Chapter 308: 308
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Zhang Fan's sleep was really solid. It was estimated that he slept more than one o'clock at noon. He didn't even have time to sleep. Zhang Fan went into deep sleep until more than eight o'clock at night. When he got up, Zhang Fan was dizzy. How to say this? First of all, there are a lot of operations, and the partners are the little girl and the incompetent Xue Fei.
Zhang Fan almost did the steel plate orthopedic, bone block splicing, electric drill drilling and screws alone. It sounds like a carpenter making furniture. The amount of labor is really not small. He can't walk freely and consumes a lot. Although Lao Gao said at the morning meeting that he would take Zhang Fan for surgery, the main knife was Zhang Fan. Two Zhenggao, Lao Gao and Lao Chen, two inpatients, Zhang Fan and Xu Xian. After the anesthesiologist finished anesthesia, he said to several doctors, "start." Xu xianlisuo's brush hands began to disinfect. Before the operation, Zhang Fan finally went through the X-ray carefully. Although the X-ray has been printed in his mind, Zhang Fan still looked at it carefully.
Lao Gao and Lao Chen stood aside, silent. There is too little they can help with this operation. Lao Gao is also ready. Once the blind fight fails, he will immediately cut open and fix it. Wash your hands and wear surgical clothes. "It's okay. Don't have pressure. It's a big deal. It's nothing to cut and fix." When Zhang Fan put on his clothes, gloves and picked up the sharp knife, Lao Gao said.
"Yes!" This is not good for Zhang Fan. Once he has an operation, he can't speak without talking, and he doesn't like others to speak. Therefore, as long as it is Zhang Fan's operation, the air pressure in the operating room is quite low, and anesthesiologists and itinerant nurses dare not speak. This is the problem of personal temperament.
"Start." Zhang Fan finished and began to prepare to cut the skin. What is the operation? Roughly speaking, the femur is a person's thigh, and then the thigh is broken from the middle without much displacement of the broken end. Zhang Fan now needs to open a small opening at the uppermost end of the femur, then use an electric drill to open the bone, and insert a long alloy rod from this opening. There are two holes at the lower end and two holes at the upper end of the alloy rod, which are all holes for screws. After fixation and good alignment of the broken end, tighten the four screws, OK fracture fixation, and the operation is over.
It's that simple. Eighty or ninety percent of orthopedic doctors can't do simple surgery. Don't say blind beating, just cut and fix it. A doctor with a lower level can't even find the screw hole of this alloy! Zhang Fan opened a small opening and then stopped bleeding with an electric knife. When there was no electric knife before, he was ligated with silk thread.
Zhang Fan is the main knife. Lao Gao smokes with an attractor. Lao Chen gently uses a small retractor to open his skin. Xu Xian has nothing to do now, so he stands and looks. Electric knife, in fact, is very simple, just like electric soldering iron. The human body has evolved so well that there are almost no large blood vessels in the superficial layer. When cutting the skin and dermis, the bleeding is not obvious. Only when it reaches the fat layer and muscle layer, can there be a larger capillary. Electric knife direct electrocoagulation, Zi! Zi! Zi, no bleeding.
The more you go to the rice point for surgery, the more painful it is. Especially when you use an electric knife, you are also scalding the fat while scalding the blood vessels. The oil is smoking instantly. Although you wear a mask, a smell of barbecue comes directly. Really, when you are hungry, you can smell this smell and saliva can come down.
"Electric drill." Open a small opening of the skin, separate the muscle and fascia layer with bare hands to stop bleeding. After exposing the bone, Zhang Fan said. The operation nurse stood aside and installed the electric drill early. After debugging, she handed the electric drill to Zhang Fan calmly.
"Squeak! Squeak! Squeak! " The hard bone, like tofu, loosened a mouth. Bones, especially big bones, have been eaten. There are bone marrow and red soft bones like honeycomb. When the electric drill is drilled, how to say the bone is like coffee with milk, white bone powder, dark red blood, milk and white bone marrow are stirred together, and then mixed quickly, and finally become a little white milk soup.
The early way of this operation is very cruel. When there is no electric drill or the electric drill is not popularized, this operation is like a meat stall, bone chisel, bone hammer, bang! Bang! Bang, hard to break a hole in the bone. Moreover, the early intramedullary fixation is very troublesome. The femur is not a smooth cavity. There are spirals and various bone trabeculae. This shape can make the femur very hard and hematopoiesis.
So when fixing, first insert a small reamer into the femoral cavity and hit it with a hammer. How strong is this? If you stand behind the operating table, you can see the patient, and the whole body of the bound patient is shocked!
