Both Sun Lien and Professor Pascal were a little uneasy. Sun Lien had not been to the operating room a few times. The last time he visited the operating room, he met Director Zheng Guoyou who had suffered a heart attack. Since Professor Pascal got his M.D.
He never entered the operating room again. An emergency department trainee and an immunology physician with a certain reputation, just like Grandma Liu who had just entered Grand View Garden, craned their necks to watch the progress of the operation.
Unlike Sun Lien and Pascal, Xu Yourong and Hu Jia were as relaxed and at ease as if they had returned home. Needless to say, Hu Jia was in the operating room five days a week assisting in various surgeries. She was very fond of the constant-temperature operating room.
And those gleaming surgical instruments are very familiar, and there is no discomfort at all. Xu Yourong's attitude goes further than Hu Jia. She is an excellent neurosurgeon. Although at the Fourth Central Hospital, spinal surgeries are basically
They are all handled by orthopedics. But this does not prevent her from using her expertise in this field. The spinal cord and medulla oblongata are one of the key research directions of neurosurgery.
It is precisely because Xu Yourong is good enough that she understands better than Sun Lien and others how important the surgery that is being carried out in an orderly manner is before her eyes. In the past, doctors could only use titanium mesh and titanium alloy strips of various lengths to barely replace it.
.And these hard-bent titanium mesh and alloy strips are indeed not qualified for the work of the atlas and axis. And everyone’s atlas and axis are different in size, shape, and even tilt angle. 3D printing technology only has 3D
Only with printing technology can it be possible to truly become a long-term replacement for the atlantoaxial vertebrae. Although such prostheses still have huge flaws. In case of ligament damage, the patient may lose almost all the ability to rotate the head. In layman's terms,
Song Hualin may never be able to shake his head again.
But it will still be an amazing initiative and he can't shake his head. It's better than being burned to ashes and placed in a box. As long as the operation is successful, he can still hug his family and walk in the warm sunshine and spring breeze.
Therefore, Xu Yourong watched intently. Rachel next to her didn't show much excitement about this. She just secretly held Xu Yourong's hand. Most of her face was covered by the mask, so she couldn't see much expression.
.But there is a hint of smile between his eyebrows from time to time.
The opening and closing of the human mouth is limited, so there is not much room for Wang Yifei to operate. The surgical assistant used an opening device to open Song Hualin's mouth, exposing his soft palate as much as possible. Then he used a tongue depressor
He pressed down his tongue as much as possible. The movement was a little rough and forceful, and the tongue depressor was even pressed into an arc under the operation of the assistants.
"Move gently, I will use this tongue again in the future." Wang Yifei smiled and criticized his assistant, "Don't be so nervous."
The operating bed gradually rose, but due to Song Hualin's fractured axis, the angle at which Wang Yifei could operate was still very limited. He tried several times, but in the end he could only lie down on the operating bed, using a very awkward posture to cut
The scalpel was inserted into Song Hualin's mouth.
After confirming that Song Hualin's uvula was deviated to the left, he paused for a moment and began to cut. When the blade approached the uvula (small tongue), the scalpel went around the left side of the uvula, along the
The cut continued along the midline of the uvula, and the scalpel was drawn back along Song Hualin's soft palate toward the incisors until it touched the edge of the hard palate.
The first small step was completed. Director Wang Yifei stepped aside and turned to look at the MRI and CT pictures taken previously. The assistants took advantage of this opportunity to quickly stop the bleeding of the incised soft palate and used a small
The traction hook pulled open the cut soft palate, exposing Song Hualin's posterior pharyngeal wall more completely.
It may seem unnecessary to incise a completely disease-free part just to obtain a better operating space and expose the field of view. But in fact, it is the least invasive option. In fact, if the patient has congenital jaw movement
Due to problems such as restriction, resulting in poor vision and insufficient operating space, doctors may even make the decision to split the mandible. As long as it can resolve the concern for life, additional damage is completely acceptable.
Although the exposed posterior pharyngeal wall still looked small, it was finally possible to perform further surgery. Wang Yifei once again stood at the position of the surgeon. The scalpel was drawn from the posterior pharyngeal wall and incised along the middle suture of the posterior pharyngeal wall.
After hemostasis and traction again, the upper and middle pharyngeal constrictors and part of the longus capitis muscle were exposed.
The reason why the atlantoaxial vertebrae is called a "surgery restricted area" is highlighted here. The oral cavity itself has a certain depth, and there are a large number of muscles, nerves, ligaments and blood vessels in this area. It is very easy to operate during surgery.
Injury to these important and fragile tissues.
Injury to muscles may lead to movement obstruction or infection, injury to nerves may lead to numerous consequences including facial paralysis and long-term pain, and injury to ligaments may lead to joint instability, leading to more serious spinal cord and even medulla oblongata problems.
.
