godfather of surgery

Chapter 593 The Back
Three days later, Yang Ping saw Tan Xiaowei again at the gate of the ICU. His skin was obviously darker, with traces of being sunburned, and all the tapes on his hands had been changed, his hair was cut shorter, and he looked more energetic. Around the fanny pack.

Li Jun hasn't woken up yet, only when he first entered the ICU, he felt agitated and tended to wake up, and there has been no movement since then. ECMO costs over [-] a day, bedside blood filter machines cost [-] to [-] a day, and all kinds of expensive imports Medicine, plus various examinations, etc., cost [-] to [-] a day to maintain Li Jun's life. As long as one of these life-saving treatments is stopped, Li Jun's life will collapse.

His life is persistently maintained by expensive drugs and machines.

Every time Yang Ping came to make ward rounds, the director of the ICU would accompany him. He still respected this young professor very much.

"Li Jun suffers from severe anemia, which is renal anemia. At present, he relies on blood transfusion to maintain the concentration of hemoglobin and the number of red blood cells. Sistat), we had an EEG again yesterday, the brain waves exist, and the activity is very good, and cranial nerve reflexes such as the pupillary reflex exist.”

From this point of view, theoretically, he must be able to wake up.

"As long as the brain waves are normal and cranial nerve reflexes exist, it means that there is no necrosis of the brain tissue, and there is no anatomical evidence of inability to wake up."

Yang Ping checked the pupils by the light of the flashlight, and indeed the pupil reflexes were more sensitive.

The nurse is turning Li Jun over, doing a body scrub, checking the skin condition of some bony protruding parts, and replacing the protective pads on these bony protruding parts to prevent pressure sores from forming.

Bedridden patients can easily develop pressure sores if they are not well cared for.

The director of the ICU is quite emotional: "Hope is not completely lost. Even if you wake up, you still face the problem of whether you can go offline. These two life-and-death tests must be passed. We have used it for more than three months to successfully go offline, but the cost is huge. The part at his own expense alone is more than 200 million, even if his family has the heart, the money is still a problem."

As a doctor, the director of the ICU is well aware of how many people fall into the issue of money. Gambling on the chance of survival at a time like this is a waste of money.

Ordinary people sell their houses and sell their pots and irons, and in the end they lose their money and life, and no one can accept it.

Many problems turn into economic problems in the end.

"How about the one next door, still insisting?" Yang Ping asked by the way.

The director of the ICU smiled wryly: "How is it possible? He was brain-dead a few days ago. The patient actually hoped to be older than Li Jun, and he also relied on ECMO for maintenance. After [-] days, the family really couldn't support it, and the family members signed and gave up."

Yang Ping remained silent.

After watching Li Jun, Yang Ping came out of the ICU. Qin Xiaowei was talking with the bed doctor, Dr. An, and he was going to leave for a while, which was quite a while.

Qin Xiaowei told Dr. An to call Li Jun once he woke up.

And there is another emergency backup phone, which belongs to my friend Aaron.

Before formal rock climbing, he has to climb dozens of times with cables to select the best route, study the difficulties in the route, and design countermeasures in advance.

It is also necessary to carry out various professional training, including physical training, etc., just like the training camp before the competition of athletes. This kind of high-risk outdoor extreme sports is very professional, and it is by no means a passionate one.

Every detail is in place to be successful.

-

August has basically mastered the scoliosis orthopedic technique, and has a deep understanding of the technique.

As a great figure in spine surgery, his understanding of spine is by no means comparable to that of ordinary doctors.

Yang Ping's technology makes full use of Elizarov's theory to correct scoliosis. The difficulty lies in having a full understanding of spinal deformity, and then knowing where distraction osteogenesis is helpful for deformity correction.

August thoroughly understood these core theories bit by bit, and asked Yang Ping for advice if he didn't understand anything.

In order to have a deeper and more comprehensive understanding of the cases, he personally changed the dressings and rotated the knobs of the external fixator of the spine every day.

Now August's work in Sanbo Hospital is all the work of a resident doctor, and he never tires of it.

"Why is my pen gone again?"

In the doctor's office, August hangs his doctor's badge, sits down to rest for a while, takes a pen from his breast pocket to record something, but finds that the pen is gone.

And Robert sat at the desk, counting pens triumphantly, there were a dozen of them, blue and black fountain pens, surgical markers, everything that one expects to find, and the two pen holders were inserted slowly.

For each pen, Robert affixed a label with his name, which is an oath of ownership.

August said angrily, "Student Luo, you took my pen?"

Robert protected his pen with both hands: "I consulted with Mr. Zhang and took it from other departments. Every pen has my name."

For doctors, these pens are a lot of money, how could they be taken away by others.

No matter how many pens there are, doctors often can't find them.

There is no need to hurt the relationship between roommates for a pen, so Takahashi handed August a pen: "Use it first, I still have this."

August took over the pen, and his dislike for the Japanese decreased a little bit.