The reamer is very like what kind of triangular bayonet, but it is not so sharp, but very thick. Trumpet, medium, large, let's expand the bone marrow cavity and make it unobstructed. You can imagine how you eat bone marrow with chopsticks. In fact, the principle is the same, but chopsticks can't make the cavity bigger, and the power to insert chopsticks is a little smaller. There's no hammer to hit the head of chopsticks!
When the hammer hit the reamer. Smash, blood with bone marrow, white and red blood splashed everywhere. At this time, if a blood flies into the doctor's eyes, and the patient has a blood infectious disease, it is very troublesome! With the development of science and technology, now there are instruments without reaming, which also makes this operation elegant.
Open the medullary cavity, Zhang Fan gently insert the intramedullary nail and slowly descend. This operation, whether blind or not, will calculate the length by comparing the X-ray, which can not be long or short. Slowly down, "the lower end of the femur rotates outward ten degrees." Zhang Fan held the intramedullary nail with one hand and pressed the upper end of the femur with the other hand, saying to Lao Gao and Lao Chen.
Orthopedic doctor, a good orthopedic doctor has a strong sense of three-dimensional space and good knowledge of geometry. When Lao Lu failed to draw, geometry was even worse. Drawing a blood vessel made his head big. He was discouraged before he learned bones.
It's really hard to grasp the various angles of orthopedics. Don't mention the operating table. Ordinary people cross two chopsticks. You don't need measuring tools and put an angle of ten degrees. It's estimated that not many people can put it out, not to mention the situation where you can't look directly.
"Stop! Internal rotation two degrees with pull-down, slight pull-down. " Zhang Fan commands the assistant to reset. If the assistant is not available at this time, Zhang fan can't get one person, so the team and operation team are very important. Lao Gao and Lao Chen rotate slowly. Xu Xian grabs her calf and pulls it down slowly.
The reason for pulling down is to slightly separate the broken end of the fracture. If the force is too large, it may be pulled and displaced. It is too small to separate the broken end. Zhang Fan gently touched the broken end with the intramedullary nail, just like his hand. The changes at the broken end were clearly presented in his mind.
This is the feeling, this is the feeling that practice makes perfect. Lao Gao hasn't felt like this in his whole life. It's conceivable how much liver Zhang Fan has! I don't know how many operations I have done in the system“ Click! " A slight vibration came, which was the sound of bone stubble restoration.
"OK, don't move. Now keep this position." Fracture reduction changes during exercise, because it is an oblique fracture. There is an angle during reduction, and at this time, the patient's lower limbs on the affected side are suspended, that is, an old lady, and her thighs are not heavy. If a fat man keeps in position, he can keep his three assistants until their muscles are sore.
This is not a simple lift. Keep in a fixed position. Three people should have a slightly supporting force together. In short, if the chopsticks are broken, you should tie them up. Do you have to align them, and then hold them together with a force to tie them? That's a truth.
And this requires three people to cooperate together. Zhang Fan commands, five minutes, ten minutes, twenty minutes. It really takes a lot of people to keep a fixed position and continuously output a stable force. Although it is an old man, one lower limb also has some weight.
Zhang Fan inserts, slightly deflects, slowly slides down, avoids the broken end, slowly sticks to the bone, and can't be impatient at all. This is not an impatient thing. The sweat of Lao Gao and Lao Chen Dou has appeared. Tour, the head nurse sent another tour to gently wipe the two old doctors.
"Director, why don't you turn down the temperature of the air conditioner." The head nurse came in and asked when she saw the two old men sweating.
"No! No, no lower, patient, cold! " Lao Gao's continuous speech is inconvenient. He is afraid that his continuous speech will cause vibration and lead to the displacement of the broken end of the reduced fracture.
Enter, Zhang Fan a knob, "reset. Knife! " The operation nurse immediately turned the handle of the knife to Zhang Fan and the blade to herself and handed it to Zhang Fan. Zhang Fan cut with a knife, then opened a hole and prepared to screw. This is also a difficult point, let alone blind beating. Sometimes, when cutting and looking directly, doctors with inadequate technology can't even find this screw hole.
"I've opened a hole. I must keep it well." Zhang Fan said to the three assistants with an electric drill.
"Good!" Xu Xian said.
Lao Gao and Lao Chen just nodded.
Opening, "Ka!" Zhang Fan's positioning is too awesome. After drilling the bone, it is directly the screw hole. There is no need to adjust the position. This is the feel and technology of Niu force. Xu Xian looked silly. He estimated that Zhang Fan would have to adjust and find a position. After all, this is blind fighting, even if it is not blind fighting. He hasn't seen many successful positioning at one time.
