Start From Emergency Doctor

Chapter 251

“Don’t worry, I am also a deputy director anyway…”

He Jianyi quickly calmed down.

“Zhao Han’s situation is a bit dangerous. His spine injury is more serious.”

Zhou Yuan asked, “What’s the situation?” while performing a dural incision.

“Spine burst fracture…” He Jianyi sighed.

There are generally three types of vertebral fractures, simple wedge compression fractures, burst fractures, and unstable fractures that cover a wide range of fractures, including Chance fractures, flexion-distraction injuries, and displacement injuries.

The spinal stability of simple wedge compression fractures is not affected, and the spinal cord is not damaged, and conservative treatment is adopted.

As long as possible to restore the height of the anterior edge of the injured vertebral body to normal, correct the kyphosis, restore the weight-bearing function, and avoid complications and sequelae such as traumatic spondylitis, the problem can be solved.

Burst fractures are more serious, and bones may squeeze into the spinal canal.

The spinal canal is a tissue formed by the foramen of the free vertebrae and the sacral canal of the sacrum. It contains structures such as spinal cord and capsule, and also contains a large number of ligaments to maintain the movement of the spine and so on.

Once the spinal canal is damaged, it is a trivial matter that the waist cannot move, and the nerves and blood vessels may also be damaged, causing serious consequences such as high paraplegia26.

“I plan to perform spinal fracture removal and intervertebral bone grafting and fusion.” He Jianyi said. z

In this case, the vertebral fracture cannot be reduced, otherwise it will cause more serious consequences. It can only be removed, and an internal fixation can be inserted at the resection site.

“Teacher, leave it to you!” Zhou Yuan said solemnly.

Whether Zhao Han can save his life depends on Zhou Yuan, and whether he can exercise like normal people after saving his life depends on He Jianyi.

It is impossible for Zhou Yuan to run to repair the spine. He and He Jianyi must undergo surgery at the same time…

“Don’t worry, I’ve done surgery for so many years anyway, if you save my life, I can make her move!” He Jian said with a serious face.

If even this heroic teacher can’t be saved, He Jianyi may feel guilty for a long time.

“The flap incision of the dura mater. Needle-holding forceps.” Zhou Yuan continued the operation.

There is a cerebellar falx at the midline of the dura mater of the posterior cranial fossa, which contains the occipital sinus. There is also a ring sinus along the margin of the foramen magnum. If this is cut, there will be more bleeding and sutures are needed to stop the bleeding.

The ocean is ready to hold needle pliers.

After the incision, Zhou Yuan held the tweezers in his left hand to fix the suture site, and manipulated the needle-holding forceps with his right hand. The needle pierced the skin, and hemostasis was completed in just a few strokes.

The ocean swallowed.

“Junior Brother Zhou Yuan, your hemostasis point is too good…”(Read more @ wuxiax.com)

He is a maniac of surgery. He has gone to the brain surgery department many times to observe the operation. It often takes several minutes for other doctors to sew up the bleeding here…

Zhou Yuan smiled, and then opened the incised dural flap toward the transverse sinus, revealing the lower part of the cerebellum, the inferior vermis, the tonsils, the lower part of the fourth ventricle, the medulla oblongata, and the junction of the cervical spinal cord.

After revealing the intracranial structure, Zhou Yuan began to check.

The key to skull fracture is not the degree of skull damage, but the damage of the skull that is spread by the fractured skull.

Generally speaking, fractures are often accompanied by rupture of blood vessels in the plate barrier, and hematomas inside and outside the cranial plate occur, which may cause local swelling of the scalp.

Soon, Zhou Yuan made a diagnosis.

“Brain contusion and traumatic intracranial hematoma.”

Zhou Yuan’s expression was a little serious. Cerebral contusion and laceration are serious closed head injuries, including rupture of cerebrovascular vessels and tissue necrosis.

Intracranial hematomas are usually accompanied by brain contusions. Intracranial hematomas will directly compress the brain tissue, which will block the cerebral circulation and cerebrospinal fluid circulation, which will increase the degree of brain compression and form a vicious circle.

However, fortunately, the symptoms of brain compression are related to the amount of bleeding and the speed of bleeding. Zhao Han is bleeding from the veins, so the development of symptoms is relatively slow.

Therefore, Zhou Yuan intends to deal with the brain contusion first.

Soon, he found obvious tissue necrosis on the surface of the brain, and there was a slight increase in intracranial pressure, and there was bloody cerebrospinal fluid in the ventricle.

The subpiatum of the brain injury was purple-red, and some small blood clots and broken, necrotic, and softened brain tissue were visible on the surface.

“Attractor.” Zhou Yuan said.

Zhou Yuan quickly aspirated the lost cells and tissues, and gradually cleaned the necrotic tissues.

“Brain pressure plate.” Zhou Yuan said.

Cerebral pressure plate is a medical device used to stretch brain tissue and expose the field of operation. It is often used in neurosurgery and brain surgery.

After lifting the frontal and temporal lobes with a brain pressure plate, and completely removing the necrotic tissue on the underside of the brain, Zhou Yuan stopped and began to test the removal effect.

There is a standard for the complete removal of necrotic tissue, that is, the brain becomes soft, sinks, and the cerebral blood vessels return to pulsation.

“Clearing is complete.” Zhou Yuan felt the sensation of soft pedaling, and he sighed in relief.

Next is the treatment of intracerebral hematoma.

Zhao Han’s intracerebral hematoma is relatively hidden and cannot be seen with the naked eye. Zhou Yuan can only use a ventricle needle to gradually puncture the brain to confirm the location of the hematoma.

After determining the location of the deep brain hematoma, Zhou Yuan quickly selected a puncture point on the gyri in the non-functional area of ​​the brain. After electrocoagulation, a 3 cm cerebral cortex was incised, and then a brain pressure plate and aspirator were used to gradually follow the puncture direction. Separate to the deep part of the brain and reach into the hematoma cavity.

Zhou Yuan slowly sucked out the hematoma with a suction device.

Intracerebral hematoma is a relatively serious disease. Once it is not handled properly, the patient will experience headaches, vomiting, and even mental disorders and hemiplegia, that is, one side of the body is completely paralyzed.

“Electrocoagulation to stop bleeding.” Zhou Yuan said.

Multi-vessel bleeding often occurs during the process of removing the hematoma. Almost every time Zhou Yuan attracts, hemorrhage will be caused. Therefore, after each suction, he must undergo coagulation to stop the bleeding to avoid excessive blood loss.

This process is extremely cumbersome and requires meticulous operation.

Blood vessels are distributed in the functional areas of the brain. Once the brain is damaged, it will inevitably cause physical or mental obstacles to the patient.

Soon, the hematoma disappeared.

Zhou Yuan moved the drainage tube to attract all the water in the brain. After checking again to confirm that there was no necrotic tissue or hematoma, Zhou Yuan began to close the skull.

After intracranial surgery, you should try to close the skull as quickly as possible. The longer the delay, the more unfavorable the patient’s postoperative recovery.

“Needle holding forceps.” Zhou Yuan said.

It takes extra effort to suture the dura mater. There is a lot of tension in this area and it is very difficult to suture.

Zhou Yuan chose to use the softer fascia next to him for repair.

Next, begin to suture the suboccipital muscles with thick silk thread intermittently.

The suture of the suboccipital muscle is very strict, and the suture must run through the entire layer of the muscle without leaving a little gap.

Once the suture is not tight, cerebrospinal fluid leakage and pseudocyst will occur.

Especially the extraoccipital tuberosity is the intersection of muscle and fascia, where leakage is most likely to occur. .