"Doctor Ao! The professor asked you to go to his office."

Young doctors call them Dr. Ao, Dr. Luo, and Dr. Gao.

The professor is looking for me?August temporarily put down the hatred of a pen, adjusted his white coat, pulled himself together, and came to Yang Ping's office.

The door was ajar, he gently pushed it open, poked a head in, and asked in a low voice:
"Professor, are you looking for me?"

"Come in!" Yang Ping was studying surgery and wanted to discuss it with him.

August came in, stood up, put his hands on the seams of his trousers, and leaned forward slightly.

Then he stared at the professor's pot of tea out of the corner of his eye, because he knew that if the professor poured a cup of tea from the pot to the student, it meant that the student was approved by the professor. It was said that this was a tradition.

So far, Dr. O has not had that cup of tea.

Yang Ping pushed the 3D model of the spine on the table to the center: "Doctor Ao, if you use a spinal external fixator to treat this case, how would you tell me how to cut the bone? This is your patient."

This spine model is the spiral spine of the Duke's precious son, and August is a little excited.

Is this testing yourself?August is confident.During this period of time, I worked hard on the new technology. I had surgery during the day, changed the dressing before leaving get off work, returned to the dormitory to add notes, and summarized the work of the day.

"Professor, look!" August took out a pen: "Each vertebra needs to be osteotomized, and the osteotomy should be kept in the posterior column as much as possible to maintain the stability of the spine and make full use of distraction osteogenesis. I started from this The vertebrae start--"

August gestured with a pen, explaining in detail the specific position, orientation and depth of each osteotomy.

The site of osteotomy will be the site of distraction in the future, not only the orthopedic, but also the deformation tolerance of the dispersed spinal cord should be considered.

Sure enough, he is a great figure in spinal surgery, who has such a thorough understanding of the new technology of osteotomy.

The promotion of new technologies in Europe depends on Dr. Ao in front of us.

Yang Ping applauded him, and then made revisions to several osteotomies.

These few modifications will make the operation easier and easier. This is something August has never understood. He always feels wrong, but he doesn't know how to modify it.

After Yang Ping's dialing, the ice-snow-smart August finally understood the profound meaning.

"Professor, when can I invite you to fly a knife in Germany to operate on this patient?" August took the opportunity to invite.

Yang Ping did not refuse, and asked, "Is the patient's cardiopulmonary function not very good?"

"Because of severe spinal deformity, the thoracic space is extremely narrow, causing severe compression and distortion of the heart and lungs, and the heart and lung function is very poor. Once other problems occur, it may be life-threatening due to insufficient compensation of the heart and lung function. His son had surgery."

August was well aware of the professor's temper, and the patient might not be saved if he didn't have the operation quickly.

professor!Do you shoot or not?
Yang Ping thought for a moment, then nodded, "I'll go to Germany with you after I've been busy."

"By the way, check out the projects funded by the Duke Fund. I guarantee with my personality that this fund is very serious."

August swallowed as if his throat was dry.

"Okay, let's go and have a look."

"By the way, the spinal cord injury research project under my guidance, let's see if our hospital is qualified as a clinical trial base. For this phase III clinical trial, the Duke Fund gave [-] million euros. Patients from all over the world can enjoy free treatment when they go to Germany, Professor ! Each of your spinal external fixators is benefiting mankind." August threw out the cards he had held in his hand for a long time.

For the sake of his son, the Duke is very generous and signed an agreement with the Harlaching Orthopedic Hospital in Munich. If he wins the third phase of clinical trials, he will give him a subsidy of [-] million euros.

That's a lot of money, no matter where it is.

"Then by the way—"

Yang Ping patted August on the shoulder.

August was disappointed that he didn't drink that cup of tea until the end of the conversation with the professor.

Auguste had a few patients changing their dressings before he got off work, so he went to push the dressing change cart, put on a mask and hat, and prepared to change the dressings.

In the corridor, I saw Professor Zou from the First Attachment, standing at the door, holding a bag of fruit in his hand.

"teacher--"

Professor Zou waved his hand.

August looked back, then gestured for Professor Zou to go back, and then pushed the medicine changing cart into the ward.

Looking at the back of the tutor pushing the medicine changing cart, Professor Zou felt a sense of sadness welling up in his heart, stronger than last time, tutor, my tutor!It looked like a Gui Peisheng, pushing the medicine changing cart to change the medicine of the patient, Professor Zou almost shed tears.

When we got here, Professor Zou wanted to say hello to Yang Ping, so he went to Yang Ping's office.

Yang Ping was very surprised to see Professor Zou with a bag of fruit, and made a surprise visit without saying hello in advance.

"I'm on the way, come and have a look, Professor Yang!" Professor Zou put down the fruit in his hand, took out a tissue to wipe his sweat, and his eyes were moist.

"Professor Zou, what is this?" Yang Ping felt that his expression was wrong.

