godfather of surgery

Chapter 625
next morning.

Teacher Wu and his two younger brothers waited for Yang Ping's reply in the general surgery patients' family lounge.

She felt a little uneasy, wondering if Professor Yang could do anything about it.

My father's life was too hard. For the sake of the three siblings, he relied on coolies to earn money, and he insisted on sending the three siblings to college.

I remembered that when I was in middle school, my father would give me living expenses regularly every month, rain or shine, and I was never late, and the monthly living expenses would never be less than ordinary people. In the gazebo of the park far away from the school, give the money to yourself, and explain a few words: When you study hard and grow your body, don’t be too frugal. If you have any difficulties, tell your father that you can only be successful if you read a good book. Don’t believe it. It is said that reading is useless, but don't put too much pressure on it. Reading well is beneficial no matter whether you can be admitted to university or not.

Every time my father never talked about his suffering, but always told her some interesting things, as if there was no suffering in his life, but only happiness and hope.

Sometimes my father would bring some food, watch myself finish eating, and then take the lunch box back.

Sometimes I would bring some chicken legs, saying that the customer saw him working hard to move the goods and bought them for him. He was full, so he brought them.

In fact, I know that it was bought by my father, and he wants his daughter to taste something that others can afford.

Sometimes I will give some more money to buy myself beautiful clothes and skirts, and I will explain repeatedly: earning money is spent, don’t wrong yourself too much, as long as you don’t waste it, it’s normal to wear better clothes and skirts, not extravagance and waste .

When I got to college, I could have used student loans to complete my studies, but my father said that he had prepared tuition fees, so he didn't let me take out loans.

When she was in college, her father called her every week to chat, telling her to take it step by step, not to be poisoned by the messy thoughts in society, and to live her life well.

She understood her father's thoughts at the time, fearing that she would go astray because of poverty and low self-esteem.

Thinking about it, Teacher Wu's eyes were moist.

She just wanted her father to be happy and healthy in his later years, and she wanted to take him to travel everywhere.

"elder sister?"

The second brother saw that something was wrong with his sister.

"Father is fine, at worst, let's push the wheelchair and take him out to play."

The younger brother also noticed the expression of his sister.

At this time, a doctor came and told them to go to the consultation room. Professor Yang invited them to talk about their illness.

Teacher Wu was very excited when he heard Yang Ping said that he could perform knee-preserving surgery, which meant that his father could stand up and walk, and he could also visit the great rivers and mountains of the motherland in the future.

The surgical plan in a nutshell: the bilateral fibula was amputated, the cartilage from the ankle joint was transplanted to the knee joint, and the ankle joint was fused.

This operation is based on the specific situation of Mr. Wu, organically combining several surgical methods, which can not only solve the problem of Mr. Wu, but also preserve the knee joint.

Knee-preserving surgery is relative to artificial knee replacement. Artificial joint replacement is to amputate the original cartilage and part of the bone and replace it with an artificial joint. The artificial joint replaces the original articular surface.

Knee-sparing surgery is to keep your knee cartilage, not use artificial joints, and use other methods to solve the pain.

The core surgical value of knee osteoarthritis is to eliminate pain and obtain a pain-free joint.
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Mr. Wu was lying on the operating bed, and Fatty Liang was about to be anesthetized.

The fat man marveled at the muscles of the old man, which was no worse than that of the trainer in the gym. Moreover, with his bronzed skin, the strength and health displayed were obviously inconsistent with his 74-year-old age.

The old man spoke Chongqing dialect. Fatty Liang graduated from West China Medical University and could understand the Sichuan dialect.

"Old man, you also push iron? Without ten years of practice, you can't develop this muscle, right?"

In order to lose weight, Fatty Liang now goes for a run when he has free time, and goes to the gym to exercise.

The old man didn't understand the meaning of rolling iron, but he knew that he was asking about his muscles, so he stretched out three fingers: "I have been doing a stick for more than 30 years. Every day, I either carry goods or pull carts, and I have to climb mountains when carrying goods."

It turned out that the muscles in this body were real and were shaped by labor.

"Don't just look at the muscles, the old man trained three college students with a shoulder pole." Xiao Wu said beside him.

Fatty Liang didn't expect the old man to be a ruthless character: "Under the stick, a schoolmaster will emerge!"

However, hitting with a shoulder pole is too hard, and it is easy to cause problems.

Zhang Lin explained: "It seems that you, Fatty, were often beaten when you were a child. The old man's pole is not used to beat people, but to make money. He sent three college students with the pole to earn money."

Fatty Liang was filled with admiration.

"If you don't study, you can't do it. If you have to study, you will have a way out."

The old man expressed his ideas in Chongqing dialect.

What a great father, Xiao Wu Zhang Lin is still young, otherwise I really want to discuss with the old man about his teaching experience.

