My medical path

Chapter 11 Case Discussion

Back home, Chen Bo couldn't wait to check the progress of the system. After non-stop background operations, the current progress of the system is as follows:

Simulated operating room: Open the permission of the surgery expert area, and have the opportunity to simulate real surgery.There is no permission to open the surgery master area temporarily.

Diagnosis area: The progress has reached 30%, and there is no permission to open the diagnosis expert area and diagnosis master area temporarily.

Treatment area: 100% progress in the massage part, 30% progress in the acupuncture part, and the two functional parts of blood circulation and anesthesia are temporarily not authorized to use.

Intensive training room: physical strength, increase by 20%, memory, increase by 10%, speed, increase by 20%, mental strength, increase by 2%.

Chen Bo is quite satisfied with this result, and now his condition can be said to be better than ever.

In a sense, he's stronger and wiser now than he was before.

Chen Bo turned his attention to the simulated operating room. Osteoid osteoma, the operation needs to remove the tumor nest and the surrounding bone in the reaction area to reduce recurrence.

The little boy Chen Bo admitted to the hospital had a tumor on the proximal humerus, so what Chen Bo wanted to simulate next was to perform humeral surgery through various incisions.

How to make the incision?
How to try to protect the muscles from injury?

How to avoid blood vessels and nerves?

How to expose?

How to excavate the tumor and reactive bone without damaging the epiphysis?
How to install the drainage tube?
How to deal with various emergencies?

Chen Bo flicked and operated over and over again, tirelessly.

...............

Today is the case discussion meeting.

Generally, if there are difficult or special cases, the department will organize a case discussion meeting, and the technical strength of the comprehensive department will solve the problem.

The patient being discussed today is a young man with osteoid osteoma who was hospitalized by Chen Boshou.

Ma Shangqu reported the basic situation of the young man to everyone:
"Zhang Xu, male, 13 years old, hospitalized with right shoulder pain, no past medical history, this is his X-ray."

Ma Shangqu said that he played Zhang Xu's X-ray film on the projector.

The patient's medical history is very simple, and there is no problem in diagnosing osteoid osteoma.

The disease is not complicated at all, what is special is that the tumor nest of this patient grows near the proximal end of the humerus near the epiphysis (the epiphysis is a special structure where the bone is not fully developed, which indicates that the bone still has the ability to grow, and the development of the bone will be affected after injury), and Biased to the rear position.

This increases the difficulty of the operation, and how to choose the approach has become the main problem.

"How to deal with it, let's talk about it?"

Director Wei Chengfu looked around at the participants and said.

The case discussion usually starts with the report of the medical history by the resident physician, then the speech at the attending physician level, then the speech at the deputy director level, and finally the summary at the director level.

Now that Ma Shangqu has reported his medical history, Director Wei's question is actually for the three attending doctors present to express their opinions.

Zhang Yu was silently drinking water from his own cup, and did not receive Director Wei's gaze, implying: I don't want to express my opinion, please don't call me!
Seeing that none of the three showed any intention of showing, Deputy Director Zhao Donglai gestured to Wu Zhennan with his eyes, and the latter nodded.

"Let me tell you my opinion." Wu Zhennan put down the pen in his hand and said.

"There is basically no problem in the diagnosis of osteoid osteoma in this patient, the main problem is the choice of surgical approach and method"

“Because the proximal humerus is surrounded by a rich deltoid muscle, it is very difficult to expose the operation, and the axillary nerve runs from the back to the front in the deep part of the deltoid muscle. It will be safer to choose the front approach, so I tend to use the front approach. surgery."

"As for the bone defect after the tumor is excavated, you can take the patient's own ilium or fill it with artificial bone."

After Wu Zhennan finished speaking, he glanced at Director Wei and Director Zhao, indicating that he was finished, and the latter nodded, giving Wu Zhennan a look of approval.

Moderate plan!Wu Zhennan was not as useless as Zhang Yu said, after all, he was brought out by Deputy Director Zhao.

"I think this plan is very good."

After Wu Zhennan finished speaking, Deputy Director Zhao Donglai expressed his support before listening to other people's opinions.

In normal times, Chen Bo has no desire to speak at this time, because this plan is also more practical.

But now that Chen Bo has such a powerful system, he can't be satisfied with this plan.

Just when Director Wei was about to make a concluding speech, Chen Bo spoke up.

"Director Wei, Director Zhao, I still have some ideas."

Everyone's eyes were suddenly attracted by Chen Bo.

Seeing that Chen Bo was going to speak, Director Wei nodded encouragingly, while Deputy Director Zhao frowned.

"I received this patient number in the outpatient clinic, so I am quite clear about the situation." Chen Bo began to express his views.

"Dr. Wu also said just now that there is no problem with the diagnosis of this disease, the main thing is the choice of approach." Chen Bo paused and continued.

"We can see from the film that the tumor nest of this tumor is at the proximal end, and the tumor nest is very small, only 0.5 cm in diameter...

If you approach from the front or the outside, you need to open a channel in the normal bone, which will increase the damage of the patient, and may cause fractures of the proximal humerus, and the tumor nest may not even be found. "

When Chen Bo said this, he stopped and took a sip of water.

Ma Shangqu, who was next to him, nodded in agreement, thinking to himself, Brother Bo is on point!
He was the only one who had seen Chen Bo's miraculous performance when he dismantled the steel plate, so he had an inexplicable trust in Chen Bo.

After listening to Chen Bo's speech, Director Wei was thoughtful, but Deputy Director Zhao still frowned.

"Surgery is definitely risky, and of course we have to clarify this with the patient's family."

Seeing that Chen Bo easily denied his plan, Wu Zhennan was a little displeased and said, "If it were you, what do you think we should do?"

Wu Zhennan's words once again brought everyone's attention to Chen Bo.

"I think it is entirely possible to perform surgery from the posterior approach for three reasons:
First of all, the tumor nest is at the back, next to the posterior cortex, we only need to open a small opening to open the posterior cortex to remove the tumor nest and the corresponding bone.

Secondly, we do not use bone grafting from the rear side, because there are few bone defects, and the bone can grow out to fill the defect cavity.

Finally, if you do this, the trauma is small, and you don't have to worry about risks such as fractures. "

"But how do you ensure that the nerves and accompanying blood vessels are not damaged from the posterior approach?"

Wu Zhennan questioned: "If you can't solve this problem, then the previous advantages are meaningless."

After listening to Wu Zhennan's words, Deputy Director Zhao nodded. Others also had this doubt and were waiting for Chen Bo's solution.

"I think this problem can be solved...

We can use intraoperative X-ray fluoroscopy to determine the location of the tumor nest, and at the same time use intraoperative ultrasound to find nerves and blood vessels...

Under ultrasonic monitoring, first use small Kirschner wires (steel needles) to avoid blood vessels and nerves, then pass through soft tissues and directly reach bones...

Then use the channel tool to open up a channel, and drill a small hole with a hollow core along the Kirschner wire...

Next, you can remove the tumor nest through this channel. "

Chen Bo said the specific plan.

(End of this chapter)