Chapter 2181

Many orthopedic operations, like interventional surgery, are performed under X-rays.

The position of L2 vertebral body and bilateral pedicle was located by C-arm X-ray fluoroscopy. The assistant began to disinfect and lay a sterile operation sheet.

There was no problem with the location. Before the operation, Professor Tian explained the whole process of the operation with his assistant.

On the stage, Professor Tian cut about 0.5cm at the marked point of the patient's second lumbar spine after local anesthesia with 1% lidocaine.

Under the guidance of fluoroscopy, puncture was performed on both sides, and the core puncture needle was inserted at the outer upper edge of L2 bilateral pedicle, with an inclination of about 10 °.

The operation is skilled. This kind of difficult operation is almost no difficulty for those at Professor Tian's level.

After the needle tip enters the pedicle under C-arm X-ray fluoroscopy, pull out the needle core and put it into the guide needle, insert the guide needle into the front 1 / 3 of the vertebral body, pull out the puncture needle and insert the working cannula.

After the hand drill reaches 1 / 2 of the vertebral body, pull out the hand drill and guide needle, and place the inflation balloon through the working sleeve. The fluoroscopy shows that the inflation balloon is in good position. After the inflation balloon is gradually opened, the C-arm X-ray fluoroscopy shows that the vertebral body height returns to close to the normal height.

Professor Tian took out the balloon and his assistant had prepared the bone cement.

After 1 minute and 30 seconds, the bone cement was slowly injected through the working sleeve under the perspective of C-arm.

The operation is coming to an end. Professor Tian is injecting bone cement while focusing on the image of bone cement.

"The operation here must be careful and careful." Professor Tian explained to his assistant while playing bone cement.

"What is the biggest complication of bone cement?" Professor Tian asked.

"Bone cement leakage." The assistant replied.

Professor Tian belongs to the more academic type. He is not angry in the Jianghu. He looks like a southerner.

For the doctors who come to study under him, Professor Tian asks a lot of questions every operation.

As a refresher doctor, I was not used to it at first, but I can't be asked by Professor Tian with some simple questions on the operating table.

Although it is hard for doctors to preview, endorse and study, their level has improved rapidly.

"Not exactly." Professor Tian explained while slowly injecting bone cement: "the most serious complication is pulmonary embolism. Bone cement leakage is very common. Because patients have osteoporosis, 73% of patients have no reaction after leakage."

Professor Tian didn't continue to talk about it because the patient was under local anesthesia. If it was too serious, resulting in tension and myocardial infarction, it would be nothing to find something for himself.

"As long as you are careful, the tip of the injection needle should not touch the artery and vein of the traffic branch." Professor Tian injected 2ml of bone cement. "Generally, this is a very low-risk operation. You have to operate the next one yourself, and I'll be your assistant."

The patient was glad to hear Professor Tian say so. He seemed lucky and hurried Professor Tian to do it himself.

When about 2.5ml of bone cement was injected, Professor Tian was stunned.

Fluoroscopy showed that a strip of "bone cement X-ray developer" extending upward appeared on the right paravertebral side of the anterior edge of the vertebral body. The image is like a small insect, constantly climbing.

Er... Professor Tian is very speechless. If he says leakage, he will leak. Has he ever opened his mouth?

It's all right, it's all right. Professor Tian comforted himself.

It is reported that the incidence of bone cement venous leakage accounts for about 24% of bone cement leakage, and the incidence of pulmonary embolism caused by venous leakage is 4.6% ~ 6.8%. Most of them were a small amount of pulmonary embolism without obvious clinical symptoms.

Only 0.4% ~ 0.9% of patients with pulmonary embolism will have clinical symptoms.

This probability is so small that there is almost no need to worry.

In clinical operation, Professor Tian also encountered bone cement leakage and even pulmonary embolism.

Most patients just lie down for a while, and there are no special complications. There is not much treatment after operation, which does not affect anything.

He comforted himself and cheered himself up - it'll be fine, it'll be fine.

Through continuous C-arm dynamic fluoroscopy, it was observed that the position of the developer changed continuously, passed through the right atrium and right ventricle, and finally stayed in the right lung.

Professor Tian has stopped the operation. He helplessly watched the bone cement enter the right lung, and his hands were numb.

Really special! How did you encounter pulmonary embolism. Professor Tian, who has always been mild tempered, scolded in his heart. Now he can only pray that the patient has no clinical symptoms.

No one can avoid complications after surgery.

No matter how careful, no matter how sufficient the preoperative preparation is, it can not be avoided.

The only thing that doesn't happen is less surgery! This is a consensus of the medical profession. As long as a certain number of operations are done, we must face all kinds of complications.

For example... Today's pulmonary embolism.

"Any discomfort?" Professor Tian asked softly when he saw that the bone cement had reached his right lung.

"No." The patient replied, "everything is very good. Professor Tian, you did a good job. You didn't feel any pain at all."

Professor Tian sighed in his heart, is he doing well?

The operation should be good, but there are complications. How can I have the cheek to say that I did well.

The patient's imaging showed that the bone cement entered the right lung, but there was no clinical manifestation of pulmonary embolism.

Professor Tian considered that the bone cement overflowed from the vertebral body, entered the paravertebral vein and then moved to the lung, resulting in multiple embolism of pulmonary arterioles.

Stop the operation. If you do it hard, nothing will become something.

He immediately stopped bone cement injection and sutured the incision.

After that, Professor Tian helped the patient lie flat, fearing that the assistant's misoperation would aggravate the patient's fracture or other accidents.

There are enough accidents. You can have fewer.

The patient was changed from prone to supine, oxygen inhalation ECG monitoring was given, and venous access was opened.

For patients with asymptomatic bone cement pulmonary embolism, there is no recognized treatment scheme at home and abroad. At present, they tend not to use anticoagulants prophylactically, and only closely follow-up to observe the changes of the disease.

Although the operation failed, as long as the patient is fine, there can be no big problem. Professor Tian felt uneasy and closely observed the patient's situation.

While closely observing his condition, he urgently invited respiratory medicine, cardiothoracic surgery and other relevant departments to the operating room for consultation.

After 1 hour of observation, the patient had no discomfort symptoms. Respiratory medicine and cardiothoracic surgery are not recommended to do too much treatment. Observe the changes of the condition. If there are changes, just say it.

After pulmonary embolism occurred during operation, the patient did not have the performance of pulmonary gas exchange disorder such as dyspnea, shortness of breath and increased respiratory rate.

Professor Tian thinks he is lucky. At least the patient is OK.

But the operation failed. When you go back, you have to do a lot of explanation with your family members to strive for the understanding of the patient's family members. Don't make any doctor-patient disputes.