Chapter 320

When you first enter the society, you want to struggle with great ambition. When you want to fight, you encounter all kinds of procrastination, all kinds of hidden rules, all kinds of constraints and all kinds of strife. Then you think the industry is hopeless! All people are inferior to you. Leadership is an egg.

Then wait for you to stay in this industry for four or five years, and then you will slowly realize the truth contained in it. For example, this is the case now. An operation should be discussed and discussed, and then two friends should sit together and make a plan. Procrastination? It's very procrastination, but it's really a conventional way. There's only one reason: safety. After all, genius is rare!

Lao Gao, Lao Wang and Zhang Fan sat together in the small conference room of the first Department of orthopedics. How to say, these two people are very strange. In front of the public, they are incompatible, but when there are only three of them, the relationship between Lao Gao and Lao Wang seems not so bad. At least Lao Gao will take the initiative to add water to Lao Wang. Zhang fan can't understand. He really can't understand what's going on between the two old guys, but he doesn't have the mind to gossip.

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

"I'm going to choose the posterior approach to perform a predictive correction of Bart's lumbar spine from the posterior approach."

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

"Yes!" Zhang Fan replied positively.

Then he said, "look, two directors."

Zhang Fan gets up, opens the film viewer and puts all Bart's image examinations on it. Then "card" opened the caliper, pulled out the Dragon butcher's knife, pointed to the image on the film viewer and said: "the scoliosis parietal vertebra of the child is the vertebral body. What we need to do is to fuse the upper and lower vertebral bodies of the parietal vertebra. The Cobb angle here is greater than 50 °. During the operation, the two upper and lower vertebral bodies are fused, and then an open intervertebral disc at the end vertebra does not need to be fused, The distal vertebral body should be parallel to the sacral vertebral body. When the two are inconsistent, the longest segment should be selected for fixation and fusion.

After spinal fusion, the balance of the spine is maintained by the non fused movable segments rather than by the fusion site. These can be determined by the dynamic X-ray image, 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, the distal vertebral endplate should be parallel in the bending image, and the axial plane in the bending direction should reach the neutral position, so it is absolutely guaranteed that Bart will slowly change the deformity in the future. "

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

The spinal activity of these two places is relatively large. And especially the lumbar spine, which is directly the pillar of the body, should not only bear weight but also have mobility, so people often have neck pain and low back pain. Few people say back and spine pain. Once there is pain or numbness in the waist and legs, we must pay attention to it. Sit less, lose weight, eat less and exercise more.

What is the shape of the spine? Let's make an image analogy. It is like an S-shaped column stacked with chess pieces. There is a latex cushion between the chess pieces, which is the lumbar intervertebral disc. Then, several rubber bands from top to bottom are attached to the front, back, left and right of the chess piece to stabilize the chess piece column, which is the ligament. And these pieces are divided into front and back. The front is bare, with two wings on the side called transverse process, and a tail called spinous process on the back. The pieces and pieces are stacked, and then the tail and tail are listed layer by layer like roof tiles.

There is a hole between the pawn and the tail, running from top to bottom. There is also a small hole between the two pairs of wings and the chess pieces. The hole between the pawn and the tail is an extension of the brain: the spinal cord. Between the wings and the chess pieces, there are nerves like silk thread from the spinal cord. The human spine is probably such a structure.

The spinal cord is like a water pipe, or a signal transmission line. The stimulation received by the muscle is fed back to the brain. After the brain makes calculations, it is fed back to the muscle, and then the muscle reacts. Or the brain directly gives orders to the muscles to make movements after calculation.

In fact, this thing is very simple. For example, you touch the ass of a beautiful woman, and the muscles on the girl's ass transmit this feeling to the brain, huh! Uncomfortable, the brain orders, fan ya, and then you are slapped by a beautiful woman. Or, uh! Comfortable, the brain orders, a kiss, and then you get a kiss. This information is transmitted through the spinal cord.