Screw on the screw, "OK. Director, all right! " Zhang Fan said that he had started washing and was ready to sew. Lao Gao secretly rubbed his sour and numb hands and said to Zhang Fan, "why don't you look under the C-arm?"
"Just, don't worry, it should be no problem, but let's see. Don't worry." Lao Chen also said. This is Zhang Fan. If other residents are hospitalized, they will directly push the C-arm! As for Zhang Fan, both of them had a tone of discussion.
In the audio-visual education room, a group of orthopedic doctors looked in the water and fog. There was nothing to see in this operation. Only two small openings were cut, and the whole process depended on the hand and feeling of the chief surgeon. It's good that Zhang Fan, who can't die, doesn't speak as soon as he has surgery, just like a mute. Zhang Fan did not explain his feelings, and only the other three doctors on the operating table felt a little.
The doctor in the electric classroom was tangled, "this is over. Zhang Fan, too, didn't say how to fix it or confirm it. Hey! I saw it in vain. Like a pantomime, I left and wrote a medical record. "
"Hey, wait, look at the results of the C-arm!"
"Look at the fart, don't you see that Zhang Fan is ready to sew up! Even if you see what happens, you'll do it? Really, let's go! " A group of doctors left with a feeling in their hearts.
It's not that Zhang Fan doesn't say. Sometimes, this feeling, especially this mysterious hand feeling, really can't be expressed in words, but can only be understood!
The little nurse pushed the C-arm over, and all the doctors and nurses stood behind the typeface next door to observe. Take a pat, OK, the broken end of the fracture on the display is in good alignment.
"Cow! The angle judgment is too powerful. " Old Chen raised his big finger and said to Zhang Fan.
"Mr. Zhang, how do you judge? In that case, how do you judge that you need to rotate ten degrees?" After Xu Xian was shocked, he began to seek advice. This is a learning mentality.
"Yes, tell me." Lao Gao also said.
"Well, this, feel it. Look at the original X-ray. Although the angle is slightly larger, after downward rotation and pulling, the internal rotation of the muscle corrects this angle a little. Moreover, you see that the muscle strength of the old man has been relaxed, so the angle should be about 10 degrees to 12 degrees. When I used the probe to probe, I felt that it was at this point, These two points are together! " Zhang Fan pointed to the original film and said.
"Well!" Xu Xian's cold sweat came down, which could be felt. When Xu Xian had to open her mouth to speak, the anesthesiologist said, "Hi! Why are you talking? I can't sew. I can tell you that the old lady is waking up. "
"Ha ha, go on and sew it up. Lao Chen left. Let's have an operation and let the boy give instructions for a long time. His hands are sore. Let's leave the rest to them! "
"Yes, you should have a rest. Doctor Xu, you can go down too. I'll take the rest. " Zhang Fan said.
"It's okay, it's okay. Go down and have a rest. Leave the rest to me."
Can Zhang Fan go down? No, so Xu Xian didn't even sew. Xu Xiandu got the needle holder and wanted to sew. As a result, Zhang Fan robbed him. "This knife edge seems to have cut a small blood vessel when I cut it. I sew it. You don't know where!"
"Why is this thing so unique? I won't even let it sew. Besides, your sister, what blood vessels are there!" Xu Xian's face is cute!
The operation is over!
Please report us if you find any errors so we can fix it asap!
Zhang Fan's sleep was really solid. It was estimated that he slept more than one o'clock at noon. He didn't even have time to sleep. Zhang Fan went into deep sleep until more than eight o'clock at night. When he got up, Zhang Fan was dizzy. How to say this? First of all, there are a lot of operations, and the partners are the little girl and the incompetent Xue Fei.
Zhang Fan almost did the steel plate orthopedic, bone block splicing, electric drill drilling and screws alone. It sounds like a carpenter making furniture. The amount of labor is really not small. He can't walk freely and consumes a lot. Although Lao Gao said at the morning meeting that he would take Zhang Fan for surgery, the main knife was Zhang Fan. Two Zhenggao, Lao Gao and Lao Chen, two inpatients, Zhang Fan and Xu Xian. After the anesthesiologist finished anesthesia, he said to several doctors, "start." Xu xianlisuo's brush hands began to disinfect. Before the operation, Zhang Fan finally went through the X-ray carefully. Although the X-ray has been printed in his mind, Zhang Fan still looked at it carefully.
Lao Gao and Lao Chen stood aside, silent. There is too little they can help with this operation. Lao Gao is also ready. Once the blind fight fails, he will immediately cut open and fix it. Wash your hands and wear surgical clothes. "It's okay. Don't have pressure. It's a big deal. It's nothing to cut and fix." When Zhang Fan put on his clothes, gloves and picked up the sharp knife, Lao Gao said.
