Chapter 460: 460
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The three major complications of fracture are infection, osteofascial syndrome and nonunion. One is more terrible than the other. The first two are short-term complications and the latter is long-term complications. If you don't follow up after operation, the situation will be serious until symptoms appear.
In the orthopaedic operating room in the morning, Zhang Fan looked at the patient's X-ray and frowned. It was not that the operation was difficult, but that he could not feel the sense of permeability of doing liver tumor.
Orthopedics is the earliest subject Zhang Fan came into contact with. He has also had a lot of liver surgery. Although the surgery is becoming more and more skilled, he always has no sense of permeability. It seems that he is missing something.
"Why? Is the operation done less, or is the operation difficult enough? " Zhang Fan has pimples on his eyebrows, and others dare not disturb him.
In fact, this thing is very simple. Where there is oppression, there is resistance. As long as it is not overwhelmed, it will definitely sublimate and break through. Liver tumor surgery is not the most difficult, but it is not simple.
And huge liver tumor surgery, the risk is huge, in this kind of trembling. Zhang Fan refuels to use knowledge and refuels to think.
Suddenly, the knowledge of liver was forcibly broken through. Instead, it is a simple orthopedic operation. The more you do it, the more skilled you become. It has become a habit, and there is no way to make a breakthrough.
"Zhang Yuan, anesthesia is ready. We're all ready. " Zhou Chengfu gently reminded Zhang Fan who was in a daze.
"Oh, all right. Let's start. " Zhang Fan suddenly woke up, put down his thoughts and concentrated on the operation. So far, there is no unified definition of nonunion in the medical community.
Zhang Fan believes that if the broken end of the fracture cannot be healed without intervention within three months, it should be called nonunion. Zhou XX because of diabetes, and Chen Qi wants to make the X film more beautiful, stripping off too many estimates of soft tissue.
Moreover, the patient also smoked and drank alcohol, and did not have an appropriate amount of strength exercise, which eventually led to bone nonunion. At this time, the fracture of the middle end of his humerus had shrunk and formed a large number of granulation.
The human body is so strange. If normal tissue cannot grow in normal places, abnormal tissue will grow. If it is found a few months later, the atrophy will be exacerbated because of the disuse of the bone.
In a short time, there will be a false joint. The normal arm has only one elbow joint. Because there is a false joint at the broken end, his arm becomes a three stick.
If the time is prolonged, it will be like infection, and the original normal bone will begin to shrink. The final outcome can only be to shorten the arm. Then he became a long arm and a short arm, leaving an unalterable disability in his body.
There are many ways to treat nonunion. There are lengthened steel plates. After the original five or six centimeter steel plate is taken out, the broken end is corrected, bone grafting is performed, and then a longer steel plate is placed to strengthen the stability of the fracture and make it recover.
The other is intramedullary nail fixation, which directly looks at the opening from both ends of the long bone and puts it into the intramedullary nail for fixation.
Another is external fixation. Just like building a building, a steel frame is erected outside the fracture to fix it.
Because the current atrophic distance of the broken end of Zhou XX's fracture is not very large, Zhang Fan is ready to use an extended steel plate for fixation. Each of the three fixation methods has its own advantages. There is no best, only the most appropriate.
Cut. On the original incision, Zhang Fan continued to cut. This kind of secondary operation can't talk about the hierarchical structure at all. Because of the operation, the adhesion around the incision is severe.
Zhang Fan observed the two assistants as he entered. They cooperate with Zhang Fan, and their techniques are quite skillful. After the incision is opened, there are black silk threads that have not been absorbed, long and short.
Although this kind of silk thread can be absorbed, if it is found, it should be removed as far as possible. After all, the thread head is also a foreign body. Silk thread absorption, there is a joke in the medical industry that is not a joke.
It is said that in the early years, the national technology was poor, and the silk thread materials used were not qualified. Thirty years after a person has completed appendix surgery, he can still produce a black thread head in a certain section of his body.
When the muscle is opened, the steel plate has been wrapped by proliferative granulation tissue. What's the situation? It's like a steel plate on a gypsum mold, and the gypsum mud overflows after being pressed. This calcified granulation tissue is all around the steel plate attached to the bone.
"Steel nails for inner six." After taking a look, Zhang Fan said to the nurse. The screw heads of orthopedic steel nails used to be plum blossom and cross.
Once the force of this type of screw is not appropriate, the screw head will have a gap, and it will not be able to bite when taken out. That is, orthopedics has an unwritten rule.
Who gets the steel plate! With the large number of Tucao doctors in Department of orthopedics, this plum blossom and cross screw also slowly withdrew from the clinic, which is the origin of the legend of the legend of the Department of orthopedics: there is no steel plate that can not make complaints about it, only the steel nails that can not be obtained.
