Chapter 286 Xiao Zhou, this is unscientific (please subscribe)
Zhou Cheng took the initiative to speak again and worked with everyone on the detailed plan of the surgical procedure!
During the discussion, Director Zheng and others didn't pay much attention to it. It was Zhou Cheng who was performing a one-man show. Based on Professor Xue Xiude's trust in Zhou Cheng, the entire small incision open reduction and internal fixation procedure itself came from Zhou Cheng.
Derived and integrated.
Therefore, neither Hu Xianhe nor Scenery Star, including Director Zheng and others, spoke.
But after Zhou Cheng talked about it for a while, it seemed that some of the processes that they had thought were within theory and outside of operation were actually stripped out by Zhou Cheng in a very clever way.
The essence of difficult surgical procedures is often not complicated. If you think it is complicated, then you must not have been able to step in.
Some operations can also be dismantled. Even Category IV surgeries can be gradually split into Category III or even Category II surgeries, which are just superimposed as a whole.
As the second professor after Xue Xiude who can actively perform small-incision open reduction and internal fixation, Jingxing Xing has the most say and the best knowledge of the difficulties in this operation.
He opened his mouth and asked: "Xiao Zhou, do you mean that such a formula sleeve can be designed in the future? As long as the fracture line is properly aligned, such a difficult surgery will actually be relatively simple?"
Formula, sleeve, and the simplest one is a Kirschner wire as a guide, and then drive the screw at a fixed point.
Then various other ‘formulas’ were derived.
Zhou Cheng nodded and said: "Yes, Professor Jing, the indications for the small incision open reduction and internal fixation we are currently proposing are actually limited. Fractures with such long fracture lines are not among the indications.
Inside."
"These need to be improved step by step."
Zhou Cheng's words instantly made Scenery Star and Hu Xianhe look at each other.
"Can the indications for this kind of surgery be gradually expanded?" Hu Xianhe asked first.
"It should gradually mature as the technique is performed more often." Zhou Cheng didn't say anything, and thought to himself.
The road has to be walked step by step. The good things that Yang Yifeng has developed over several lifetimes cannot be released all at once. He is not a fool.
Scenery Star asked again: "Xiao Zhou, do you actually have a relatively comprehensive plan in mind? It's just that you didn't put it forward before?"
Zhou Cheng remained silent and did not speak.
Closed reduction and plaster external fixation of fractures has a relatively big impact on the equipment companies related to traditional plate, screw, and intramedullary nail internal fixation.
I am just an individual, not an official, and I certainly cannot force anything in the form of a national policy.
If the indications for small-incision open reduction and internal fixation of all fractures are released at once, forcing others to have no other way out, it will be like forcing a dog to jump over the wall.
Committing suicide.
Destroying people's financial resources, such as killing their parents, can affect other people's way of survival to a certain extent. This is competition.
But if you crush others all at once without having the strength to support your monopoly, you are seeking death.
"Professor Jing, you think too highly of me. These are relatively common diseases in clinical practice. I just think about them in secret sometimes." Zhou Cheng is not arrogant because he no longer needs to be arrogant.
Xue Xiude knew that Zhou Cheng didn't want to go deep into this topic, so he interrupted: "Xiao Zhou, Professor Jing, let's focus on the core of the problem first, today's surgery."
"Xiao Zhou, the formulas you just mentioned can simplify the operation, but there is no such formula for this surgery at present. So how can we do this surgery as well as possible without the formula?
This is a difficulty we need to pay attention to.”
"Long fracture line..."
After almost another five minutes, everything was ready.
Zhou Cheng and others walked into the operating room. Zhou Cheng washed his hands with Professor Xue Xiude and asked, "Professor Xue, is it okay for me to perform this type of III surgery here?"
Every doctor, whether professor or associate professor, has a designated practice location.
If you practice medicine in another place, you need to report to your current practice location.