"Yes!" This is not good for Zhang Fan. Once he has an operation, he can't speak without talking, and he doesn't like others to speak. Therefore, as long as it is Zhang Fan's operation, the air pressure in the operating room is quite low, and anesthesiologists and itinerant nurses dare not speak. This is the problem of personal temperament.
"Start." Zhang Fan finished and began to prepare to cut the skin. What is the operation? Roughly speaking, the femur is a person's thigh, and then the thigh is broken from the middle without much displacement of the broken end. Zhang Fan now needs to open a small opening at the uppermost end of the femur, then use an electric drill to open the bone, and insert a long alloy rod from this opening. There are two holes at the lower end and two holes at the upper end of the alloy rod, which are all holes for screws. After fixation and good alignment of the broken end, tighten the four screws, OK fracture fixation, and the operation is over.
It's that simple. Eighty or ninety percent of orthopedic doctors can't do simple surgery. Don't say blind beating, just cut and fix it. A doctor with a lower level can't even find the screw hole of this alloy! Zhang Fan opened a small opening and then stopped bleeding with an electric knife. When there was no electric knife before, he was ligated with silk thread.
Zhang Fan is the main knife. Lao Gao smokes with an attractor. Lao Chen gently uses a small retractor to open his skin. Xu Xian has nothing to do now, so he stands and looks. Electric knife, in fact, is very simple, just like electric soldering iron. The human body has evolved so well that there are almost no large blood vessels in the superficial layer. When cutting the skin and dermis, the bleeding is not obvious. Only when it reaches the fat layer and muscle layer, can there be a larger capillary. Electric knife direct electrocoagulation, Zi! Zi! Zi, no bleeding.
The more you go to the rice point for surgery, the more painful it is. Especially when you use an electric knife, you are also scalding the fat while scalding the blood vessels. The oil is smoking instantly. Although you wear a mask, a smell of barbecue comes directly. Really, when you are hungry, you can smell this smell and saliva can come down.
"Electric drill." Open a small opening of the skin, separate the muscle and fascia layer with bare hands to stop bleeding. After exposing the bone, Zhang Fan said. The operation nurse stood aside and installed the electric drill early. After debugging, she handed the electric drill to Zhang Fan calmly.
"Squeak! Squeak! Squeak! " The hard bone, like tofu, loosened a mouth. Bones, especially big bones, have been eaten. There are bone marrow and red soft bones like honeycomb. When the electric drill is drilled, how to say the bone is like coffee with milk, white bone powder, dark red blood, milk and white bone marrow are stirred together, and then mixed quickly, and finally become a little white milk soup.
The early way of this operation is very cruel. When there is no electric drill or the electric drill is not popularized, this operation is like a meat stall, bone chisel, bone hammer, bang! Bang! Bang, hard to break a hole in the bone. Moreover, the early intramedullary fixation is very troublesome. The femur is not a smooth cavity. There are spirals and various bone trabeculae. This shape can make the femur very hard and hematopoiesis.
So when fixing, first insert a small reamer into the femoral cavity and hit it with a hammer. How strong is this? If you stand behind the operating table, you can see the patient, and the whole body of the bound patient is shocked!
The reamer is very like what kind of triangular bayonet, but it is not so sharp, but very thick. Trumpet, medium, large, let's expand the bone marrow cavity and make it unobstructed. You can imagine how you eat bone marrow with chopsticks. In fact, the principle is the same, but chopsticks can't make the cavity bigger, and the power to insert chopsticks is a little smaller. There's no hammer to hit the head of chopsticks!
When the hammer hit the reamer. Smash, blood with bone marrow, white and red blood splashed everywhere. At this time, if a blood flies into the doctor's eyes, and the patient has a blood infectious disease, it is very troublesome! With the development of science and technology, now there are instruments without reaming, which also makes this operation elegant.
Open the medullary cavity, Zhang Fan gently insert the intramedullary nail and slowly descend. This operation, whether blind or not, will calculate the length by comparing the X-ray, which can not be long or short. Slowly down, "the lower end of the femur rotates outward ten degrees." Zhang Fan held the intramedullary nail with one hand and pressed the upper end of the femur with the other hand, saying to Lao Gao and Lao Chen.
Orthopedic doctor, a good orthopedic doctor has a strong sense of three-dimensional space and good knowledge of geometry. When Lao Lu failed to draw, geometry was even worse. Drawing a blood vessel made his head big. He was discouraged before he learned bones.
It's really hard to grasp the various angles of orthopedics. Don't mention the operating table. Ordinary people cross two chopsticks. You don't need measuring tools and put an angle of ten degrees. It's estimated that not many people can put it out, not to mention the situation where you can't look directly.
