Medical road

The three major complications of fractures are infection, osteofascial syndrome, and nonunion.One is more terrible than the other, the first two are recent complications, and the latter are long-term complications.If you do not follow up after the operation, the situation will be serious until symptoms appear.

In the early morning orthopedic operating room, Zhang Fan frowned as he looked at the X-rays of the patient's examination. It was not that the operation was difficult, but that he couldn't feel the transparency of a liver tumor.

Orthopedics is the first subject Zhang Fan has contact with, and he has undergone many liver operations. Although the operations are becoming more and more skilled, there is always no sense of transparency, as if something is missing.

"What's the reason? Is it because the operation has been done less or the operation is not difficult enough?" Zhang Fan's brows were bulging, and other people did not dare to disturb him.

In fact, this matter is very simple.Where there is oppression, there will be resistance, as long as it is not overwhelmed, it will definitely sublimate and break through.Liver tumor surgery, although not the most difficult operation, is not easy.

The risk of surgery for huge liver tumors is even greater.Zhang Fan is cheering to use knowledge and thinking.

Suddenly, the liver's knowledge was forcibly broken through.On the contrary, it is a simple orthopedic surgery. The more you do it, the more skilled you become. It has become a habit, and breakthroughs are impossible.

"Zhang Yuan, the anesthesia is ready. We are all ready." Zhou Chengfu gently reminded Zhang Fan who was in a daze.

"Oh, okay. Let's start." Zhang Fan felt as if he had just woke up, let go of his thoughts, and concentrated on starting the operation.So far, the medical profession has not unified the definition of nonunion.

Zhang Fan believes that within three months, if the fracture end fails to heal without intervention treatment, it should be called nonunion.Zhou XX was diabetic, and Chen Qi wanted to make the surgical X-films more attractive, so he stripped too much soft tissue.

In addition, the patient smoked, drank alcohol, and did not have the right amount of strength exercise, which eventually led to nonunion. At this time, his humerus fractured at the middle end had shrunk, forming a large amount of granulation.

The human body is so strange. If normal tissue cannot grow in a normal place, abnormal tissue will grow.If it is discovered a few months later, the atrophy will increase because of the apraxia of bones.

Pseudo joints will appear in a short time. A normal arm has only one elbow joint. Because of the pseudo joint at the broken end, his arm becomes a three-section stick.

If the time is longer, it will be like an infection, and the original normal bone will begin to shrink, and the final outcome can only be to shorten the arm.Then it became one arm long and one short arm, leaving the body with an unchangeable disability.

There are many ways to treat nonunion. There are extended steel plates. After the original five or six cm steel plates are removed, the broken ends are corrected, bone grafted, and then longer plates are placed to strengthen the stability of the fracture and allow it to recover.

The other is intramedullary nail fixation, which is fixed by placing the intramedullary nail directly from both ends of the long bone.

There is also external fixation.Just like building a building, outside the fracture, a steel frame is set up for fixation.

Because Zhou XX's fractured end is currently not shrinking too far, Zhang Fan plans to use an extended steel plate to fix it.Each of the three fixing methods has its own advantages, there is no best, only the most suitable.

After the incision, Zhang Fan continued to insert the knife into the original incision. There is no way to talk about the hierarchical structure of this kind of secondary operation. Because of the operation, the adhesion around the incision is severe.

Zhang Fan entered while observing the two assistants.The two of them cooperated with Zhang Fan, and they were quite skilled.After the incision was opened, the black silk thread that had not been absorbed continuously appeared, long and short.

Although this kind of thread can be absorbed, if it is found, it should be removed as much as possible. After all, the end of the thread is considered a foreign object.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 country's technology was poor and the silk thread materials used were not enough. After 30 years of appendix surgery, a person could still grow a black thread on a certain part of the body.

Opening the muscle, the steel plate has been enveloped by the hyperplastic granulation tissue.What is the situation? It is like putting a steel plate on a plaster mold, and the plaster mud overflows after being pressed.This calcified granulation tissue surrounds the steel plate attached to the bone.

