory arrest and death.
Therefore, it is very rare to be able to see a doctor, even in the world.
"Atlas, this term is taken from the Titan Atlas in Greek mythology. Just like this giant god carries the earth, the atlas carries the entire head, and the joint formed between the atlas and the head ---
The atlanto-occipital joint is the only connection between the head and the cervical vertebrae. Our huge human heads rely on this small joint to connect to the cervical vertebrae and to the trunk---"
August pointed to the three-dimensional reconstructed CT image of the head and neck that was automatically and slowly rotating on the screen, and explained.
"Now that there is no Atlas, who will carry the earth? Without the atlas, I don't know how to place this head?" August shrugged.
Robert said helplessly: "The separation of the atlanto-occipital joint is really an unbearable separation in life!"
"We can only customize the prosthesis. The upper part of the prosthesis supports the occipital part of the head, the lower part is connected to the axis vertebrae, and the middle part must simulate the atlas vertebrae, which means an artificial atlas vertebrae, atlanto-occipital joint and atlantoaxial joint must be created," Song Zimo said.
own opinion.
This idea is bold and easy to say, but very difficult to do.
This chapter is not over yet, please click on the next page to continue reading! "There are still single-digit cases of simple dislocation of the atlanto-occipital joint, and cases of combined comminuted fractures of the atlas. There is currently no precedent in the world to follow." Austrian
Gust was very disappointed.
"According to common sense, this case will not appear in front of us, but he happened to appear. We have to do something, right?" Xu Zhiliang was silent for a long time and began to join the discussion.
However, Zhang Lin and Xiao Wu remained silent. It was not that they were unwilling to participate in the discussion, but that the discussion was too high-end and they could not intervene at all. They could only learn from it as bystanders.
"If a custom-made prosthesis is used, the shattered atlas needs to be removed. It is difficult to completely remove the atlas. Unpredictable bleeding will occur during the operation. What is even more difficult is that the operation requires prone positioning and has to be transferred to the prone position midway.
The supine position and switching of body positions make it very difficult to fix the head and cervical spine. It is impossible to fix it with a brace during the operation, and traditional skull traction and various brackets are unable to do anything." August added new worries.
Indeed, how to allow the patient to freely switch positions during surgery without damaging the cervical spinal cord is another huge problem.
"Using a prosthesis for fixation is a good solution, but if the atlas prosthesis is used to complete the operation, how to achieve stable and long-term fixation between the head and occiput and the prosthesis, and between the prosthesis and the axis? Of course, we can
There is no need to think about the long term, after all, as long as we can complete the operation, no matter how long it lasts, it will be a medical victory."
August once participated in an academic exchange meeting between Europe and the United States. An American doctor tried to use this method to complete the operation, but in the end due to the loosening of the screws, the connection between the patient's headrest and cervical spine became loose, and eventually the patient stopped breathing.
"This method can be improved. The artificial atlas uses a mesh structure similar to titanium mesh. The mesh structure assumes the task of temporary fixation, and the mesh structure is filled with autologous bone, such as ribs or iliac bones, or the patient's existing comminuted atlas.
, allowing the autogenous bone to complete bony fusion with the upper headrest and lower axis, thus killing two birds with one stone." Yang Ping leaned back on the chair and expressed his opinion.
Sometimes, when faced with this kind of problem, innovative thinking is necessary to solve the problem.
Because they are difficult problems because there is no solution based on existing knowledge, and you need to use your imagination to come up with a brand new solution.
"The hollow cage structure is filled with autogenous bone in the middle, allowing the prosthesis to take on the dual tasks of temporary fixation and head and neck fusion?" August said in surprise.
"That's right!" Yang Ping said with certainty.
"Bone cyst is now only an imaging diagnosis. Pathological biopsy is required during the operation to clarify the nature of the atlas tumor. If it is malignant, not only can we not use the atlas as a donor bone, but we will also face more troubles."
Xu Zhiliang raised new questions.
Yang Ping said approvingly: "The idea is very rigorous! It is not certain whether the bone cyst is a bone cyst or not. Pathological examination must be performed during the operation. However, no matter what, the purpose of our current operation is only to complete the fixation of the head and neck. Let him survive.
The only purpose for now.”
"Imaginative plan, what can I do?" Robert snapped his fingers.
Yang Ping thought for a moment and said: "You can do many things, but I decided to give you the most important and core task. I hope you can do it."
Robert patted his chest excitedly: "Don't worry, trust me."
"Starting from today, you join the nursing team of the trauma ICU. They need a member who is proficient in orthopedic knowledge and is physically strong, because turning over in nursing work is so important. A little carelessness can lead to head and neck dislocation." Yang
Ping said very seriously.
Robert's brows tightened, then relaxed in an instant: "Professor--I promise--to complete the task---can I have a request?"
"Please tell me!" Yang Ping replied easily.
"During the mission, the working meal is arranged for two people?"
“No problem, not only it’s standard for two people, but it also comes with chicken legs!”
"This is an arduous and sacred task. This is the most critical and core link in the entire treatment plan. You must not make any mistakes. As a brother, I really want to fight side by side with you, but the situation does not allow it. I will keep silent in my heart.
Cheer for you, believe in yourself, you can do it, come on." August encouraged his roommate.
"The nursing team also needs an expert who is proficient in spinal surgery. If necessary, I can reluctantly get it for you." Yang Ping assigned August another task.
August straightened his chest and swallowed: "Professor, I don't want to embarrass you."
"It's okay! You touched me. No matter how difficult it is, I will try my best!" Yang Ping said calmly.