After unscrewing the steel nail, Zhang Fan directly grabbed the steel plate with two Alice pliers and pulled it out of the calcified granulation tissue.
The instrument nurse looked. Zhang Fan took the steel plate with Alice's forceps, bit his teeth and didn't speak. If other residents or general attending doctors, the little nurse would not be happy for a long time.
The operation belongs to the doctor, but the instruments belong to the nurse. And because of the violence of orthopedic doctors, doctors in other departments are very reluctant to use the instruments used by orthopedic doctors.
The pliers clamp the bone and steel plate. After clamping it several times, the very brand-new instrument can't be used. It's impossible to sew with a suture needle.
Pull out the steel plate“ Bone knife! " Zhang Fan started to remove the calcified cartilage on the bone surface after passing the bone knife. The bone surface was like inlaid with a bony steel plate.
If the density of calcification is relatively high and it is not enough to rely on a bone knife, use a hammer. Like chiseling a stone, remove the calcification from the bone one by one.
This operation must be stable and there must be no accidents. Once the hand slides, the kinetic energy of the hammer plus the strength of the doctor's arm can definitely break the patient's bone.
"Steel! Steel! Steel! " The sound of hammer hitting the bone knife rang in the operating room. And still have a sense of rhythm. You can't knock indiscriminately. The time interval between the last time and the next time should be about the same.
Zhang Fan knocked, Zhou Chengfu spread his fingers and pressed the incision. Because of the strong percussion, the blood, bone marrow and fat particles in the wound are like jumping in the wild with Zhang Fan's percussion. Although Zhou Chengfu had covered the wound with his hand, there were still yellow fat particles eloping out with blood.
There are scattered fat particles and blood immersed in the list on the operation sheet, which is very like sesame cake, not black sesame, but Yellow Sesame.
"Scraper! You start taking bones. Don't take too much. Take the periosteum! " Zhang Fan said to Zhou Chengfu. The bone is atrophic. If we don't find a way to connect it, it can't heal again.
Bone graft must be cancellous bone with periosteum. Because there are a large number of bone progenitor cells on the periosteum, which can make bones develop and grow, and cancellous bone is like the plug of an old thermos after it is dried. There are a lot of voids inside, rich in various growth factors, which can induce bone growth.
There are few places with both periosteum and cancellous bone in human bones, and there are even fewer places that can be intercepted. For example, the iliac spine is a very good bone bank.
"OK." After Zhou Chengfu promised, he took Xu Xian to the pelvic position. If Zhang Fan's bone smashing knife is violent, taking the bone is called rage.
After cutting the skin and pulling away the fat and muscle, Zhou Chengfu began to take out the bone by biting his teeth. When the bone knife was placed on the iliac spine, Zhou Chengfu wore a mask. If he didn't wear a mask, he would look ferocious at this time.
The hardness of periosteum and bone cortex is very high. With Zhou Chengfu's percussion, the bound patient's whole body was shaking. It's "bang! Bang! Bang! " The blood is as elegant as flowers. That's not the roughest in orthopedics.
The bone was chiseled off by a bone knife. It was not big. It was slightly shorter than green arrow gum. The bone as thick as a matchbox was taken off.
After taking out the bones, Zhou Chengfu began to cut them into pieces with scissors. Zhang Fan is using a scraper to clean up the granulation tissue at the broken end. How to describe this? It's like digging a few remaining yogurt cans with a spoon.
Calcified granulation tissue shall be chiseled with a bone knife, and white non calcified granulation tissue shall be dug with a scraper. This thing must be cleaned up. If it is not cleaned up, there is still residue at the broken end. If the bone thinks that this place is fleshy, it will not send out new bones.
"Gauze." After Zhang Fan dug it clean, he began to wipe it with gauze. The removal of granulation tissue must be ensured. After wiping, the broken end of the fracture is as white as a broken Ivory chopstick.
"Zhang Yuan, look, is it enough?" Zhou Chengfu handed Zhang Fan the bone pieces that had been cut into the size of soybeans.
"Yes, the estimate is good. It should be enough." Zhang Fan praised Zhou Chengfu. In the past, old Zhou would definitely scoff, but now Zhou Chengfu is happy and his eyes are in a line.
Filling, this requires technology. Like a hollow bamboo, when it is broken, it is necessary to fill the soybeans in the middle without spilling them. This is the technology.
Students who couldn't play well with building blocks when they were young couldn't do this well. Lao Zhou estimated that there were no building blocks to play when he was young. Finally, he had no choice but to write articles.
First put the broken bone with bone cortex and periosteum for priming, then fill the cancellous bone on it bit by bit, and then fill the broken bone with bone cortex and periosteum on the top.
