If you are bold and careful, and have sufficient knowledge reserves and skills, you can easily handle the problems you encounter, accumulate experience, and achieve a state of ease.

Min Hong led Lu Cheng and others along the way, and soon exposed the shape of the femoral canal. Moreover, the patient's luck was relatively good. The blind end did not extend upwards, but only reached the inguinal ligament, where it stopped abruptly.

This shows that the patient only has a rare tuberculous arthritis sinus tube extending upward, rather than tuberculosis in the abdomen or lumbar spine, flowing through the body's gaps and causing secondary tuberculous arthritis in the hip joint.

In this way, the patient's prognosis can be well assessed, and at the same time, the trauma of this operation will not increase!

However, in patients with tuberculous arthritis, the sinus tube extends to the femoral canal. Fortunately, it is discovered early, otherwise, once the sinus tube here forms a capsule in the later stage, it will compress the femoral nerve.

Not only will surgery become more difficult, but the sequelae caused by compression of nerves and blood vessels cannot be solved by surgery.

But even so, it is not the worst case. It is relatively dangerous to peel off the stock tube at its position. During many operations, Lin Hui was so frightened that he broke into a cold sweat and wished he had the phone at hand at all times.

, and then be ready to call Professor Zhou Xuanqing or the Professor of Vascular Surgery at any time.

The femoral canal is surrounded by the femoral artery, femoral vein and femoral nerve. Once it is broken, it will cause massive bleeding, and a vascular surgeon must come to intervene. And during the process, will the patient bleed to death? This is a question.

Unknown!

Even if vascular surgery comes, it is still unknown where the blood vessel will be clamped, how long it will be clamped, and whether it will cause irreversible damage to the distal end.

Our nerves usually touch the back of the elbow, and the numbness in the forearm and hand of one hand will be extremely sore. If the femoral nerve is accidentally torn or cut, even if it is called microsurgery immediately, it will be sutured.

It turns out that the numbness sequelae caused to the patient after surgery will last for at least one or two years or even for life.

So, under such circumstances, even if the operation is completed, it will not improve the patient's quality of life. So what is the significance of this operation?

This patient’s preoperative preparation was still not complete enough!

Lin Hui only felt a wave of fear, because as the chief resident, after the operation, if the above situation occurs, his nightmare has just begun. Of course, Professor Min will also have a huge headache.

If such a patient has been evaluated before surgery, Lin Hui may not recommend surgery directly!

It's too difficult and there are too many risks.

It's not over yet. There is another sinus canal that leads to the direction of the sciatic nerve. The sciatic nerve is on the posterolateral side of the hip joint. This direction is actually easier to operate than the femoral canal.

Although it was an easy operation, Lin Hui was still nervous!

Because the sciatic nerve has high variability, even after a seemingly large nerve is isolated, there may be branches of the same size hidden elsewhere. In such a case, it can easily lead to injury!

After Min Hong finished the operation carefully, he took a deep breath, and then glanced at the timing panel of the operation.

Said: "This time we performed the debridement operation quite smoothly, Lin Hui, don't you think so?"

Of course Lin Hui nodded and looked at the operation timer. It was less than two hours: "Professor Min, our estimated operation time for this operation was six hours, but most of the debridement operations were completed in two hours.

Even though there are multiple sinus tracts, this has already greatly shortened our expected operation time."

Fast? It was very fast, but he never wanted to rush Min Hong to finish the operation quickly. Today, he hoped to finish the operation as soon as possible, so as not to make him nervous because he was always on tenterhooks.

"This is very good. It proves that our team is quite good and cooperates properly. Including our anesthesiologists, handwashing and circulating nurses, we have built a very professional team, which can completely overcome this more difficult task.

Operation."

"Professor Dai, do you think so?" Min Hong looked at his old partner and asked with a smile.

Professor Dai is a middle-aged man of about fifty years old with a calm face. He is wearing a mask and an anesthesiologist's back jacket to keep out the cold. He wears a silk flower hat on his head. He sits in front of the patient and adjusts his inhalation slightly.

