godfather of surgery

Chapter 183 The Calm Professor Ye
9. During the operation, Professor Ye brought Director Guan and Chen Ge to perform the operation.

This operation is also a quadruple reconstruction, the intercondylar notch is deformed, and when the femoral tunnel is opened, the medial femoral condyle is split, which is troublesome.

Let Professor Ye do it, this problem will not occur at all, the operation lasted half an hour, and the rear fork was rebuilt. Chen Ge wants to try it. Chen Ge is Director Guan's Ph.D., and he is also Professor Ye's nephew, let alone in the third hospital I also studied with Professor Ye for a year, so it doesn't matter if I let him try.

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

Now it is time to take out the broken drill bit from the bone. When Yang Ping and Su Nanchen went in, Professor Ye had just finished seeing through and determined the position and direction of the drill bit.

Professor Ye didn't speak, neither did Chen Ge and Director Guan, they were all frowning, and there were many people around in the operating room, watching.

Su Nanchen pointed to the patient, and the anesthetist said, "It's under general anesthesia!" It was much more convenient to speak like this.

Professor Ye looked at the images on the screen of the C-arm X-ray machine and pondered how to remove the drill bit. He wanted to remove the drill bit minimally, that is, without incision, but under arthroscopic removal, which was very difficult.

How did this drill work?Professor Ye scolded his mother in his heart, and now he has the heart to vomit blood. If he was in the third courtyard, he would probably scold Chen Ge for blood when he stepped down.

Removing the drill bit is still the first step. After removing the drill bit, the fracture needs to be fixed. After the fracture is fixed, the tunnel needs to be re-opened. 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. This patient did not have osteoporosis, nor did he have pathological factors such as tumors. The medial condyle was broken 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 is at the top level in the country, he would have given up on the operation and would have just cut it open, got the drill out, fixed the fracture, waited a few months, at least three months, until the fracture healed, and then performed the operation.

As expected of the top level in the country, Professor Ye was not in a hurry, calm and calm. He used the nucleus pulposus forceps to penetrate into the joint cavity, took a little from the bone, and handed it to the nurse, who took it with saline gauze.

Professor Ye explained: "Send to pathology!"

This kind of accidental fracture should not have occurred. As a strict professor, pathological factors must be considered, especially tumors.Although visual inspection is not, many things are not counted by visual inspection. For the sake of caution, 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. Most doctors cannot do it, and they have to cut it to remove it. However, Professor Ye does not seem to be planning to cut it. He plans to use arthroscopy to remove it.

The camera found the best angle of view, and saw that the drill bit was stuck in the bone tissue and exposed a little bit. The intercondylar fossa is like a hole. Things buried in the hole wall are not something you can take out if you want to. The instrument cannot reach it. It can't be used, but it is firmly stuck in the bone.

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

"The thinnest drill!"

Professor Ye inserted the thinnest drill bit along the exposed guide pin on the inner thigh, made contact with the broken drill bit, and 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 thin drill.

"hammer!"

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

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

Using such a method is very clever, but it requires rich experience and hand feeling, otherwise it will not only fail to remove it, but will also lead to new fractures.

In a few minutes, Professor Ye easily took out the drill and handed it to the nurse: "Fit it with the other half, see if it matches? Prepare the C-arm machine to see through it."

The two halves meet, if they can be aligned, it means that there is no residue, if they don't, it means that there is residue.

Sure enough, the operation was prudent and meticulous. After taking it out, the severed end should be examined through perspective to ensure nothing goes wrong.

The drill bit was taken out, and it seemed that there was nothing wrong with Yang Ping. Su Nanchen thought that Professor Su called Yang Ping to save the stage, but now it seems that there is nothing wrong, so let's not waste his time.

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

Professor Su said: "Wait!"

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

Professor Su said so. It seems that there must be other things to keep him here, and Yang Ping is not easy to leave: "It's okay, they can take the surgery, but I just want to check it. It doesn't matter if it's later."

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

Professor Su waved his hand, stopped explaining, and ignored Su Nanchen.

"Concentrate on it! Let's see how Professor Ye responds on the spot and how he handles this situation."

Could it be that Yang Ping was left behind just to let him study with Professor Ye?How to manage this rare accidental comminuted fracture of the medial or lateral condyle in quadruple reconstruction?
"Xiao Yang, I'm sorry, you can arrange the family affairs." Professor Su ordered again.

Yang Ping responded, "Professor Su has spoken, what else can I say, and I will carry it out."

"How about it? Continue to do it? Or wait three months?" Director Guan took the opportunity to ask.

In this case, the fracture is generally operated according to the fracture, and the fracture is fixed. After three months, the fracture has healed, and then the ligament is reconstructed. The difficulty of the operation is not only increased. The remaining bone does not have much space for tunneling. , and even if there is space, many of them are in the dead corner of the operation, and no good tunnel can be created at all, so the operation will not achieve the effect.

This kind of operation is not just to rebuild the ligament, but also to ensure the effect.Just like making test papers, you don’t pursue grades, you just need to fill up the test papers, that’s how easy it is, if you’re after the ultimate high score, you don’t just have to fill in the test papers.

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

"It's under general anesthesia!" the anesthetist replied.

Professor Ye took a short rest. The doctor in the audience was pushing the C-arm machine to see through. Everyone moved away to make room.

"I always say that the operation is not big or small, and every step must be careful. Our surgeons are walking on thin ice every step. You see, if you are a little careless, something went wrong. If the operation is stopped like this, the patient walks off the stage with a fracture, how do you explain it? How do you explain it? The recovery time is delayed, the competition period is not mentioned, and new problems are left." Professor Ye's tone was not bad, he just reprimanded, not scolded.