It's not good to be loose, because the steel plate has to be drilled with an electric drill. If it's loose, the steel plate hasn't been put on, and the filled bones will collapse long ago.
What is a needle in the hole? This is a needle in the hole. After the broken ends are filled, they must be forcibly inserted into their gaps with broken bones with bone cortex. They must be inserted with force.
Then, the missing bone is connected. Then put the steel plate. The humerus is not a very round pipe, because four or five holes have been drilled on both sides of the broken end for the first time.
The second time you put the steel plate on, you must stay away from these places, or the bone may break when you put the screws on it. Therefore, the original steel plate only five or six centimeters long has become a steel plate of twenty or thirty centimeters. It is like adding a metal protective plate to the humerus.
When the steel plate is long, of course the incision will extend. For example, the length of steel plate is 30cm, and the crossing is less, but it also needs 20cm. The place covered by the organization is forcibly opened with a retractor.
Just as a person's mouth opens to the maximum, continue to pull it with a metal hook until you see the innermost big teeth.
When installing the steel plate, the humerus is slightly curved and slightly triangular. Therefore, the steel plate must find a face that can stick to a better face.
After the steel plate was applied, Zhang Fan began to open holes. Although doctors in other departments joke about orthopedics, saying that a good carpenter can do fracture surgery is actually a joke. The carpenter can't do this job.
This kind of steel plate is pressurized steel plate. One of the nail holes on the pressure plate is a pressure hole, and a slope is designed in the hole. This hole looks like stretching an ordinary hole. The utility model has the advantages that it can play the role of compression, make the fracture ends close and promote healing. The disadvantage is that the pressure hole is the weakest part of the steel plate and is easy to break.
During the doctor's operation, the pressure is not easy to grasp. If the pressure is large, it will lead to slight bone necrosis at the broken end. If the pressure is small, it will not play the role of pressure. Because each patient's constitution is different, it is difficult to grasp this strength in practical work.
This strength can't be mastered in a few years. Drill along the pressure hole of the steel plate, and Zhang Fan observes the connected bone while drilling.
To tell the truth, if this kind of operation takes a step forward, we must ensure the appropriateness of the original step. If we take a step forward, there will be problems in the original step and we can't get off the operating table.
Zhang Fan was very cautious when drilling. Although he personally inserted it, after all, manpower can't compete with the vibration generated by the electric drill, so Zhang Fan is very careful.
After opening the hole, start screwing. This is also a technical activity. Apart from others, it is very particular about one angle. The perpendicularity of the screw and the contact surface with the steel plate bone must be vertical.
How to make sure, feeling! Yes, it's a very unreliable feeling. If you don't feel it, you'll wait for the sliding wire. There is no problem at all. The screw strength of the upper compression steel plate. Once there is a direction problem in the bite between the screw and the steel plate, the sliding wire will not run away.
Put on the steel plate and start flushing and stitching! When the suture was almost finished, Zhang Fan suddenly looked up and said to Zhou Chengfu and Wang Pingshan, "who will take over this patient?"
Zhou Chengfu hesitated. Wang Pingshan took a look at Zhang Fan and said directly, "if you don't worry, give it to me!"
"Good!" Zhang Fan doesn't talk much. Zhou Chengfu next to him suddenly wanted to feel something far away from him.
Please report us if you find any errors so we can fix it asap!
The three major complications of fracture are infection, osteofascial syndrome and nonunion. One is more terrible than the other. The first two are short-term complications and the latter is long-term complications. If you don't follow up after operation, the situation will be serious until symptoms appear.
In the orthopaedic operating room in the morning, Zhang Fan looked at the patient's X-ray and frowned. It was not that the operation was difficult, but that he could not feel the sense of permeability of doing liver tumor.
Orthopedics is the earliest subject Zhang Fan came into contact with. He has also had a lot of liver surgery. Although the surgery is becoming more and more skilled, he always has no sense of permeability. It seems that he is missing something.
"Why? Is the operation done less, or is the operation difficult enough? " Zhang Fan has pimples on his eyebrows, and others dare not disturb him.
In fact, this thing is very simple. Where there is oppression, there is resistance. As long as it is not overwhelmed, it will definitely sublimate and break through. Liver tumor surgery is not the most difficult, but it is not simple.
And huge liver tumor surgery, the risk is huge, in this kind of trembling. Zhang Fan refuels to use knowledge and refuels to think.
Suddenly, the knowledge of liver was forcibly broken through. Instead, it is a simple orthopedic operation. The more you do it, the more skilled you become. It has become a habit, and there is no way to make a breakthrough.
"Zhang Yuan, anesthesia is ready. We're all ready. " Zhou Chengfu gently reminded Zhang Fan who was in a daze.
