My medical path

Chapter 112 Chapter Replacement

Chapter 112 Joint Replacement
Today Wednesday, according to the plan, today the patient with ankylosing hip made an appointment with Professor Sha to come over for consultation and surgery.

Professor Sha came early in the morning, so the operation must be arranged first.

According to Professor Sha's explanation, the patient was prepared by Chen Bo, and when Professor Sha arrived at the hospital, he went straight to the operating room.

The atmosphere in the operating room this time is different from before. I heard that Professor Sha is coming down, but the tense atmosphere is gone...

Before learning that Professor Sha was coming down, Lu Shiqing spent the night reading and sorting out the operation process, fearing that she would not cooperate well during the operation and would be attacked by the "sound roar" skill.

This time it was still arranged for Lu Shiqing to come on stage, but she actually slept very soundly last night.

Everyone knows that such a change occurred because of Chen Bo.

It was Chen Bo who changed Professor Sha and turned the original "Western Poison" into a pleasant and approachable old man.

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

When Professor Sha walked into the operating room, Chen Bo hurriedly stood up to greet him.

"Long time no see, Xiao Chen, are you all right?"

Professor Sha stretched out his hand to hold Chen Bo together, and said with a smile.

"Mr. Tosha's blessing, everything is fine, but I haven't had an operation with Mr. Sha for a long time, my hands are very itchy, and I feel weak all over!"

Chen Bo said with a look of thorns all over his body.

"You boy, the best nonsense!"

Professor Sha pointed to Chen Bo, expressing his admiration for this young man he was optimistic about.

"Hehe~"

Chen Bo just smirked.

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

Because the patient has ankylosing spondylitis, it is very difficult to anesthetize the waist, and general anesthesia is used for anesthesia.

Joint replacement surgery is the top surgery in the field of joint surgery, and it is also one of the key operations monitored by the Ministry of Health.

There are many methods, but the main reason is that the choice of approach is different. The most popular one is the anterior approach and the other is the posterior approach.

Today, the patient chose the posterior approach.

Professor Sha is the chief surgeon, Chen Bo is the first assistant, and Ma Shangqu and Pang Minghui are responsible for pulling the hook and swinging the legs.

When Chen Bo came back with Professor Sha after washing his hands, Ma Shangqu and Pang Minghui had finished disinfecting and spreading the towels.

Professor Sha took the knife that Lu Shiqing handed over with a curved plate, and signaled to the anesthesiologist Wang Ruoyun, and the operation began.

There was no tourniquet for this operation, so when Professor Sha cut the wound, the blood vessels at the edge of the skin began to bleed.

Ankylosing spondylitis is an immune disease, and patients with this type of disease tend to bleed more than normal people when undergoing surgery.

Professor Sha is already a veteran in dealing with this kind of patients. In Wujiang City, he should have performed the most joint replacement operations.

After cutting the skin, Professor Sha used gauze to protect the skin and subcutaneous tissue, and then skillfully cut the external rotator brevis.

Under normal circumstances, the joint capsule is under the external rotator brevis. There is nothing to say about it, it is a step-by-step matter.

But at this time, the wound suddenly bled, and the surgical wound was quickly submerged by the bleeding...

Bleeding during surgery is the most annoying thing for surgeons, just like the feeling of a girl wearing a beautiful skirt who is suddenly splashed with mud by a passing car while walking on the road.

So Professor Sha frowned slightly at this time.

Chen Bo could see it clearly under the system scan. When Professor Sha cut off the external rotator brevis, he cut off a branch of the femoral circumflex artery...

This is not a critical part, so Chen Bo did not make a sound to interfere with Professor Sha's operation.

According to Professor Sha's past habits, at this time, he must take the suction device in the assistant's hand, suck the blood away, and then expose the blood vessels to stop the bleeding.

But when Professor Sha stretched out his hand, he found that no one handed him the suction device, which made him stunned.

Then Professor Sha found that Chen Bo's suction device had quickly sucked the blood away, and he didn't know if it was a coincidence, Chen Bo's suction head flicked lightly, and the bleeding blood vessels were exposed the next moment...