Professor Xue Xiude heard this and smiled: "These are the most basic issues of principle. Director Zheng must have considered them before, so don't worry. Process issues are not issues that you and I need to consider."
"Asking for a consultation will look like asking for a consultation. There will be no traps unless everyone in this unit never wants to have contact with any other colleagues in the future."
Please consult for surgery. If you don't complete the process yourself, you will deceive others.
This time, I resisted. If you don’t say anything, who will dare to do things with you in the future? Are you kidding me?
Everything is ready.
Everyone arrived at the operating room, and Zhou Cheng once again confirmed his operating position: "Professor Xue, Professor Jing, Professor Hu, Director Zheng, this surgery does not have formula assistance for the time being, so I will try it first?"
"Xiao Zhou, we are also very curious about how you operate without a formula. We are not sure, so naturally you are the only one." Landscape Star replied.
Zhou Cheng came on stage and saw that the previous approach had been completed. It should be the remnants of the unfinished technique last time.
Zhou Cheng did not give up, but looked at the two approaches. Then, Zhou Cheng asked Xue Xiude, who was the first assistant, to get a Kirschner needle first.
After carefully looking at it, he used a Kirschner wire to locate the approximate edge of the fracture line. After that, Zhou Cheng did not perform any more operations, but continued to insert the internal fixation device specially designed for small incisions into the original opening.
placed.
After placing the mushroom-like instruments at both ends into the medullary cavity, the combined fixation was not started directly.
But once again, he let it go.
After this, Zhou Chengcheng said: "To be on the safe side, let's do another fluoroscopy now to see the fracture line and displacement."
Zhou Cheng's words caught everyone else by surprise.
However, it is a routine operation to perform another fluoroscopy before the formal operation.
Everyone exited and went to the isolation room.
Soon, the fluoroscopy results came out. The fracture line was quite well aligned. It should have been the reduction done by Professor Xue Xiude or Professor Jingxing Xing. It was done extremely well and the fracture line seemed to fit much better than the fracture line before the operation.
.
After this, everyone entered the operating room again. Xue Xiude asked: "Xiao Zhou, you just did this fluoroscopy. What are you going to do?"
"Professor Xue, it's mainly for positioning and orientation."
"The position where I just placed the K-wire is roughly at the upper edge of the fracture line. I am thinking about whether the K-wire should be inserted at the upper edge of the fracture line or at the lower edge."
"The main basis for evaluating this is that I want to look at the oblique angle of the fracture line and the upper and lower length of the small incision internal fixation device we are going to use."
"This is also the reason why I don't fix the internal fixation device in advance. And I need to evaluate the shaft diameter, because the best fixation method is to drive the Kirschner wire below the fracture line, and the internal fixation device can just cross the Kirschner wire.
needle position."
"This is the only way to achieve the best fixation effect." Zhou Cheng said while starting to operate again.
Professor Xue Xiude and others are still digesting what Zhou Cheng just said.
Then he saw that Zhou Cheng had already manipulated the internal fixation devices at both ends, fitting them together perfectly.
However, at this moment, Zhou Cheng did not complete the operation of spreading the internal fixation device to grasp the bone inside the bone, but was making gestures.
Seeing this situation, Xue Xiude suddenly reacted and asked: "Xiao Zhou, you are not thinking about driving the K-wire into the hole of the internal fixation device through a blind guide, are you?"
Xue Xiude is the professor who has seen the most internal fixation devices, so he is the most familiar with its structure. Among them, there is a hole left in the pedicle of the mushroom structure. He has never figured out what it is for.
However, now that I think about it, it seems that Zhou Cheng had left this hole in advance.
In fact, when Zhou Cheng designed this internal fixation device, he had already thought of a small incision internal fixation device for fractures with long fracture lines.
So, there are some rather strange and invisible shapes in this mushroom structure. Do they have other uses?