"Stop! Internal rotation two degrees with pull-down, slight pull-down. " Zhang Fan commands the assistant to reset. If the assistant is not available at this time, Zhang fan can't get one person, so the team and operation team are very important. Lao Gao and Lao Chen rotate slowly. Xu Xian grabs her calf and pulls it down slowly.
The reason for pulling down is to slightly separate the broken end of the fracture. If the force is too large, it may be pulled and displaced. It is too small to separate the broken end. Zhang Fan gently touched the broken end with the intramedullary nail, just like his hand. The changes at the broken end were clearly presented in his mind.
This is the feeling, this is the feeling that practice makes perfect. Lao Gao hasn't felt like this in his whole life. It's conceivable how much liver Zhang Fan has! I don't know how many operations I have done in the system“ Click! " A slight vibration came, which was the sound of bone stubble restoration.
"OK, don't move. Now keep this position." Fracture reduction changes during exercise, because it is an oblique fracture. There is an angle during reduction, and at this time, the patient's lower limbs on the affected side are suspended, that is, an old lady, and her thighs are not heavy. If a fat man keeps in position, he can keep his three assistants until their muscles are sore.
This is not a simple lift. Keep in a fixed position. Three people should have a slightly supporting force together. In short, if the chopsticks are broken, you should tie them up. Do you have to align them, and then hold them together with a force to tie them? That's a truth.
And this requires three people to cooperate together. Zhang Fan commands, five minutes, ten minutes, twenty minutes. It really takes a lot of people to keep a fixed position and continuously output a stable force. Although it is an old man, one lower limb also has some weight.
Zhang Fan inserts, slightly deflects, slowly slides down, avoids the broken end, slowly sticks to the bone, and can't be impatient at all. This is not an impatient thing. The sweat of Lao Gao and Lao Chen Dou has appeared. Tour, the head nurse sent another tour to gently wipe the two old doctors.
"Director, why don't you turn down the temperature of the air conditioner." The head nurse came in and asked when she saw the two old men sweating.
"No! No, no lower, patient, cold! " Lao Gao's continuous speech is inconvenient. He is afraid that his continuous speech will cause vibration and lead to the displacement of the broken end of the reduced fracture.
Enter, Zhang Fan a knob, "reset. Knife! " The operation nurse immediately turned the handle of the knife to Zhang Fan and the blade to herself and handed it to Zhang Fan. Zhang Fan cut with a knife, then opened a hole and prepared to screw. This is also a difficult point, let alone blind beating. Sometimes, when cutting and looking directly, doctors with inadequate technology can't even find this screw hole.
"I've opened a hole. I must keep it well." Zhang Fan said to the three assistants with an electric drill.
"Good!" Xu Xian said.
Lao Gao and Lao Chen just nodded.
Opening, "Ka!" Zhang Fan's positioning is too awesome. After drilling the bone, it is directly the screw hole. There is no need to adjust the position. This is the feel and technology of Niu force. Xu Xian looked silly. He estimated that Zhang Fan would have to adjust and find a position. After all, this is blind fighting, even if it is not blind fighting. He hasn't seen many successful positioning at one time.
Screw on the screw, "OK. Director, all right! " Zhang Fan said that he had started washing and was ready to sew. Lao Gao secretly rubbed his sour and numb hands and said to Zhang Fan, "why don't you look under the C-arm?"
"Just, don't worry, it should be no problem, but let's see. Don't worry." Lao Chen also said. This is Zhang Fan. If other residents are hospitalized, they will directly push the C-arm! As for Zhang Fan, both of them had a tone of discussion.
In the audio-visual education room, a group of orthopedic doctors looked in the water and fog. There was nothing to see in this operation. Only two small openings were cut, and the whole process depended on the hand and feeling of the chief surgeon. It's good that Zhang Fan, who can't die, doesn't speak as soon as he has surgery, just like a mute. Zhang Fan did not explain his feelings, and only the other three doctors on the operating table felt a little.
The doctor in the electric classroom was tangled, "this is over. Zhang Fan, too, didn't say how to fix it or confirm it. Hey! I saw it in vain. Like a pantomime, I left and wrote a medical record. "
"Hey, wait, look at the results of the C-arm!"
"Look at the fart, don't you see that Zhang Fan is ready to sew up! Even if you see what happens, you'll do it? Really, let's go! " A group of doctors left with a feeling in their hearts.
It's not that Zhang Fan doesn't say. Sometimes, this feeling, especially this mysterious hand feeling, really can't be expressed in words, but can only be understood!
The little nurse pushed the C-arm over, and all the doctors and nurses stood behind the typeface next door to observe. Take a pat, OK, the broken end of the fracture on the display is in good alignment.
