Path of Medicine With a System

Chapter 461 Who Takes Over

The three major complications of fracture are infection, osteofascial syndrome, and nonunion. One is scarier than the other, the first two are near-term complications and the latter are long-term complications. If you do not follow up after surgery, until the symptoms appear, the situation is already serious.

In the morning's orthopaedic operating room, Zhang Fan looked at the patient's examination X-ray and frowned, not because the operation was difficult, but because he could not feel the transparency of liver tumors.

Orthopedics is the earliest subject of Zhang Fan's contact. It is also a lot of liver surgery. Although the operation is getting more and more skilled now, but there is always no sense of transparency.

"What's the reason? Is it that the surgery is done less or the surgery is not enough?" Zhang Fan frowned and the others didn't dare to disturb him.

Actually, this thing is very simple. Where there is oppression, there is resistance. As long as it is not overwhelmed, it will definitely sublimate and break through. Although liver tumor surgery is not the most difficult operation, it is not easy.

The risk of huge liver tumor surgery is even greater. Fan Zhang is going to use knowledge and think hard.

Suddenly, the knowledge of the liver was forcibly broken. On the contrary, it is a simple orthopedic operation. It becomes a habit to become more and more proficient, and it is impossible to talk about breakthroughs.

"Zhang Yuan, you are anesthetized. We are all ready." Zhou Chengfu reminded Zhang Fan in a daze.

"Oh, are you okay. Let's get started." Zhang Fanzhang, like she was awake, let go of her worries and concentrated on the operation. So far, the definition of bone nonunion in the medical community has not been unified.

Zhang Fan believes that within three months, fracture fractures can not be treated without intervention and should be called nonunion. Because of diabetes, and Chen Qi wanted to make the surgical X-ray look more beautiful, she stripped away too much soft tissue.

In addition, the patient smoked and drank alcohol without proper strength exercise, which eventually led to bone nonunion. At this time, the mid-point of his humerus had shrunk and a large number of granulations had formed.

The human body is so weird. If normal tissues cannot grow in normal places, abnormal tissues will grow. If it is discovered a few months later, the atrophy will be exacerbated by the bone's disuse.

A pseudo joint will appear in a short period of time. The normal arm has only one elbow joint. Because of the pseudo joint at the stump, his arm becomes a three-stick.

If the time is longer, it will be like an infection, and the original normal bone will begin to shrink, and the final result can only be shortening the arm. Then it became a long arm and a short arm, leaving the body with an immutable disability.

There are many ways to treat bone nonunion. There are lengthened steel plates. After removing the original 56-cm steel plate, the broken end is corrected, bone is grafted, and then a longer steel plate is added to strengthen the stability of the fracture and allow it to recover.

The other is intramedullary nailing, which is viewed directly from both sides of the long bone and placed in the intramedullary nail.

The other is external fixation. Just like building a building, outside the fracture, a steel shelf is set up to fix it.

Because the distance of Zhou XX's fracture and atrophy is not shrinking at present, Zhang Fan is going to use lengthened steel plate to fix it. Each of the three fixing methods has its own advantages. There is no best, only the most suitable.

Incision, on the original incision, Zhang Fan continued to enter the knife. This secondary operation, there is no way to talk about the hierarchical structure, because of the surgery, the adhesion around the incision is very strong.

Zhang Fan entered while observing the two assistants. The two cooperated with Zhang Fan, their skills were quite skilled. After the incision was opened, the black silk threads that had not been absorbed continued to appear.

Although this kind of silk can be absorbed, if it is found, it should be removed as much as possible. After all, the end of the thread is also considered a foreign body. Silk absorption, there is a joke in the medical community that is not a joke.

It is said that in the early years, the country had poor technology, and the silk thread material was not enough. After 30 years of appendix surgery, a person can grow a black thread head somewhere in the body.

Opening the muscles, the steel plate has been wrapped by the proliferating granulation tissue. What is the situation, it is like a steel plate placed on a plaster mold, and the plaster mud overflows after being pressed. The steel plate affixed to the bone was surrounded by this calcified granulation tissue.

"Nei Liu's nails." After Zhang Fan glanced, he said to the nurse. The screw heads of orthopedic steel nails were also plum and cross.

