Path of Medicine With a System

Where is the first metatarsophalangeal joint? In fact, it is very simple. It is the joint where the thumb and the instep connect. The function of the thumb on the hand is considered to be the most important, and the same is true on the feet. This joint can also be regarded as a force-generating joint.

The people with joint injuries are all big fat people, some ball players. The fat people are because they are too heavy and their joints can't bear it. Athletes mostly suffer from exertional injuries. But there are still some ordinary people who are not fat, who are prone to this disease. It is women who wear high heels, especially those high-heeled shoes that they like to wear. They look beautiful and tall, but this shoe is really a sharp weapon for damaging the metatarsophalangeal joints.

Because wearing high-heeled shoes can increase the load on the forefoot, excessive dorsiflexion of the metatarsophalangeal joints, relaxation of the deep transverse ligament between the forefoot metatarsals, collapse of the transverse arch, and sinking of the 2nd, 3rd, and 4th metatarsal heads. Excessive compression, resulting in total neuroma of the bottom of the toe. In addition, because the heel is too high, the arch of the foot collapses and the metatarsal head sinks, which can compress the common toe artery adjacent to the bottom of the toe nerve at the metatarsal head, causing arterial blockage and toe nerve ischemia , hypoxia, fibrosis.

This is not alarmist talk, and because this joint is a terminal load-bearing joint, once it is injured, it is very troublesome to deal with and treat, and this kind of injury is a chronic process. If it is an acute injury, it can be recovered by surgery. But this kind of chronic injury, The vascular beds and nerves at the extremities are damaged first, and then the bone. In layman's terms, when women wearing high heels start to experience pain, they have already damaged the joints and related soft tissues and bones.

If it is found that the treatment is late, she will be accompanied by permanent toe pain, burning pain, and numbness, severe numbness of the soles of the feet, one can imagine how uncomfortable this is. Even early treatment is very troublesome. There are two methods, surgical and non-surgical.

The non-surgical method is to wear flat shoes, and then place something on the front and bottom of your toes, so that your thumbs can be straightened as much as possible. Imagine how difficult it would be to forcefully straighten the bent bones. Not only was it difficult, it was also painful, very painful. On weekdays, when a woman wears high heels for a day, why her feet hurt is because the curvature of the force is changed. Therefore, if you love your woman, please take off her hat!

The black man is hospitalized. He is two meters tall and weighs more than two hundred catties. There is really no way for him to lie down in a normal hospital bed. After reaching the end of the bed, it was just enough for the big black man to lie flat.

Because the inspections are very complete, all the inspections that can be done have been done, and they are all recent inspection results, so there is no need to repeat the inspection. Arranging the operation directly is the result Ms. Wang wants. For them, time is money, and they should recover early and play early.

The metatarsophalangeal joint is a very small joint in the human body. However, after this joint is injured, general orthopedic surgery can only improve the symptoms and relieve the pain. If you want it to return to a normal state, the requirements are high. Many basketball players , all because of this joint leading to retirement.

"Make a dorsal incision, open it and do repairs. Now prepare for the operation, Lao Chen, you go to the patient to discuss the condition and inform the patient, and sign where you need to sign." Zhang Fan directly confirmed the plan.

Old Chen said cutely: "I, I don't know English!"

"Hehe, isn't Ms. Wang here? Just tell her!"

"That's right, that's right, forget about it." After saying that, Lao Chen went to find Ms. Wang. Although black brothers are very reluctant to have surgery here. But there is no way, he has passed the peak of his sports career, and now it is good to have a financial backer, and he has to do whatever the financial backer asks him to do.

At the beginning of the operation, the anesthetist estimated the weight of the big black man and added anesthetics, "Doctor Zhang, this fat man weighs so much, I dare not give too much anesthetics, so the effect may not be very obvious. ,

You add a little local anesthesia. "The anesthesiologist had never seen such a huge person, so he was a little unsure.

"Okay!" Zhang Fan looked at the fat man's limbs, it was really too big and thick. It's dark, very dark, shut up, close your eyes and turn off the lights, and you won't be able to find it right away. "Doctor Zhang, do you think his skin is also black!" Li Liang asked, grabbing the big black man's thick toes.

"Probably not. The dermis is probably black, but below the dermis, it's the same as us." Zhang Fan also performed surgery on black people for the first time.

"Start! The anesthesia is ready." The anesthesiologist said.

Li Liang began to sterilize, spread the sheets, and put the hole towels. After everything was ready, Zhang Fan and Li Liang performed the operation, and Song Bing made a tour. Looking at the black's weird toes, Zhang Fan sighed. The athletes looked at the scenery, but ordinary people really couldn't understand their hard work.

Although the big black man is not a first-class athlete, his toes have all become deformed due to years of weight training, overloaded sports, and his huge weight. Although each toe is very thick, it is very bent like an old man.