"Cow! The angle judgment is too powerful. " Old Chen raised his big finger and said to Zhang Fan.
"Mr. Zhang, how do you judge? In that case, how do you judge that you need to rotate ten degrees?" After Xu Xian was shocked, he began to seek advice. This is a learning mentality.
"Yes, tell me." Lao Gao also said.
"Well, this, feel it. Look at the original X-ray. Although the angle is slightly larger, after downward rotation and pulling, the internal rotation of the muscle corrects this angle a little. Moreover, you see that the muscle strength of the old man has been relaxed, so the angle should be about 10 degrees to 12 degrees. When I used the probe to probe, I felt that it was at this point, These two points are together! " Zhang Fan pointed to the original film and said.
"Well!" Xu Xian's cold sweat came down, which could be felt. When Xu Xian had to open her mouth to speak, the anesthesiologist said, "Hi! Why are you talking? I can't sew. I can tell you that the old lady is waking up. "
"Ha ha, go on and sew it up. Lao Chen left. Let's have an operation and let the boy give instructions for a long time. His hands are sore. Let's leave the rest to them! "
"Yes, you should have a rest. Doctor Xu, you can go down too. I'll take the rest. " Zhang Fan said.
"It's okay, it's okay. Go down and have a rest. Leave the rest to me."
Can Zhang Fan go down? No, so Xu Xian didn't even sew. Xu Xiandu got the needle holder and wanted to sew. As a result, Zhang Fan robbed him. "This knife edge seems to have cut a small blood vessel when I cut it. I sew it. You don't know where!"
"Why is this thing so unique? I won't even let it sew. Besides, your sister, what blood vessels are there!" Xu Xian's face is cute!
The operation is over!
Zhang Fan's sleep was really solid. It was estimated that he slept more than one o'clock at noon. He didn't even have time to sleep. Zhang Fan went into deep sleep until more than eight o'clock at night. When he got up, Zhang Fan was dizzy. How to say this? First of all, there are a lot of operations, and the partners are the little girl and the incompetent Xue Fei.Zhang Fan almost did the steel plate orthopedic, bone block splicing, electric drill drilling and screws alone. It sounds like a carpenter making furniture. The amount of labor is really not small. He can't walk freely and consumes a lot. Although Lao Gao said at the morning meeting that he would take Zhang Fan for surgery, the main knife was Zhang Fan. Two Zhenggao, Lao Gao and Lao Chen, two inpatients, Zhang Fan and Xu Xian. After the anesthesiologist finished anesthesia, he said to several doctors, "start." Xu xianlisuo's brush hands began to disinfect. Before the operation, Zhang Fan finally went through the X-ray carefully. Although the X-ray has been printed in his mind, Zhang Fan still looked at it carefully.Lao Gao and Lao Chen stood aside, silent. There is too little they can help with this operation. Lao Gao is also ready. Once the blind fight fails, he will immediately cut open and fix it. Wash your hands and wear surgical clothes. "It's okay. Don't have pressure. It's a big deal. It's nothing to cut and fix." When Zhang Fan put on his clothes, gloves and picked up the sharp knife, Lao Gao said."Yes!" This is not good for Zhang Fan. Once he has an operation, he can't speak without talking, and he doesn't like others to speak. Therefore, as long as it is Zhang Fan's operation, the air pressure in the operating room is quite low, and anesthesiologists and itinerant nurses dare not speak. This is the problem of personal temperament."Start." Zhang Fan finished and began to prepare to cut the skin. What is the operation? Roughly speaking, the femur is a person's thigh, and then the thigh is broken from the middle without much displacement of the broken end. Zhang Fan now needs to open a small opening at the uppermost end of the femur, then use an electric drill to open the bone, and insert a long alloy rod from this opening. There are two holes at the lower end and two holes at the upper end of the alloy rod, which are all holes for screws. After fixation and good alignment of the broken end, tighten the four screws, OK fracture fixation, and the operation is over.It's that simple. Eighty or ninety percent of orthopedic doctors can't do simple surgery. Don't say blind beating, just cut and fix it. A doctor with a lower level can't even find the screw hole of this alloy! Zhang Fan opened a small opening and then stopped bleeding with an electric knife. When there was no electric knife before, he was ligated with silk thread.Zhang Fan is the main knife. Lao Gao smokes with an attractor. Lao Chen gently uses a small retractor to open his skin. Xu Xian has nothing to do now, so he stands and looks. Electric knife, in fact, is very simple, just like electric soldering iron. The human body has evolved so well that there are almost no large blood vessels in the superficial layer. When cutting the skin and dermis, the bleeding is not obvious. Only when it reaches the fat layer and muscle layer, can there be a larger capillary. Electric knife direct electrocoagulation, Zi! Zi! Zi, no bleeding.The more you go to the rice point for surgery, the more painful it