The joint capsule of the hip joint has been broken open.

The muscles around the joint capsule are dark red in color and are covered in pus, flowing outward like mud.

If that's all, there are at least three sinus passages extending in all directions.

Sinus tract is a channel created after bacteria erode soft tissue. Wherever the sinus tract leads, there will be bacteria remaining. Moreover, the sinus tract is a closed cavity with no blood vessels inside, so even antiseptic drugs are difficult to reach.

!

The direction of the sinus tract is also random and not straight. It is impossible to know where it goes and the finer gaps it extends, just like not knowing where the refuge of tuberculosis bacteria is. This will make complete debridement difficult.

Comes with great difficulty.

At the same time, if the joint capsule is damaged, the recovery of joint stability after surgery is also a relatively big problem.

Doing a good job of debridement does not mean just cutting off all the necrotic tissue and then ignoring the follow-up of the surgery.

In an instant, Lin Hui and Ji Mo Deng Zhi took a deep breath.

Lin Hui frowned and said, "Xiao Lu, can you handle this situation? Why don't you just call Professor Min down?"

This patient had tuberculous arthritis, and the expected operation time was quite long, so he was given general anesthesia directly. Therefore, Lin Hui spoke more straightforwardly without too much scruples.

Of these sinus tracts, one runs posteriorly and medially, and the other runs proximally and anteriorly.

What does this mean? The anatomy of the hip joint has the sciatic nerve going back and the femoral canal going toward the heart. The femoral canal surrounds the femoral nerve, femoral artery and femoral vein.

These things are not so easy to avoid.

"Tourist, please call Professor Min. I'll give it a try first!" Lu Cheng didn't finish his words directly. In such special circumstances, he still had to call Professor Min to the side.

Lin Hui thought for a while, and seemed to be unsure about this situation, so he didn't say anything like I would do it.

The circulating nurse heard this and immediately made a call.

Lu Cheng held an electric knife in his hand. After straightening out his thoughts for a while, he started the debridement operation.

Debridement of the joint capsule is still relatively routine. The joint capsule wall is completely removed, and the round ligament of the femoral head is also removed.

Lu Cheng chose to peel off the round ligament, and then used the electric knife to slide a circle in the acetabular socket very neatly, and then took out the rotten round ligament.

This thing is a bit like purulent appendicitis, but it is not the stench caused by bacterial infection like appendicitis, which is like the color of dead fish flesh.

Lu Cheng did not throw away the round ligament. Instead, just to be on the safe side, he sent the round ligament along with the removed femoral head for examination. Long-term infection stimulation is likely to cause malignant transformation of the tissue.

Although this chance is very small, it should also be taken into consideration for the patient's prognosis.

Then there are the muscles near the hip joint.

Lu Cheng changed the electric knife to a round knife because the electric knife was a bit too blunt and was not conducive to quick resection. It was only used to stop bleeding during the removal process. For this kind of large-scale initial debridement, using a round knife was obviously faster.

.

When Lu Chengcai just applied the knife, Lin Hui's eye circles shrank slightly.

Because Lu Cheng's knife was used to skim the knife, it happened to be right at the edge of the dead flesh color of the muscle and the normal bright red muscle, and he probably removed only one millimeter more of the normal muscle!

Lin Hui had never seen this kind of control before.

Ji Mo didn't notice anything, and Deng Zhi took a breath of cold air: "Brother Lu's knife skills are enough to make him a chef, and he can be so accurate!"

Just kidding, has Deng Zhi seen this kind of control before? They do debridement, that is, they cut out whatever is broken. They would rather cut out three thousand more than let one go.

Then Lu Cheng once again chopped open the necrotic tissue like a butcher chopping meat, following the shape of the muscles, basically restoring 90% of the original shape of the muscles.

This level of control made the scene extremely quiet for a while.

When the first piece of dead meat was cut off, Ji Mo said: "Brother Hui, according to the normal principles after infection, debridement should not be at least 0.5cm beyond the infected site. Try to remove the infected tissue."

Clear it?"

"The cut is less than 0.2cm. Doesn't it meet the standard of complete debridement?"

This is a question at the end of the season, and it is also a kind reminder. Because that is what is written in the book.

Lin Hui answered directly: "The principle of debridement is this, but why should this principle be established in this way? We need to understand that when it is about 0.5cm away from the edge of infection, it is to maintain the blood supply and leave the soft tissue.

Residual bacteria in the body can be killed by antibiotics in the blood system."

"The blood supply inside our joints is not rich, so we should try our best to clean up the soft tissues inside the joints. However, the blood supply in the surrounding soft tissues is relatively abundant, so we can keep it as much as possible."

"And have you seen that this patient's joint capsule has been completely destroyed. After we complete the joint replacement, we must restore the stability of the joint capsule, otherwise it will easily slip even after replacement."

"In this case, we must try our best to preserve the function. Otherwise, there will not be enough soft tissue to protect the stability of the joint. Then even if the operation is performed, it will only treat the infection, and it will not be very meaningful.

big."

