Then when he walked in, he found that the junior doctors and nurses were no longer there, and everyone else seemed to be waiting for him.
"Director Chen, Professor Ning, and Professor Li, now the problem of surgical contraindications and the anesthesiology department not accepting patients has been solved."
"But we still need to carefully discuss whether the current patient's disease is suitable for surgery, how to operate, or whether there are other treatment options?" Xue Guoqing felt a little pain in his head.
You want to say that this patient is a problem in the hand surgery department. You, Ningling, are so active, so that's it. But he is still a fracture patient in the trauma surgery department. He is here because of muscle dysfunction.
I invited Ningling to come over for consultation and surgery, but who knew there would be such changes in the process?
Of course, Xue Guoqing can also understand the pressure that Ningling is facing now. Part of it is that the disease that is currently being discussed in depth is diabetic foot. On the other hand, there is also the pressure of second-hand surgery. Ningling wants to grasp both.
Ningling still actively asked him to find a way to solve the problem of surgery. Ningling wanted to challenge himself.
Ningling was invited here by himself, and you have to give him some respect. But what Director Zhang said about this patient is actually correct. He has a special status.
Xue Guoqing actually hoped from the bottom of his heart not to have surgery so as not to get into trouble.
However, in order to go further, he could only bite the bullet and go to the medical department to find other directors to make advance preparations for Ningling to continue the operation.
If Ningling wasn't a professor at Xiangya Hospital, he would definitely be a lunatic who was hung up and beaten.
Chen Xuehua said: "Professor Ning, you previously considered that this patient is likely to have neurological damage, so I specially kept Director Su and Director Ling here. Professor Ning, can you tell me your thoughts?"
The words of Chen Xuehua and Xue Guoqing made Zhou Cheng, who was sitting next to Ningling, change his face slightly.
Good guy!
When he first came in, he always thought that Director Zhang from the medical department was being annoying and that he was up to something, but after going around and around, it turned out that something was wrong here in Ningling.
It was Ningling who insisted on the surgery, but Director Zhang, including Professor Li Neng and others, did not recommend surgery on such patients. However, Zhou Cheng did not think there was anything wrong with Ningling's decision.
Ningling took a deep breath and slowly said: "Professor Li, and directors, let me first tell you what I think."
"First, we can clearly rule out central nervous system damage in this patient, because we can see that the patient has no organic disease, whether through MRI or physical examination."
"Second, the patient's current sensory function is present, but the motor function is missing."
"This looks a lot like dissociative sensory disorder!"
"But dissociated sensation refers to the partial loss of pain, temperature, coarse touch or deep sensation, and fine touch in the same part. The difference in deep and superficial sensory conduction pathways is the anatomical basis of dissociative sensory disorder."
"This patient still has no organic changes."
"Third, in fact, the patient's current fracture condition is a good one and can be treated with surgery. I believe that both Professor Li Neng and Director Chen can easily solve it."
"Since we are fully prepared in terms of performance diagnosis, basic fracture skills, and the patient's physical condition, we can work hard for the patient's quality of life!"
"Now, let me talk about some current speculations about the patient's muscle dysfunction."
"The first one is that the patient has a functional loss of descending motor neurons, but the segment happens to be in the right lower limb, because the family has said before that the movement of the right lower limb is intact."
"Moreover, the patient's vaginal contraction function exists, which proves that it is not a large-scale damage to the descending motor neuron area. So we can rule out this diagnosis for the time being."
"Second, I think it may be a partial tear inside the nerve fiber, causing concussive damage to the motor nerve fiber."
"This is unlikely, but our hand surgery has such a possibility, and what if such a situation occurs?"
When Ningling said this, he frowned slightly: "For nerve stripping and precise suturing of nerve fibers like this, under normal circumstances, you may have to invite professors from Huashan Hospital to perform the surgery."
In China, the hand surgery department at Huashan Hospital is absolutely among the best in the country, and even far ahead in the world.
When Ningling said this, everyone turned their heads in the direction of Zhou Cheng.
Huashan Hospital, is Ningling inviting Zhou Cheng here just to set up such a line?
But?
Why didn't Ningling directly send the invitation letter for consultation to Huashan Hospital?
"Dr. Zhou, can you tell by reading the MRI scans what is the specific diagnosis of muscle dysfunction in this patient?" Ningling asked.
Hearing this, Zhou Cheng felt a little bitter in his heart. Brother, you finally thought of this. I have been waiting here for half an hour!