"Oh, all right. Let's start. " Zhang Fan suddenly woke up, put down his thoughts and concentrated on the operation. So far, there is no unified definition of nonunion in the medical community.
Zhang Fan believes that if the broken end of the fracture cannot be healed without intervention within three months, it should be called nonunion. Zhou XX because of diabetes, and Chen Qi wants to make the X film more beautiful, stripping off too many estimates of soft tissue.
Moreover, the patient also smoked and drank alcohol, and did not have an appropriate amount of strength exercise, which eventually led to bone nonunion. At this time, the fracture of the middle end of his humerus had shrunk and formed a large number of granulation.
The human body is so strange. If normal tissue cannot grow in normal places, abnormal tissue will grow. If it is found a few months later, the atrophy will be exacerbated because of the disuse of the bone.
In a short time, there will be a false joint. The normal arm has only one elbow joint. Because there is a false joint at the broken end, his arm becomes a three stick.
If the time is prolonged, it will be like infection, and the original normal bone will begin to shrink. The final outcome can only be to shorten the arm. Then he became a long arm and a short arm, leaving an unalterable disability in his body.
There are many ways to treat nonunion. There are lengthened steel plates. After the original five or six centimeter steel plate is taken out, the broken end is corrected, bone grafting is performed, and then a longer steel plate is placed to strengthen the stability of the fracture and make it recover.
The other is intramedullary nail fixation, which directly looks at the opening from both ends of the long bone and puts it into the intramedullary nail for fixation.
Another is external fixation. Just like building a building, a steel frame is erected outside the fracture to fix it.
Because the current atrophic distance of the broken end of Zhou XX's fracture is not very large, Zhang Fan is ready to use an extended steel plate for fixation. Each of the three fixation methods has its own advantages. There is no best, only the most appropriate.
Cut. On the original incision, Zhang Fan continued to cut. This kind of secondary operation can't talk about the hierarchical structure at all. Because of the operation, the adhesion around the incision is severe.
Zhang Fan observed the two assistants as he entered. They cooperate with Zhang Fan, and their techniques are quite skillful. After the incision is opened, there are black silk threads that have not been absorbed, long and short.
Although this kind of silk thread can be absorbed, if it is found, it should be removed as far as possible. After all, the thread head is also a foreign body. Silk thread absorption, there is a joke in the medical industry that is not a joke.
It is said that in the early years, the national technology was poor, and the silk thread materials used were not qualified. Thirty years after a person has completed appendix surgery, he can still produce a black thread head in a certain section of his body.
When the muscle is opened, the steel plate has been wrapped by proliferative granulation tissue. What's the situation? It's like a steel plate on a gypsum mold, and the gypsum mud overflows after being pressed. This calcified granulation tissue is all around the steel plate attached to the bone.
"Steel nails for inner six." After taking a look, Zhang Fan said to the nurse. The screw heads of orthopedic steel nails used to be plum blossom and cross.
Once the force of this type of screw is not appropriate, the screw head will have a gap, and it will not be able to bite when taken out. That is, orthopedics has an unwritten rule.
Who gets the steel plate! With the large number of Tucao doctors in Department of orthopedics, this plum blossom and cross screw also slowly withdrew from the clinic, which is the origin of the legend of the legend of the Department of orthopedics: there is no steel plate that can not make complaints about it, only the steel nails that can not be obtained.
After unscrewing the steel nail, Zhang Fan directly grabbed the steel plate with two Alice pliers and pulled it out of the calcified granulation tissue.
The instrument nurse looked. Zhang Fan took the steel plate with Alice's forceps, bit his teeth and didn't speak. If other residents or general attending doctors, the little nurse would not be happy for a long time.
The operation belongs to the doctor, but the instruments belong to the nurse. And because of the violence of orthopedic doctors, doctors in other departments are very reluctant to use the instruments used by orthopedic doctors.
The pliers clamp the bone and steel plate. After clamping it several times, the very brand-new instrument can't be used. It's impossible to sew with a suture needle.
Pull out the steel plate“ Bone knife! " Zhang Fan started to remove the calcified cartilage on the bone surface after passing the bone knife. The bone surface was like inlaid with a bony steel plate.
If the density of calcification is relatively high and it is not enough to rely on a bone knife, use a hammer. Like chiseling a stone, remove the calcification from the bone one by one.
This operation must be stable and there must be no accidents. Once the hand slides, the kinetic energy of the hammer plus the strength of the doctor's arm can definitely break the patient's bone.
"Steel! Steel! Steel! " The sound of hammer hitting the bone knife rang in the operating room. And still have a sense of rhythm. You can't knock indiscriminately. The time interval between the last time and the next time should be about the same.
