Nineteenth Century Medical Guide

Chapter 210 207. Waste utilization

Chapter 210 207. Waste utilization
Hills was a fringe figure throughout the operation, passing instruments and other chores, often away from the operating table.And other people's attention is also in the operation area, if there is no particularly important matter, they will not look at him at all.

If Hills was stupid, didn't realize that the drop would carry bacteria, or was more selfish, or wanted to save face, and chose to keep silent, then the accidental drop of a small ilium bone flap would not attract the attention of others at all.

As long as you simply squat down and pick it up, you can be an outsider without anyone noticing.

At that time, the bone flap that touched the dirty towel would bring dense bacteria into the old marshal's intervertebral disc, and the infection rate that might have been only [-] to [-] percent would be magnified to [-] percent.As for whether Ludwig can survive the intervertebral disc infection, everything will become unknown.

Surgical operations are not afraid of encountering problems, but they are afraid of being bored when encountering problems.

Now Sears has stated his mistake very bluntly and has not evaded it, so there is still room for maneuver.

Carvey has taught countless students. He knows that although it is useful to swear at people at this time, it is easy to damage self-confidence, but not saying a few words will make the other party think that the problem is not serious, so the tone, attitude and follow-up operation methods are very important: " How did it fall to the ground?"

Hills knew he was wrong, and explained: "My hand slipped when I was holding it."

"Where did it fall? On the ground?"

"It didn't touch the ground, it fell on the towel."

".Skeletal surgery has high requirements for asepsis." Carvey just looked up at the bone flap in his hand, and then continued to scrape the bone in his hand. "I have repeatedly emphasized this in the previous autopsy exercises." , If you can’t do the aseptic operation well, you are not qualified to operate on the marshal.”

Compared with the treatment of interns on the modern surgical operating table, this sentence is already very soft.

However, Hills is also the chief surgeon of Graze Hospital, and Kavey is equivalent to talking about a senior attending doctor as a hospitalist, so the words are naturally very heavy.Fortunately, this place is not an operation theater but the marshal's bedroom, and there is no one else around, so he has preserved his most basic self-esteem.

"It's my problem. The line of sight and movement were staggered just now." Hills admitted the mistake, "What should I do now?"【1】

As for the bones, the four people present have done three kinds of treatment, one is amputation, the other is drilling the skull, and the third is fracture and bone grafting.There is no bone surgery in the strict sense, let alone such delicate and complicated spinal surgery.

In their eyes, surgery itself is a blind spot.

After all, Hills has many years of clinical experience, and it is impossible for Carvey to pursue his mistake: "First find a normal saline rinse, it is a rinse, not soaking in it, otherwise the whole basin of water will have to be poured out."

"And then?" Hills guessed the beginning.

"Then take the diluted methylene blue." Carvey said, "It's in my toolbox, put half a bottle in a liter of water, mix it and let it soak for half an hour."

Upon hearing that it would take so long, Hills speeded up his hands: "You guys do other things first, and I'll get it done as soon as possible."

Carvey was not happy that the operation process was forcibly changed, but this is also an established fact. At least Sears did not hide it: "Before disinfecting and soaking, help me get a small leather bag out of the suitcase."

Hills saw the long leather bag in the box at a glance: "Is it this?"

"Correct."

Carvey handed over the fascia-skin suture of the posterior superior iliac spine to Massimov, and spread out a clean gauze after switching positions: "Open it carefully, and then take out the white cloth bag inside."

Hills untied the rope on the leather bag, and slowly took out a white cloth bag inside: "What is it, wrap it in two layers."

Carvey didn't reply, just said: "Open it carefully as before, and then slowly pour the contents on this piece of gauze. Be careful not to touch the contents with your fingers."

Hills nodded.