Zhou Chengyi smiled: "Yes, Professor Xue, in fact, this concept is borrowed from the external instrument formula used in the process of intramedullary nail internal fixation. The screw can be blindly driven into the screw hole of the intramedullary nail from outside the body.
among.”
"It's just that the design hasn't been completed yet." Zhou Cheng replied.
Without saying much, he first punctured the outer skin through the tip of the Kirschner needle, then passed through the muscle layer until it reached the outside of the skeleton.
"For small incision open reduction and internal fixation, we choose to place the internal fixation device at least 2cm above the fracture line, and the length of the middle part is generally not less than 5cm!"
"The hole in the middle of our internal fixation device is usually placed in the middle. Therefore, at least the place we choose to insert the Kirschner wire is 3cm below the fracture line. The longer the middle part, the greater the distance."
"This way, the bone on both sides of the fractured end will be better preserved."
As Zhou Cheng spoke, he used an electric drill to drive the Kirschner needle directly into the femur. Apart from the blockage caused by the femur, there was no other blockage at all.
Soon, the K-wire came to the inner wall of the bone on the other side of the medullary cavity.
What does this mean? It means that Zhou Cheng either crossed over the umbrella handle fixed in the umbrella mushroom, or passed through the hole.
Is it too accurate to be able to penetrate exactly that part?
Unbelievable, right?
Zhou Cheng did not immediately perform fluoroscopy on the inserted Kirschner needle. Instead, he used the same method to insert the second Kirschner needle.
Another front and side perspective.
Through the C-arm X-ray reader, you can see that the Kirschner wire goes right through the hole of the internal fixation without any bias.
This is absolute control over the entire surgical process!
During the operation, some experienced surgeons can blindly penetrate certain structures, such as directly hitting the greater trochanter of the femur. This is based on experience.
However, it is necessary to drill a fixed point into a hole, and the hole is still random. This is not something that can be done with experience.
It is not an exaggeration to say that this kind of operation is like the magical skill of an oil seller.
In the isolation room, there were gasps of cold air.
But Zhou Cheng did not hesitate because of these sounds, but continued: "Because the fracture line was very flat during the first fluoroscopy, therefore, during this process, we must fix the internal fixation device first."
"It may cause oblique fractures to shorten and shift obliquely, eventually leading to failure of the operation. This is also a constraint in the internal fixation step of small incision open reduction and internal fixation."
"When you have an oblique fracture, you have to pay great attention to this."
"But if we cross and fix it first, we can avoid this situation from happening."
There is sliding when traveling diagonally, and the tendency of sliding is great.
Zhou Cheng continued: "For oblique fractures, simple parallel fixation with Kirschner wires cannot achieve the fixation effect, so we'd better add internal fixation. The internal fixation device is square fixation. I just connected the middle of the upper and lower ends.
Together."
"At this moment, when the internal fixation capillary fixation device is opened, the deviation of the fracture will no longer be caused, and the preoperative manual reduction is excellent. Therefore, this is a compression fixation."
“This is based on the principle of pressure screws.”
As Zhou Cheng spoke, he opened the umbrella frame of the internal fixation device of the filamentous mushroom and penetrated into the bone marrow cavity!
"This is the second fixation device to prevent a certain degree of front-to-back and left-to-right dislocation, because it is a multi-axial fixation that can fill the medullary cavity when it is fully stretched."
"But that's not enough. We also need to add steel wire binding and fixation of the jacket to prevent lateral displacement. This is borrowed from the concept of steel wire binding and fixation for patella fractures."
After saying that, in order to verify his theory, Zhou Chengcheng looked through it again.
After the fluoroscopy was completed this time, Scenery Star let out a long sigh: "Put what you have learned into practice and innovate. Xiao Zhou did a great job with this surgery."
Green comes from blue and is better than blue, and green comes from blue.
When everyone can understand it and can find a reference object, then combine and use it, this is to innovate.
With the internal fixation method that everyone is familiar with as a reference for analysis, everything comes naturally.