During the chat, Fatty Liang completed the lumbar puncture, implanted the hose, and then pushed the medicine.

The old man felt a hot sensation in his lower limbs, and gradually lost sensation in his lower limbs, as if it wasn't his own legs.

After washing hands and disinfecting sheets, the operation began in an orderly manner.

The whole operation is done in a minimally invasive way, except for the fibular osteotomy, other steps are done under arthroscopy.

First, arthroscopy was performed on both knee joints to confirm once again whether it was suitable for the surgical plan formulated before the operation.

Arthroscopy, compared with various preoperative imaging examinations, can visually observe the various structures inside the joint, whether there are lesions and injuries, and the extent of the lesions and injuries.

Both knees were probed with an arthroscope, which was completely consistent with the preoperative imaging examination. The cartilage at the medial condyle was missing, exposing the yellow subchondral bone. The probe could feel the hardness and roughness of the subchondral bone, which was the source of the pain. No The protection and cushioning of the cartilage, the subchondral bone is directly rubbed and compressed, and the pain-sensing nerves cannot bear this stimulation, so pain occurs.

The cartilage of the lateral condyle is relatively good, white and smooth, and only a very small area can be seen as rough, indicating that there is mild wear and tear.

There was hyperplasia in the synovium, floating in the field of view under the microscope like waterweed, but the patient had no obvious symptoms of synovitis.

Yang Ping simply cleaned up the bilateral knee joints and partially resected the torn meniscus.

The arthroscopy was transferred to the ankle joint, and the ankle joint was checked, which was consistent with the preoperative judgment.

The cartilage wear on the distal end of the tibia and the inner side of the talus is lighter than that of the knee joint, but it is enough to cause chronic pain. The outer cartilage is very good and can be used as transplanted cartilage, both in terms of quality and quantity.

The treatment of ankle osteoarthritis is different from that of the knee joint. It is also a severe stage. Generally, artificial joint replacement is considered for the knee joint, while fusion for the ankle joint is considered, because the artificial joint replacement of the ankle joint is very immature and cannot be done like the knee joint. The average service life is 15 to 20 years.

Even if the ankle joint replacement technology is mature, this patient cannot undergo ankle joint replacement due to metal allergies.

Yang Ping plans to perform fusion treatment on the ankle joint. The so-called joint fusion is to grow the bones composed of the joint into one piece, which is equivalent to "welding to death" and eliminating the movement of the joint. To "weld to death" the joint, all cartilage must be removed, allowing the bone to It is in close contact with the bone so that it can fuse.

Therefore, the cartilage of the ankle joint can be used as waste and transplanted to the knee joint. For the knee joint, these cartilages are invaluable.

Using special instruments under the microscope, Yang Ping began to take cartilage from the ankle joint. Good quality cartilage was removed for use, and poor quality cartilage was removed for use.

All the operations are done under arthroscopy. Cartilage harvesting instruments are used to remove some cylindrical cartilage on the distal tibia and talus of the ankle joint. There is cancellous bone under the cartilage. This kind of cartilage-bone structure is most vulnerable In medicine, bone-to-bone healing is always the most reliable and strongest.

Yang Ping drilled a uniform cylindrical cavity in the cartilage-deficient part of the medial femoral condyle.

Then, the cylindrical cartilage and bone complex taken out of the ankle joint is stuffed into the pre-drilled cylindrical hole of the medial femoral condyle of the knee joint, compacted and plugged tightly. Slowly, these cylindrical cartilages fill up the cartilage loss and form a normal condyle The shape, even the curvature is so beautiful.

If the ankle joint does not contribute so much cartilage, the lack of cartilage in the knee joint cannot be filled with so much articular cartilage, and the effect of allogeneic cartilage transplantation is very poor. The 3D printed cartilage is far from meeting the requirements of real articular cartilage. Only autologous articular cartilage can It is the best filling material.

After the ankle joint cartilage is removed, the remaining unqualified cartilage is ground away until the cancellous bone is exposed, and the tibiotalar joint is fused together. Because metal cannot be used, Yang Ping uses a cylindrical artificial bone plug of the same size. It is inserted into the cylindrical hole of the distal tibia and talus.

These cylindrical holes have been precisely designed for a perfect fit when harvesting cartilage.

Therefore, the bone plugs are inserted into the round holes of the tibia and the talus, and then squeezed and tapped on the heel, and the bone plugs are tightly embedded in the distal tibia and the talus.

This is like the mortise and tenon structure used to make furniture in ancient times. Without any metal screws and steel plates, only artificial bone plugs are used to complete the fusion of ankle joints.

In order to increase the firmness, two more absorbable screws were implanted, so that the reinforcement of the ankle joint fusion was successfully completed, and the operation on the other side was followed in the same way.