Simple posterior lumbar interbody fusion destroys the posterior bone structure and affects the stability, so the long-term effect of the operation in those years when it first appeared was not ideal.It was not until later that the orthopedics department pointed out the skill tree of internal fixation, and the addition of internal fixation on the basis of intervertebral fusion led to various types of LIF that are widely used in modern times. 【2】

The screws needed for internal fixation are placed in the bag. Because there is no stainless steel and the texture of sterling silver is too soft, Carvey can only choose silver alloy. 【3】

"The worries of the teachers before were really necessary, so I chose to fix the lumbosacral area with screws after filling the intervertebral disc." Carvey briefly demonstrated, "The part that was hit."

As soon as the conversation started, Olgi felt inappropriate: "You mean to drive a nail into the Marshal's bone?"

"Yes, I have measured the size before, and it is just right." Carvey said while finding the opening cone from inside. "Hurry up, the longer the time, the greater the risk of infection."

The previous abdominal surgery on Fernan had already revealed Kawei's unique surgical thinking. He did not follow the routine at all, and he was very willing to take risks and do some complicated operations.The current vertebral body fusion alone has opened their eyes. They have seen skin flaps before, but they have never seen bone flaps.

Fusion is seven or eighty years ahead, but relying on the clinical basis, these can still be within their understanding.

But the implantation of bone nails was incredible. They had never had such a bold surgical idea, and they didn't even dare to think about it.

Wouldn't such an operation destroy the stability of the bone?

After a long time, the bones will not break down?
Is implanting it harmful to the body?

Do you want to take it out later?

There are so many problems to be solved, their minds are blank, and they dare not imagine what will happen after the silver nail enters the body: "Kavi, do you want to discuss it again?"

"No need." Carvey pointed to the signed consent form on the table in the distance, "The old marshal has given me the power to decide on the operation, and there is nothing to discuss."

"But if you drive into the pedicle like this, will it damage the surrounding bones?"

"No problem as long as the angle is right." Carvey said while choosing the entry point.

"The pedicle is so thin, won't it be damaged?"

"Don't worry, this is the strongest part of the entire spine. I tried it on a corpse and it's fine."

"How long has it been?"

"No, because the old marshal will be restricted from moving for three months after the operation. Even if he can really move after that, the curvature of the waist will be affected. He can't exercise vigorously, he can't bear weight, and he needs to squat down to pick up things, and he can't bend directly. waist"

Carvey did not hide the troubles caused by internal fixation: "But you must know that this is much more comfortable than the previous pain in the waist and legs."

"Won't it affect the body if the implant is just stuffed in the body?"

"Don't be allergic. As for whether to take it later, I don't think it should be taken as long as there are no special circumstances." Carvey answered all the last two questions, picked up the road awl, and started firing at the nail entry point that had been determined. Li [4], "Oh, by the way, just take a look at this surgical method, don't use it lightly, it is easy to cause accidents."

Four people: "."

"I'm not saying that you are not capable, but the angle is not easy to grasp and needs practice." Carvey said, "When I was young, I felt that fractures should be solved by surgery, so I often use an awl to drill bones. There will be no problem in judging the angle. .”

The structure of the vertebrae of the spine is not the same. Although they are all called the spine, the selection of the entry point, the angle of inclination, and the length of the penetration are all different.

The opening cone just drills an opening in the cortical bone, and after entering the cancellous bone, a probe needs to be used to determine the direction of screw entry.

In fact, the old marshal's rear lamina has been completely removed, and the pedicle screws can be inserted under direct vision, which is much better than those cases of complex traumatic fractures.Carvey has a lot of experience in spinal trauma surgery, not only the concept of modern surgery, but also the feel.

The nail insertion angle is not fixed. For the lumbar spine, it can range from 5° to 30°, depending on the differences between people.

Modern surgery may use imaging image navigation to increase accuracy, but its practical image navigation will increase the cost of surgery, navigation learning costs and equipment costs.For the surgical medical team, image navigation means eating rays.