Once this type of screw is uncomfortable, the screw head will have a gap, and it will not be able to bite when removed. Orthopedics has an unwritten rule.

Whoever takes the steel plate! With the large number of vomiting by orthopedists, this kind of plum and Phillips screws also slowly withdrew from the clinic. This is the origin of the orthopaedic legend: there is no steel plate that cannot be accessed, only steel nails that cannot be removed.

Unscrew the steel nail, Zhang Fan directly bite the steel plate with two Alice forceps, pull it hard, and the steel plate was pulled out from the calcified granulation tissue.

The equipment nurse looked at Zhang Fan holding Alice's forceps to pick up the steel plate, gritted his teeth and did not speak. If it was another resident doctor or a little more general attending, the little nurse would have been unwilling.

The operation is under the control of the doctor, but the equipment is under the control of the nurse. And because of the violence of the orthopaedic surgeon, doctors in other departments are very reluctant to use the instruments used by the orthopaedic surgeon.

The forceps clamped the bones and the steel plate. After being clamped several times, the very new appearance of the instruments could not be used, and there was no way to sew with a suture needle.

Remove the steel plate. "Bone knife!" Zhang Fan began to remove the calcified cartilage tissue on the surface of the bone, and the surface of the bone was like a bone plate.

If the density of calcification is relatively high, you can't do it with a bone knife, just hit the hammer. Just like chiseling a stone, remove the calcium from the bone.

This operation must be stable, and there must be no accidents. Once you slide your hand, the kinetic energy of the hammer supports the strength of the doctor's arm, and it will definitely break the patient's bones.

"Steel! Steel! Steel!" The sound of the hammer striking the bone knife rang in the operating room. And it still needs to have a sense of rhythm, can't knock randomly, the time interval between the last time and the next time should be about the same.

Zhang Fan knocked, Zhou Chengfu stretched out his fingers and held the incision. Because of the strong blow, the blood, bone marrow, and fat particles in the wound followed Zhang Fan's blow as if he was jumping wild in the wild. Although Zhou Chengfu had covered the wound with his hand, yellow fat particles eloped out with blood.

The stars on the operation sheet are scattered with fat particles and blood immersed in the list, like a sesame cake, not black sesame, but yellow sesame.

"Squeegee! You start to take bone, don't take too much. Bring a periosteum!" Zhang Fan said to Zhou Chengfu. The bone has shrunk. If you don't want to connect it, it can't heal again.

The bone graft must be cancellous bone with periosteum. Because there are a large number of bone progenitor cells on the periosteum, this cell can make bones grow and grow, and cancellous bones are like the plugs of old-style thermos bottles when they are dried. There are a lot of voids inside, which are rich in various growth factors, which can induce bone growth.

There are few places where there is periosteum and cancellous bone in human bones, and there are not many places that can be cut off. For example, the spines are a very good bone bank.

"Okay." After Zhou Chengfu agreed, he took Xu Xian and moved to the pelvic position. If Zhang Fan's smashing bone knife is considered violent, it is directly called violent where the bone is taken.

After cutting the skin, pulling away the fat and muscles, Zhou Chengfu gritted his teeth and began to take bones. The bone knife was placed on the spine spine, and Zhou Chengfu was wearing a mask. If he didn't wear a mask, he would be absolutely shameless at this time.

The hardness of the periosteum and bone cortex is very high. With Zhou Chengfu's percussion, the tied patient's whole body was shaking. It's directly "哐! 哐! 血液!" In this regard, it is not the most rude in orthopedics.

The bone was cut by a bone knife, not too big, slightly shorter than the green arrow gum, and the bone was as thick as the matchbox.

After taking out the bone, Zhou Chengfu began to cut it into pieces with scissors. Zhang Fan is using a spatula to clean the broken-end granulation tissue. How to describe this thing is like using a spoon to dig out the yogurt pot that has little left.

The calcified granulation tissue is chiseled with a bone knife. The white, uncalcified granulation tissue is dug with a spatula. This must be cleaned up. If it is not cleaned and there are residues at the stump, the bones think that the place is fleshy, and no new bone will be emitted.

"Gauze." After Zhang Fan dug it out, he started wiping it with gauze. The removal of granulation tissue must be ensured. After wiping, the fractured ends at this time are as white as broken ivory chopsticks.