is. Especially when you use an electric knife, you are also scalding the fat while scalding the blood vessels. The oil is smoking instantly. Although you wear a mask, a smell of barbecue comes directly. Really, when you are hungry, you can smell this smell and saliva can come down."Electric drill." Open a small opening of the skin, separate the muscle and fascia layer with bare hands to stop bleeding. After exposing the bone, Zhang Fan said. The operation nurse stood aside and installed the electric drill early. After debugging, she handed the electric drill to Zhang Fan calmly."Squeak! Squeak! Squeak! " The hard bone, like tofu, loosened a mouth. Bones, especially big bones, have been eaten. There are bone marrow and red soft bones like honeycomb. When the electric drill is drilled, how to say the bone is like coffee with milk, white bone powder, dark red blood, milk and white bone marrow are stirred together, and then mixed quickly, and finally become a little white milk soup.The early way of this operation is very cruel. When there is no electric drill or the electric drill is not popularized, this operation is like a meat stall, bone chisel, bone hammer, bang! Bang! Bang, hard to break a hole in the bone. Moreover, the early intramedullary fixation is very troublesome. The femur is not a smooth cavity. There are spirals and various bone trabeculae. This shape can make the femur very hard and hematopoiesis.So when fixing, first insert a small reamer into the femoral cavity and hit it with a hammer. How strong is this? If you stand behind the operating table, you can see the patient, and the whole body of the bound patient is shocked!The reamer is very like what kind of triangular bayonet, but it is not so sharp, but very thick. Trumpet, medium, large, let's expand the bone marrow cavity and make it unobstructed. You can imagine how you eat bone marrow with chopsticks. In fact, the principle is the same, but chopsticks can't make the cavity bigger, and the power to insert chopsticks is a little smaller. There's no hammer to hit the head of chopsticks!When the hammer hit the reamer. Smash, blood with bone marrow, white and red blood splashed everywhere. At this time, if a blood flies into the doctor's eyes, and the patient has a blood infectious disease, it is very troublesome! With the development of science and technology, now there are instruments without reaming, which also makes this operation elegant.Open the medullary cavity, Zhang Fan gently insert the intramedullary nail and slowly descend. This operation, whether blind or not, will calculate the length by comparing the X-ray, which can not be long or short. Slowly down, "the lower end of the femur rotates outward ten degrees." Zhang Fan held the intramedullary nail with one hand and pressed the upper end of the femur with the other hand, saying to Lao Gao and Lao Chen.Orthopedic doctor, a good orthopedic doctor has a strong sense of three-dimensional space and good knowledge of geometry. When Lao Lu failed to draw, geometry was even worse. Drawing a blood vessel made his head big. He was discouraged before he learned bones.It's really hard to grasp the various angles of orthopedics. Don't mention the operating table. Ordinary people cross two chopsticks. You don't need measuring tools and put an angle of ten degrees. It's estimated that not many people can put it out, not to mention the situation where you can't look directly."Stop! Internal rotation two degrees with pull-down, slight pull-down. " Zhang Fan commands the assistant to reset. If the assistant is not available at this time, Zhang fan can't get one person, so the team and operation team are very important. Lao Gao and Lao Chen rotate slowly. Xu Xian grabs her calf and pulls it down slowly.The reason for pulling down is to slightly separate the broken end of the fracture. If the force is too large, it may be pulled and displaced. It is too small to separate the broken end. Zhang Fan gently touched the broken end with the intramedullary nail, just like his hand. The changes at the broken end were clearly presented in his mind.This is the feeling, this is the feeling that practice makes perfect. Lao Gao hasn't felt like this in his whole life. It's conceivable how much liver Zhang Fan has! I don't know how many operations I have done in the system Click! " A slight vibration came, which was the sound of bone stubble restoration."OK, don't move. Now keep this position." Fracture reduction changes during exercise, because it is an oblique fracture. There is an angle during reduction, and at this time, the patient's lower limbs on the affected side are suspended, that is, an old lady, and her thighs are not heavy. If a fat man keeps in position, he can keep his three assistants until their muscles are sore.This is not a simple lift. Keep in a fixed position. Three people should have a slightly supporting force together. In short, if the chopsticks are broken, you should tie them up. Do you have to align them, and then hold them together with a force to tie them? That's a truth.And this requires three people to cooperate together. Zhang Fan commands, five minutes, ten minutes, twenty minutes. It really takes a lot of people