When the latex cushion between the chess pieces is squeezed by the huge weight or long-term bad posture, it loses its retraction elasticity, and then protrudes like a rotten latex. When it protrudes to the spinal cord, although it is rotten to the upper bone, it is much harder to the upper spinal cord, and it begins to oppress and bully the spinal cord, The spinal cord begins to make an aggrieved sound, and then you begin to have low back pain and leg numbness, which is the so-called lumbar disc herniation. When one or more pieces are displaced, it is lumbar protrusion or bulging. This bulging is also a kind of deformity, but it is only local.

Spinal surgery is a top surgery in orthopedics, because there are too many things to consider. General fracture surgery also considers the plane problem. The butt joint is not tight, and whether it conforms to the physiological position. The spine is very troublesome, at least from three directions and three coordinates.

The median, coronal, sagittal and median position are easy to understand. Coronal position is generally said to be a glass plate, facing the same direction as the eyes, and then cut directly from the head. This orientation is coronal position. Sagittal position is a plane formed after the bow and arrow is inserted into the face. This thing is really anti-human. It takes a lot of trouble to explain it in words, so this professional word must be explained in pictures, and then memorized by rote. These three positions must be considered in spinal surgery. As long as there is an inappropriate position, there will be sequelae, because it does not conform to the physiological position, resulting in the chain reaction of human stability problems.

Spinal deformity, in short, is a column built with chess pieces. One or more chess pieces are placed in the wrong direction, which leads to the change of the overall shape. Orthopedic surgery is to put the wrong pieces in the right direction. But there is a very, very difficult thing. The child's development is growing. After the operation adjusts the abnormal position, if the position or orientation does not conform to the future growth trend, the operation is a complete failure.

The failure of the operation leads to more terrible secondary injury. Not only did it not improve the symptoms, it might aggravate the disease. It is such a terrible thing. Therefore, once some uncertain factors are added to some things, the difficulty of things will increase by an order of magnitude. Therefore, Lao Gao and Lao Wang should not be cautious in this operation.

This treatment in the early years was symptomatic. It is to forcibly adjust the wrong posture of the spine. There are many postoperative complications, because it is forcibly corrected. What often occurs is pseudojoints, deformity recurrence and huge incision trauma. Later, with the development of materials science, a variety of new materials appeared, and doctors slowly conquered the disease.

But this disease is so rare that many orthopedic doctors can't meet it all their life. Say less, it accounts for a large proportion of teenagers, and women account for the majority. And this operation can't be quantified. For example, appendiceal surgery is from the iliac bone to the middle and outer third of the navel. Even if the position is wonderful, it's a big deal to cut a bigger hole and pull the cecum to find it. It can be found sooner or later.

But this operation can't work. It should be combined with the actual situation. Different doctors have different perceptions of the patient's future growth, and different surgical methods or orthopedic methods. For example, Lao Gao believes that the child can grow up to 1.8 meters in the future, while Lao Wang believes that the child can grow up to 3 meters in the future. This is a thing that cannot be quantified directly, so if there is no master to teach and want to do this kind of operation, just think about it.

This kind of operation has been performed since 1914. So far, most hospitals still can't do it, and most spine orthopedics doctors won't do it. Imagine the difficulty of this operation.

Zhang Fan's very detailed and persuasive operation plan made the two directors nod involuntarily at the same time.

"Have you ever had such an operation when you were a bluebird?" What Zhang Fan said was too clear and clear. Lao Wang couldn't refute it. He had to look for other basis to reassure himself. At the same time, Lao Gao also paid attention to it.

"Yes!" Lie, especially this kind of lie, said a lot. Zhang Fan felt that he was telling the truth. He was almost schizophrenic.

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

"Director, really, there must be no problem. Absolutely well done. " In order to determine their thoughts, Zhang Fan had to say in a very positive tone.

"Do it!" Lao Gao took a look at Zhang Fan and agreed.

"OK, in that case, let's sign the operation plan together. I'm the director of spinal surgery. Let me sign the first name."

"The patient is from our department." Lao Gao said impolitely.

At this time, Zhang Fan's tears came down. Really, how lucky he was to meet such a good teacher and protect his teacher. The first thing here is not honor or interest. If the operation is done well, it should be done well. If it is not done well, it must be responsible and take the main responsibility.

"I'll sign the first one." Zhang Fan is crying.

"Ha ha!" The two old men looked at him at the same time and sneered! Naked despise!