Medical road

Zhang Fan slept really solidly. It is estimated that he slept more than a little at noon, and he did not even have time to fall asleep. Zhang Fan went into deep sleep. He slept until more than 8 o'clock in the evening. After getting up, Zhang Fan was dizzy. .How do you say this? First of all, the amount of surgery is a bit too much, and the partners are the little girl and the troubled Xue Fei.

Almost all Zhang Fan did it alone, such as steel plate orthopedics, jointing bone pieces, electric drill openings, and screwing. It really sounds like a carpenter is making furniture. The amount of labor is really not small, and he can't move around freely, which consumes a lot of money. .Second, the hospital canteen is to blame. The lunch at noon and the lunch at night are directly boiled cabbage in white water, stewed potatoes in white water, not to mention meat, there is not much oil, it is really a healthy diet in this era.

But for Zhang Fan and the others, they can’t do physical work. This kind of diet with no fat and no protein consumes all two steel plate orthopedics. If there is a high-quality diet, Zhang Fan will not be so tired, and the system can The dean can change the energy quickly, but one of my mother’s cafeteria owners can’t change it. It’s also a wonderful thing!

Zhang Fan shook his head, after feeling a little better, he got up and went out.Looking at it, the old couple and Shao Hua were like puppets, sitting on the sofa without talking or watching TV. They sat blankly."Why didn't you watch TV!" Zhang Fan asked before going to the bathroom.

"Shao Hua is afraid of quarreling you!" The old man pouted, not happy or unhappy, just like a child complaining.After Shao Hua called, the old couple wandered around the community all afternoon with the food they got from the farm, and finally Shao Hua got off work.

When he got home, the old man said that he watched the news and kept his voice down. Shao Hua disagreed.It's not that Shao Hua is unreasonable. Today Zhang Fan's state really makes Shao Hua distressed, so he directly rejected his father's request.When Zhang Fan got up, the father sued.

Zhang Fan cleaned up for a while and went out of the bathroom. He smiled and said to the old couple: "Today I was a little tired. I couldn't hear anything when I fell asleep. From now on, I will go to bed after the night shift. What should you do? Even singing at home is noisy. Not mine."

"If you don’t watch TV, you won’t lose a piece of meat. It’s okay if you don’t have a good rest. You are doing a life-threatening thing. You must not be careless. Let’s eat first and be hungry. Today is a large plate of chicken and noodles. Favorite belt noodles. Chicken, the taste is good!" The old lady said after taking a look at the old man.

"Really, I said how it smells so fragrant. Oh! Someone gave me two bottles of Moutai, and my uncle will give me a taste to see if it's true!"

"Hey! Moderately special, he can taste the true and the false." The old lady said before leaving. The old man's best skills were contemptuous and almost dizzy.

"Why can't I taste it anymore, I tell you, I have drunk more wine than you have ever seen." The old man wanted to chase and quarrel.Zhang Fan hurriedly took out the wine that the medical representative had sent during the dinner in the department a few days ago, "Uncle, you can see, this packaging is okay!"

Old kids, old kids, just like that when you get old, you have to coax.The old man held the wine in a serious manner, and looked at it for several times, "Well! It shouldn't be a big problem!"

"Puff!" Shao Hua almost laughed. Zhang Fan gave Shao Hua a blank look. Shao Hua covered his mouth, stood up with a smile, and said to the kitchen: "Mom, get some fur teeth too!" Then he hurried to the kitchen. The mother and daughter secretly laughed in the kitchen.

"Hair is long and knowledge is short." After the old man said, he said to Zhang Fan, "You have a great future, you can't make mistakes for this thing. In fact, everything I drink is the same. As long as you are healthy, healthy and safe, I It’s better than drinking anything."

"Well, rest assured, it's okay."

"Okay, it's okay, just go and eat. Today is a local chicken. I bought it at the farm. The young chicken is less than a year old. It's very tender." The old man didn't say much, just mention it.The Shao Hua family's taste is a little bit Jiangsu and Zhejiang, and the food is sweeter.Even poached eggs are sweet, sweetened.But Zhang Fan from the Northwest couldn't eat this sweet.

Once Shao Hua’s mother made sweet poached eggs, Zhang Fan ate like medicine. Since then, the family has hardly eaten sweets, and pasta accounts for most of them.The two old people really took care of Zhang Fan in every possible way.At the beginning of Hua Deng, the family sat together and had a lively meal of chicken and noodles.Zhang Fan was really hungry. A plate of chicken with potatoes and noodles did not eat more than half of what Zhang Fan ate.

