Path of Medicine With a System

When you first entered the society, when you wanted to fight and struggle with great ambitions, you encountered all kinds of procrastination, all kinds of unspoken rules, all kinds of constraints, and all kinds of conflicts. Then you feel that this industry is hopeless! Everyone is inferior to you, and the leader is an egg.

Then, after you have been in this industry for four or five years, you will slowly realize the truth behind it. For example, this is the case now. For an operation, it needs to be discussed and discussed, and then two friends sit together to formulate a plan. Procrastination, very procrastination, but this is indeed a conventional method, not for anything else, but for one reason: safety. After all, geniuses are rare!

In the small meeting room of the Department of Orthopedics, Lao Gao, Lao Wang, and Zhang Fan sat together. How should I put it, these two people are very strange, in front of everyone, the two are incompatible, but when there are only three of them left, the relationship between Lao Gao and Lao Wang doesn't seem to be that bad. At least Lao Gao would take the initiative to add water to Lao Wang. Zhang Fan couldn't understand, really couldn't understand what happened to the two old guys, but he didn't have the heart to gossip.

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

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

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

"Yes!" Zhang Fan replied affirmatively.

Then he said: "Two directors, look."

Zhang Fan got up and opened the film viewer, and put all Bart's video inspections on it. Then "Ka" opened the caliper, like pulling out a dragon knife, pointed at the image on the film viewer and said: "The apical vertebra of the child with scoliosis is a vertebral body. What we need to do is to fuse 1 One vertebral body, where the Cobb angle is greater than 50°, the two upper and lower vertebral bodies are fused during the operation, and then an open intervertebral disc at the end vertebrae does not need to be fused, so that the upper and lower segments can compensate for excessive correction. The distal vertebral body should be parallel to the sacral vertebrae. If 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 unfused movable segments rather than by the fusion to maintain future balance. These can be determined by dynamic X-ray images, so in this way, the end vertebrae should be able to move in all directions, the most important thing is the distal end, that is to say, the distal intervertebral space should be able to move in the bending direction, and the distal end vertebra should be able to move in the bending direction. The end plate of the end vertebra is parallel in the bending image, and the axial plane of the bending direction should reach the neutral position. It is absolutely guaranteed that Bart will gradually change the deformity in the future. "

Having said that, let's talk about the spine first. The spine is curved. Especially for slender women, the soft waist is like a willow, which makes people want to hug. This is the credit of the spine, which is slightly S-shaped as a whole. Generally, the cervical spine and lumbar spine are the most prone to problems.

The range of motion of the spine at these two locations is relatively greater. And especially the lumbar spine is directly the pillar of the body. It must bear weight and have mobility, so people often have neck pain and back pain. Few people say that the back and spine hurt. Once there is soreness or numbness in the waist and legs, you must pay attention to it. Sit less, lose weight, eat less, exercise more.

What is the shape of the spine? Let me give you an image metaphor. It's like an S-shaped cylinder stacked with chess pieces. There is a latex cushion between the chess pieces, and this cushion is the lumbar intervertebral disc. Then, several rubber bands from top to bottom are attached to the front, back, left, and right sides of the chess piece to stabilize the column of the chess piece. This is the ligament. And these chess pieces are divided into front and back, the front is bare, there are two wings called transverse processes on the sides, and tails called spinous processes on the back. Chess pieces were piled up, and then tails and tails were laid out layer by layer like roof tiles.

There is a hole between the chess piece and the tail, which runs through from top to bottom. Between the two pairs of wings and the chess pieces, there is also a smaller hole that runs through from top to bottom. The hole between the pawn and the tail runs an extension of the brain: the spinal cord. Between the wings and the chess pieces are the nerves that go out like silk threads 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 muscles is fed back to the brain, the brain makes calculations and then feeds back to the muscles, and then the muscles respond. Or the brain directly issues commands to the muscles to act after calculation.

In fact, this thing is very simple. For example, if you touch the buttocks of a beautiful woman, the muscles on the girl's buttocks will transmit this feeling to the brain, um! Uncomfortable, the brain ordered, slap, and then you were slapped by the beauty. Or, uh! Comfortable, the brain ordered, a kiss, and you were kissed. These messages are transmitted through the water pipe of the spinal cord.