"The steel nails in the inner six." Zhang Fan said to the nurse after taking a look.The screw heads of orthopedic steel nails used to have plum blossoms and crosses.

Once this type of screw is uncomfortable, there will be a gap in the screw head, and there is no way to bite when it is taken out.That is, there is an unwritten rule in orthopedics.

Whoever gets the steel plate!With a lot of complaints from orthopedic doctors, this kind of plum blossom and cross screw slowly withdrew from the clinic. This is the origin of the orthopedic legend: there is no inaccessible steel plate, only inaccessible steel nails.

Unscrewing the steel nails, Zhang Fan directly bit the steel plate with two Alice forceps and pulled it hard, and the steel plate was pulled out from the calcified granulation tissue.

The instrument nurse looked at Zhang Fan holding Alice's forceps to take the steel plate, gritted his teeth and said nothing.If this were other resident doctors or general attendants, the young nurse would have been unhappy.

The operation is under the control of the doctor, but the equipment is under the control of the nurse.And because of the violence of orthopedic surgeons, doctors in other departments are very reluctant to use instruments used by orthopedic surgeons.

The pliers clamped the bone and the steel plate. After several times of clamping, the very new-looking instruments were no longer available, and there was no way to force sutures with a suture needle.

Pull out the steel plate."Bone knife!" Zhang Fan started to remove the calcified cartilage tissue on the surface of the bone, as if it was inlaid with a bony steel plate.

If the density of calcification is relatively high, bone knife is not enough, just use the hammer.Just like chiseling a rock, remove the calcification from the bone one by one.

This kind of operation must be stable, and there must be no accidents.Once the hand slips, the kinetic energy of the hammer supports the strength of the doctor's arm, which can definitely break the patient's bones.

"Steel! Steel! Steel!" The sound of the hammer hitting the bone knife rang in the operating room.And you still have to have a sense of rhythm, don't knock randomly, the time interval between the previous and the next is similar.

Zhang Fan knocked, Zhou Chengfu stretched his fingers apart and pressed the incision.Because of the vigorous percussion, the blood, bone marrow, and fat particles in the wound, following Zhang Fan’s percussion, were like jumping in the wild.Although Zhou Chengfu had covered the wound with his hands, there were still yellow fat particles eloped with blood.

The surgical drape is scattered with fat particles and blood immersed in the drape. It looks like a sesame cake, not black sesame seeds, but yellow sesame seeds.

"Curette! You start to take the bone, don't take too much. Bring the periosteum!" Zhang Fan said to Zhou Chengfu.The bone has shrunk. If you don't want to connect it, it will not be able to heal again.

The bone graft must be cancellous bone with periosteum.Because there are a large number of bone progenitor cells on the periosteum, this cell allows bones to develop and grow, while cancellous bone is just like the stopper of an old-fashioned thermos after it has dried.There are a lot of voids inside, rich in various growth factors, which can induce bone growth.

There are not many places where there is periosteum and cancellous bone in human bones, and there are not many places that can be intercepted.For example, the iliac spine is a very good bone bank.

"Okay." After Zhou Chengfu agreed, he moved to the pelvic position with Xu Xian.If Zhang Fan's smashing a bone knife is considered violent, then taking the bone directly is called violent.

After cutting open the skin and pulling away the fat and muscles, Zhou Chengfu gritted his teeth and began to take the bones.The bone knife was placed on the iliac spine, and Zhou Chengfu was wearing a mask. If he didn't wear a mask, he would definitely look hideous at this time.

The hardness of the periosteum and bone cortex is very high.Following Zhou Chengfu's percussion, the whole body of the tied patient was shaking.It just means "! ! !" The blood was scattered like a flower.This is not the most rude in orthopedics.

A piece of bone was chiseled off by a bone knife, not too big, slightly shorter than the green arrow gum, and a bone as thick as a matchbox was removed.

After removing the bones, Zhou Chengfu began to cut into pieces with scissors.Zhang Fan is using a spatula to clean up the broken granulation tissue. How do you describe this thing? It's like digging a small yogurt jar with a spoon.