After eating and drinking, Zhang Fan and Shao Hua took a walk on the side of the road.This night market in the border area is very distinctive. In winter, haggis and mutton soup are the mainstream. A warm bowl can drive away the cold from the whole body.When the weather is a little hot, roast lamb will be the mainstream, as well as lamb's head, tendons, and hot and sour lamb tripe with cold sauce. The smell will tell you that it is quite good.Their craftsmanship is really good, and the cold lamb is very tasty.

Although there are many ethnic groups in frontier tea, but this kind of night market is almost always a stall, people really have a set of catering.Sanchuan people’s meals are good enough, but in the frontier, that is, they are divided into two parts.Definitely unlike other provinces, Sanchuan hot pot can directly destroy the local catering industry.

Early in the morning, after Zhang Fan got up, the old lady had prepared Zhang Fan’s breakfast and put it on the table. Although the old man was very kind to the old lady, the two of them had good feelings, had heavy things, and had a little physical work. Will make the old lady dry.But in this kitchen, he never interfered. After Zhang Fan came, he would not let Zhang Fan interfere. Shao Hua would not object. His words are: a big man who always walks in the kitchen will smooth out his fighting spirit!Zhang Fan can only respect the opinions of the elderly!

There is an operation today, and it is still a relatively important operation, so Zhang Fan greeted the old lady in advance last night. He didn’t drink milk, soy products and pickles. Zhang Fan was afraid of diarrhea. This is the detail. No matter how small is a matter of life, nothing can be overstated.Zhang Fan drank some porridge, ate an egg, and went to work after eating a little steamed bread.

In the department, the doctors also came early.Xue Fei didn’t go to play mahjong last night, so Zhang Fan dragged him into a dog. He went home and fell asleep. He didn’t eat dinner and stayed asleep until dawn. His wife would be happy. If this happens for half a year, It is estimated that Xue Fei's mahjong can be given up!

The only difficulty in this operation is to determine whether the fracture ends are connected to the physiological position.There are not many people doing this kind of surgery now. The specific reason is hard to say. There are not many people anyway.The mainstream is still to cut and fix it. This is just a rush. Lao Gao is willing to carry out this operation method. It is estimated that this will be fine if the director is changed.

Blind typing, the feeling under the hand is very important. This feeling is not to boast, it is true. When the fracture line is well aligned, the experienced doctor will feel it, but this experience is extremely difficult and difficult. There are so many patients for you to practice hands.Even if there are patients who are willing to let you practice hands, the director of the department and other doctors are not willing, anyway, it is profit.

There is a difference between the anatomical position and the physiological position of the fracture. The biggest advantage of the incision and internal fixation is that it can achieve the anatomical position, which means that it can be tightly closed, just like no fracture. This is for the fracture end.But the damage was also quite huge, almost all of the periosteum around the broken end was destroyed.

The physiological position means that although it cannot be the same as the original one, it does not affect the function and has no deformity.

The ancestors of orthopedics in China are very good in this aspect. These doctors have been able to reduce most fractures with bare hands hundreds or even thousands of years, and then achieve physiological Anatomical position, but now that the more advanced technology, this kind of technique is becoming less and less common, where is it?Who wants to know!

The patient has been sent to the operating room. After the morning meeting, Lao Gao took a group of orthopedic doctors and walked to the operating room in an orderly manner.Of course, Zhang Fan was at the end of the team at this time. There was nothing he could do. He had no hair on his mouth and no title on his head.

There are a lot of people who know about the three orthopedics departments.The motivated, curious, and crowded are all very concerned. There are all kinds of people with all kinds of mentalities. However, the operating room is the operating room. Only a few surgeons can enter, plus one or two observation doctors at most. If there are too many people, it is impossible to achieve a sterile environment.

But this problem is not big. The operating room of the city hospital is divided into three floors, and there is an electronic classroom on the bottom floor where you can watch the operation process."Director, let me go up and help lift a leg and kill the poison!" When I was about to enter the operating room, Xu Xian hurriedly found Lao Gao. This is a motivated person. Otherwise, a dignified graduate student would have no face!

Lao Gao looked at Xu Xian, and Xu Xian looked at the director with a clear and clear gaze."Okay, you also go to the stage, Sansuke. Go and change your hand washing clothes." Xu Xian hurriedly entered the locker room when he heard it.To be honest, he had never heard of this kind of surgery before, and all the cases were on the teaching materials.