When the latex cushion between the chess pieces is squeezed by huge weight or long-term bad posture, it loses the elasticity of retraction, and then protrudes out like a piece of pulp. When the protrusion reaches the spinal cord, this thing Although the upper bone is considered squishy, ​​but the upper spinal cord is much harder, it starts to oppress and bully the spinal cord, and the spinal cord starts to make a sound of grievance, and then you start to have backache and leg numbness. This is the so-called lumbar disc herniation. When one or more chess pieces are shifted, the lumbar spine protrudes or bulges. This bulge is also a kind of deformity, but it is only partial.

Spine surgery is considered the top surgery in orthopedics, because there are too many things to consider. Ordinary fracture surgery also considers the plane problem, whether the butt joint is tight and whether it conforms to the physiological position. The spine is very troublesome, at least three coordinates in three directions should be considered.

Median, coronal, and sagittal. The median position is easy to understand. In layman’s terms, the coronal position is a piece of glass, facing in the same direction as the eyes, and then cut directly from the head. This position is the coronal position. The sagittal position is to form a plane after the bow and arrow are shot into the face and inserted into it. This thing is really anti-human, and it takes a lot of time to explain it in words, so this kind of professional words must be explained with pictures, and then memorized by rote. For spinal surgery, these three positions must be considered. As long as one position is not suitable, sequelae will appear, because it does not conform to the physiological position, which will lead to a chain reaction of problems with the stability of the human body.

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

If the operation fails, it will lead to even more terrible secondary injuries. Not only does it not improve the symptoms, it may even worsen the condition, which is such a terrible thing, so once some uncertain factors are added to certain things, it will lead to an order of magnitude increase in the difficulty of things. Therefore, Lao Gao and Lao Wang cannot be cautious about this operation.

This treatment in the early years was symptomatic. It is to forcibly adjust the wrong position of the spine, and there are many postoperative complications. Because it is a forced correction, pseudoarthrosis often occurs, deformity recurs, and the incision trauma is huge. Later, with the development of material science, various new materials appeared, and doctors gradually conquered this disease.

But this kind of disease is said to be so common that many orthopedic surgeons will never encounter it in their lifetime. To put it mildly, it accounts for a large proportion of teenagers, and it is mostly women. And this operation cannot be quantified. For example, in appendix surgery, the place between the iliac crest and the middle and outer third of the navel, no matter how strange the location is, the big deal is to make the incision bigger and pull the cecum a little bit to find it, sooner or later it will be found.

But this operation is not possible, it must be combined with the actual situation. Different doctors have different cognitions about the future growth of patients, so the surgical methods or orthopedic methods are different. For example, Lao Gao thinks that the child will grow to 1.8 meters in the future, but Lao Wang thinks that the child will grow to 3 meters in the future. This is something that can't be quantified directly, so if you don't have a master master to take and teach, if you want to do this kind of surgery, just think about it.

This operation has been performed since 1914. So far, most hospitals are still unable to do it, and most spine orthopedic doctors can't do it. You can imagine the difficulty of this operation.

When Zhang Fan explained the very detailed and convincing operation plan, the two directors nodded involuntarily at the same time.

"Did you encounter this kind of surgery when you were in Jade Bird?" Zhang Fan said so clearly that Pharaoh had no way to refute it, so he could only look for other evidence to reassure him, and Lao Gao also paid attention to it.

"I did it!" There were so many lies, especially this kind of lies, that Zhang Fan felt that he was telling the truth, and he almost made himself schizophrenic.

"How about~~" Lao Wang looked at Lao Gao and said uncertainly.

"Director, really, there must be no problem. Absolutely did a good job." Zhang Fan had to say in a very affirmative tone in order to confirm the two people's thoughts.

"Do it!" Lao Gao agreed after glancing at Zhang Fan.

"Okay, in this case, let the three of us sign the operation plan together. I am the director of spinal surgery, so let me sign the first name."

"The patient number belongs to our department." Lao Gao said bluntly.

At this time, Zhang Fan was in tears. Really, how lucky he is to meet such a good teacher, such a teacher who protects him. The number one here is not an honor or a benefit. If the operation is done well, it should be done. If it is not done well, you have to be responsible, and you have to bear the main responsibility.

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

"Hehe!" The two old men looked at him at the same time and sneered! Naked contempt!

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