The Godfather of Surgery

9 During the surgery, Professor Ye took Director Guan and Chen Ge to perform surgery.

This operation is also a quadruple reconstruction. The intercondylar fossa is deformed. When the femoral tunnel is opened, the medial condyle of the femur is split, which is troublesome.

Let Professor Ye do it, there will be no such problem at all. The operation is completed for half an hour, and the fork is after the reconstruction. Chen Ge wants to try it. Chen Ge is Director Guan's doctor, and he is also Professor Ye's nephew, not to mention in the third hospital. I also spent a year with Professor Ye when I was studying, so it didn't matter if he tried it.

Because the posterior fork reconstruction is also a double bundle, there are two tunnels on the medial femoral condyle, so the tunnel location is more crowded. Chen Ge was inexperienced, and Professor Ye was also a little careless. As soon as the tunnel opened, it collapsed, the inner condyle was split into three pieces, and the drill bit was broken inside.

Now, the broken drill is to be taken out of the bone. When Yang Ping and Su Nanchen entered, Professor Ye had just finished the perspective and determined the position and direction of the drill.

Professor Ye didn't speak, and Chen Ge and Director Guan didn't speak either.

Su Nanchen pointed to the patient, and the anesthesiologist said, "General anesthesia!" This made it much easier to speak.

Professor Ye looked at the image on the screen of the C-arm X-ray machine and wondered how to take out the drill bit. He wanted to take it out with minimal invasiveness, that is, without cutting it, but taking it out under an arthroscope, which was very difficult.

How did you get this drill done? Professor Ye cursed his mother in his heart, and now he is vomiting blood. If this were in the third hospital, he would have scolded Chen Ge like a dog when he stepped down.

Taking the drill is still the first step. After taking the drill, the fracture must be fixed. After fixing the fracture, the tunnel must be reopened. Generally speaking, only the posterior part of the condyle is split, which does not affect the suspension and fixation. Now the entire condyle is broken. Yes, the trouble is dead.

Su Nanchen looked at the screen and was speechless. The patient had neither osteoporosis nor any other pathological factors such as tumors. He broke the medial condyle into three pieces.

In this case, each step can be regarded as an independent and difficult operation, and the combination of several steps is very difficult and daunting.

If it weren't for Professor Ye, who was at the top level in the country, he would have given up the surgery, cut it directly, took out the drill, fixed the fracture, and waited for a few months, at least three months, when the fracture healed, and then the surgery was performed.

Professor Ye deserves to be at the top level in the country. He is unhurried and calm. He used the nucleus pulposus forceps to insert into the joint cavity, took a bit of the bone block, and handed it to the nurse, who took it with saline gauze.

Professor Ye explained: "Send pathology!"

This kind of accidental fracture should not have occurred. As a rigorous professor, pathological factors, especially tumors, must be considered. Although visual inspection is not, but many things are not counted by visual inspection. To be cautious, Professor Ye took a bit of bone tissue for pathological examination to rule out tumors.

Removing the drill bit under arthroscopy is a difficult technical task, and most doctors can’t do it. It has to be cut to remove it. However, Professor Ye doesn’t seem to be ready to cut it. He intends to use an arthroscope to remove it.

The camera found the best angle of view, and saw that the drill bit was stuck in the bone tissue, exposing a little bit, the intercondylar fossa was like a hole, and what was buried in the wall of the hole could not be taken out if you wanted, and the instruments were out of reach. It can't be cast, it's stuck in the bone.

The drill bit is hollow. Professor Ye took a guide needle and, under arthroscopic monitoring, passed it through the hollow hole in the middle of the broken drill bit to the inner side of the lower thigh, penetrated the skin, and poked it out.

"The thinnest drill bit!"

Professor Ye inserted the thinnest drill bit along the exposed guide pin on the inner thigh, made contact with the broken drill bit, held the tip of the broken drill bit, then removed the electric drill and pushed the guide pin to be flush with the end of the fine drill.

"hammer!"

Professor Ye tapped lightly with a hammer, and slowly broke the drill bit and was knocked out.

Sure enough, it is a master. If it is placed in other hospitals, this kind of drill is either not taken, or it is cut to take it. It will take a long time to cut it.

Using such a method is very ingenious, but requires a wealth of experience and feel, otherwise not only will it not be able to be taken out, but it will also lead to new fractures.

In just a few minutes, Professor Ye took out the drill easily and handed it to the nurse: "Align with the other half and see if you can match? Prepare for a C-arm perspective."

If the two halves meet, if they can meet, it means that there is no residue.

Sure enough, the operation was done prudently and meticulously. When it was taken out, the severed end was subjected to a fluoroscopy to ensure that nothing went wrong.