to keep a fixed position and continuously output a stable force. Although it is an old man, one lower limb also has some weight.Zhang Fan inserts, slightly deflects, slowly slides down, avoids the broken end, slowly sticks to the bone, and can't be impatient at all. This is not an impatient thing. The sweat of Lao Gao and Lao Chen Dou has appeared. Tour, the head nurse sent another tour to gently wipe the two old doctors."Director, why don't you turn down the temperature of the air conditioner." The head nurse came in and asked when she saw the two old men sweating."No! No, no lower, patient, cold! " Lao Gao's continuous speech is inconvenient. He is afraid that his continuous speech will cause vibration and lead to the displacement of the broken end of the reduced fracture.Enter, Zhang Fan a knob, "reset. Knife! " The operation nurse immediately turned the handle of the knife to Zhang Fan and the blade to herself and handed it to Zhang Fan. Zhang Fan cut with a knife, then opened a hole and prepared to screw. This is also a difficult point, let alone blind beating. Sometimes, when cutting and looking directly, doctors with inadequate technology can't even find this screw hole."I've opened a hole. I must keep it well." Zhang Fan said to the three assistants with an electric drill."Good!" Xu Xian said.Lao Gao and Lao Chen just nodded.Opening, "Ka!" Zhang Fan's positioning is too awesome. After drilling the bone, it is directly the screw hole. There is no need to adjust the position. This is the feel and technology of Niu force. Xu Xian looked silly. He estimated that Zhang Fan would have to adjust and find a position. After all, this is blind fighting, even if it is not blind fighting. He hasn't seen many successful positioning at one time.Screw on the screw, "OK. Director, all right! " Zhang Fan said that he had started washing and was ready to sew. Lao Gao secretly rubbed his sour and numb hands and said to Zhang Fan, "why don't you look under the C-arm?""Just, don't worry, it should be no problem, but let's see. Don't worry." Lao Chen also said. This is Zhang Fan. If other residents are hospitalized, they will directly push the C-arm! As for Zhang Fan, both of them had a tone of discussion.In the audio-visual education room, a group of orthopedic doctors looked in the water and fog. There was nothing to see in this operation. Only two small openings were cut, and the whole process depended on the hand and feeling of the chief surgeon. It's good that Zhang Fan, who can't die, doesn't speak as soon as he has surgery, just like a mute. Zhang Fan did not explain his feelings, and only the other three doctors on the operating table felt a little.The doctor in the electric classroom was tangled, "this is over. Zhang Fan, too, didn't say how to fix it or confirm it. Hey! I saw it in vain. Like a pantomime, I left and wrote a medical record. ""Hey, wait, look at the results of the C-arm!""Look at the fart, don't you see that Zhang Fan is ready to sew up! Even if you see what happens, you'll do it? Really, let's go! " A group of doctors left with a feeling in their hearts.It's not that Zhang Fan doesn't say. Sometimes, this feeling, especially this mysterious hand feeling, really can't be expressed in words, but can only be understood!The little nurse pushed the C-arm over, and all the doctors and nurses stood behind the typeface next door to observe. Take a pat, OK, the broken end of the fracture on the display is in good alignment."Cow! The angle judgment is too powerful. " Old Chen raised his big finger and said to Zhang Fan."Mr. Zhang, how do you judge? In that case, how do you judge that you need to rotate ten degrees?" After Xu Xian was shocked, he began to seek advice. This is a learning mentality."Yes, tell me." Lao Gao also said."Well, this, feel it. Look at the original X-ray. Although the angle is slightly larger, after downward rotation and pulling, the internal rotation of the muscle corrects this angle a little. Moreover, you see that the muscle strength of the old man has been relaxed, so the angle should be about 10 degrees to 12 degrees. When I used the probe to probe, I felt that it was at this point, These two points are together! " Zhang Fan pointed to the original film and said."Well!" Xu Xian's cold sweat came down, which could be felt. When Xu Xian had to open her mouth to speak, the anesthesiologist said, "Hi! Why are you talking? I can't sew. I can tell you that the old lady is waking up. ""Ha ha, go on and sew it up. Lao Chen left. Let's have an operation and let the boy give instructions for a long time. His hands are sore. Let's leave the rest to them! ""Yes, you should have a rest. Doctor Xu, you can go down too. I'll take the rest. " Zhang Fan said."It's okay, it's okay. Go down and have a rest. Leave the rest to me."Can Zhang Fan go down? No, so Xu Xian didn't even sew. Xu Xiandu got the needle holder and wanted to sew. As a result, Zhang Fan robbed him. "This knife edge seems to have cut a small blood vessel when I cut it. I sew it. You don't know where!""Why is this thing so unique? I won't even let it sew. Besides, your sister, what blood vessels are there!" Xu Xian's face is cute!The operation is over!