This operation is simple to say, and it looks very simple. It looks difficult without incision and internal fixation, but this operation is too particular about the feel and consciousness.A slight deviation is a thousand miles away, because the skin and soft tissues at the broken end will not be cut open, and everything can't be seen directly. It's difficult!

In the operating room, anesthesiologists, itinerant nurses, and surgical nurses are all ready, waiting for the doctors to enter.In the audio-visual classroom, almost all the orthopedic doctors came. Although Zhang Fan did not notify the second and third departments of orthopedics, but Zhang Fan wanted to beat blindly, almost all of them came, and even the medical office sent people.Although they don't understand the difficulty of this operation, as long as the operation is successful, a cluster of articles will appear in the hospital newspaper immediately.

Although Lao Gao said at the morning meeting that he was taking Zhang Fan for the operation, Zhang Fan was the chief surgeon.Two Zheng Gao, Lao Gao and Lao Chen, and two inpatient doctors, Zhang Fan and Xu Xian.After the anesthetist finished the anesthesia, he said to several doctors: "Start." Xu Xianlisuo brushed his hands and began to disinfect.Before the operation, Zhang Fan went through the X-film carefully one last time. Although the X-film was already engraved in his mind, Zhang Fan still watched it carefully.

Lao Gao and Lao Chen stood aside, silently not talking.There are too few places they can help with this operation, and Lao Gao is also prepared. Once the blind beat fails, he will immediately cut the internal fixation.Washing hands and putting on surgical gowns, "It's okay, don't stress, it's okay to cut the internal fixation, it's nothing." Zhang Fan put on his clothes, put on gloves, and picked up the sharp knife, Lao Gao said.

"Yeah!" Zhang Fan is not good at this. Once he has surgery, he can't speak without speaking, and he doesn't like other people talking. Therefore, as long as Zhang Fan performs surgery, the pressure in the operating room is quite low. Itinerant nurses dare not speak, this is a matter of personal temperament.

"Start." After Zhang Fan said, he was ready to cut the skin.What is the operation like? Let’s probably say that the femur is a human thigh, and then the thigh is broken in the middle, and the broken end is not much displaced.Zhang Fan will now open a small opening on the upper end of the femur, then use an electric drill to open the bone, and insert a long alloy rod from this opening. This alloy rod has two holes on the lower end and two holes on the upper end. , These are holes for screws.After the fixation is done and the broken ends are well aligned, then tighten these four screws, OK the fracture is fixed, and the operation is over.

It's that simple. Eighty to ninety percent of orthopedic surgeons can't perform simple operations.Don't talk about blind punching, just cut it and fix it. If the doctor is a little bit lower, it won't even be able to find the screw holes of this alloy!Zhang Fan opened a small opening and used an electrosurgical knife to stop the bleeding. When there was no electrosurgical knife before, he used silk thread to ligate.

Zhang Fan led the sword, Lao Gao took the suction device and smoked, Lao Chen gently opened the skin with the small hook, Xu Xian was okay now, so she stood and watched.Electric knife is actually very simple, just like an electric soldering iron.The human body has evolved too well, and there are almost no large blood vessels in the superficial layer.When the skin and dermis were cut, the bleeding was not obvious. Only when the fat layer and muscle layer were reached, there were bigger capillary capillaries.The electric knife is directly electrocoagulated, nourish!Nourish!No more bleeding.

The more you have to do the surgery, the more you suffer, especially when you use an electric knife, the blood vessels are scalded, and the fat will smoke instantly. Although you wear a mask, the smell of barbecue comes directly. Really When you are hungry, you can smell this smell, and your saliva can come down.

"Electric drill." Zhang Fan said after opening a small opening in the skin, separating the muscle and fascia layer with bare hands, stopping the bleeding, and exposing the bone.The operating nurse stood aside and installed the electric drill early. After the commissioning was completed, the electric drill was calmly handed over to Zhang Fan.

"Squeak! Squeak! Squeak!" The hard bones were like tofu, unscrewing a mouth.Everyone has eaten bones, especially large bones. They contain marrow and red soft bones like honeycombs.When the electric drill is turned on, how do the bones say, like coffee with milk, the white bone meal, the dark red bloody milky white marrow are stirred together, and then quickly mixed, and finally it becomes a little whitish milk. Same as soup.