"And you can see that there is just a small amount of blood oozing out of the wound now. This is a good thing. It proves that the blood supply to the remaining muscles is very normal. Where the blood supply can reach, the postoperative resistance will be better."

Tuberculosis drugs and antibacterial drugs are within reach."

"And we will leave irrigation and drainage in the joint cavity after surgery, so that we can kill the residual tuberculosis bacteria in the joint cavity to the greatest extent."

Ji Mo suddenly understood and nodded quickly.

Looking at Lu Cheng's side face, what he was thinking was, was Lu Cheng thinking of this when he cut the knife?

Lu Cheng nodded in his mind and didn't say anything else. He shouldn't just praise his master for saying this. Then it wouldn't be a compliment, but an insult.

Soon, Lu Cheng cut off all the surrounding muscles and removed the femoral head.

The residual femoral moment will not affect subsequent joint replacement.

After this, Lu Cheng continued to use a round knife to clean up the necrotic soft tissue inside the acetabulum and around the hip bone.

In this way, after the muscle wound has been completely stopped bleeding, the most important step of debridement is finally reached.

Excise and clean the sinus tract.

The current description of the sinus tract is not accurate. It should be a sinus duct. The sinus tract should directly connect the inside and outside. It is just that it will eventually develop into a sinus tract, so it is customary to call this sinus duct a sinus.

road.

This kind of sinus tube has no blood supply and is a unilaterally closed dead space. Once it remains, the antibiotics in the postoperative blood cannot reach it, and neither can the antibiotics in the irrigation fluid.

It is the best refuge for Mycobacterium tuberculosis. As long as it finds an opportunity, it can relapse again!

There were three in total, and the one Lu Cheng dealt with first was the sinus tract on the outside, which was relatively safe.

After carefully opening the sinus tract, Lu Chengcheng discovered that the sinus tract was not very deep. He could directly remove the infected part on the inside of the sinus tube connected to the sinus tract, and then leave it temporarily vacant. After the operation was completed, the resected cavity could be removed.

The gap can be completely closed with suturing.

Next, only the more difficult parts of the posteromedial and proximal-anterior sinus canal are left.

Lu Cheng took a deep breath, and then asked the circulating nurse to change to a round blade. The previous long-term removal of muscle tissue had made the current round blade dull.

There is a saying in cross talk that unclear words are like killing people with a blunt knife. When cutting meat, if the knife is not good, it needs to be torn open. Now we are performing surgery on people, so the weapons in our hands must be very sharp and cannot be sloppy.

Min Hong hasn't arrived yet, so the operation has to continue.

Lu Chengcheng chose the relatively simple posteromedial sinus tube, thought for a moment, and then opened it.

After the sinus canal is incised, use a steel needle to probe the bottom slightly, at least five centimeters. This requires that the sinus canal does not turn around.

Is five centimeters long?

That depends on where it is.

This kind of debridement is not as simple as just cutting five centimeters casually.

There are several options. The simplest one is to add another incision. This is safe, but the trauma is large. Once the trauma is large, the chance of reinfection after surgery is greater.

If it weren't for the fact that he had no choice in the end, Lu Cheng still wouldn't want to take this path.

When the hip joint is opened, the gluteus maximus and gluteus medius muscles block the field of view. If it is cut directly, it may cause the patient's hip muscles to atrophy and cause deformity after surgery, or the gluteal muscle scars will proliferate in large quantities, resulting in lumps and sitting posture.

Can't even sit down.

Lin Hui also seemed to see Lu Cheng's current hesitation and difficulties, and was also thinking of countermeasures for Lu Cheng.

However, almost a minute later, Lu Cheng suddenly brightened up and said, "Give me the gluteus medius retractor."

The nurse who washed the hands immediately handed over the gluteus medius muscle retractor. Then, Lu Cheng extended the existing opening a little toward the anterior superior iliac spine, and then inserted the gluteus medius muscle retractor inside.

Suddenly, a magical scene appeared. The gluteus medius and gluteus maximus muscles, which were originally very tightly blocked, were strangely pulled apart by Lu Cheng. The gluteus minimus, which had been cut off by Lu Cheng before, was stretched again.

turn.

Hey.

The cellulite that looked like a girl waiting to be married came out. Of course, along with the cellulite, there was also the light yellow hard stuff.

Inside a pile of fat tissue, running through is the sciatic nerve, which is slightly outside the back of the femur and is divided into two bundles!

Where the sinus tube runs, fat accumulates and becomes very hard. One end of it falls right on the sciatic nerve.

Lin Hui didn't even have time to think about how Lu Cheng was like this. He frowned and said, "This is a bit troublesome. If the sciatic nerve is also strained, it may be difficult to recover for a long time after the operation."

What is the sciatic nerve? It is the largest nerve in our body.

The sciatic nerve is the motor nerve of the hamstrings, calf and foot muscles, and is also an important sensory nerve of the calf and foot.

Many people have heard of sciatica. Once it is damaged, it is difficult to squat on the toilet or sit down on a stool. This function is lost, and it is no different from being disabled.
To be continued...