Are you familiar with compression screws, open reduction of patellar fractures, Kirschner wires, and wire bundled internal fixation? You couldn't be more familiar. This is a classic surgical procedure that has been verified many times in history.
"Yes, these techniques and theories are actually what we see every day. Xiao Zhou has really understood these things thoroughly before he can draw side effects."
"Xiao Zhou's mastery of the knowledge system has reached a certain level." Hu Xianhe also said the same.
Then, he added: "This is still the case even for the projects that our research group is currently working on."
Speaking of this, Hu Xianhe stared at Zhou Cheng.
His stupid student had no problem with his IQ, but he was manipulated by Zhou Cheng, which made him uncomfortable.
Zhou Cheng knew that he was suspected of taking advantage of Yu Heng, but he also felt no guilt. It was Yu Heng who proposed it himself, and he only gave a certain amount of help.
But in the end, he still took advantage and refused to behave: "Thank you, Teacher Hu, and thank you, Professor Jing, for the compliment."
"The operation is actually over after reaching this step. However, to be on the safe side, we still have to add an extra step, wire binding!"
Zhou Cheng then changed the topic: "What if the patient can rest after surgery? But if he still needs to get out of bed early, then it is necessary to fix it as well as possible."
After the operation, getting up early and doing activities must be absolutely fixed. Otherwise, the operation is not a joke. How can you participate in activities so quickly?
Director Zheng heard this and said, "Thank you, Dr. Zhou. If it weren't for you, I really don't know what to do today."
"Although each step seems simple, it is actually thrilling. I am afraid it cannot be repeated."
Xue Xiude shook his head: "Director Zheng, it's better not to repeat this kind of surgery again."
Medicine does not allow for showing off skills. Whether it is Xue Xiude, Jingxing Xing, or even Zhou Cheng, seeing this case for the first time, the preferred treatment plan is still a very safe traditional treatment method.
When it comes to pursuing beauty versus pursuing quality, the quality of medical treatment is undoubtedly more important.
If not for Director Zheng's secret help and the patient's own special requirements, this small-incision open reduction and internal fixation surgery should not have been officially carried out.
Thinking of so many ways, don’t you think it’s a waste of your brain?
Director Zheng is also an experienced person, so he naturally understood what Xue Xiude meant: "Professor Xue, this kind of thing will never happen again next time."
Although the idea of this operation is borrowed from many previous operations, the operation is very difficult. If you are not careful, you may fail. Even if it is successful, the patient himself has to bear various risks.
Although Director Zheng took the risk on his own, if something happened to the old gentleman, it would be a big obstacle to the promotion of small incision open reduction and internal fixation.
In today's situation, I don't know how many people hope to find out the limitations and flaws of small incision open reduction and internal fixation, and then put them in prison, where they will never be reincarnated.
It’s just that now, there are still curative effects, backing, and funds to support it.
Zhou Cheng was unmoved and still cautiously added a third layer of steel wire binding.
I saw Zhou Cheng binding the steel wire into a certain shape in advance, similar to a spring shape, and then inserted the far end into the opening.
Outside the periosteum, it is close to the muscles. What Zhou Cheng has to do is to wrap this steel wire around the bone. The difficulty of this step is also difficult to imagine.
Even in the incision state, placing the steel wire still requires the assistance of formulas!
But I saw that Zhou Cheng inserted the steel wire as easily as twisting a screw, and then easily took out the steel wire head from the incision below.
Upon seeing this, everyone including Professor Xue Xiude's scalp was numb, and the muscles in his hands were extremely stiff.
This was the most difficult step in this operation. It was even more difficult than blind drilling into the hole of the internal fixation device. They thought Zhou Cheng would spend a lot of time!
but?
It seems that this is not the case.
Several people were stunned, and their tone was not calm. Scenery Star even grabbed Zhou Cheng's hand, carefully looked at it for a while, and said in a trembling tone: "Xiao Zhou?"