crazy scalpel

Xie Ke felt very sorry. First of all, he felt that the injured could obviously get better treatment, but it was too cruel for him to miss the chance of recovery because of this reason.The second one, the skin flap surgery that could have been done by him, it's a pity that it wasn't done.After all, car accidents happen every day, but such opportunities may not be encountered often.

This kind of skin flap operation needs to be divided into two phases. In the first phase, the hand bones are stuffed into the abdomen to let the flesh and blood grow, and then the second phase is performed after a while, when the hands are taken out, and then other fleshy parts such as the buttocks are removed. Some skin and nerves and blood vessels were cut from the thigh and transplanted to the hand for reconstruction.

This is not a difficult task for Xie Ke. With his current reputation and the fact that he was the one who received this patient, the second-stage operation will undoubtedly be handed over to him.

But since the family members are unwilling to spend the money, he has nothing to do as a doctor.

So now you have to pay attention to signing everything, otherwise, even if your doctor has done something with good intentions, if you meet someone who is unreasonable, he will blame you in turn.

The patient is afraid that people in the hospital will mess around for money, so they don't trust the doctor; the doctor is afraid that the patient and family members will renege on their debts, so they are unwilling and dare not take responsibility.

Know that without that signature, once you do, you are wrong!Even if you cure the person, the family members can still sue you!Even if you say, okay, you pay the money yourself, is it okay for the head office?no!Even if you pay to cure the patient, as long as there is no family member's signature, you will still lose the lawsuit!And you have to lose money again!

So this is the rule, as a doctor you have to have a conscience, you have to be technical, and you have to follow the rules.

On the surface, it seems that this kind of rule not only protects the interests of patients, but also protects doctors from being harmed afterwards, but in fact it directly leads to the inability of both parties to trust each other, and the result is that it must be done by a piece of paper. decide the fate of those injured.

It is not uncommon for many patients to receive the best treatment at the first time due to time delay.

What about the doctor?The doctor actually didn't feel much better.

It is impossible for a person to choose a doctor as his profession solely for the so-called "golden rice bowl".When most doctors decide to enter the hospital, they have the ideal of curing diseases and saving lives.Making money is of course important, but if you only want to make money, what can't you do?To be honest, most doctors do not earn as much as doing bricks.

Those who can become famous doctors or directors are very few after all.

Drug sharing, surgery red envelopes, these are far less than people imagined.

Some big hospitals are still a little bit better, and more people change careers because they can't bear the burden of life.

When entering the clinical department, who has not recited the oath:

Health depends on life.I volunteer...[note]

The high-spiritedness of youth is real, but it often cannot stand the waste.Years will wash away all the lead, so that those once powerful rhetoric will also disappear in the sky.

This is the sorrow of medical practitioners, and it is also the pain of medical service recipients.

For example, now, Zhao Hua and Xie Ke are performing this operation on the injured Guan Yi.

The thoracolumbar spine is the transition zone between the thoracic and lumbar spine.

Specifically, it consists of the last three segments of the thoracic spine and the first and second segments of the lumbar spine.This section is just between the thoracic spine with less mobility and the lumbar spine with greater mobility, and is most likely to be damaged due to the concentration of stress.

Generally, such injuries are caused by excessive external force, and the common ones are car accidents and falls.

When the axial load acts on these vertebral segments, and the load continues to increase, and finally exceeds the limit that the human spine can withstand, mechanical damage will occur.At this time, the bones will burst radially to the surroundings.Bone and soft tissue fragments usually travel up or down into the relatively low-pressure spinal canal.

I also want to know that the severity of vertebral fracture is closely related to the axial load it bears.

And one of the dividing lines is to see if the posterior wall of the vertebral body is broken.

The back wall of the vertebral body is very important. It can protect the nerves and ligaments, and it can also prevent the protrusion of the spine. It is an extremely important barrier.

If the back wall of the vertebral body is not broken, then it is a compression fracture, which is much better.And if it breaks, it's a burst fracture.

Guan Yi's situation, from imaging examinations, that is, CT scans and tomography, clearly shows that the spinal canal is severely blocked and the nerves are compressed, so surgical treatment is definitely required.

Jiao Zhenmei originally hoped to use conservative treatment, but Zhao Hua told her that surgery can shorten the length of hospital stay, shorten the recovery period, and it is easier and more convenient to care for. More importantly, it can prevent deformity and improve neurological function, so she agreed.

Xie Ke was very suspicious. She was pointing to her father-in-law who would continue to work for their family in the future.

Because it was an emergency operation, there was no time to make a pre-operative plan. Fortunately, Zhao Hua was quite experienced, and Xie Ke was there to assist, and the two quickly discussed the operation process.Zhao Hua went to select the materials, while Xie Ke used the traction device to fix the injured person's position.

Shayk then made an incision from the posterior approach.

He has long been familiar with this kind of thing. It is generally believed that the human head is the most important place. He is so handy at opening the skull. It is really not a big problem to open the chest and back.

After Zhao Hua came in, it was no surprise that Xie Ke had made all the preparations, and he couldn't help but glance at him with admiration.

It is also a blessing for the chief surgeon to have such an assistant.

The first is repositioning, which is the alignment of bones that have been moved out of their original positions.

