godfather of surgery

Chapter 623 Transfer it to us

Coming out of the ward and returning to the doctor's office, after Yang Ping washed and dried his hands, everyone sat down and discussed the treatment plan.

In fact, for patients with metal allergies, there are still certain ways to perform artificial joint replacement.

If you simplify the treatment, the problem is easy: severe metal allergy, conservative treatment.

This way of handling, for any doctor, will not cause any trouble, but will get rid of trouble.

In a provincial hospital like Sanbo Hospital, the director of the joint surgery department can perform a few hundred artificial joint replacements without too much effort. Is this operation still missing?

With bilateral knee osteoarthritis at this severe stage, conservative treatment is synonymous with giving up treatment, which is not in line with Yang Ping's philosophy of going all out.

Therefore, he did not plan to end the consultation hastily, and then give a steady and watertight opinion according to the formula: agree with Guike's diagnosis, and suggest conservative treatment because the patient is allergic to multiple metals.

It is a habit of consultation to review the medical records before seeing a patient, and to review the medical records again after seeing a patient.

Learn the new by reviewing the past, and sometimes there will be unexpected discoveries when reviewing medical records.

Yang Ping manipulated the mouse by himself to quickly browse through the entire medical record. It is also the basic skill of a doctor to read the medical record quickly.

After reading it, he was not in a hurry to speak.

Now as a superior doctor, Yang Ping needs to give his subordinate doctors a chance to think.

I have countless cases in the system space to practice, but Song Zimo and Xu Zhiliang can only rely on real cases to practice, so Yang Ping will not deprive them of the opportunity to practice.

"Metal allergy, the allergic reaction is still relatively serious."

Yang Ping looked away from the computer screen, narrowed his eyes slightly and said.

Director Chang was at the side, leaned very close, supported Yang Ping's chair back with one hand and said, "That's right, because we heard from his family members that he had a history of metal allergies, we were more cautious and tested all kinds of metals involved in artificial prostheses. Allergy tests showed strong positive reactions, and I have never seen patients who are allergic to these metals.”

There are fewer patients with metal allergies, and fewer people are allergic to several metals at the same time.

But doctors can't ask patients to follow their own wishes. This kind of regular diagnosis of patients is fine, at most it can't be cured.If there is an emergency rescue, the doctor can't say: This is too rare, I'm not ready yet, push it back, the next one.

Director Chang's words actually have a deep meaning: it's not that I'm incompetent, but that the patient's condition is too complicated to be replaced by anyone else.

In order to strengthen this deep meaning, Director Chang continued: "We are also considering using gold joint prosthesis, but this kind of allergy test is strongly positive, and we are also worried that a small amount of metal ions may also cause severe allergies."

Gold joints are actually not joints made of gold, but the prosthesis has certain specialties in the process. The physical vapor deposition process is used to deposit titanium, niobium and nitrogen onto the cobalt-chromium-molybdenum substrate, and then perform high-precision polishing to obtain the prosthesis.

Titanium niobium nitrogen (TiNbN) can effectively reduce the release of cobalt chromium molybdenum metal ions in the matrix, has better biocompatibility, and can prevent metal allergies, providing a more reliable solution for patients with metal allergies, and its combination, strength, Wear resistance, biocompatibility, fatigue resistance and safety are better than ordinary artificial knee joints.

Because the color of the surface of the prosthesis is golden yellow, it is often called "golden joint" by doctors.

This prosthesis can be used in patients with metal allergies, but doctors still dare not use it in patients with severe allergic reactions.

Titanium niobium nitrogen can reduce the release of cobalt chromium molybdenum metal ions, but cannot completely prevent the release of metal ions.

As long as metal ions are released, there is a possibility of allergies.

If the prosthesis becomes loose due to allergies, severe inflammatory reactions occur in the surrounding soft tissues, and the surgical incision does not heal, the consequences will be disastrous.

One less operation is nothing to Director Chang, but if a surgery with disastrous consequences is done, Director Chang may have trouble sleeping and eating.

Therefore, "golden joints" are ruthlessly excluded!
As the chief physician of joint surgery, Director Chang is also experienced, and he should have thought of all the methods he can think of.

"It would be great if there was an all-ceramic knee prosthesis?" Xu Zhiliang said regretfully.

Ceramic artificial joints are widely used in hip joints, whether it is ceramic-to-ceramic, or ceramic-to-highly cross-linked polyethylene, because of its low wear and tear, ceramic prostheses often exist as high-end prostheses.