The early method of this kind of surgery is very cruel. When there is no electric drill or electric drill is not popular, this kind of operation is like a meat stall, bone chisel, bone hammer, bang!!Klang, smashed the bone abruptly.In addition, the early intramedullary fixation was very troublesome. The femur was not a smooth cavity. It contained spirals and various trabeculae. This shape made the femur very hard and could also make blood.

Therefore, when fixing, you must first use a small reamer, insert it into the femoral cavity, and smash it in with a hammer. How strong is this? If you stand behind the operating table, you can see the patient’s number, which is tied. The patient's whole body was shaken!

The reamer is very similar to any triangular bayonet, but it is not sharp, but very thick.Small size, medium size, and large size. The bone marrow cavity is opened up in a single step, and it expands smoothly. You can imagine the way you eat bone marrow with chopsticks. In fact, the principle is similar, but the chopsticks cannot make the cavity larger. That's it, the power to insert the chopsticks is just a little bit smaller, and there is no more than a hammer to hit the head of the chopsticks!

When the hammer hits the reamer.Smash it, the blood is carrying bone marrow, and white and red blood spots are splashing everywhere.At this time, if blood flies into the doctor's eyes, and the patient has a blood-borne disease, it is very troublesome!With the development of science and technology, there are now instruments that do not require reaming, which also makes this kind of surgery elegant.

Opening the medullary cavity, Zhang Fan gently inserted the intramedullary nail and slowly descended.In this operation, whether blind typing or blind typing, the length must be calculated by comparing the X-rays. It cannot be long or short.Slowly descend, "The lower end of the femur is externally rotated ten degrees." Zhang Fan held the intramedullary nail with one hand and the upper end of the femur with the other, and said to Lao Gao and Lao Chen.

Orthopedics, a good orthopedic surgeon must have a strong sense of three-dimensional space and a good knowledge of geometry. Back then, when Lu was unable to paint, he was not able to do geometry. When he painted a blood vessel, he made his head bigger. He was persuaded before he learned the bones. Return.

The various angles of orthopedics are really hard to grasp.Don't talk about the operating table. Ordinary people have two chopsticks crossed. You don't need a measuring tool to put it at a ten-degree angle. It is estimated that not many people can put it out, not to mention this situation where you can't look directly.

"Stop! Internal rotation twice with pull-down, slightly pull-down." Zhang Fan commanded the assistant to reset. At this time, if the assistant is not good, Zhang Fan can't get it alone, so the team, the surgical team is very important.Lao Gao and Lao Chen slowly rotated, Xu Xian grabbed his calf and slowly pulled down.

The reason for pulling down is to slightly separate the broken ends of the fracture. The force cannot be too big or too small, or it may be pulled and displaced.Too small to allow the broken ends to separate.Zhang Fan held the inner medullary nail and gently touched the broken end, just like his hand, the changes at the broken end were clearly presented in his mind.

This is the feeling, this is the feeling of practice makes perfect.Lao Gao hasn't felt this way for a lifetime. One can imagine how much Zhang Fan has!I don’t know how many operations have been done in the system."Crack!" A slight vibration came, and this was the sound of bone stubble resetting.

"Okay, don't move, keep this position now." The fracture reduction changes during the movement, because it is an oblique fracture, there is an angle when the reduction, and at this time the patient's affected lower limb is suspended, that is, an old lady, thigh not heavy.If you are a big fat man, this posture can keep the three assistants until the muscles are sore.

This maintenance is not simply a matter of lifting it up. It is necessary to maintain a fixed position.It is also necessary for the three people to have a slight holding force together. Simply put, if the chopsticks are broken, you have to tie them up, do you have to align them, and then use a force to hold them together to tie them together, a reason.

And this requires the cooperation of three people, directed by Zhang Fan, five minutes, ten minutes, and twenty minutes.Keeping a fixed position and continuously outputting a steady force is really too laborious.Although it is an old man, a lower limb is also a bit weighty.

Zhang Fan inserted, slanted slightly, and slowly slid down, avoiding the broken end, and slowly sticking to the bone, without being impatient at all. This is not something that can be impatient.The sweat of Lao Gao and Lao Chen Dou Da has appeared.During the tour, the head nurse sent another one from the original tour and gently wiped the two old doctors.

"Director, would you like to lower the temperature of the air conditioner." The head nurse came in and asked the two old men sweating.

