I can see the status bar

Chapter 142 Axis Replacement (2)

Both Sun Lien and Professor Pascal were a little uneasy.Sun Li'en has not been in the operating room a few times. The last time he visited the operating room, he met Director Zheng Guoyou who had a heart attack.And Professor Pascale has never been in the operating room since he got his MD.Ji Peisheng from the emergency department and a well-known immunology physician, just like Grandma Liu who had just entered the Grand View Garden, stretched their necks to watch the progress of the operation.

Unlike Sun Li'en and Pascal, Xu Yourong and Hu Jia were as relaxed as if they had returned home.Needless to say, Hu Jia, she spent five days a week assisting in various surgeries in the operating room.She was very familiar with the temperature-controlled operating room and those surgical instruments that shone with cold light, so she didn't feel any discomfort at all.And Xu Yourong's attitude went further than Hu Jia's - she was an excellent neurosurgeon, although in the Fourth Central Hospital, spine operations were basically handled by the Department of Orthopedics.But this does not affect her to develop her expertise in this field - the spinal cord and medulla oblongata are one of the key research directions of neurosurgery.

It is precisely because Xu Yourong is good enough that she understands better than Sun Li'en and others how important the operation that is being carried out in an orderly manner in front of her eyes is - previous doctors could only use titanium mesh and titanium alloy strips of various lengths that were not suitable for surgery. Barely replaced.And these hard-bent titanium meshes and alloy strips are really not up to the work of the atlas and axis.The size, shape, and even angle of inclination of the atlantoaxial vertebrae vary from person to person. 3D printing technology, and only 3D printing technology, can truly become a long-lasting substitute for the atlantoaxial spine.Although such prostheses still have huge drawbacks—for safety, the undamaged atlas needs to be internally fixed before the prosthesis can be installed—the patient may lose almost all head rotation.In layman's terms, Song Hualin may no longer be able to shake his head.

But it would still be a remarkable feat—better not being able to shake your head than being incinerated in a box.As long as the operation is successful, he can still embrace his family and walk in the warm sunshine and spring breeze.

Therefore, Xu Yourong stared intently.Rachel next to her didn't show much excitement about it, she just secretly held Xu Yourong's hand, most of her face was covered by the mask, so she couldn't see much expression.But there was a smile from time to time between his brows and eyes.

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The opening and closing of the human mouth is limited, so there is not much room for Wang Yifei to operate.The surgical assistant pulled Song Hualin's mouth open with a gag, exposing his soft palate as much as possible.Then he used a tongue depressor to depress his tongue as much as possible.The movements were a little rough and forceful, and the tongue depressor was even pressed out of an arc under the operation of the assistants.

"Be gentle, I will use this tongue in the future." Wang Yifei laughed and criticized his assistant, "Don't be so nervous."

The operating table was gradually raised, but because of Song Hualin's fractured axis, the angle at which Wang Yifei could operate was still very limited.He tried several times in a row, but in the end he could only lay down 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-biased, he paused for a moment and began to cut with the knife.When the blade was almost at the position of the uvula (little tongue), the scalpel bypassed the left side of the uvula and continued to cut along the midline of the uvula. The scalpel moved back along Song Hualin's soft palate toward the position of the incisors until it touches the hard palate.

The first small step is done.Director Wang Yifei stepped aside and turned to look at the MRI and CT pictures taken before.The assistants took advantage of this opportunity to quickly stop the bleeding of the cut soft palate, and used a small traction hook to pull away the cut soft palate.This exposed Song Hualin's posterior pharyngeal wall more thoroughly.

It seems unnecessary to incise a site without lesions just to obtain a better operating space and exposure field of view.But in fact, it is already the least invasive option-in fact, if the patient has problems such as congenital limited jaw movement, which leads to poor vision and insufficient surgical operation space, doctors may even make a split Mandible decision.As long as it can solve the worry of life, additional damage is completely acceptable.

Although the exposed posterior pharyngeal wall still looks small, it is finally possible to perform further surgery.Wang Yifei once again stood in the position of the chief surgeon.The scalpel was drawn down from the posterior pharyngeal wall, and the posterior pharyngeal wall was incised along the midline.After hemostasis and traction again, the upper and middle pharyngeal constrictor muscles and part of the longus capitis are exposed.

The reason why the atlantoaxial region is called "surgical restricted area" is highlighted here.The mouth itself has a certain depth, and there are a large number of muscles, nerves, ligaments and blood vessels in this area.These important and fragile tissues are easily injured during the operation.

Injuries to muscles can lead to impaired movement or infection, injuries to nerves can lead to a number of consequences including facial paralysis and long-term pain, and injuries to ligaments can lead to joint instability that can lead to more serious spinal and even bulbar problems .