"C-arm machine, push it hard, higher, come in here!" Chen Ge had a bad temper, suffocating in his heart, and vented his anger on the little doctor who pushed the C-arm.

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

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

Sure enough, Professor Ye lost his temper and stared at Chen Ge. He caused trouble by himself. Everyone wiped his ass, and he even cursed at the doctor below.

If Professor Su wasn't there, Professor Ye would have cursed, but Professor Su was there. Although he is Chen Ge's uncle, he is also a foreign guest, so it is not good to scold his doctors in front of Professor Su.

Everyone went out of the operating room, after the fluoroscopy, and went in to see that the drill bit had been completely taken out without any residue.

"Prepare hollow screws, which are usually used for femoral condyle fractures, and fix the fractures."

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

This kind of transarticular fracture, some still have cartilage, so it is very skillful to fix it. Not only must it be fixed well, but the position of the nail must not affect the next step of ligament reconstruction and tunneling. The nail head or nail tip must be buried and cannot be exposed. .

It is also very difficult to reduce and fix the fracture under minimally invasive arthroscopy. Professor Ye used the grasping forceps to grasp a bone fragment. The grasping forceps are very small, and they are generally not very good at using them. They cannot grasp such a large bone fragment at all. Just grasp it firmly, put it in the original position, release the pliers, and wait until the bone fragments have not loosened and fell off. In an instant, Professor Ye used the closed end of the grasping forceps to withstand the fracture, and the operation was like acrobatics.

"Guide needle electric drill!"

To fix this bone block, the guide pin cannot be inserted from the inside, because the intercondylar fossa is an arched socket, which is equivalent to a hole. From the inside to the outside, there are some dead ends. into.

Breaking in from the outside, you encountered the same problem as Yang Ping opened the tibial tunnel. You 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, no matter whether it is a point or a circle, it is very difficult!

From the outside, he pierced the guide needle through the skin and muscle, and pressed it against the bone cortex. He thought for a while, and then repeatedly moved the insertion point and angle of the guide needle. Bone fragment held in one hand with grasping forceps.

Adjusted many times, rustling, the electric drill sounded, the guide pin went through, hit the bone, came out of a good position, awesome!Everyone was amazed and almost cheered.

This bone fragment is relatively small, a screw is enough, and the upper screw can only be from the outside to the inside. After the measurement, I picked a half-threaded hollow nail and screwed it in. It just fixed the fracture and fixed it tightly with pressure. The tip of the screw Into the subchondral bone, but not exposed.

The first-class level in the country is well-deserved. When encountering such a thing, most experts think it is a catastrophe, and they directly surrender and are forced to give up the operation.But he can easily continue, and judging by the level of handling, it is at its peak.

Sniping the circle behind the wall with just one hand, this level of penetrating steel needles, few in the country can do it, and even less can do it at one time.

The senior brother is really good, Director Guan admired this operation, Chen Ge drooped his head, and was stared at by Professor Ye and Professor Guan from time to time, how dare he have a temper.

There are three bone fragments in total, and the other one is about the same size. Professor Ye used the same method to fix the bone fragment with a hollow nail; The needle went in exactly the first time, and the position was good.

"Okay! Open the femoral tunnel again!" Professor Ye put down the screwdriver and moved his wrist.

"Do you still have double bundles?" Director Guan asked.

It is already very difficult to continue double-beaming, and three problems lie ahead.

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

Another problem, the three bone fragments are all reset, but there are several fracture gaps, and the tunnel is opened to the gap, which is not very good.

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

"Of course--" Professor Ye could not doubt it.

If it is replaced with single-bundle reconstruction, the effect of the surgery will be compromised. This is a professional athlete, and he is looking for high-quality surgery. If he compromises on the quality of the surgery, Professor Ye can't do it.

His professional conscience would not allow it, nor could his own reputation.

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

"Guide pin! Open femoral tunnel!"

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

After trying a few times, I shook my head, no, the exit point is not in the safe zone.The exit point must be in the safe zone, otherwise the cortical suspensory ligament is not thick enough, and the cortex is easily torn.

Another angle, from straightening to extreme flexion of the knee joint, will not work.

It is almost possible to pierce the skin and penetrate from other positions, not from the outside. Professor Ye has tried everything, 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 happens to be a dead end, which is too tricky.

It seems that it can only be penetrated from the outside to the inside, using the method of sniping on the partition wall. Last time, the target of the sniping on the partition wall was a circle, but now the target of the sniping is a point, and the difficulty has increased.

I made a profit today. Seeing the top talents in the country perform magic tricks, sniping through a wall, or sniping at a point, this is a divine operation.

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

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

Song Zimo didn't urge him, and Yang Ping didn't answer the phone either. He just kept watching, watching the whole process of Professor Ye's operation just now, which is really the top level in the country.

Professor Ye held the electric drill steadily without any shaking. The technique of holding the electric drill was also strictly trained. The guide pin was against the cortex above the medial condyle of the femur and the cortex on the inner side of the lower end of the femur. Move, very steady.

After adjusting the position and direction of the guide needle many times and observing repeatedly, Professor Ye finally pulled the trigger.

rustle!The guide pin was driven in, and the place where it came out was about 5 mm away from that point, that is, it deviated by 5 mm. If someone else, it is estimated that it was very successful and the tunnel could be opened.

But he is at the top level in the country, how could he accept the [-] points, what he wants is [-] points.

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

Again!
Farther again, almost 7mm this time.

　Sorry for the slow update!Because I am too busy during the day, I only have time to update at night, let alone come, it will be better in a few days, I will definitely improve the update when I have time!Bow to everyone!

　　
　
(End of this chapter)