After the anesthesia flow increased, he smiled and said: "It's mainly up to you, Professor Min, to conquer the city. I just do the logistics. I have always believed in Professor Min's surgery."

"Anyway, we all follow Director Min's instructions."

Dai Ruping was joking.

Dai Ruping has the title of professor. Although he is not currently the director of the Department of Anesthesiology, even the director of the Department of Anesthesiology will ask him some questions about anesthesia in private. The reason why he does not ask him in person is that he is the director after all and still wants to save face.

Well, he is also a strong contender for the next director of the anesthesiology department.

When Lin Hui heard Dai Ruping and Min Hong exchanging business blows, he suddenly thought to himself: It's over!

Dai Ruping said that he was Min Hong's royal anesthesiologist, but the wording may not be accurate. It should be said that the anesthesiologist that Min Hong likes to set up the most is Dai Ruping, and Dai Ruping is as courageous as Min Hong. Don't call this a pediatrician, what?

Patients with thrombocytopenia, hemophilia, pulmonary infarction, and patients with fat embolism syndrome before surgery.

As long as the professor in the surgery department dares to send the patient down, Dai Ruping will dare to numb the patient unless it is the kind of surgery that will kill him at a glance!

Not limited to orthopedic surgeries.

It can be said that the reason why Min Hong dares to be so bold seems to be that he is brave and has good skills. In fact, the most important thing is that Dai Ruping is supporting him from behind.

The surgeon is a dancer in the long-term prognosis of the disease, so the anesthesiologist is the escort during the operation. A good anesthesiologist can increase the patient's safety rate on the stage by at least 90%. This is no joke.

of.

If it is a surgery performed by a consultation from an outside hospital, and the patient's condition is very complicated, Min Hong would not dare to go alone. At this time, Dai Ruping would usually work overtime on weekends...

"Lao Dai, you always put a high hat on me. This is not good."

"If the department agrees, I actually don't want to be the director." Min Hong said with a smile.

This is the truth and a joke. Min Hong doesn't have much pursuit of being a director, but it seems that since he became a professor, no one dared to let him lead a group alone because something went wrong with the professor who led the group.

The ward director will also have joint responsibilities, and the department director will also be held accountable.

Professor Wang Shidong was Min Hong's master and the head of the department. There was nothing he could do about it, but even so, he didn't dare to put Min Hong in his own department, so he simply separated him.

Therefore, Dai Ruping made a contribution on Min Hong's path to becoming the ward director.

"Professor Min, if you use a popular term on the Internet today, it's Versailles. We can't be the director even if we want to be, so don't be a slut here."

"Hurry up and do the surgery. If you have been chatting for so long, you might have finished all the debridement of my old friend." Dai Ruping wrinkled the corners of his eyes and looked casually in other directions.

Dai Ruping's most powerful anesthesia is nerve block anesthesia. Basically, he can control the anesthesia area and anesthesia effect of any nerve block very well.

Sciatic nerve block is naturally what he is good at, so Dai Ruping is used to calling the sciatic nerve his old friend.

Of course, the reason why Dai Ruping yelled like this was to warn Min Hong, what I am best at is bringing down my old friends, you have to be careful, little brother!

Min Hong quickly said: "Yes, I'm afraid of you! You are my eldest brother."

"Come on, let's continue the operation."

"It's time to go around and get new surgical instruments and a complete set of joint replacement instruments. We'll also get two arthroscopic connecting tubes. We'll use indwelling drainage later." Min Hong immediately arranged for the next operation.

The instruments to be used prove that Min Hong has evaluated all surgical procedures and knows every step of the operation.

Immediately afterwards, everyone returned the surgical area to the posterolateral incision of the hip joint.

When Min Hong stood at the surgeon's position, with Lu Cheng and others assisting in exposing his field of vision, when he saw that the fat cuff wrapped around the sciatic nerve had loosened, he asked: "Lin Hui, the sinus cuff here is

,Did you peel it off? It was peeled off very well."