The calcified granulation tissue is chiseled with a bone knife, and the white granulation tissue that has not been calcified is dug with a curette. This must be cleaned up.If it is not cleaned up, there are still residues at the broken end, and the bones think that the place is fleshy, and there will be no new bones.

"Gauze." After Zhang Fan dug clean, he started to wipe with gauze.It is necessary to ensure the removal of granulation tissue.After wiping, the fractured ends at this time are as white as broken ivory chopsticks.

"Zhang Yuan, look, if it's 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. If before, Lao Zhou would definitely sneer, but now, Zhou Chengfu is happy and his eyes are in line.

Filling, this requires technology.Just like when a hollow bamboo is broken, the soybeans must be filled in the middle, but not spilled. This is the technique.

Classmates who didn't play well with building blocks when they were young couldn't do it well. Lao Zhou estimated that there were no building blocks to play with when he was a child, and in the end he had no choice but to write articles.

First put the broken bone with cortical periosteum as the base, then fill the cancellous bone little by little, and then fill the broken bone with cortical and periosteum on the top.

Looseness is not good, because the steel plate needs to be opened with an electric drill. If it is loose, the steel plate is not installed, and the filled bones have long collapsed.

What is a cracked needle? This is a cracked needle.After the broken ends are filled, broken bones with cortical bones are used to force them into the gaps, and they must be inserted forcefully.

Then, even the missing bones are connected.Then put the steel plate.The humerus is a pipe that is not very round, because the first time the steel plate is applied, four or five holes have been drilled on both sides of the broken end.

The second time the steel plate must be placed away from these places, otherwise the bone may be broken when the screw is installed, so the original steel plate of only five or six centimeters long has become a steel plate of twenty or thirty centimeters.It is attached to the humerus like a metal protective plate.

As the steel plate becomes longer, of course the cut will extend.For example, the length of the steel plate is 30 cm, although the crossing is less than 20 cm.The area covered by the organization is forced to open with a hook.

Just like a person's mouth is opened to the maximum, continue to use the metal hook, pull it vigorously, until you see the innermost teeth exposed.

Install the steel plate, the humerus is slightly curved, slightly triangular.Therefore, the steel plate must find a surface that can fit better.

After the steel plate was attached, Zhang Fan began to make holes.Although doctors in other departments laugh at orthopedics, saying that a good carpenter can do fracture surgery is actually a joke.The carpenter really can't do this job.

With holes, this steel plate is a pressurized steel plate.One of the nail holes on the pressure plate is a pressure hole. The hole is designed with a slope. This hole looks like an ordinary hole is elongated.The advantage is that it can play a role in compression, make the fracture ends close together, 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 of the pressure is also very difficult to grasp. If the pressure is too high, it will cause slight osteonecrosis of the broken end. If the pressure is small, it will not work, and the pressure will not work.Because each patient's physique is different, in actual work, this strength is difficult to grasp.

With this strength, I can't master it in a few years.Drilling along the compression hole of the steel plate, Zhang Fan observed the connected bone while drilling.

To be honest, for this kind of surgery, one step forward must ensure the suitability of the original step. If it takes one step forward, the original step has problems, and if it fails, there is no way to get off the operating table.

When Zhang Fan drilled holes, he was very cautious.Although he personally inserted it with force, the manpower cannot 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 job, not to mention other things, just one angle is very particular, the verticality of the screw must be guaranteed, and the contact surface with the steel plate must be vertical.

How to be sure, feel!Yes, it's a very unreliable feeling. If you don't feel it, just wait for the silk.There is no problem at all. The screw strength of the upper pressurized steel plate, once the direction of the screw and the steel plate occludes problems, the slipping wire cannot escape.

Put on the steel plate, start washing and sewing!When the stitching was almost finished, Zhang Fan suddenly raised his head and said to Zhou Chengfu and Wang Pingshan: "Which of you two will take over this sick number?"

Zhou Chengfu hesitated, Wang Pingshan glanced at Zhang Fan and said directly, "If you don't worry, just leave it to me!"

"Good!" Zhang Fan didn't say much.Zhou Chengfu next to him suddenly wanted to feel that something was moving away from him.