Start as an Emergency Physician

"Don't worry, I'm also a deputy director..."

He Jianyi quickly calmed down.

"Zhao Han's situation is a bit dangerous, and the spinal injury is more serious."

Zhou Yuan asked while performing a dural totomy, "What's the situation?" "

"Vertebral burst fracture..."He Jianyi sighed.

There are generally three types of vertebral fractures, simple wedge compression fractures, burst fractures, and a wide range of unstable fractures, including chance fractures, flexion-distraction injuries, and displaced injuries.

Spinal stability is not affected in simple wedge compression fractures, and the spinal cord is not damaged, and conservative treatment is used.

As long as the height of the anterior edge of the injured vertebral body is restored to normal as much as possible, kyphotic deformity is corrected, the weight-bearing function is restored, and the occurrence of complications and sequelae such as traumatic spondylitis can be avoided.

Blowout fractures are more severe, and there is a possibility that a bone fragment may squeeze into the spinal canal.

The spinal canal is a tissue connected by the vertebral foramen of the free vertebrae and the sacral canal of the sacrum, which contains structures such as the spinal cord and the capsule, as well as a large number of ligaments to maintain the movement of the spine.

Once the spinal canal is damaged, the inability to move the waist is still a trivial matter, and the nerves and blood vessels may also be damaged, resulting in serious consequences such as high paraplegia.

"I intend to have a spinal canal fracture removal and intervertebral bone graft fusion." He Jianyi said. z

In this case, the vertebral fracture cannot be reduced, otherwise it will cause more serious consequences, and it can only be removed and treated with an internal fixation at the place of resection.

"Teacher, I'll leave it to you!" Zhou Yuan said in a deep voice.

Whether Zhao Han can save his life depends on Zhou Yuan, and whether he can exercise like a normal person after saving his life depends on He Jianyi.

It is impossible for Zhou Yuan to run to repair his spine now, he and He Jianyi must undergo surgery at the same time...

"Don't worry, I've had surgery for so many years, if you save your life, I can let her move!" He Jian said with a serious face.

If he can't even save this heroic teacher, He Jianyi may feel guilty for a long time.

"A flap-like incision of the dura mater. Needle forceps. Zhou Yuan continued the operation.

There is a cerebellar sickle at the midline of the dura mater of the posterior cranial fossa, which contains the occipital sinus, and there is also a cricoid sinus along the margin of the foramen magnum of the occipital bone.

The ocean is ready with needle holders.

After Zhou Yuan cut it, he held the tweezers in his left hand to fix the suture site, and manipulated the needle forceps with his right hand, and the needle pierced into the skin, and the hemostasis was completed in just a few strokes.

The ocean swallowed.

"Senior Brother Zhou Yuan, you have a good grasp of the hemostatic point..."

He is a surgical maniac, and he has gone to the brain surgery department many times to observe the operation, and it often takes several minutes for other doctors to suture and stop the bleeding here...

Zhou Yuan smiled, and then turned the incised hard sinus in the direction, revealing the lower cerebellum, the lower vermi, the tonsils, the lower part of the fourth ventricle, the junction of the medulla oblongata and the cervical medulla, and so on.

After revealing the intracranial structure, Zhou Yuanxing was examined.

The key to a skull fracture is not the degree of damage to the skull, but the injury to the skull affected by the fractured skull.

In general, fractures are often accompanied by plate barrier rupture, and hematomas inside and outside the skull plate occur, which tend to cause local swelling of the scalp.

Soon, Zhou Yuan made a diagnosis.

"Cerebral contusion and traumatic intracranial hematoma."

Zhou Yuan's expression was a little serious. Cerebral contusion is a serious type of closed head injury, including rupture of cerebral blood vessels and tissue necrosis.

Intracranial hematomas are generally accompanied by cerebral contusions, and intracranial hematomas will directly compress the brain tissue, causing cerebral circulation and cerebrospinal fluid circulation to be blocked, which in turn aggravates the degree of cerebral compression and forms a vicious circle.

However, fortunately, the symptoms of cerebral compression are related to the amount and speed of bleeding, and Zhao Han is a venous hemorrhage, so the development of symptoms is relatively slow.

Therefore, Zhou Yuan planned to deal with the cerebral contusion and laceration first.

Soon, he discovered significant tissue necrosis on the surface of the skull, a slight increase in intracranial pressure, and bloody cerebrospinal fluid in the ventricles.

The submateral appearance of the brain injury is purplish-red, and some small blood clots and fragmented, necrotic, and softened brain tissue can be seen on the surface.

"Suctifier." Zhou Yuandao.

Zhou Yuan quickly sucked up the eroded and lost cell tissue, and gradually cleaned the necrotic tissue.

"Brain pressure plate." Zhou Yuandao.

Cerebral pressure plate is a medical device used to stretch brain tissue and expose the surgical field, and is often used in neurosurgery and brain surgery.

After lifting the frontal and temporal lobes with a cerebral pressure plate and completely removing the necrotic tissue on the underside of the brain, Zhou Yuan stopped and began to test the removal effect.

There is a criterion for the complete removal of necrotic tissue, which is the softening and sinking of the brain and the restoration of cerebral vascular pulsation.

"Cleared." Zhou Yuan felt the touch of the soft pedaling and breathed a sigh of relief.

This is followed by the management of the intracerebral hematoma.

Zhao Han's intracerebral hematoma was relatively hidden and could not be seen with the naked eye, so Zhou Yuan could only use a ventricular needle to gradually puncture the brain to confirm the location of the hematoma.

After determining the location of the deep intracerebral hematoma, Zhou Yuan quickly selected a puncture point on the gyrus in the non-functional area of the brain, cut 3 cm of cerebral cortex after electrocoagulation, and then used a cerebral pressure plate and suction device to gradually separate to the deep brain in the direction of puncture, directly into the hematoma cavity.

Zhou Yuan slowly sucked out the hematoma with a suction device.

Intracerebral hematoma is a relatively serious condition, once not properly treated, patients will have headaches, vomiting, and even mental disorders, hemiplegia, that is, one side of the body is completely paralyzed.

"Electrocoagulation to stop bleeding." Zhou Yuandao.

In the process of removing the hematoma, there is often multi-vessel active bleeding, and almost every suction of Zhou Yuan will cause bleeding, so electrocoagulation should be performed after each suction to stop bleeding to avoid excessive blood loss.

This process is extremely tedious and requires meticulous operation.

Blood vessels are distributed in the functional areas of the brain, and once the brain is damaged, it will inevitably cause physical or mental disorders in patients.

Soon, the hematoma was eliminated.

Zhou Yuan pulled the drainage tube again, attracted all the fluid in the brain, and after checking again to confirm that there was no necrotic tissue or hematoma, Zhou Yuan began to close the skull.

After intracranial surgery, the cranial closure should be tried as quickly as possible, and the longer the delay, the more detrimental the patient's postoperative recovery will be.

"Needle holders." Zhou Yuandao.

Suturing the dura mater is particularly laborious, and there is a lot of tension in this area, and it is very difficult to suture.

Zhou Yuan chose to use the softer fascia next to it for repair.

Next, begin to suture the suboccipital muscles with thick silk threads.

The sutures of the suboccipital muscles are very tight, and the sutures must run through the entire thickness of the muscles, leaving no gaps.

Once the sutures are not tightly closed, cerebrospinal fluid leakage and pseudocysts can occur.

In particular, the extraoccipital tuberosity is where the muscle meets the fascia, and leakage is most likely to occur. _

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