Medical road

When you first entered the society, when you wanted to fight with great ambitions, what you encountered was all kinds of procrastination, all kinds of unspoken rules, all kinds of constraints, all kinds of tumult.Then you feel that the industry is hopeless!All people are not as good as you, and the leader is an egg.

Then, after you have been in this industry for four or five years, you will slowly realize the truth behind it.For example, this is the case now, an operation needs to be discussed and discussed, and then two enemies sit together to make a plan.Procrastination? It's very procrastination, but this is indeed a normal way, not for anything else, for one reason: safety.After all, genius is rare!

Lao Gao, Lao Wang, and Zhang Fan sat together in the small meeting room of the Department of Orthopedics.How should I put it, these two people are very strange. In front of everyone, they are considered to be incompatible with fire and water, but when only the three of them are left, the relationship between Lao Gao and Lao Wang is not that bad.At least Lao Gao would actively add water to Lao Wang. Zhang Fan couldn't understand, really couldn't understand what was going on with the two old guys, but he didn't have the mind to gossip.

"Tell me, how did you prepare." Lao Gao said to Zhang Fan.

"I am going to choose a posterior approach. The surgery will make a predictive correction to Bart's lumbar spine from the posterior approach."

"You mean, soft correction?" Old Wang asked.

"Yes!" Zhang Fan replied affirmatively.

Then he said: "Two directors, look at it."

Zhang Fan got up and opened the viewer, putting up all Bart's image checks.Then "Ka" opened the caliper, as if pulling out a dragon knife, clicked on the image on the viewer and said: "The child with scoliosis apical vertebra is a vertebral body. What we need to do is to fuse the upper and lower apical vertebrae. The Cobb angle here is greater than 50°. During the operation, the two upper and lower vertebrae are fused, and then an open intervertebral disc at the end vertebrae does not need to be fused, so that the upper and lower segments can compensate for the excessive correction. The distal vertebrae should be parallel to the sacral vertebrae. When the two are inconsistent, choose the longest segment for fixed fusion.

After fusion of the spine, the balance of the spine is maintained by the unfused movable segments rather than the fusion to maintain future balance.These can be determined by dynamic X-ray images, so in this way, the end vertebrae should be able to move in all directions, the most important is the distal end, that is, the distal intervertebral space should be able to move in the bending direction, and the distal The endplates of the end vertebrae are parallel in the bending image, and the axial surface of the bending direction should reach the neutral position. In the future, it is absolutely guaranteed that Bart will slowly change the deformity."

Speaking of this, let's talk about the spine first.The spine is curved.Especially for slender women, the soft waist is like a willow, which makes people have the desire to hug. This is the credit of the spine. It has a slight S shape as a whole. Generally, the cervical and lumbar spine are the most prone to problems.

The spinal motion in these two places is relatively larger.And especially the lumbar spine, which is directly the backbone of the body, requires both weight-bearing and mobility, so people often have neck pain and back pain.Few people say that the back spine hurts.Once there is soreness or numbness in the waist and legs, it must be taken seriously.Sit less, lose weight, eat less, and exercise more.

What is the shape of the spine?It's like an S-shaped cylinder stacked with chess pieces.There is a latex cushion between the chess pieces and the chess pieces, and this cushion is the lumbar disc.Then, several rubber bands are attached to the front and back of the chess piece from top to bottom to stabilize the pillar of the chess piece. This is the ligament.Moreover, these chess pieces are divided into front and back. The front is bare, with two wings on the side called the transverse process, and the back with a tail called the spinous process.Chess pieces and chess pieces are stacked, and then the tails and tails are laid out one after another like roof tiles.

There is a hole between the chess piece and the tail, which runs through from top to bottom.There is also a smaller hole between the two pairs of wings and the chess piece, which runs through from the top.The hole between the chess piece and the tail is the extension of the brain: the spinal cord.Walking between the wings and the chess pieces is the nerves that are like silk threads from the spinal cord.The human spine is probably such a structure.

The spinal cord is like a water pipe or signal transmission line.The stimuli received by the muscles are fed back to the brain, the brain makes calculations and then feeds back to the muscles, and then the muscles respond.Or the brain directly issues commands to the muscles after calculating.

In fact, this thing is very simple. For example, if you touch a beautiful woman's butt, the muscles on the girl's butt convey this feeling to the brain, eh!Feeling uncomfortable, the brain gave orders, slapped her, and then you were slapped by the beauty.Or, um!Comfortable, the brain gives an order to kiss, and then you are kissed.This information is transmitted through the spinal cord.