"Look, his second and third toes have obviously been fractured many times, and there has been compensatory thickening here." Zhang Fan said to Li Liang after observing the rest of the toes.

"Their money is really not easy to earn." Li Liang has already separated the first toe. This separation is a bit laborious and too thick, probably as thick as the wrist of a two-year-old child.

"It's not easy for anyone, nothing is easy." The anesthetist interjected.

At the beginning of the operation, Zhang Fan gently opened the skin with a small sharp knife. The scalpel is very sharp. In the early years, the scalpel was used many times. Now the scalpel is disposable. Although it is sharp, it is not durable. , the skin becomes blunt after a few strokes.

"This operation must pay attention to minimizing damage to the blood supply. His injury has destroyed most of the vascular bed. If you want him to continue to maintain high-intensity exercise, you must ensure the remaining blood supply." Zhang Fan said While gently avoiding the dorsal toe artery, use the handle of the knife to separate the flexor hallucis brevis.

In surgery, not all places that need to be exposed need to use a knife. For example, the skin requires a knife, and a very sharp knife is used. When the muscle layer is reached, it is usually separated with fingers or the handle of the knife. Especially for this kind of athletes, muscles are very important to them. If the sharp weapon is severed, although it can heal later, it will form scar tissue, which will affect the burst and durability of strength.

This kind of functional joint surgery for athletes is very difficult to do. If it is an ordinary person who has this joint injury, because there is no need to do extreme strength exercise, so as long as the joint function is reached, the pain and variation will be eliminated. As for some insignificant blood vessels, The ligation that can be tied does not need to pay special attention to the joint capsule, and the scar will heal in the later stage.

But if athletes do this, the pain will be relieved, but the sports career will be considered over. This is also why many teams have regular orthopedic joint doctors. This top joint doctor can achieve joint pain with minimal trauma. recover.

Although Zhang Fan has only opened the first-level microsurgery, the amount of surgery displayed is only more than half, but because he is so capable, Zhang Fan has practiced in the system for countless times, and the three-dimensional graphics of the joint structure , directly took shape in his mind.

Metatarsal, phalanx, Zhang Fan slowly separated some inflammatory tissues with tweezers little by little, and then rinsed them with normal saline. This operation is not so dangerous, but for the surgeon's understanding of joints, the delicate operation of the hands is too demanding.

It is important not to be sloppy in surgery. What is the meaning of sloppy here? It means less movement. For example, some inflammatory tissues in the joint capsule can be scraped once with a curette. Do not scrape twice with force. The more movements, the greater the damage. This kind of operation is a comprehensive consideration of the comprehensive quality of doctors.

After the inflammatory tissue was cleaned up, Zhang Fan began to repair it. This kind of subtle repair, ordinary doctors can't do it, and can't use it, but it is very important for this special group of people. In the United States, there are no more than 20 doctors who are good at this kind of surgery, and the doctor is too old to do this kind of surgery, so the cost of the surgery is quite expensive.

"Doctor Zhang, why is the repair oblique?" Li Liang couldn't understand, because according to the physiological position, it should be oblique. Zhang Fan didn't speak, this is the most critical moment, the success or failure of the operation depends on this moment.

Zhang Fan held his breath, tried his best to make his hands reach an absolute stability, and repaired gently, once, twice, three times, four times. Finally, Zhang Fan let out a long breath, "Hush!" Finally, the deformed and scarred muscles were repaired.

More than three hours have passed. This is micro surgery, which is very time-consuming. Zhang Fanlue waited for his breathing to be smooth, and said to Li Liang: "The oblique shape here is to consider his weight and occupation. The oblique shape is more stable."

"Oh!" Although Zhang Fan explained, Li Liang was still a little dazed. After all, there were few operations, so he couldn't comprehend it for a while.

"Electric drill, Kirschner wire." Zhang Fan said to the surgical nurse. Song Bing was almost bored to death, almost the whole operation was done under a microscope, he couldn't see anything. The electric drill lightly opened the small hole, and the Kirschner wire firmly fixed the joint.

"When applying plaster, you must ensure that the plaster is fixed around. It won't work even if it's less than a day." Zhang Fan said to Li Liang and Song Bing.

"Okay!" The operation was over, and Ms. Wang and the athlete's black friend were almost falling asleep outside the operating room! When Zhang Fan and the others pushed the big black man out of the operating room with great difficulty, the gang of black buddies surrounded them cheerfully, chattering non-stop. Zhang Fan didn't understand them after studying English for so long. What more!

"Thank you, Doctor Zhang." Ms. Wang looked at Zhang Fan expectantly, and Zhang Fan understood what she meant. After taking off the mask, he first smiled, and then said: "The damage is considered serious, but it has been repaired. The rest depends on his own recovery in the later stage, and he will know in four weeks. It is estimated that he will continue to play basketball in the future. "Before the operation, Zhang Fan couldn't guarantee anything, but it was different after the operation.

He has confidence in himself, because he has worked hard and sweated so much in the system!

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