"Zhang Yuan, look at it, it's enough." Zhou Chengfu handed Zhang Fan the bone pieces that had been cut into soybeans.

"Yes, the prediction is good, it should be enough." Zhang Fan exaggerated Zhou Chengfu. If before, Lao Zhou would sniff, but now, Zhou Chengfu is happy, his eyes are in a line.

Fill, this is technical. Just like a hollow bamboo, if you want to fill the soybeans in the middle, you can't spill them. This is technology.

Students who did not play well with building blocks when they were young did not do well in this matter. Lao Zhou estimated that there were no building blocks to play with when he was a kid. In the end, there was no way to write articles.

First put the broken bone with cortical periosteum as the base, then fill the cancellous bone little by little, and then fill the broken bone with cortical and periosteum on top.

It's not okay to loose it, because the upper steel plate must be opened with an electric drill. If it is loose, the steel plate is not on, and the filled bones have long collapsed.

What is a stitch? This is a stitch. After filling the broken ends, they must be forcibly inserted into the gaps with the broken bones carrying the cortical bone. To insert them forcefully, they must be inserted forcefully.

Then, the missing bones were connected. Then put the steel plate. The humerus is not a very round pipe, because for the first time on the steel plate, four or five holes have been drilled on both sides of the stump.

The second time the steel plate must be kept away from these places, or the bone may break when the screw is put on again, so the original steel plate, which was only 56 cm long, became a steel plate of 20-30 cm. Just like adding a metal shield, blessing is on the humerus.

As the steel plate grows, the cut will of course extend. For example, the length of the steel plate is thirty centimeters, and the crossing level is twenty centimeters even though there are few crossings. Wherever it is covered by the organization, use the hook to force it away.

Just like when a person's mouth is opened to the maximum, continue to use metal hooks to pull it open until you see the large inner teeth exposed.

With the steel plate installed, the humerus is slightly curved and slightly triangular. Therefore, the steel plate must find a side that can adhere to a better side.

After the steel plate was applied, Zhang Fan began to make holes. Although doctors in other departments make jokes in orthopedics, saying that a good carpenter can do fracture surgery, it is actually a joke. The carpenter really couldn't do the job.

Opening, this steel plate is a pressed steel plate. One of the nail holes on the pressure plate is a pressure hole, and a **** is designed in the hole. This hole looks like an ordinary hole is elongated. The advantage is that it can play a role of pressurization, make the fracture ends close butt, and promote healing. The disadvantage is that the pressure hole part is the weakest part of the steel plate and is easy to break.

During the operation of the doctor, the strength of the pressure is also very difficult to grasp. If the pressure is too large, it will cause slight osteonecrosis at the broken end, and it will not work if the strength is small. Because each patient's constitution is different, in actual work, this intensity is difficult to grasp.

In this effort, it took a few years to master it. Drilling along the pressure hole of the steel plate, Zhang Fan observed the connected bone mass while drilling.

To be honest, this kind of surgery, one step forward, must ensure the suitability of the original step. If there is a problem with the original step, if the original step fails, it will be impossible to get off the operating table.

When Zhang Fan was drilling, he was very respectful. Although he inserted it with his own strength, after all, the manpower could not compete with the vibration of the electric drill, so Zhang Fan was very careful.

After making the hole, start screwing. This is also a technical task. Other than that, the angle is very particular. The verticality of the screw must be guaranteed, and the contact surface with the steel plate bone must be vertical.

How to determine it, feel! Yes, it ’s a very unreliable feeling. If you ca n’t feel it, just wait for silk. There is no problem at all. The strength of the screw on the pressurized steel plate. Once the direction of the bite between the screw and the steel plate is a problem, it is the wire that cannot run away.

Load the steel plate, start rinsing, suture! Near the end of the stitching, Zhang Fan suddenly looked up and said to Zhou Chengfu and Wang Pingshan, "Who will you take over this sickness?"

Zhou Chengfu hesitated. Wang Pingshan glanced at Zhang Fan and said directly, "If you feel relieved, give it to me!"

"Okay!" Zhang Fan said nothing. Zhou Chengfu next to him suddenly wanted to feel that something was leaving him.

More than ten thousand words!

miss!

Miss you can speak!

Hey!

I really miss it!

Although most of you scold Lao Zang soft again

But really miss

(End of this chapter)