Lin Hui quickly shook his head: "Xiao Lu used a blunt bone pick to separate them."

Bone picks, similar to chisels, are divided into flat bone knives and blunt bone knives. The blunt bone knives are used to separate the periosteum, or to pry the steel plate, or to clean the fracture debris from the broken end.

Because the sharp bone knife is relatively sharp, it is used for osteotomy. For example, when removing the iliac bone graft, the flat bone knife will be used.

Min Hong had already guessed it in his heart. Just based on Lin Hui's current operation, he didn't dare to directly play with the sinus tube outside the nerve as if it were a condom.

Min Hong paused for a moment and said to Dai Ruping: "Professor Dai, look, I am also under a lot of pressure. The young people in our department are all little monsters. You must help me more, otherwise

I will soon be overtaken and crushed by them."

"Go away! I don't have time to care about you." Dai Ruping rolled his eyes, too lazy to pay attention to this shameless old man Min.

You are still a little monster. Don’t you know how the little monster came to be? Don’t you know clearly how the nurses and other anesthetists in the operating room called you and were afraid of you, an old monster?

With an old monster like you here, it would be strange if there weren't a few little monsters in the department.

However, Dai Ruping still looked at Lu Cheng, a fresh face, and after a little comprehensive evaluation, he still felt that this young man was a bit fierce.

It should be said that it is quite fierce.

He is an intruder.

Min Hong touched the removable femoral canal scar sleeve that had been separated on the sciatic nerve with his hand, and then said: "Our sciatic nerve is big enough and tough enough. The outer membrane of the nerve is also thick enough.

, then in this case, even if it is surrounded by external scars.”

"Because of its special anatomical structure, we can be a little bolder. Although the blunt osteotome cannot be used to peel off intracapsular neurofibroma, it can certainly be used to remove the scar tube outside the capsule.

.”

"Under normal circumstances, bacteria will not erode the nerve envelope, because bacteria actually have tropism, trophic tropism and vasotropism. They are unwilling to go to places with relatively few blood vessels. In adipose tissue and muscle tissue,

They are rich in nutrients and are the easiest place for bacteria to stay.”

"Similarly, bacteria also have the ability to avoid harm. If there is a dead space left after we debridement, once we use antibiotics, they will move to and accumulate in the dead space that the antibiotics cannot reach."

"Understanding this characteristic, we can better understand some of the symptoms and possible complications after infection."

"Once the sinus tube of the femoral canal is detached, in this case, we can actually use a sharp knife to remove it in reverse direction."

As he spoke, Min Hong actually cut open the sinus tube that covered the sciatic nerve in one direction. After peeling it off, he boldly started to cut again along the shape of the sinus tube.

"As long as we find the bones, we have actually found a safe area. If we find the sciatic nerve and femoral nerve, then our operable area will be even larger. There are no important tissues in between. We can do whatever we want.

The sinus canal will be completely removed."

"And the soft tissue gap in the middle, we don't have to worry about whether it needs sutures after surgery, because it is close to the surface of the femur..."

The operation went on smoothly without any pause.

Just watching Professor Min Hong do this, Lin Hui suddenly felt guilty, because after Lu Cheng had taken off the sinus tube before, it was actually easy to solve the sinus tube, but he called Lu Cheng

After changing the direction, Lu Chengcai stopped and did not continue forcibly.

It gave him enough face. In fact, the sinus canal of the sciatic nerve could have been dealt with long ago.

Before Lu Cheng could even determine when the danger was high and when the danger had actually been eliminated, he gave him advice and dissuasion. This was not advice!

This is called being blind and chaotic.

Since then, Lin Hui suddenly felt that his whole face was a little burning, but it was not red.

Well, once I got used to being red in the past, I can stop being red all the time.

Ji Mo and Deng Zhi also had expressionless faces. They had seen this situation often and were used to it. There was no need to go see Lin Hui or put more pressure on Lin Hui.

You don't need to think about it to know that Lin Hui is under great psychological pressure at the moment.
Chapter completed!