Now that it has been dissected—to put it nicely, it is cut—there is no difficulty in the step of repositioning. After Xie Ke is satisfied with the position, he looks at the size of the steel plate Zhao Hua selected, peels off the local periosteum, and fixes the bone with a fracture fixator. Bones set.

Zhao Hua placed the steel plate on the bone surface, then pressed the two ends of the fracture together, and signaled Xie Ke to tighten the fixator.In this way, the fractured part and the steel plate are connected together.

Then you need to drill holes at both ends of the steel plate. This requires strength, otherwise the position will be off if you use a little force, so Zhao Hua personally used the drill to drill vertically in the center of the steel plate.After Zhao Hua drilled through the cortex on both sides, Xie Ke measured the bone diameter with a detector, and added the thickness of the steel plate to obtain the length of the required screw.

Zhao Hua screwed the screw in along the direction of the drilled hole, and it was done.Do the same for the other holes.

After inserting the steel plates on the thoracic spine, the pedicle screws on the lumbar spine were performed.

Putting nails is a little more complicated than inserting steel plates, but in general it is similar.

It is necessary to determine the direction of needle insertion. The lumbar spine is about 5-10 degrees in cohesion angle. After the needle insertion point is determined, the periosteum is peeled off with a rongeur.

Xie Ke compared the direction and the position of the needle insertion point with his fingers after only one glance.

Zhao Hua originally thought of him as casual, but after he used the c-arm—a kind of radiography machine—to locate him, he took a closer look and found that he couldn't find a better entry point and angle!

He couldn't help but glance at Xie Ke, it seems that those legends are really not groundless.

This kind of keen understanding and positioning of the human body is simply a cheating tool for surgeons.At least Zhao Hua himself thought that, not to mention whether it could be so accurate, it was impossible to find the location so quickly in terms of time alone.

Zhao Hua implanted the pedicle screws with bare hands, and then installed the round rod bent by Xie Ke on the side for connection, stretched and reset and fixed it.

After the fixation, Zhao Hua used the C-arm fluoroscopy again, and only after seeing that the fracture was restored satisfactorily, did he install the cross-link.

Xie Ke asked him why he didn't do vertebral body surgery together, Zhao Hua nodded his head outside the operating room.

Xie Ke understood, and it was to save money, so he didn't hook up this project.

Vertebral body shaping is actually injecting bone cement into the vertebrae, which can increase the strength and stability of the vertebral body, prevent collapse and relieve pain.

This method was only popular in foreign countries before, but now it has been introduced in China, and it is the best when combined with pedicle screw placement, reduction and internal fixation.Because of the relatively high failure rate of pedicle screw placement in the posterior short segment, it does not mean that the operation was not done well, but that the nail is displaced and broken due to force bearing and other factors after the operation. More, if bone cement is injected, it can be significantly improved.

The only disadvantage of this method should be that the cement is not a bone after all, and the bone cannot grow back to its original shape after filling.It's like a stick that has been broken into three pieces, one of which is gone, and the middle is glued with other materials to restore the length.

The imported surgical materials are about [-] to [-] yuan, and the domestic ones are only about [-] yuan. The family members can afford it, but they don’t tick the boxes. Xie Ke is also speechless.

Since there is no need for vertebral body shaping, the operation is basically completed here, and Xie Ke is naturally in charge of finishing. Anyway, he moves quickly and can get it done in a few strokes.

Postoperative wound drainage, but also to prevent infection and complications.

After Xie Ke finished the doctor's order, he showed it to Zhao Hua, and Zhao Hua signed it almost without reading it.He is extremely satisfied with Xie Ke now.

Guan Yi, also known as the old man Guan, woke up after the operation and didn't say anything after knowing that such a big accident had happened to him.His son stayed here every day, and occasionally changed to other relatives. The daughter-in-law probably didn't come here because of the inconvenient pregnancy.

More than two weeks later, Xie Ke saw Bao Gangping in the corridor once, and it seemed that he had been released when he was detained.

He carried a basket of fruit, put it in front of Guan Yi's hospital bed when Guan's family was away, and turned around without saying anything.

Seeing Xie Ke, he greeted Xie Ke, said a few words to Xie Ke, and thanked Xie Ke again and again.

So far, it seems that Guan Yi is recovering well, but Xie Ke does not have a good opinion of his prognosis. He feels that the nail is not secure and will have to be reworked sooner or later.

Xie Ke told Zhao Hua about this matter, and Zhao Hua actually understood it in his heart, but this matter has to be decided by the patient himself or his family.

Zhao Hua: "Don't bother with it. I signed the record of the conversation with them. If something like this happens, they can only blame themselves."

"Well, yes." Xie Ke hesitated and said, "Ms. Zhao, have you ever thought about using calcium sulfate cement to fill bone defects instead of the pmma bone cement we are using now for vertebral body shaping?"

Zhao Hua asked strangely: "Is there such a usage? Who did you hear it from?"

Xie Ke shook his head and said, "I just think it's feasible. We can apply to Director Huang for the experiment."

Zhao Hua saw that he seemed to be serious, so he thought about it, and then said: "Your idea is quite good, but to be honest with our hospital's research... Hehe, it doesn't matter, you can ask Director Huang."