However, the application of ceramic prosthesis in the knee joint is very rare, and the all-ceramic prosthesis without a little metal, not to mention the knee joint, even the hip joint cannot be found, because the femoral stem of the prosthesis is still metal.

Ceramics are generally alumina and zirconia, or a combination of the two. Alumina has been used in artificial joints for more than 40 years, and zirconia has been used for more than 30 years. It is hard, smooth, wear-resistant, and wears little. It is an artificial joint prosthesis. good material.

But it also has its disadvantages, that is, it is very brittle, and once damaged, it is easy to break, but the possibility of the current implantable ceramics breaking is very small, less than one in ten thousand.

At present, the best medical implant ceramics on the market is CeramTec in Germany. Almost all artificial joint manufacturers, regardless of the United States, the United Kingdom, or China, all purchase its ceramic blanks for the manufacture of artificial joints. .

No way, other countries cannot produce qualified ceramics of this kind.

CeramTec's medical implantable ceramics occupy 90.00% of the global market[-], a well-deserved monopoly.

"Tao-to-Tao's all-ceramic knee joint prosthesis must not be found in the market at present. It is a ceramic-to-highly cross-linked polyethylene knee joint prosthesis, and the tibial end also has a metal support." Song Zimo responded to Xu Zhiliang's regret.

Because the movement mode of the knee joint is completely different from that of the hip joint, ceramics are used more in the hip joint and less in the knee joint.

The hip joint is a ball-and-socket joint, and the femoral head rotates in the acetabular socket, so there is more friction between the ball and the socket when moving.

The knee joint is a complex joint based on the flexor joint. Its movements include flexion and extension, rotation, and fretting varus and varus. Be patient, because it just hits its weak point - it is very brittle, and once the impact forms a small damage, it will also cause the ceramic to crack.

Implantable ceramic technology is improving and will solve this problem, but at least there is no all-ceramic knee joint on the market.

"We have also considered ceramics. There is no all-ceramic knee prosthesis on the market. What about it? Is there any other way?" Director Chang asked indifferently, saying that he had considered everything. There are no loopholes.

You, Professor Yang, have to think of ways within the rules and regulations. Director Chang has thought about these ways. Recently, Director Han is very satisfied with the two departments of trauma orthopedics and sports medicine, but not very satisfied with the two departments of spine and joints.

Director Chang was a little unconvinced. Anyway, the operation is done every day. My old Chang's level is not bad, so what tricks can I come up with.

Yang Ping has not spoken, let them continue to speak freely.

If there is a knee prosthesis without metal at all, you can only go to Germany to find it. The Germans are sitting next to it. Just say a word, and the Germans can make a few phone calls, and the ceramic joint will be delivered.

The problem is that it is not available now, and even if it is, it is still an experimental product and cannot be used if it is used. This will involve some medical regulations.

Using all-ceramic joints can be discussed and discussed, but in practice it cannot be done, and this road will not work. Yang Ping looked at the X-rays repeatedly, thinking about it.

"Professor, I am familiar with CeramTec and Link. Let me ask if they have any products in this field?" August was able to keep up with Yang Ping's thinking.

Link is a German manufacturer of artificial joints.

Robert did not speak, because he knew that several major artificial joint manufacturers in the United States, whether it was Johnson & Johnson Depuy, Zimmer Biomet, or Stryker, all imported ceramic blanks from CeramTec for processing, and their research and development would definitely not be faster than CeramTec.

Dr. Ao's casual words attracted everyone's attention. No matter Director Chang or other joint surgeons, they were envious. For manufacturers like CeramTec and Link, the foreigner said that he would call directly to ask, and the line was quite large.

"Ask!" Yang Ping agreed.

It doesn't hurt to ask, at least to learn about the latest developments in ceramic artificial joints.

Professor Zhang has a famous saying - if you don't buy a plane ticket, you have to find a way to go to the imperial capital. Yang Ping is thinking now, how to get to the imperial capital, you can't go there on foot.

Everyone is a bit helpless in the face of this patient.

Yang Ping called out the MRI of the patient's bilateral knee joints and ankle joints, and checked them repeatedly.

"Why don't you transfer this patient to us? Let's figure out a solution slowly?" Yang Ping didn't intend to continue the discussion here. He is not a patient of joint surgery.

If you transfer to general surgery, it will be much more convenient to do many things, such as communicating with family members and discussing treatment plans, and consulting in other departments, after all, it is the identity of the adviser.