As for blood vessel damage... If the injury is an artery, and the bleeding cannot be stopped quickly, then even the rescue is unnecessary—once the vertebral artery near the atlas ruptures, basically all the blood in the body can be drained within 1 minute. In the narrow operating space of the mouth, the rupture of the vertebral artery is equivalent to losing all vision in an instant.The doctor had to rely on his memory and hand feeling to find the rupture point of the vertebral artery in the gushing bright red blood, and suture the ruptured artery within 1 minute.Naturally, the success rate of this kind of rescue, which is almost the same as chance, will 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 he didn't feel any tension.He moved his shoulders and neck, motioned to his assistant to bring a small camera for video shooting, and explained the anatomy of this part on the spot.

"Usually, there are not many opportunities for you to see the muscles in this part. Basically, you can only see them on the general teacher." Professor Wang's tone was calm, stable and full of confidence. "But generally, the muscles in this part of the teacher have basically shrunk, and there are relatively few opportunities to see fresh muscles. Please experience more about the structure."

This operation is not only a challenge to the authority of the god of death by the doctors of the co-operation, but also a very important course content.Like many excellent medical schools, Tongxie's teaching style is not only rigorous, but also actively encourages the application of new technologies and procedures.Medical technology is a technology that is always evolving by itself.The sooner the medical value of the new technology is discovered, and the sooner a new surgical method can be designed around the new technology, the more patients can be saved.

Saving lives and improving the quality of life of patients is the most important core content of 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.The task on him is heavier, he wants to make these spells mastered by the students as soon as possible.There is no such thing as self-preservation in medical technology. Only when a technique is continuously spread can it be further improved.There can be no medical progress without broad and active medical communication.He is well aware of this.Therefore, Wang Yifei chose to emphasize the anatomical structure to the doctors who visited the operation at this time.He can still fully grasp the current situation. After bluntly separating the muscles and exposing Song Hualin's broken axis, he probably won't have the energy to teach.

After waiting for a minute or two, after confirming that all the doctors visiting the operation had seen this part of the muscle, the assistants picked up the forceps and pulled Song Hualin's tongue out.And Wang Yifei picked up the scalpel again, this time instead of using the sharp blade, he turned the scalpel around and used the handle to push away the two long muscles blocking his face.As for the upper and middle pharyngeal constrictors, it needs to be incised along the median seam.

After pulling away the middle pharyngeal constrictor hidden behind the superior pharyngeal constrictor with a separator again, Song Hualin's anterior longitudinal ligament was finally exposed.This is a major ligament that connects the front of the cervical spine.As the longest ligament in the human body, the main function of the anterior longitudinal ligament is to limit the hyperextension of the spine and prevent the intervertebral disc from protruding forward.

Blunt separation again, the hypopharyngeal constrictor and longus capitus are pulled away, and now, the C1 cervical atlas and the C2 cervical axis are completely exposed to the air.After layers of traction, the room for Wang Yifei to operate has become very small.

"Use an endoscope." For this result, Wang Yifei had already expected it.The reason why the operation through the oral approach is adopted is to minimize the intraoperative trauma to the patient.In order to reduce trauma, it is bound to lose some vision and operating space.But fortunately there is still an endoscope.If the previous surgery is the pinnacle of traditional surgery, then what Wang Yifei wants to show next is one of the main development directions of future surgery - endoscopic surgery.

Because other tissues have been separated, the endoscope for observation and operation and the two operating arms are all fixed by extracorporeal stents.Wang Yifei bent his body halfway and started the operation.Observing through the endoscope, Wang Yifei slowly cut Song Hualin's broken axis vertebrae into small pieces through two manipulator arms about 20 centimeters long and the grinding tools on the manipulator arms, and then took them out one by one.Each piece of axis bone, as well as the bone cement that was filled in to increase strength 15 years ago, were carefully cut into small pieces less than one centimeter.It is then removed by the manipulator arm.

This process proceeds extremely slowly.The shape of Song Hualin's fracture of the axis is very irregular. There are three fracture lines on his axis. In addition to the fracture of the odontoid process on the back side, there are two fracture lines on the body of the axis. If the tip of the human nose is used as the clock If the coordinate system is established in the direction of 12 o'clock, the two fracture lines are roughly equivalent to the positions of the hour hand at 4:50 and 10:20.With the frontal approach, the range of the axis that can be directly exposed is approximately between 9:00 and 3:00.That is to say, only one of the fracture lines can be observed through the frontal transoral approach, while the other fracture line does not appear in the field of view of the endoscope.

　I have to admit here that I really underestimated the difficulty of the fourth-level surgery... This set of surgery is so difficult that Sanguan can't even create a smooth sequential animation in my mind.It can only be slowly deliberated according to the anatomical structure...

　　It was 2019:3 in the morning on March 18, 3 when I wrote this chapter, and the orthopedic boss who has been helping me has already fallen asleep.Therefore, this chapter has not been fully reviewed at present, and there may be some errors. I will make a revision before twelve noon on March 18.

　　Thank you for your support, Sanguan is very grateful.

　　At 3:18 am on March 8, a revision was made.Corrected the reason why the head cannot be rotated after the axis replacement.

　　
　
(End of this chapter)