Ankle joint fusion originally requires the two ends of the bone to be tightly pressed together in order to obtain good contact between the two ends of the bone. With good contact, the new bone can connect the two ends and complete the "welding".

Because metal cannot be used, steel plates and screws cannot be used, and compression methods cannot be used. Bone plugs are used to connect the two ends of the joint. The bone plugs not only play a role in biological connection, but also induce osteogenesis, and new bone will crawl along the bone plugs. Go through the gaps at both ends of the ankle joint, connect the two ends, and complete the bony welding, so that the joint can grow together without pressure.

After the ankle joint is fused, both lower limbs can still walk, and as long as it is not for sports, it will not have a great impact on daily walking.

This fusion can eliminate previous chronic pain in the ankle joint.

In this way, the problems of the four joints are solved at one time.

Finally, the fibula was amputated at the middle and upper third of the bilateral fibula, and 3 cm of the fibula was cut off to disable the function of the abutment on the outside of the knee joint, so that the medial and lateral sides of the tibial plateau can be evenly subsided.

Just like a house, one side of the foundation collapsed and the house tilted, and now the other side of the foundation is also artificially collapsed, and this method is used to make the house straight.

For patients with knee osteoarthritis, Academician Zhang Yingze's uneven settlement theory will achieve good results if used properly.

The emergence of the theory of uneven settlement has opened up a new idea of ​​knee-preserving surgery. In practice, many knee joints have been preserved and joint replacements have been avoided.

Yang Ping combined Academician Zhang's uneven subsidence theory with autologous cartilage transplantation to successfully solve Mr. Wu's problem.

The theory of the entire operation is ready-made, and no innovative theory has been applied, but the combination of the two theories and the combination of two sets of joints has produced a miraculous solution.

Coupled with the excellence of surgical operations, the application of mortise and tenon joint thinking in ankle joint fusion, and the perfect operation of knee cartilage transplantation, the entire operation has been linked together to achieve the desired goal.

If another person performs this kind of operation and uses the same protocol, it may be difficult to achieve the desired effect without special training.

The distal end of the tibia of the ankle joint takes a round hole in the cartilage from the talus, and aligns up and down without any mistakes. Finally, an artificial bone plug is inserted to obtain a tight connection and correct the line of force. This operation requires very high surgical skills. .

This operation is generally based on theoretical innovation, half of which is supported by superb surgical operations.

A professor is a professor!

Robert once again saw the world's best surgery.

Not to mention anything else, the operation of this cylindrical cartilage transplantation is simply like an art. After the round cartilage surfaces are put together, it can be close to the round articular surface.

The same is for cartilage transplantation. Robert’s surgery is much rougher, and he does not consider the precise remodeling of the articular surface radian at all. If he learns Yang Ping’s trick, young patients with cartilage injuries in the future can achieve precise remodeling of the articular surface. The effect is multiplied.

At some point, Director Gao appeared in the corner of the operating room again, as if he was always paying attention to the surgery here, and he would never miss any surgery related to sports medicine.

Video, copy operation video, cartilage transplantation operation during operation, no matter what you have to learn by hand.

Director Gao took off the USB flash drive hanging from his neck and started to seize the computer.

Robert reacted and followed to copy the video.

After the operation, Mr. Wu walked out of the operating room, and the three siblings were waiting at the door of the operating room.

They discussed it properly, and the three siblings took turns to take care of their father during the hospitalization. After all, this is the only operation in this life, so it is a bit uneasy to ask a escort.

"Dad, are you okay? Does it hurt?"

The daughter touched her father's forehead warmly, and the two younger brothers followed behind.

Mr. Wu said with a smile: "I didn't even know about surgery on my own leg. I was dreaming of pulling the scooter uphill. Before the scooter was pulled up, the doctor woke me up and said the operation was over."

This kind of operation is combined spinal epidural anesthesia, commonly known as semi-anesthesia, and then uses auxiliary sedative drugs to make the patient sleep, so he wakes up very clearly, unlike general anesthesia, which sometimes causes confusion when waking up.

These words made the children burst into laughter. It seems that the old man is an optimistic and interesting person with a good attitude.

"That slope is relatively long, otherwise why would it take so long?" the daughter joked.

The old man said: "It's not very long, but I feel that my legs are weak, and I can't move them all the time. I'm anxious!"

"Both lower limbs are anesthetized, so they must be weak. Do you want me to give you some more medicine to let you sleep for a while? Pull the cart up?" Fatty Liang laughed together.

"Don't—" the old man shook his head.

"Don't shake your head, lie down and don't move." Fatty Liang pressed his head.

"You are all busy. I can do it by myself. You don't need to accompany me. It will take up too much of your time. The second child has come so far away."

"No matter how far away, it will only be these days. It's okay. Don't worry, we have all arranged vacations."

The children comforted the father, and the family enjoyed themselves happily.

(End of this chapter)