"No! No, no matter how low it is, patient, catch a cold!" It is inconvenient for Lao Gao to speak continuously. He is afraid that continuous speaking will cause vibrations, which will cause the displacement of the reduced fracture.

Entering, Zhang Fan turned the knob and said, "Reset. Knife!" The surgical nurse immediately turned the handle of the knife to Zhang Fan and the blade to herself, and handed it to Zhang Fan.Zhang Fan took a knife to cut open, then made a hole, ready to install the screw.There is also a difficult point here, let alone blind punching, sometimes, under the condition of incision and direct vision, doctors with inadequate skills can't even find this screw hole.

"I have made a hole, and I must keep it well." Zhang Fan said to the three assistants with the electric drill.

"Good!" Xu Xian said.

Lao Gao and Lao Chen nodded.

Open the hole, "click!" Zhang Fan's positioning is too awesome. After drilling the bone, it is the screw hole directly without adjusting the position. This is the awesome feel and the awesome technology.Xu Xian looked dumbfounded. He estimated that Zhang Fan had to adjust and still find a position. After all, this was a blind hitting, even if it was not a blind hitting, he hadn't seen many successes in this positioning at one time.

Put the screws on, "OK. Director, that's all right!" After Zhang Fan finished speaking, he had already started washing and was ready to sew.Lao Gao secretly rubbed his sore and numb hands, and said to Zhang Fan, "Would you like to see under the C-arm?"

"That is, don't worry, it should be okay, but let's take a look and rest assured." Old Chen also said.This is Zhang Fan. If it is another resident, it is straightforward: Push the C-arm!As for Zhang Fan, the two of them were discussing.

In the audio-visual room, a group of orthopedic doctors looked at the water in the mist. The operation was originally nothing to see. The cut was only two small cuts, and the whole process was done by the surgeon's feel and feel.But Zhang Fan, who was so immortal, was like a dumb man after undergoing the operation. If he could not speak, he would not speak.Zhang Fan didn't explain his feelings, only the other three doctors on the operating table felt a little bit.

But the doctor in the TV room was entangled, "This is over, and Zhang Fan too, don't talk about how to fix it, how to confirm it, hey! I watched it in vain, like a pantomime, left, and wrote medical records. "

"Hey, wait, look at the result of the C-arm!"

"Look at me, are you ready to sew up without seeing Zhang Fan! Even if you see the result, you will do it? Really, let's go!" A group of doctors left with a sense of feeling.

It's not that Zhang Fan didn't say anything. Sometimes, this feeling, especially this mysterious and mysterious hand, really can't be expressed in words, but I can only understand it!

The little nurse pushed the C-arm over, and the doctors and nurses all stood behind the stereotypes next door to observe.Gently tap, OK, the fracture ends on the monitor are aligned very well.

"Niu! The angle is too powerful." Old Chen said to Zhang Fan with his thumb up.

"Teacher Zhang, how did you judge it? At that time, how did you judge that you need to rotate ten degrees?" Xu Xian started asking for advice after being shocked. This is a learning mentality.

"Yes, tell me." Old Gao also said.

"Well, this, feel it. If you look at the original X-film, although it has a slightly larger angle, the internal rotation of the muscles corrects this angle a bit after being rotated downwards, and you look at the old man’s The muscle strength has been relaxed, so this angle should be around ten to twelve degrees. When I used a probe to probe, I felt that it was at this point. These two points are together!" Zhang Fan pointed out Said with the original film.

"Uh!" Xu Xian was all sweating down, and I could feel it.When Xu Xian opened his mouth to talk, the anesthesiologist said, "Hey! Why are you talking now? I can't sew, I can tell you that the old lady will wake up soon."

"Haha, go on and say, let's sew up. Old Chen is going, let's have the operation, let this kid be instructed for a long time, his hands are sore, and the rest is left to them!"

"That's right, let's take a break. Doctor Xu, go down, too, and I'll do the rest." Zhang Fan said.

"It's okay, it's okay, go down and rest, and leave the rest to me."

Can Zhang Fan go down?No, so Xu Xian didn't even get sutures.Xu Xiandu got the needle holder and was about to sew, but Zhang Fan snatched it, "This incision, when I cut it seems to have cut a small blood vessel, I sew it, you don't know the place!"

"Why is this thing so unique? You can't even stitch it up. Besides, your sister, what blood vessels are there!" Xu Xian looked cute!

The operation is over!