When the drill was taken out, it seemed that there was nothing wrong with Yang Ping. Su Nanchen thought that Professor Su had asked Yang Ping to come to rescue the station. Now it seems that there is nothing to do, so it will not be a waste of time.

"Professor Su, if there's nothing wrong, I'll send Dr. Yang back." Su Nanchen asked carefully.

Professor Su said, "Wait!"

He turned his head and said to Yang Ping, "Xiao Yang, please wait a little longer. Is the operation at home urgent? What kind of operation? Can I ask Nan Chen to help?"

Professor Su said so, it seems that there should be other things to keep him here, and Yang Ping is not easy to leave: "It's okay, they can take the operation, just want me to check, it won't get in the way if it's late."

"Professor Su?" Su Nanchen meant, nothing to do, let them go back.

Professor Su waved his hand, no longer explaining, and ignoring Su Nanchen.

"Watch carefully! See how Professor Ye responds on the spot and how he handles this situation."

Could it be that Yang Ping was left behind so that he could study with Professor Ye? How to deal with this rare accidental comminuted fracture of the medial or lateral condyle in quadruple reconstruction?

"Xiao Yang, sorry, please arrange the family affairs." Professor Su ordered again.

Yang Ping responded, and Professor Su had spoken. What else did he say? Follow the instructions.

"How about it? Continue to do it? Or wait three months before talking?" Director Guan asked at the opportunity.

In this case, the operation is usually performed according to the fracture, and the fracture is fixed. After three months, the fracture is healed, and then the ligament is reconstructed. The difficulty of the operation is not only increased, there is not much room for tunneling in the remaining bone. , and even if there is space, many of them are dead ends of the operation, and there is no good tunnel at all, so the operation will not be effective.

This kind of surgery is not just about rebuilding the ligament, but also guaranteeing the effect. It's like doing a test paper, you don't pursue the grades, as long as you fill up the test paper, it is very easy. If you pursue the final high score, you don't need to fill out the test paper.

"Continue! Is the patient under general anesthesia?" Professor Ye confirmed again.

"General anesthesia!" the anesthesiologist replied.

Professor Ye took a short break. The doctor under the stage was pushing the C-arm machine to see through it. Everyone moved away and made room.

"I always say that the operation is no big or small, every step should be careful, our surgeons are walking on thin ice every step, you see, be a little careless, something went wrong, if the operation stops like this, the patient steps down with a fracture, how to explain How do you explain it? Delaying the recovery time, not talking about the season, and leaving new questions." Professor Ye's tone was quite good, just reprimanded, not scolding.

"C-arm machine, push it well, a little higher, come in here!" Chen Ge had a bad temper, holding his breath in his heart, let out his breath on the little doctor who pushed the C-arm.

Although Professor Ye has a big temper, he doesn't lose his temper. He is a rather harsh kind. If you don't do well, if you don't like him, you will curse people.

"Chen Ge, what are you doing?" Director Guan saw that Professor Ye's eyes were wrong and stopped Chen Ge.

Sure enough, Professor Ye got mad, staring at Chen Ge, he caused trouble, everyone wiped his butt, and he even scolded the doctor below.

If it wasn't for Professor Su, Professor Ye would have scolded people, but with Professor Su, although he was Chen Ge's uncle and a guest from outside, it would be difficult to scold his doctor in front of Professor Su.

Everyone went out of the operating room, finished the fluoroscopy, and went in to see that the drill had been completely taken out, and there was no residue.

"Prepare cannulated screws, which are usually used for fractures of the internal and external condyles of the femur. Let's fix the fracture."

The C-arm machine exited, Professor Ye returned to the position of the main knife, and everyone returned to their positions.

Some of these transarticular fractures also carry cartilage. It is very skillful to fix. Not only must the fixation be done well, but the position of the nails should not affect the next step of ligament reconstruction and tunneling. The nail head or nail tip should be buried and not exposed. .

Minimally invasive arthroscopic reduction and fixation of fractures in this step is also very difficult. Professor Ye used grasping forceps to grasp a bone fragment. It was firmly grasped, placed in the original position, the forceps were released, and when the bone fragments were not released, Professor Ye used the closed end of the grasping forceps to hold the fracture, and the operation was like performing acrobatics.

"Guide needle drill!"

To fix this bone block, the guide needle cannot be inserted from the inside, because the intercondylar fossa is an arched fossa, which is equivalent to a hole. From the inside to the outside, some are dead corners. This bone block is in the dead corner and can only be moved from the outside Enter in.

Driving from the outside to the inside, I encountered the same problem as Yang Ping opened the tibia tunnel. He had to snipe the target behind the wall through a thick wall.

The difference is that Yang Ping's goal is a point, and now Professor Ye's goal is a circle. Whether it's a point or a circle, it's very difficult!

