Chapter 140 Axial Replacement (2)
Both Sun Lien and Professor Pascal were a little uneasy. Sun Lien had not been to the operating room several times. The last time he visited the operating room, he encountered Director Zheng Guoyou with myocardial infarction. Professor Pascal had never been to the operating room since he got his M.D. An emergency department student and an immunology physician who enjoyed a certain reputation, just like Liu Laolao, who had just entered the Grand View Garden, stretched her neck and watched the operation progress.
Unlike Sun Lien and Pascal, Xu Yourong and Hu Jia were as relaxed and comfortable as if they had returned home. Needless to say, Hu Jia assisted in various surgeries in the operating room for five days a week. She was extremely familiar with the constant temperature operating room and the cold-glowing surgical instruments, and there was no discomfort at all. Xu Yourong took a step further than Hu Jia's attitude - she is an excellent neurosurgeon. Although in the Fourth Central Hospital, spinal surgery is basically handled by orthopedics. But this does not affect her performance of her strengths in this field - spinal cord and medulla oblong are one of the key research directions of neurosurgery.
It is precisely because Xu Yourong is excellent enough that she understands better than Sun Lien and others how important the operation is to be carried out in an orderly manner before her - in the past, doctors could only barely replace it with titanium mesh and titanium alloy bars of various lengths. These hard-bent titanium mesh and alloy bars are indeed not capable of the work of the atlaspinus axial vertebra. Everyone's atlaspinus body size, shape, and even inclination angle are different. 3D printing technology, and only 3D printing technology, can truly become a substitute for atlaspinus that can be used for a long time. Although such prosthesis still has huge defects - under ligament injury, patients may lose the ability to rotate almost all their heads. In layman's terms, Song Hualin may never be able to shake his head again.
But this will still be an amazing initiative - you can't shake your head, it's better than being burned into ashes and put it in a box. As long as the surgery is successful, he can still embrace his family and walk in the warm sunshine and spring breeze.
Therefore, Xu Yourong looked at it without looking around. Rachel next to her did not show much excitement or excitement about it. She just secretly held Xu Yourong's hand, and most of her face was covered by a mask, and she could not see too many expressions. But there was a smile between her eyebrows and eyes from time to time.
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The human oral opening and closing degree is limited, so there is not much room for operation for Wang Yifei. The surgical assistant used an opening to pull Song Hualin's mouth open, exposing his soft palate as much as possible. Then he used a tongue pressing plate to press his tongue as much as possible. The movement was a little rough and forceful. The tongue pressing plate was even pressed out of an arc under the operation of the assistants.
"The movement is a little lighter, and I will use this tongue in the future." Wang Yifei smiled and criticized his assistant, "Don't be so nervous."
The operating bed gradually rose, but due to Song Hualin's axial fracture, the angle at which Wang Yifei could get the surgery was still very limited. He tried several times in a row, but in the end he could only lie on the operating bed, and in a very awkward position, he inserted the scalpel into Song Hualin's mouth.
After confirming that Song Hualin's uvula was left sideways, he paused for a moment and began to cut. When the blade was about to reach the position of the uvula (small tongue), the scalpel went around the left side of the uvula and continued to cut along the midline of the uvula. The scalpel shook back along Song Hualin's soft palate to the incisors until it touched the hard palate edge.
The first small step was completed. Director Wang Yifei moved away from the position and turned to look at the MRI and CT pictures he had taken before. The assistants took this opportunity to quickly stop the bleeding of the cut soft palate and used a small traction hook to pull the part of the soft palate that had been cut. This made Song Hualin's posterior pharyngeal wall more thoroughly exposed.
Cutting a part without lesions is not necessary just to obtain better operating space and expose the visual field. However, it is actually the least traumatic option. In fact, if the patient has problems such as congenital restricted jaw movement, which leads to poor vision and insufficient surgical operation space, doctors may even make the decision to split the jaw bone. As long as the life worry can be solved, additional damage is completely acceptable.
Although the exposed posterior pharyngeal wall still looks very small, it can finally be performed further surgery. Wang Yifei once again stood at the position of the main surgery. The scalpel cut off the posterior pharyngeal wall and cut the posterior pharyngeal wall along the middle seam. After stopping the bleeding and traction again, the exposed ones are the upper, midpharyngeal contractile muscles and some of the longus cephalic muscles.
The reason why the atlantoaxial vertebra is called a "surgical restricted area" is highlighted here. The oral itself has a certain depth, and this area contains a large number of muscles, nerves, ligaments and blood vessels. These important and fragile tissues are easily damaged during surgery.
Injuring muscles may lead to movement obstruction or infection, and injuring nerves may lead to many consequences including facial paralysis and long-term pain. Injuring ligaments may lead to joint instability, which may lead to more serious spinal cord and even medulla oblong problems.