Zhang Fan knocked, Zhou Chengfu spread his fingers and pressed the incision. Because of the strong percussion, the blood, bone marrow and fat particles in the wound are like jumping in the wild with Zhang Fan's percussion. Although Zhou Chengfu had covered the wound with his hand, there were still yellow fat particles eloping out with blood.
There are scattered fat particles and blood immersed in the list on the operation sheet, which is very like sesame cake, not black sesame, but Yellow Sesame.
"Scraper! You start taking bones. Don't take too much. Take the periosteum! " Zhang Fan said to Zhou Chengfu. The bone is atrophic. If we don't find a way to connect it, it can't heal again.
Bone graft must be cancellous bone with periosteum. Because there are a large number of bone progenitor cells on the periosteum, which can make bones develop and grow, and cancellous bone is like the plug of an old thermos after it is dried. There are a lot of voids inside, rich in various growth factors, which can induce bone growth.
There are few places with both periosteum and cancellous bone in human bones, and there are even fewer places that can be intercepted. For example, the iliac spine is a very good bone bank.
"OK." After Zhou Chengfu promised, he took Xu Xian to the pelvic position. If Zhang Fan's bone smashing knife is violent, taking the bone is called rage.
After cutting the skin and pulling away the fat and muscle, Zhou Chengfu began to take out the bone by biting his teeth. When the bone knife was placed on the iliac spine, Zhou Chengfu wore a mask. If he didn't wear a mask, he would look ferocious at this time.
The hardness of periosteum and bone cortex is very high. With Zhou Chengfu's percussion, the bound patient's whole body was shaking. It's "bang! Bang! Bang! " The blood is as elegant as flowers. That's not the roughest in orthopedics.
The bone was chiseled off by a bone knife. It was not big. It was slightly shorter than green arrow gum. The bone as thick as a matchbox was taken off.
After taking out the bones, Zhou Chengfu began to cut them into pieces with scissors. Zhang Fan is using a scraper to clean up the granulation tissue at the broken end. How to describe this? It's like digging a few remaining yogurt cans with a spoon.
Calcified granulation tissue shall be chiseled with a bone knife, and white non calcified granulation tissue shall be dug with a scraper. This thing must be cleaned up. If it is not cleaned up, there is still residue at the broken end. If the bone thinks that this place is fleshy, it will not send out new bones.
"Gauze." After Zhang Fan dug it clean, he began to wipe it with gauze. The removal of granulation tissue must be ensured. After wiping, the broken end of the fracture is as white as a broken Ivory chopstick.
"Zhang Yuan, look, is it enough?" Zhou Chengfu handed Zhang Fan the bone pieces that had been cut into the size of soybeans.
"Yes, the estimate is good. It should be enough." Zhang Fan praised Zhou Chengfu. In the past, old Zhou would definitely scoff, but now Zhou Chengfu is happy and his eyes are in a line.
Filling, this requires technology. Like a hollow bamboo, when it is broken, it is necessary to fill the soybeans in the middle without spilling them. This is the technology.
Students who couldn't play well with building blocks when they were young couldn't do this well. Lao Zhou estimated that there were no building blocks to play when he was young. Finally, he had no choice but to write articles.
First put the broken bone with bone cortex and periosteum for priming, then fill the cancellous bone on it bit by bit, and then fill the broken bone with bone cortex and periosteum on the top.
It's not good to be loose, because the steel plate has to be drilled with an electric drill. If it's loose, the steel plate hasn't been put on, and the filled bones will collapse long ago.
What is a needle in the hole? This is a needle in the hole. After the broken ends are filled, they must be forcibly inserted into their gaps with broken bones with bone cortex. They must be inserted with force.
Then, the missing bone is connected. Then put the steel plate. The humerus is not a very round pipe, because four or five holes have been drilled on both sides of the broken end for the first time.
The second time you put the steel plate on, you must stay away from these places, or the bone may break when you put the screws on it. Therefore, the original steel plate only five or six centimeters long has become a steel plate of twenty or thirty centimeters. It is like adding a metal protective plate to the humerus.
When the steel plate is long, of course the incision will extend. For example, the length of steel plate is 30cm, and the crossing is less, but it also needs 20cm. The place covered by the organization is forcibly opened with a retractor.
Just as a person's mouth opens to the maximum, continue to pull it with a metal hook until you see the innermost big teeth.
When installing the steel plate, the humerus is slightly curved and slightly triangular. Therefore, the steel plate must find a face that can stick to a better face.
After the steel plate was applied, Zhang Fan began to open holes. Although doctors in other departments joke about orthopedics, saying that a good carpenter can do fracture surgery is actually a joke. The carpenter can't do this job.
This kind of steel plate is pressurized steel plate. One of the nail holes on the pressure plate is a pressure hole, and a slope is designed in the hole. This hole looks like stretching an ordinary hole. The utility model has the advantages that it can play the role of compression, make the fracture ends close and promote healing. The disadvantage is that the pressure hole is the weakest part of the steel plate and is easy to break.