When the latex cushion between the chess piece and the chess piece is squeezed by the huge weight or long-term bad posture, it loses the elasticity of retraction, and then it protrudes like a pulpy latex. When the protrusion reaches the spinal cord, this thing Although the upper bone is considered to be pulpy, the upper spinal cord is much harder. It begins to oppress and bully the spinal cord, and the spinal cord starts to make grievances. Then you start to have back pain and leg numbness. This is the so-called lumbar disc herniation.When one or more of the chess pieces are displaced, the lumbar spine is protruding or bulging. This bulging is also a kind of deformity, but it is only a partial.

Spine surgery is considered to be apical surgery in orthopedics, because there are too many things to consider.Ordinary fracture surgery also considers the plane problem, whether the butt is tightly connected, and whether it conforms to the physiological position.The spine is very troublesome, and at least three coordinates must be considered from three directions.

Median, coronal, and sagittal. Median is easy to understand. The coronal is a glass plate, facing in the same direction as the eyes, and then cut directly from the head. This position is the coronal position.The sagittal position means that the bow and arrow are shot into the face to form a face.This thing is really anti-human, and it is very troublesome to explain with words, so such professional words must be explained with pictures, and then rote memorization.For spinal surgery, these three positions must be considered.As long as there is an inappropriate position, sequelae can occur, because it does not conform to the physiological position, which leads to a chain reaction of human stability problems.

Spine deformity, to put it simply, is a column built up with chess pieces, one of which or multiple pieces is placed in the wrong direction, and then the overall shape is changed.Orthopedic surgery is to correct the wrong direction of the chess pieces.But there is another very, very difficult thing. The child's development is growing. After the operation adjusts the deformed position, if the position or orientation does not conform to the future growth trend, then the operation is a complete failure.

The failure of the operation resulted in even more terrifying secondary injuries.Not only does it not improve the symptoms, it may also aggravate the condition, which is such a terrible thing, so once some uncertain factors are added to certain things, the difficulty of things will increase by orders of magnitude.Therefore, Lao Gao and Lao Wang cannot be cautious in this operation.

This treatment in the early years was symptomatic treatment.It is the forced adjustment of the wrong position of the spine. There are many postoperative complications. Because it is forced correction, false joints often appear, deformities recur, and incision trauma is huge.Later, with the development of materials science, various new materials appeared, and doctors slowly conquered this disease.

But this kind of disease is said to be too many, and many orthopedic doctors will never encounter it for a lifetime.Let's say it is less, it accounts for a large proportion of young people, and women make up the majority.And there is no way to quantify this operation.For example, appendix surgery involves the iliac bone reaching the middle and outer thirds of the belly button. Even if the position is strange, the big cut will be bigger and the cecum will be searched a little bit. Sooner or later, it will be found.

But this operation will not work, it must be based on the actual situation.Different doctors have different perceptions of the future growth of patients, and different surgical methods or orthopedic methods. For example, Lao Gao believes that the child will grow to 1.8 meters tall in the future, but Lao Wang believes that the child will grow to three meters tall in the future.This is a matter that there is no way to quantify it directly, so if you don't have a master master to teach you, and you want to perform this kind of surgery, you just think about it.

This type of operation has been performed since 1914.So far, most hospitals still cannot do it, and most spine orthopedics doctors cannot do it.Imagine the difficulty of this kind of surgery.

Zhang Fanyi's very detailed and convincing surgical plan made the two directors nodded involuntarily at the same time.

"Have you ever had this kind of surgery in Jade Bird?" Zhang Fan said too clearly and clearly, Lao Wang had no way to refute, he could only look for other grounds to reassure him, and Lao Gao also paid attention.

"Did it!" There are too many lie, especially this kind of lie, and Zhang Fan feels that he is telling the truth, and he is about to make himself schizophrenic.

"Or ~~" ​​Lao Wang looked at Lao Gao and said uncertainly.

"Director, really, there must be no problem. I definitely did a good job." Zhang Fan had to say in a very positive tone in order to confirm the two people's minds.

"Do!" Lao Gao gave a glance at Zhang Fan and agreed.

"Okay, in that case, let the three of us sign the surgical plan together. I am the director of spine surgery. Let me sign the first name."

"The sick number belongs to our department." Lao Gao said unceremoniously.

Zhang Fan's tears came down at this time.Really, how lucky he is to meet such a good teacher and protect his teacher so much.The number one here is not an honor or an interest.If the operation is done, it should be done. If it is not done well, then you have to be responsible, and you have to take the main responsibility.

"I signed the first one." Zhang Fan was crying.

"Haha!" The two old men looked at him at the same time and sneered!Naked look down!