Professor Zou sighed slightly: "August is my tutor, please take care of him! I just wanted to see him."

No wonder carrying a bag of fruit.

Yang Ping nodded: "That is, I will take care of it for sure, it's rare to come here, why don't we get together at night?"

"No, I'll come over to see the tutor, I have something to do tonight."

Professor Zou did have a social event at night, and he said that he came here in a hurry, didn't say hello, and ate in a hurry, what did he say.

"Li Guodong!"

Li Guodong just passed by the door of Yang Ping's office, and stopped when he heard the cry.

"Go and call Dr. Ao." Yang Ping ordered.

Professor Zou shook his head: "Forget it, I'm leaving now. The instructor said that I don't want me to disturb him during the study. I just want to come and see if I can help."

You look like this, as if this is a juvenile detention center, you are the parent of the child, and the child is being disciplined here, Yang Ping slandered a few words.

"Don't tell me that I have been here, please, take care of me. When I was in Germany, my tutor was very kind to me." Professor Zou said emotionally.

Yang Ping thought it was weird that he didn't see him when he came.

"Give this fruit to him for me."

Professor Zou was about to leave after speaking.

Aren't you the parents who look at the children in the juvenile detention center?This is not to see the teacher.

"That's it! Please!"

While the tutor was still changing the medicine, Professor Zou left quickly, obviously the tutor didn't want to see him.

This?
Carrying a bag of fruit, throw it here and leave again.

Yang Ping wanted to catch up to see Professor Zou off, but he had already disappeared.
-
In the office, Yang Ping took a few sips of tea.

Summarize the orthopedic technique of spinal external fixator.

In the system space, he revisited some monographs and journals on orthopedic surgery.

Most scoliosis patients are teenagers and are in the stage of growth and development. Can we grasp the characteristics of teenagers and find a better method?

Any treatment method is developed. For example, the treatment of gastric ulcer was initially surgery, partial gastrectomy, and later developed into selective vagus nerve block. Surgery, direct triple and quadruple drug therapy can cure the disease. This is the improvement of the treatment method, and no method is once and for all.

Yang Ping summarized the history of orthopedic surgery, especially the development of orthopedic surgery for teenagers, and then analyzed the current cutting-edge technology, and found an important information: whether epiphyseal block and stimulation technology can be used in scoliosis correction.

Now the epiphyseal block technique has been sporadically used in uncomplicated scoliosis in children.

The core concept of traditional orthopedic surgery is osteotomy, so the correction of skeletal deformities often requires osteotomy.

And teenagers and children, this kind of minors, their bones are still in the stage of growth and development.

The length of the long bones of the limbs mainly depends on the growth plates (also called epiphyseal plates) at both ends. The epiphysis is formed by the orderly superimposition of layers of chondrocytes of different maturity. The chondrocytes near the backbone continue to mature, and mature chondrocytes Transformation into osteoblasts, accompanied by calcification of the surrounding matrix, forms cancellous bone and adds to the ends of the long bones, so that the long bones continue to grow.

Under normal circumstances, the growth of this epiphyseal plate is balanced, so in the process of growth, we will not have deformed images of crooked growth.

However, due to certain reasons, such as trauma, infection, tumor, radiation, metabolism, abnormal development and other factors, the growth mechanism of the epiphyseal plate is damaged, and the growth balance is disrupted. The growth of the epiphyseal plate will be inhibited or stimulated, and the growth will be too fast or slow. Even stagnation, limbs appear unequal or bent deformity.

In the case of unbalanced growth of the growth plate and bone bending, the bone deformity can be corrected by temporarily stagnating the relatively fast growth side of the epiphyseal plate and allowing the slow growth side to fully grow.

Physicians often achieve epiphyseal block by placing a small plate and two screws across the growth plate on the convex side of the angular deformity.

In this way, the concave side grows faster than the convex side, and the curvature is corrected.

However, spinal deformities are far more complex than deformities of the long bones of the extremities.

It seems simple, but to use this technology for spinal correction, several major problems must be solved.

First, we must thoroughly study the growth mechanism of the spine, and understand the precise adjustment of each epiphysis, which can be adjusted from three axes. Second, finally master the epiphyseal stimulation technology, because currently there is only epiphyseal block technology, but no epiphyseal stimulation technology.

If this technology breaks through, the theory of spinal orthopedics will have two complementary surgeries, which will complement each other and make spinal orthopedics very easy.

For example, in children's spinal orthopedics, a few screws can be placed in a minimally invasive way, and you can do what you need to do after the operation.

These screws regulate the growth of the spine in the body, allowing it to automatically correct itself during the growth process. How you grow and bend, you can grow back for me.

There are so many ideas!
Yang Ping has a lot of ideas in his head now, so he will write them down for now, and study them slowly when he has time.
-
After changing his medicine, August was called to the professor's office again.

Tell him to get the bag of apples.

(End of this chapter)