During the doctor's operation, the pressure is not easy to grasp. If the pressure is large, it will lead to slight bone necrosis at the broken end. If the pressure is small, it will not play the role of pressure. Because each patient's constitution is different, it is difficult to grasp this strength in practical work.
This strength can't be mastered in a few years. Drill along the pressure hole of the steel plate, and Zhang Fan observes the connected bone while drilling.
To tell the truth, if this kind of operation takes a step forward, we must ensure the appropriateness of the original step. If we take a step forward, there will be problems in the original step and we can't get off the operating table.
Zhang Fan was very cautious when drilling. Although he personally inserted it, after all, manpower can't compete with the vibration generated by the electric drill, so Zhang Fan is very careful.
After opening the hole, start screwing. This is also a technical activity. Apart from others, it is very particular about one angle. The perpendicularity of the screw and the contact surface with the steel plate bone must be vertical.
How to make sure, feeling! Yes, it's a very unreliable feeling. If you don't feel it, you'll wait for the sliding wire. There is no problem at all. The screw strength of the upper compression steel plate. Once there is a direction problem in the bite between the screw and the steel plate, the sliding wire will not run away.
Put on the steel plate and start flushing and stitching! When the suture was almost finished, Zhang Fan suddenly looked up and said to Zhou Chengfu and Wang Pingshan, "who will take over this patient?"
Zhou Chengfu hesitated. Wang Pingshan took a look at Zhang Fan and said directly, "if you don't worry, give it to me!"
"Good!" Zhang Fan doesn't talk much. Zhou Chengfu next to him suddenly wanted to feel something far away from him.
The three major complications of fracture are infection, osteofascial syndrome and nonunion. One is more terrible than the other. The first two are short-term complications and the latter is long-term complications. If you don't follow up after operation, the situation will be serious until symptoms appear.In the orthopaedic operating room in the morning, Zhang Fan looked at the patient's X-ray and frowned. It was not that the operation was difficult, but that he could not feel the sense of permeability of doing liver tumor.Orthopedics is the earliest subject Zhang Fan came into contact with. He has also had a lot of liver surgery. Although the surgery is becoming more and more skilled, he always has no sense of permeability. It seems that he is missing something."Why? Is the operation done less, or is the operation difficult enough? " Zhang Fan has pimples on his eyebrows, and others dare not disturb him.In fact, this thing is very simple. Where there is oppression, there is resistance. As long as it is not overwhelmed, it will definitely sublimate and break through. Liver tumor surgery is not the most difficult, but it is not simple.And huge liver tumor surgery, the risk is huge, in this kind of trembling. Zhang Fan refuels to use knowledge and refuels to think.Suddenly, the knowledge of liver was forcibly broken through. Instead, it is a simple orthopedic operation. The more you do it, the more skilled you become. It has become a habit, and there is no way to make a breakthrough."Zhang Yuan, anesthesia is ready. We're all ready. " Zhou Chengfu gently reminded Zhang Fan who was in a daze."Oh, all right. Let's start. " Zhang Fan suddenly woke up, put down his thoughts and concentrated on the operation. So far, there is no unified definition of nonunion in the medical community.Zhang Fan believes that if the broken end of the fracture cannot be healed without intervention within three months, it should be called nonunion. Zhou XX because of diabetes, and Chen Qi wants to make the X film more beautiful, stripping off too many estimates of soft tissue.Moreover, the patient also smoked and drank alcohol, and did not have an appropriate amount of strength exercise, which eventually led to bone nonunion. At this time, the fracture of the middle end of his humerus had shrunk and formed a large number of granulation.The human body is so strange. If normal tissue cannot grow in normal places, abnormal tissue will grow. If it is found a few months later, the atrophy will be exacerbated because of the disuse of the bone.In a short time, there will be a false joint. The normal arm has only one elbow joint. Because there is a false joint at the broken end, his arm becomes a three stick.If the time is prolonged, it will be like infection, and the original normal bone will begin to shrink. The final outcome can only be to shorten the arm. Then he became a long arm and a short arm, leaving an unalterable disability in his body.There are many ways to treat nonunion. There are lengthened steel plates. After the original five or six centimeter steel plate is taken out, the broken end is corrected, bone grafting is performed, and then a longer steel plate is placed to strengthen the stability of the fracture and make it recover.The other is intramedullary nail fixation, which directly looks at the opening from both ends of the long bone and puts it into the intramedullary nail for fixation.Another is external fixation. Just like building a building, a steel frame is erected outside the fracture to fix it.Because the current atrophic distance of the broken end of Zhou XX's fracture is not very large, Zhang Fan is ready to use an extended steel plate for fixation. Each of the three fixation