As for the damage to the blood vessel... If the artery is damaged and the bleeding cannot be stopped quickly, even rescue can be avoided - once the vertebral artery near the atlas rupture occurs, basically all the blood in the body can be sprayed out within one minute. In the narrow operating space of the mouth, rupture of the vertebral artery is equivalent to instantly losing all vision. The doctor must rely on memory and feel to find the rupture point of the vertebral artery in the gushing bright red blood, and suture the ruptured artery within one minute. This rescue success rate, which is almost no different from taking a chance, will naturally not be very high. Therefore, this area has always been called the "surgical restricted area".
Director Wang Yifei glanced at the exposed muscle tissue, but there was no tension. He moved his shoulders and neck, signaled his assistant to get the small camera for video shooting, and explained the desolation structure of this part on the spot.
"You don't have many opportunities to see the muscles in this area, and you can basically see it only in the main teacher." Professor Wang's tone was calm, stable and confident. "But the muscles in the main teacher's part have basically atrophy, and there are fewer opportunities to see the fresh muscles. Please experience the structure more."
This operation is not only the doctors in Tonghui challenging the authority of Death, but also a very important course content. Like many excellent medical schools, Tonghui's teaching style is not only rigorous, but also actively encourages the application of new technologies and new techniques. Medical technology is a technology that has always been self-evolving. The sooner the medical value of new technologies is discovered, the sooner the design of new surgical methods around new technologies, and more patients will be saved.
Saving lives and improving patients' quality of life are the most important core content in every doctor's career - realizing self-worth.
Wang Yifei is not only the director of orthopedics at Tongxie Hospital, but also a professor at Tongxie Medical University. His tasks are heavier, and he wants to let these surgeries be mastered by students as soon as possible. There is no such thing as a surgeon. Only when a surgeon is constantly spread can one have the possibility of further improvement. Without extensive and active medical exchanges, medical progress cannot be made. He has a clear understanding of this point. Therefore, Wang Yifei chose to emphasize the structure of the anatomical system to the doctors visiting the surgery at this time. He can still fully grasp the current situation. After bluntly separating muscles and exposing Song Hualin's broken spine, he may not have the energy to teach.
After waiting for a minute or two, after confirming that all the doctors who visited the surgery saw this part of the muscles, the assistants picked up the surgical forceps and pulled Song Hualin's tongue out. Wang Yifei picked up the scalpel again. This time, instead of using a sharp blade, he turned the scalpel and used the hilt to push away the two long muscles in front of him. As for the upper and midpharyngeal contractile muscles, they need to be cut along the midslit.
After the separator was used to pull open the mesopharyngeal contractile muscle hidden behind the hyperpharyngeal contractile muscle, Song Hualin's anterior longitudinal ligament was finally exposed. This is a major ligament connecting the anterior side of the cervical vertebrae. As the longest ligament in the human body, the main function of the anterior longitudinal ligament is to limit excessive spinal extension and prevent the intervertebral disc from bulging forward.
After blunt separation, the lower pharyngeal constrictor and cephalosus longus were pulled open. Now, the C1 cervical atlas and C2 cervical axial vertebrae are completely exposed to the air. After layer by layer, the operating space left for Wang Yifei has become very small.
"Enter the endoscope." Wang Yifei had long expected this result. The reason for the oral approach to the surgery is to minimize intraoperative trauma to the patient. In order to reduce trauma, some vision and operation space will inevitably be lost. Fortunately, there is still an endoscope. If the previous surgery was the peak display of traditional surgical procedures, then what Wang Yifei wants to show next is one of the main development directions of future surgical procedures - endoscopic surgery.
Because other tissues have been separated, the endoscope and the two operating arms that were used for observation and operation were fixed by external stents. Wang Yifei bent his body and started the operation. Through the endoscope, through two control arms about 20 cm long and the abrasive tools on the control arms, Wang Yifei slowly cut Song Hualin's vertebra, which had broken into free state, into small pieces, and then took them out one by one. Each vertebrae block, as well as the bone cement that was filled in to increase strength fifteen years ago, was carefully cut into small pieces less than one centimeter. Then it was taken out by the control arms.
This process proceeded very slowly. Song Hualin's primordial fracture shape was very irregular. There were three fracture lines on his primordial vertebrae. In addition to the fracture of the tooth joint on the posterior side, there were two fracture lines on the primordial vertebrae. If the coordinate system is established with the tip of the human nose as the 12-point direction of the clock, the two fracture lines were approximately equivalent to the hour hand at 4:50 and 10:20. The frontal approach, the range of the climax that can be directly exposed is approximately between 9:00 and 3:00. In other words, the frontal meridian approach can only observe one of the fracture lines, while the other fracture line does not appear in the endoscopic field of view.
Chapter completed!