The blood vessels had been exposed, so it was easy to stop the bleeding. Professor Sha directly electrocoagulated to stop the bleeding, and the operative field became clear again.

Then Professor Sha used sutures to suspend the muscle that was cut off just now, exposing the joint capsule below...

Chen Bo saw that Professor Sha's movements were very proficient, and the anatomical level was clear, so he silently praised Professor Sha in his heart.

Professor Sha's skills are honed by actual combat, and they are all real skills.

After the joint capsule was exposed, Professor Sha performed a T-shaped incision. Originally, total hip replacement could remove the joint capsule, but Professor Sha wanted to keep the joint capsule because the patient was young.

This is of course more conducive to the stability of the joint in the future, but the difficulty of the operation will increase significantly.

After the joint capsule is cut, the femoral head and femoral neck inside are exposed.

At this point, the femoral neck is cut off with an oscillating saw. This step is the key.

After the femoral neck is amputated, the femoral head can be removed.

At this time, Lu Shiqing skillfully handed over two joint retractors, and Professor Sha placed the joint retractors under the femoral neck to prevent the swing saw from falling off and hurting the underlying tissues.

Because the operator's attention is focused on the position of the osteotomy, the skin is easy to ignore. Therefore, sometimes after the operation, it is found that the skin edge of the wound is always blistered or watery, which is related to the damage of the skin edge of the skin incision during the operation.

At this time, Professor Sha noticed that Chen Bo wanted to use a thyroid retractor to gently pull the skin next to the joint retractor.

This small gesture was not eye-catching, but Professor Sha nodded approvingly after seeing it.

Chen Bo's hook can be said to be very predictive!
Because the acetabular space of this patient is basically gone, it is very difficult to remove the femoral head once the femoral neck is amputated!
Therefore, Professor Sha has prepared two incisions in advance, removing part of the femoral neck and then taking the femoral head, so that the operating space is much larger.The two hooks just now protected the skin of one of them.

And Chen Bo's retractor just protected the skin that might be injured by the second cut. Only experienced doctors can have this kind of prediction.

After the femoral neck was amputated twice in a row, Professor Sha took out the part of the femoral neck that was cut out first...

After completing this step, it can be seen from Pang Minghui's perspective that the operable space is instantly expanded.

At this time, it was time for Professor Sha to have the head removed, but to everyone's surprise, Professor Sha handed the head remover to Chen Bo, which meant that Chen Bo came to pick it up.

"Try it!"

Professor Sha encouraged.

Chen Bo nodded gratefully.

Don't look at the seemingly simple task of just taking the head. Many great professors don't give others their hands at all, and they do it all by themselves.

As a result, many assistants may not be able to remove the head smoothly before they are not qualified to perform the surgery.

To be honest, this is Chen Bo's first time, but he is obviously different from others, he has gone through countless drills in the system.

After receiving the head remover, Chen Bo was not polite, and screwed the head remover into the femoral head. After feeling that the femoral head had been completely freed, Chen Bo took out the femoral head easily under Professor Sha's surprised eyes.

"Have you taken it before?"

Professor Sha asked curiously.

"To tell you the truth, it's the first time, but with Teacher Sha as your backing, you're so courageous, so you're lucky!"

Chen Bo handed over a silent rainbow fart.

"You boy, not bad!"

Professor Sha nodded in satisfaction and continued with the operation.

The femoral neck was truncated, and the acetabulum needed to be ground next.

This step is the most important part of the operation.

The selection of the size of the acetabular prosthesis, the depth and angle of grinding, and the sharpness of the grinding instruments must all be considered comprehensively.

Take acetabular grinding, for example, if the grinding depth is not enough, the prosthesis cannot grow with the bone.

If the grinding is too deep, the underlying cancellous bone may cause invagination of the acetabular prosthesis.

In particular, Professor Sha retained the joint capsule, which made this step more difficult.

So why this operation is listed as a key monitoring operation can be seen from here.

The operation itself is not complicated, but if there is a mistake in one step, there may be disastrous consequences.

(End of this chapter)

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