As for damaged blood vessels... If the injury is to an artery, and the bleeding cannot be stopped quickly, then even resuscitation can be avoided. Once the vertebral artery near the atlas ruptures, almost all the blood in the body can be spurted out within a minute.
, and in a small operating space like the oral cavity, vertebral artery rupture means losing all vision in an instant. The doctor must rely on memory and feel to find the vertebral artery rupture point in the spewing bright red blood, and in one minute
The ruptured artery will be sutured internally. The success rate of this kind of rescue, which is almost the same as chance, will naturally not be very high. Therefore, this area has always been called the "surgical restricted area".
Director Wang Yifei glanced at the exposed muscle tissue, but he didn't feel any nervousness. He moved his shoulders and neck, signaled his assistant to get a small camera for video shooting, and explained the anatomy structure of this part on the spot.
"Normally, you don't have many opportunities to see the muscles in this part. Basically, you can only see them on the gross body teacher." Professor Wang's tone was calm, stable and confident. "But the muscles in this part of the gross body teacher have basically atrophied.
, there are relatively few opportunities to see fresh muscles, so please try to understand the structure."
This surgery is not only a challenge to the authority of death by the doctors of Tongxue, but it is also a very important course content. Like many excellent medical schools, Tongxue's teaching style is not only rigorous, but also actively encourages new students to undergo surgery.
The application of technology and new surgical procedures. Medical technology is a technology that is always evolving on its own. The sooner the medical value of new technologies is discovered and the faster new surgical methods are designed around the new technologies, the more patients will be treated.
Saved back.
Saving lives and improving patients' quality of life is the most important core content in every doctor's career to achieve self-worth.
Wang Yifei is not only the director of the Department of Orthopedics of Tongxie Hospital, but also a professor at Tongxie Medical University. His task is more important. He wants these surgeries to be mastered by students as soon as possible. Medical technology is not as precious as a broom.
Only if it continues to spread, can further improvements be possible. Without extensive and active medical exchanges, there will be no medical progress. He understands this very clearly. Therefore, Wang Yifei chose to ask the visitors to the surgery at this time
The doctors emphasized the anatomical structure. He could still fully grasp the current situation, but after the muscles were bluntly separated and Song Hualin's broken axis was exposed, he would probably no longer have the energy to teach.
After waiting for a minute or two, after confirming that the doctors visiting the operation had seen this part of the muscle, the assistants picked up the surgical forceps and pulled out Song Hualin's tongue. Wang Yifei picked up the scalpel again, this time it was not
Instead of using a sharp blade, he turned the scalpel around and used the handle to move away the two longus capitis muscles that were blocking his face. As for the upper and middle pharyngeal constrictors, they needed to be incised along the middle suture.
After the separator was used again to pull away the middle pharyngeal constrictor muscle hidden behind the upper pharyngeal constrictor muscle, Song Hualin's anterior longitudinal ligament was finally exposed. This is a major ligament connecting the front side of the cervical spine. As the longest in the human body,
The main function of the anterior longitudinal ligament is to limit excessive extension of the spine and prevent the intervertebral disc from bulging forward.
After another blunt separation, the hypopharyngeal constrictor and longus capitis muscles were pulled apart. Now, the C1 cervical atlas and C2 cervical axis were completely exposed to the air. After layer by layer traction, Wang Yifei was left to operate.
The space has become very small.
"Upper endoscope." Wang Yifei had already expected this result. The reason why the transoral approach was adopted was to minimize the intraoperative trauma to the patient. In order to reduce the trauma, there will inevitably be losses.
Some fields of view and operating space. But fortunately, there is still an endoscope. If the previous operation is the pinnacle display of traditional surgery, then what Wang Yifei will show next is one of the main development directions of surgery in the future: endoscopy.
Microscopic surgery.
Because other tissues have been separated, the endoscope and the two operating arms used for observation and operation are fixed by an extracorporeal stent. Wang Yifei half-bent and started the operation. Observed through the endoscope
, using two control arms about 20 centimeters long and the grinding tools on the control arms, Wang Yifei slowly cut Song Hualin's fractured pivot vertebrae into small pieces, and then took them out one by one. Each piece of pivot vertebra bone, and
The bone cement that was filled in fifteen years ago to increase the strength was carefully cut into small pieces less than one centimeter. Then it was removed by the manipulator arm.
This process proceeds extremely slowly. The fracture shape of Song Hualin's axis is very irregular. There are three fracture lines on his axis. In addition to the fracture of the odontoid process on the rear side, there are two fracture lines on the body of the axis.
If the coordinate system is established with the tip of the human nose as the 12 o'clock direction of the clock, the two fracture lines are approximately equivalent to the hour hand at 4:50 and 10:20. The frontal approach can directly expose the range of the axis.
Between 9:00 and 3:00. In other words, through the frontal transoral approach, only one of the fracture lines can be observed, and the other fracture line does not appear in the endoscopic field of view.