Master Chang is not willing to do anything. Originally, the patient could be discharged after completing the consultation process, but the family members insisted on asking for more efforts. In Sanbo Hospital, the ceiling is general surgery.

I can't handle general surgery, and it's not that I'm incompetent.

"Okay, when will you turn?"

Director Chang is refreshing.

Yang Ping was also unambiguous: "Just transfer now! I will communicate with his family."

The patient's daughter has wandered around the door of the doctor's office several times, waiting for an answer from here. If it doesn't work, she will be discharged tomorrow, but she still hopes to find a way.

Song Zimo went to call the patient's children, and Xu Zhiliang went to the conference room to fiddle with the chairs.

In the consultation room, Yang Ping saw a daughter and two sons of the patient.

The patient's daughter is a lady in her 40s, who is the oldest child of the old man. Naturally, she is the representative. It seems that the lady is also happy to be the representative, and the two younger brothers are also happy to be represented by the elder sister.

"Who are these two?"

The lady looked at the two foreigners sitting beside her, feeling a little uncomfortable.

In particular, the two foreigners were sitting upright with serious expressions on their faces. This atmosphere made the lady feel a little bit unavoidable.

Yang Ping explained: "This is a trainee doctor in our department, you don't mind, they also came to study with me."

The lady looked at the two foreigners and sat down with confidence.

"We just discussed your father's condition. Do you think this is okay? Today, I will transfer to our general surgery department and complete some examinations. The knee joints and ankle joints on both sides will have to undergo MRI again. I want to see the old man four. How is the condition of the cartilage in this big joint? Only after this examination can I have a firm mind, and then I can judge whether your father’s problem can be solved. If not, I will be discharged from our department at that time. Talk to you in detail."

"According to the current inspection situation, I am still not sure whether I can help the elderly to solve the problem."

Yang Ping added.

The patient's daughter was straightforward and did not hesitate: "Of course, we are not in a hurry for this day. I came to the hospital just to help my dad solve the problem of joint pain. It would be better if it can be solved. If it can't be solved, there is no way. Professor Yang, I know you You have recently developed an amazing device for treating curvature of the spine, have you not?"

Do the common people know about this spinal external fixator?

Yang Ping nodded in agreement.

The woman said: "There is a child in our class with scoliosis. I have been wanting to make an appointment for your operation. I haven't made an appointment for a long time, and said that I have to wait for the third batch."

"Teacher, what's your surname?" Yang Ping asked with a smile.

A teacher in his forties said, "My surname is Wu, and I teach at the High School Attached to Normal University."

The High School Attached to Normal University is the key point.

"Ms. Wu, hello, let's make a decision like this. We will arrange to transfer subjects immediately. Can we come up with a plan and wait for the inspection tomorrow." Yang Ping saw that they had no objections, so he made the arrangement.

Teacher Wu is easy to talk: "Professor Yang, you are experts, our family members cooperate fully, and Professor Yang doesn't have to worry about the cost. Our three siblings are willing to pay for any amount. My father has worked hard for us all his life. Now everyone has a family and a career, which is the reward. When it comes to my father, please, thank you very much."

The teacher's words are pleasant, and it seems that he is either a Chinese teacher or a political teacher.

The patient's two sons kept watching the elder sister speak without interjecting, but kept nodding to agree with the elder sister's opinion. It seems that when they were young, they were often disciplined by the elder sister.

"Can I add you on WeChat?" Teacher Wu asked without losing the opportunity.

The first time is raw and the second time is familiar, regardless of whether my father can solve the problem of joint pain this time, adding Professor Yang's WeChat is always a good thing.

Just like the parents of students have WeChat accounts of famous teachers across the country, they can ask for advice from time to time.

Yang Ping showed his work WeChat, and Teacher Wu quickly took out his mobile phone.

"Do you two have any other opinions?" Yang Ping asked the two younger brothers.

No matter how they are ranked in the family, they are the family members of the patient at this time, so I have to ask.

"Professor Yang asked if you have any other comments?" My sister's tone was a bit harsh, and it was completely different from the gentle tone of the conversation just now. At this time, she was more like a teacher.

The two younger brothers turned slightly red and shook their heads at the same time: "No—no objection."

At the end of the meeting, Song Zimo began to call the doctor on duty in the ward to accept the patient.

At the same time, he and Xu Zhiliang were also thinking about what plan Yang Ping was going to come up with. Since he proposed to transfer another department, he must have a little confidence in his heart.

(End of this chapter)