From the outside, he pierced the guide needle through the skin and muscle, against the cortex of the bone, thought for a moment, and then repeatedly moved the needle insertion point and angle of the guide needle, sometimes looking at the electric drill and guide needle in his hand outside, and sometimes looking at another screen on the screen. Bone fragment held against grasping forceps in one hand.

After adjusting many times, rustling, the electric drill sounded, the guide needle drilled through, hit the bone, and came out from a good position, amazing! Everyone was amazed and almost applauded.

This bone fragment is relatively small, a screw is enough, and the screw can only be applied from the outside to the inside. After the measurement, I picked a half-threaded hollow screw and screwed it in, just to fix the fracture, tightly press and fix it, the tip of the screw It entered the subchondral bone and did not come out again.

The national first-class level is well-deserved. When such a thing happens, the general experts think it is a disaster, and they surrender directly and are forced to give up the operation. However, he can easily continue, and looking at the level of handling, it is extremely high.

Just sniping the circle behind the wall with this hand, this level of drilling into the steel needle, few in the country can do it, and even less can be done in one performance.

Senior brother is really powerful, Director Guan admired this operation, Chen Ge drooped his head, and was glared by Professor Ye and Professor Guan from time to time, how dare he have a temper.

There are three bone pieces in total, and the other piece is about the same size. Professor Ye used the same method to fix the bone piece with a hollow screw; The needle is inserted exactly once, and the position is good.

"Okay! Re-open the femoral tunnel!" Professor Ye put down the screwdriver and moved his wrist.

"Are you still double bundles?" Director Guan asked.

Continuing to double beam, it is already very difficult, three problems are in front of you.

One problem, there are four screws occupying the space of the bone tissue of the medial femoral condyle, and the tunnel is easily blocked by the screws.

Another problem, all three bone fragments were reduced, but there were several fracture gaps, and the tunnel was opened to the gap, which was not very good.

There is also a third problem. The suspended steel plate needs a certain thickness of cortex to withstand it. Now there are not many such places in suitable areas.

"Of course—" Professor Ye couldn't doubt it.

Switching to single-beam reconstruction will reduce the effect of the operation. This is a professional athlete. When people seek him for surgery, they are pursuing high quality.

His professional conscience would not allow it, and neither could it for his own reputation.

perspective! It was another C-arm X-ray fluoroscopy. The fluoroscopy was to see the distribution of several screws and prepare for the tunnel to avoid the screws.

"Guide needle! Open the femoral tunnel!"

Professor Ye put the guide needle in through the outer opening and estimated the point.

I tried several times, shook my head, no, the exit point is not in the safe zone. The exit point must be in the safe area, otherwise there is not enough thickness of the cortical suspensory ligament, and the cortex is easily pulled.

Then change the angle, from straightening to extreme flexion of the knee joint.

Not from the outer opening, but from other positions, piercing the skin, and piercing it in, almost everything that can be tried, Professor Ye has tried, but it still doesn't work.

The best position for this tunnel is currently only in one direction, and there is no room for adjustment. This direction is just a dead end, which is too tricky.

It seems that the only way to penetrate from the outside to the inside is to use the method of sniping from the wall. Last time, the target of the sniper from the wall was a circle, and now the target of the sniper is a point, and the difficulty has increased.

I earned it today. I saw the top titans in the country perform magic tricks, sniping from the wall, or sniping at one point. This is a divine operation.

The people watching the operation were all experts, and they all held their breaths and waited for Professor Ye's wonderful performance. The operating room was very quiet, and the itinerant nurses walked lightly.

Professor Ye reached in with a ruler, measured the medial condyle several times under the microscope, planned out several lines, and used the intersection of the lines to find the anatomical center of the ligament footprint. Then use the plasma knife to burn the dot marks at this point.

Song Zimo didn't urge him, and Yang Ping didn't return the call. He kept watching, and seeing the whole process of what Professor Ye had just done, he was really at the top level in the country.

Professor Ye held the electric drill steadily without any shaking. This method of holding the electric drill was also strictly trained. The guide pin pressed against the medial condyle of the femur and the inner cortex of the lower end of the femur. Move, very stable.

After adjusting the position and direction of the guide needle many times, after repeated observation, Professor Ye finally pulled the trigger.

rustle! The guide needle was driven in, and the place where it was pierced was about 5 mm away from that point, that is, it deviates by 5 mm. If others, it is estimated that it has been very successful and the tunnel can be opened.

But he is the first-class level in the country, how can he accept the score of 80 points, he wants 100%.

The guide needle is withdrawn, and once again, this time the distance is closer, and the error is smaller, about 3 mm.

Again!

Farther, this time by almost 7mm.

Sorry for the slow update, once again sincerely apologize to everyone! Because it's too busy during the day, I only have time to update at night, but I can't come. It will be better in a few days, and I must improve the update when I have time! Bow to everyone!