methods has its own advantages. There is no best, only the most appropriate.Cut. On the original incision, Zhang Fan continued to cut. This kind of secondary operation can't talk about the hierarchical structure at all. Because of the operation, the adhesion around the incision is severe.Zhang Fan observed the two assistants as he entered. They cooperate with Zhang Fan, and their techniques are quite skillful. After the incision is opened, there are black silk threads that have not been absorbed, long and short.Although this kind of silk thread can be absorbed, if it is found, it should be removed as far as possible. After all, the thread head is also a foreign body. Silk thread absorption, there is a joke in the medical industry that is not a joke.It is said that in the early years, the national technology was poor, and the silk thread materials used were not qualified. Thirty years after a person has completed appendix surgery, he can still produce a black thread head in a certain section of his body.When the muscle is opened, the steel plate has been wrapped by proliferative granulation tissue. What's the situation? It's like a steel plate on a gypsum mold, and the gypsum mud overflows after being pressed. This calcified granulation tissue is all around the steel plate attached to the bone."Steel nails for inner six." After taking a look, Zhang Fan said to the nurse. The screw heads of orthopedic steel nails used to be plum blossom and cross.Once the force of this type of screw is not appropriate, the screw head will have a gap, and it will not be able to bite when taken out. That is, orthopedics has an unwritten rule.Who gets the steel plate! With the large number of Tucao doctors in Department of orthopedics, this plum blossom and cross screw also slowly withdrew from the clinic, which is the origin of the legend of the legend of the Department of orthopedics: there is no steel plate that can not make complaints about it, only the steel nails that can not be obtained.After unscrewing the steel nail, Zhang Fan directly grabbed the steel plate with two Alice pliers and pulled it out of the calcified granulation tissue.The instrument nurse looked. Zhang Fan took the steel plate with Alice's forceps, bit his teeth and didn't speak. If other residents or general attending doctors, the little nurse would not be happy for a long time.The operation belongs to the doctor, but the instruments belong to the nurse. And because of the violence of orthopedic doctors, doctors in other departments are very reluctant to use the instruments used by orthopedic doctors.The pliers clamp the bone and steel plate. After clamping it several times, the very brand-new instrument can't be used. It's impossible to sew with a suture needle.Pull out the steel plate Bone knife! " Zhang Fan started to remove the calcified cartilage on the bone surface after passing the bone knife. The bone surface was like inlaid with a bony steel plate.If the density of calcification is relatively high and it is not enough to rely on a bone knife, use a hammer. Like chiseling a stone, remove the calcification from the bone one by one.This operation must be stable and there must be no accidents. Once the hand slides, the kinetic energy of the hammer plus the strength of the doctor's arm can definitely break the patient's bone."Steel! Steel! Steel! " The sound of hammer hitting the bone knife rang in the operating room. And still have a sense of rhythm. You can't knock indiscriminately. The time interval between the last time and the next time should be about the same.Zhang Fan knocked, Zhou Chengfu spread his fingers and pressed the incision. Because of the strong percussion, the blood, bone marrow and fat particles in the wound are like jumping in the wild with Zhang Fan's percussion. Although Zhou Chengfu had covered the wound with his hand, there were still yellow fat particles eloping out with blood.There are scattered fat particles and blood immersed in the list on the operation sheet, which is very like sesame cake, not black sesame, but Yellow Sesame."Scraper! You start taking bones. Don't take too much. Take the periosteum! " Zhang Fan said to Zhou Chengfu. The bone is atrophic. If we don't find a way to connect it, it can't heal again.Bone graft must be cancellous bone with periosteum. Because there are a large number of bone progenitor cells on the periosteum, which can make bones develop and grow, and cancellous bone is like the plug of an old thermos after it is dried. There are a lot of voids inside, rich in various growth factors, which can induce bone growth.There are few places with both periosteum and cancellous bone in human bones, and there are even fewer places that can be intercepted. For example, the iliac spine is a very good bone bank."OK." After Zhou Chengfu promised, he took Xu Xian to the pelvic position. If Zhang Fan's bone smashing knife is violent, taking the bone is called rage.After cutting the skin and pulling away the fat and muscle, Zhou Chengfu began to take out the bone by biting his teeth. When the bone knife was placed on the iliac spine, Zhou Chengfu wore a mask. If he didn't wear a mask, he would look ferocious at this time.The hardness of periosteum and bone cortex is very high. With Zhou Chengfu's percussion, the bound patient's whole body was shaking. It's "bang! Bang! Bang! " The blood is as elegant as flowers. That's not the roughest in orthopedics.The bone was chiseled off by a bone knife. It was not big. It was slightly shorter than green arrow gum. The bone as thick as a matchbox was taken off.After taking out the bones, Zhou