Carvey doesn't like this. Putting nails with bare hands has always been something he emphasizes that he must learn and practice thoroughly.Even if optical navigation, electromagnetic navigation, and robot navigation appeared later, blind penetration is still one of the items he often emphasizes when teaching newcomers. 【5】

Since it is blind piercing with bare hands, the feel is very important.There is a gritty feel to the probe as it enters the cancellous bone of the pedicle.As the needle continues to move forward, there will be an inhalation feeling of being "pinched".

"It's like sticking a stick into the sand. In fact, you will know it after you are proficient in the operation."

Carvey quickly explored the path of nails on the pedicles on both sides of the two vertebrae of waist 4 and 5. The speed is like a familiar old carpenter: "Next, two more are needed on the sacrum s1."

The shape of the sacrum is completely different from that of other vertebrae. In addition, the complex anatomical structure in front of the sacrum makes the position of the sacral nail very particular, and the angle of the nail needs to be severely introverted. 【6】

Before he knew it, more than three hours had passed since the operation, and the lumbar 4-sacral 1 were drilled out of the tunnel by Kawei.And Hills, who was carefully disinfecting the bone flap, also brought the disinfection result: "It's time for disinfection."

"Rinse twice with saline."

"Row"

With the surgery at this stage, he no longer cared about the situation in the bedroom.Because there is no washbasin, the flushing of normal saline can only be done on the ground, supported only by a few absorbent towels.In the middle, Hills asked the housekeeper for several times, but in the end it was not enough, so he had to rely on the carpet to absorb water.

Blood splatters, leftover gauze, bone debris, surgical instruments accidentally dropped, this place is no neater than the surgical theater.

"I now cut the bone flap into three pieces and put it flat into the space of the intervertebral disc."【7】

Carvey calculated the height, removed the reamer, and stuffed the bone flaps in piece by piece.

In fact, the ilium was Carvey's choice in desperation, and the intervertebral disc filler is better [8].As long as the bone is stuffed inside, there is no need to worry about the height and the risk of postoperative deformation.But now, the height of intervertebral disc filling has become the most troublesome issue before them.

"The height is not enough." Even Watman, who has no experience in spinal surgery, can see that the intervertebral disc between the lumbar 4-5 is thinner than other places. "Not only the lumbar spine, but also the intervertebral disc above the sacrum 1 is not enough."

"What should I do? Is it necessary to make an incision on the other side and then take the bone flap?"

"Or you can choose other metals. The bone nails are all punched, so it's not bad."

Carvey was also using a reamer to measure the height of the intervertebral disc space, and suddenly lifted a pile of clean gauze, which contained fragments of the lamina that had just been cut: "It doesn't matter, you can use these useless lamina. "

From a shape perspective, they lack sufficient thickness to be the main material for filling.But if the cortical bone is cut off and the cancellous bone inside is scraped off, the discarded bone can be reused.

If the original ecology has shortcomings, it is probably a waste of time.

"Come, come, let's each use a bone chisel to separate these bones."

Downstairs continued the pattern of sometimes caring about the operation and sometimes gossiping. When the clock officially passed 12 o'clock, some people silently brought up lunch on the topic column: "It's so late, why is the operation not over yet?"

"Wait a little longer. If there is no news now, it means that the operation went well."

"It's a brand new spinal surgery after all."

Everyone was chatting about the operation, but they were looking at the servants around them.They all have rich experience in serving, and the time of three meals is engraved in the biological clock. Immediately, someone reminded: "Everyone, if anyone is hungry, you can go to the restaurant first. The kitchen has prepared a sumptuous lunch."

With these words, everyone turned to Franz, seeking the king's opinion.Because in the imperial palace, even eating has to obey the emperor's order before starting.

"I also want to say a few words to Mr. Edward, you go and eat first."

Just as Franz waved his hand and was about to continue waiting for the results of the operation, there were hurried footsteps in the corridor.

The voice went from far to near, and it was the old butler who had been waiting upstairs all the time who finally came into everyone's sight: "Operation, the operation is over!"

【Wait for me to take a shower to write this chapter】

(End of this chapter)

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