You just asked me what I came for.
"You can give it a try. If there is similar damage, you should take a look." Zhou Cheng did not dare to finish his words.
Even with a perfect MRI scan, you can't see anything that cannot be visualized by MRI.
Moreover, as Ningling said, inside the nerve, only the simple motor fibers are broken, but the sensory fibers are not broken. This is a special case.
The chance of it happening is extremely small.
When Ningling heard this, he laughed: "Professor Li, Xiao Zhou should still be Xiao Zhou!"
Ningling's words made Li Neng and others frown slightly.
Obviously, before Zhou Cheng came, Ningling took the initiative to tell them something. Of course, now is not the time to trace back to the previous time.
However, before Li Nengcai frowned slightly, he still said: "Professor Ning, I'm not doubting Dr. Zhou's ability. I just think that the diagnosis can be confirmed even by reading the film."
"There are still big doubts about the current treatment of this patient. Directly considering surgery is not the safest option." Li Neng, who seems rough and arrogant, is more conservative.
"But the safest choice may not be the best choice."
"When hand surgery first appeared, it was an impossible miracle. Professor Li, what do you think?" Ningling still doubled down on his persistence.
Ningling had already reached this point, and Li Neng obviously couldn't say anything more.
"Dr. Zhou, the MRI reading system has been opened over there. You can go over and read the scans first. I will discuss the treatment of this patient with Professor Li." Ningling knew that his previous statement was still insufficient.
To support Li Neng in agreeing to the surgery.
So I asked Zhou Cheng to watch the movie first, and then he would talk about his other considerations.
After Zhou Cheng left, he sat in front of the computer screen. Then Director Ling of the Spinal Surgery Department, an old man in his fifties, went over to help and taught Zhou Cheng how to flip the MRI layers up and down.
Although the MRI reading systems of different hospitals are similar, there are also some subtle differences, such as display ratio and adjustment scale, etc.
Ningling continued: "Professor Li, Director Chen, the reason why I insist that the patient needs surgery is mainly based on the following considerations."
"First, we should abandon the problem of patients' subsequent quality of life because they are older, have higher risks, and have a limited life expectancy. Effective survival time is more meaningful than ineffective survival time!"
"Second, this is a rare case. If we can make a more refined diagnosis and analyze a relatively special treatment plan, it will be of great reference significance for the development of hand surgery and the revision of treatment guidelines for rare diseases!
"
"Third, in terms of skill reserve, the directors may not know that Dr. Zhou is not only very particular about MRI reading, but he is also the best in our hand surgery department in terms of neurotomy and suturing. Therefore, when encountering such a situation,
I only thought of Dr. Xiao Zhou when I saw the case.”
"So, if the diagnosis can be confirmed, I can cooperate with Dr. Zhou to solve this patient's neurological problem and complete this seemingly impossible operation!"
"Fourth is risk-taking. First of all, the patient's current surgical contraindications have not yet reached the level of absolute contraindications, and there are many anesthesia methods to choose from."
"If spinal anesthesia is not possible, nerve block anesthesia can be performed! This can reduce the patient's risk."
"Fifth, the problem of fracture treatment. The patient currently has an intertrochanteric fracture of the femur. The treatment of this fracture does not require a large wound. I believe Professor Li can easily solve it."
"Sixth, the issue of cognitive reserve. Our country is currently far ahead in the world in terms of pure technical reserve in orthopedic hand surgery."
"But the reason why the development of our trauma surgery is temporarily limited is because we are too conservative and dare not make breakthroughs. Even when it is possible to make breakthroughs, we remain conservative. But in fact, we also have the same pioneering spirit as foreign countries.
The conditions of precedent and technical foundation.”
"So we have to proactively understand new things, new cases, and analyze rare cases."
"In the end, no matter how bad it is!"
"The patient is just continuing the current state of paralysis, which is muscle dysfunction!"
Ningling's words were very resounding.
Although what he said was reasonable, Li Neng only pointed out one point: "But Professor Ning, we must also consider the burden on family members and patients themselves. We should not do it for the development of our discipline."
"To bring a greater burden to patients and their families, the principle of do no harm is the first principle of medical procedures!"
No matter what Ningling said, he would just continue to be paralyzed, but you performed the operation, and it was still a meaningless operation. An operation that could be predicted in advance.