Chengfu began to cut them into pieces with scissors. Zhang Fan is using a scraper to clean up the granulation tissue at the broken end. How to describe this? It's like digging a few remaining yogurt cans with a spoon.Calcified granulation tissue shall be chiseled with a bone knife, and white non calcified granulation tissue shall be dug with a scraper. This thing must be cleaned up. If it is not cleaned up, there is still residue at the broken end. If the bone thinks that this place is fleshy, it will not send out new bones."Gauze." After Zhang Fan dug it clean, he began to wipe it with gauze. The removal of granulation tissue must be ensured. After wiping, the broken end of the fracture is as white as a broken Ivory chopstick."Zhang Yuan, look, is it enough?" Zhou Chengfu handed Zhang Fan the bone pieces that had been cut into the size of soybeans."Yes, the estimate is good. It should be enough." Zhang Fan praised Zhou Chengfu. In the past, old Zhou would definitely scoff, but now Zhou Chengfu is happy and his eyes are in a line.Filling, this requires technology. Like a hollow bamboo, when it is broken, it is necessary to fill the soybeans in the middle without spilling them. This is the technology.Students who couldn't play well with building blocks when they were young couldn't do this well. Lao Zhou estimated that there were no building blocks to play when he was young. Finally, he had no choice but to write articles.First put the broken bone with bone cortex and periosteum for priming, then fill the cancellous bone on it bit by bit, and then fill the broken bone with bone cortex and periosteum on the top.It's not good to be loose, because the steel plate has to be drilled with an electric drill. If it's loose, the steel plate hasn't been put on, and the filled bones will collapse long ago.What is a needle in the hole? This is a needle in the hole. After the broken ends are filled, they must be forcibly inserted into their gaps with broken bones with bone cortex. They must be inserted with force.Then, the missing bone is connected. Then put the steel plate. The humerus is not a very round pipe, because four or five holes have been drilled on both sides of the broken end for the first time.The second time you put the steel plate on, you must stay away from these places, or the bone may break when you put the screws on it. Therefore, the original steel plate only five or six centimeters long has become a steel plate of twenty or thirty centimeters. It is like adding a metal protective plate to the humerus.When the steel plate is long, of course the incision will extend. For example, the length of steel plate is 30cm, and the crossing is less, but it also needs 20cm. The place covered by the organization is forcibly opened with a retractor.Just as a person's mouth opens to the maximum, continue to pull it with a metal hook until you see the innermost big teeth.When installing the steel plate, the humerus is slightly curved and slightly triangular. Therefore, the steel plate must find a face that can stick to a better face.After the steel plate was applied, Zhang Fan began to open holes. Although doctors in other departments joke about orthopedics, saying that a good carpenter can do fracture surgery is actually a joke. The carpenter can't do this job.This kind of steel plate is pressurized steel plate. One of the nail holes on the pressure plate is a pressure hole, and a slope is designed in the hole. This hole looks like stretching an ordinary hole. The utility model has the advantages that it can play the role of compression, make the fracture ends close and promote healing. The disadvantage is that the pressure hole is the weakest part of the steel plate and is easy to break.During the doctor's operation, the pressure is not easy to grasp. If the pressure is large, it will lead to slight bone necrosis at the broken end. If the pressure is small, it will not play the role of pressure. Because each patient's constitution is different, it is difficult to grasp this strength in practical work.This strength can't be mastered in a few years. Drill along the pressure hole of the steel plate, and Zhang Fan observes the connected bone while drilling.To tell the truth, if this kind of operation takes a step forward, we must ensure the appropriateness of the original step. If we take a step forward, there will be problems in the original step and we can't get off the operating table.Zhang Fan was very cautious when drilling. Although he personally inserted it, after all, manpower can't compete with the vibration generated by the electric drill, so Zhang Fan is very careful.After opening the hole, start screwing. This is also a technical activity. Apart from others, it is very particular about one angle. The perpendicularity of the screw and the contact surface with the steel plate bone must be vertical.How to make sure, feeling! Yes, it's a very unreliable feeling. If you don't feel it, you'll wait for the sliding wire. There is no problem at all. The screw strength of the upper compression steel plate. Once there is a direction problem in the bite between the screw and the steel plate, the sliding wire will not run away.Put on the steel plate and start flushing and stitching! When the suture was almost finished, Zhang Fan suddenly looked up and said to Zhou Chengfu and Wang Pingshan, "who will take over this patient?"Zhou Chengfu hesitated. Wang Pingshan took a look at Zhang Fan and said directly, "if you don't worry, give it to me!""Good!" Zhang Fan doesn't talk much. Zhou Chengfu next to him suddenly wanted to feel something far away from him.