Moreover, Li Neng also hid a sentence: At present, the relative contraindication for orthopedic surgery is poor preoperative muscle function!
Of course, these are only relative contraindications. Large teaching hospitals and tertiary hospitals can treat relative contraindications. Otherwise, the development of medical treatment will be restricted.
The reason why absolute contraindications are established is to break the word absolute and become relative, turn relative into non-contraindications, and expand the treatment scope of diseases!
When Ningling heard this, he fell silent.
Chen Xuehua and others basically did not dare to fight Ningling...
However, Li Neng is at the same level as Ningling. There are differences between him and Ningling in terms of their understanding and direction of choice.
And just when Li Neng and Ningling were arguing endlessly.
Zhou Cheng stood up with a strange look on his face: "Professor Ning, does this patient have any other surgical history?"
"Um?"
When Ningling heard this, his pupils shrank suddenly: "You mean? Are the patient's family members hiding anything about the patient's medical history?"
Ningling's face changed slightly. This patient's family members were originally quite arrogant. If they leave holes everywhere, then his efforts will be meaningless!
"Do you have the patient's medical record? Can I take a look at it? If I read it correctly, the patient should have undergone partial isolation of the internal pudendal nerve or other operations before." Zhou Cheng said.
"I have the medical records, right here." Chen Xuehua quickly handed the medical records to Zhou Cheng.
However, Ningling was aware of this matter: "Yes, the patient is an elderly person. He had hemorrhoid surgery a year ago. He was afraid that the postoperative irritation would be too strong, so he performed a bilateral pudendal nerve block."
"It is used for postoperative analgesia. Can this be seen on MRI?" Ningling was very surprised.
Obviously, the patient's family had talked about this surgery before.
Zhou Cheng did not reply, but first looked at the medical records in the medical record book. Hemorrhoid surgery was recorded in the book.
However, internal pudendal nerve block for pain relief is just an operation, not a surgery, and is not recorded in the medical record.
However, Ningling may still remember it because he told it orally.
After being so sure, Zhou Chengcheng said: "That's almost it. Professor Ning, Professor Li, and all the directors. Come and take a look!"
Zhou Cheng returned to the MRI computer screen while holding the medical record.
A group of people immediately became commotion.
This thing is really new. Traces of nerve block can still be seen on the MRI. What kind of skill does this have?
How can it be so magical?
Zhou Cheng pointed at the computer screen: "Professor Ning, you see, here is the origin of the internal pudendal nerve, and through this shape, you can see that there is scarring of the muscles after the block.
.”
To be honest, if Zhou Cheng hadn't pointed it out like this, no one would have noticed that scar!
Ningling nodded: "Yes, it looks a little different here, but Dr. Zhou, is this the reason why the patient cannot move his lower limbs?"
"The internal pudendal nerve, it seems? Even if it is mutated, it cannot mutate to the extent that it is continuous with the motor nerves of the lower limbs?"
"No, Professor Ning, this nerve block is quite complicated and troublesome. Even if it is performed under the supervision of color ultrasound or other imaging examinations, it cannot be done overnight."
Zhou Cheng looked around and found that there were only insiders inside, so he said: "But on this MRI, we can find that here, that is, there is a keloid in the femoral nerve outside the pudendal nerve."
"There is also a small amount of scarring, so I considered the possibility that when performing the nerve block, I made a mistake at first, or during the puncture, the drug was misplaced and directly entered the femoral nerve."
"So there is a compressive change in the femoral sheath within this nerve."
"You see, it is here, and the upper part of this nerve distributes the tibial nerve. The lower part is the area innervated by the common peroneal nerve, and there is compression right in the middle."
"There is no special change in the diameter of the patient's lower limb muscles, which proves that there is no nutritional damage. If there is only sports injury, it is estimated that the descending motor neurons have suffered compression. This compression can be removed, and it may be possible.
Restore the patient’s motor function.”
"It's not a tear in the motor neuron."
"And I guess that the patient's muscle dysfunction is gradual and does not appear immediately after the operation." Zhou Cheng raised his head like this, his voice low.
This problem is still a medical injury, not a trauma or degenerative organic injury, so it cannot be made public.
And this, if you are not a person with excellent film reading skills, you will not be able to discover it!
It's just that it's unbelievable to understand a patient's past medical history to such an extent through reading the film. Moreover, the reasons stated by Zhou Cheng are all based on the theories of modern medicine, rather than enigmatic guesses.