Auto chess in the operating room

Chapter 282 Experts from the Provincial Military Hospital arrived (third update)
In the operating room, Tang Lou and Guo Caier were ready, and the rest of the equipment, nurses and other medical staff were also present.

Guo Caier stood in the position of the first assistant, still panicking in his heart: "Tang Lou, if you really can't go on for a while, don't force it. I will go to the superior doctor to take over."

Tang Lou ignored Guo Caier, but signaled Chen Wenhao to start anesthesia.

Chen Wenhao completed the endotracheal intubation and general anesthesia very quickly. After finishing, he sat in a far corner and yawned.

"Insert a urinary catheter"

Tang Lou issued the order, Guo Caier nodded, picked up tweezers and iodophor cotton with gloved hands, scrubbed and disinfected him, then lubricated the cotton with paraffin wax and strangled the rubber tube a few times. The tweezers are again carefully sterilized.

Guo Cai'er was also a little impressed, as expected of a firefighter, most people would have been intimidated and subdued by this time.

Guo Caier kept it at an obtuse angle and began to insert the catheter. I have to say that Guo Caier's technique is still very professional and sophisticated.

After completion, place Du Sanduo in a prone position with the abdomen kept in the air.

Afterwards, the surgical area was routinely disinfected and sterile surgical drapes were spread.

"X-ray machine Kirschner wire. Scalpel"

Tanglou started the next step very quickly, and the equipment nurse tacitly provided the equipment in place.

Under the X-ray machine, a Kirschner wire was used to locate the fractured vertebral body, and with the fractured vertebral body as the center, the skin, subcutaneous tissue and lumbar dorsal fascia were incised in sequence.

For Tang Lou, under the three-star incision, the completion was very neat and straightforward.

"Blunt Dissection of the Multifidus and Longissimus Compartment."

Tang Lou gave further instructions, and Guo Caier's basic skills were also very solid, and under Tang Lou's command, he cooperated very tacitly.

"Expose the diseased vertebra and the facet joints of the upper and lower adjacent vertebral bodies."

Tang Lou continued to issue orders, and under precise control, Guo Cai'er felt as smooth as performing surgery with the chief director in Union Medical College Hospital.

And there is no need to worry about problems with the operation. Every time I complete the steps by myself, the next instruction has been accurately followed.

During Guo Caier's operation, he glanced at Tang Lou, and was really surprised, how could this guy be so familiar with such a difficult technique.

"According to the point I instructed, insert the positioning needle, take X-ray films simultaneously, and confirm the position of the needle insertion point in the vertebral body"

"Okay, Doctor Tang."

Guo Cai'er stopped his thoughts and completely entered the rhythm of Tanglou.

"Opener Pathfinder Cone. Probe"

Equipment nurses are not to be outdone.

"The bony channel is determined during the operation, and the pedicle screws are placed."

Seeing Tang Lou's very fast operation, Guo Caier's heart was about to jump out: "Doctor Tang, slow down, slow down."

At the same time, she used X-ray films to verify. Under normal circumstances, fine-tuning would be done after the first insertion, but after seeing the results, Guo Caier opened her mouth slightly, so precise length control!
"Intraoperative Confirmation of Pedicle Screw Position"

For Guo Caier's verification results, Tang Lou took it for granted and directly chose to insert the connecting rod.

Guo Caier's fearful simultaneous verification found once again that the insertion length of the Tang Lou was perfect.

"This is too beautiful."

In less than 10 minutes, Tang Lou completed the extremely difficult approach.

The next step is the more dangerous anterior decompression and internal fixation of phalanx fusion.

"Electric knife"

Under Guo Caier's fear, Tang Lou began to peel the vertebral periosteum forward and backward.

Since the periosteum at the interface between the vertebral body and the intervertebral disc is closely connected, separation is very difficult. After Guo Caier couldn't believe it, Tang Lou boldly used an electric knife to incision, and the separation was fast and clean.

Guo Cai'er could only shout in his heart: Boss Niu Boyi (broken sound)!

Guo Cai'er was shocked when he saw Tang Lou's speed in identifying the relatively bulging intervertebral discs and sunken vertebral bodies. It was really fast.

This frequency, this endurance, Guo Caier is convinced that Dr. Tang really does what he does.

Before she could react, Tang Lou had already started to carefully process and ligate the segmental blood vessels of the fractured vertebra and the upper and lower normal vertebrae in the middle of the vertebral body.

Seeing that Guo Caier was a little confused, Tang Lou taught while operating:

"Removal of the upper and lower intervertebral discs of the fractured vertebra, as well as the cartilage endplates below and above the upper vertebral body, is beneficial to the fusion of the phalanges."

Guo Caier seems to understand but not understand.

Tang Lou was very patient and continued to add: "The broken bone fragments of the fractured vertebrae are easy to scrape out to achieve sufficient decompression in front of the dura mater. Of course, if you encounter old fractures in the future, you need sharp bone knives and drills to remove them step by step. The resection of the vertebral body, especially the posterior wall of the vertebral body, must be very careful, not only to achieve complete decompression, but also to avoid tearing the dura mater and damaging the spinal cord."

Tang Lou's voice fell, and the operation in his hands was also very precise and perfect.

"understood."

Guo Cai'er's eyes lit up. It turned out that she was always nervous when she was with the Chief Director. She was afraid of making mistakes. It would be nice to be able to complete her first assistant job. Why would she go back and think about these issues considered by the Chief Surgeon.

Under the guidance of Tang Lou, Guo Cai'er's understanding of the art has risen to a higher level.

"Isn't it completely useless to follow this guy?"

Guo Caier muttered something in his heart.

"Next, for correction, vertebral body spreader. Vertebral body screws"

"Good."

Guo Caier is like a silly girl, what Tang Lou says is what.

The correction was completed quickly. Since the patient's anterior longitudinal ligament was contracted, Tang Lou chose to cut off the annulus fibrosus and the anterior longitudinal ligament.

For bone grafting, Tang Lou chose a three-sided cortical iliac bone block of appropriate size. Of course, in principle, titanium mesh and artificial vertebral bodies filled with bone fragments can also be selected.

Next is the most critical part of the whole operation except for the approach:
Z-plate fixed!
Guo Caier was also shocked. This was the first time she used the Z-plate fixation, and her palms were slightly sweaty.

Sensing Guo Caier's nervousness, Tang Lou said lightly: "Next, just follow my instructions, it's very simple."

Under the talent of listening and the head of the subject, under the gentle and calm encouragement of Tang Lou, Guo Cai'er's mind has settled down.

It has to be said that in the operating room, Tang Lou is really very aura and the ability to make people feel at ease.

"Confirm the resection of the fractured vertebral body and decompress the front of the spinal cord"

Guo Cai'er continued his work as a first assistant, and confirmed Tang Lou's assistance.

"Firstly, two screws were implanted in the upper and lower posterior corners of the upper and lower vertebral body respectively. The screw entrances were 2mm away from the posterior wall of the vertebral body and 10mm below the upper endplate of the upper vertebral body.

Tang Lou gave direct and precise instructions, and with the cooperation of Guo Caier, the vertebral height can be restored by simultaneously stretching between the screws.

"Bone block implantation. Longitudinal compression between screws by placing titanium plate"

Under Tang Lou's control, the bone blocks were quickly embedded, and the bolts and titanium plates were fixed.

"Cai'er, you did a great job. Leave the rest to me."

Tang Lou praised it, starting the locking between the last bolt and the titanium plate, screwing the two screws at the front of the upper and lower vertebral bodies through the titanium plate chute, and quickly and perfectly completed the locking.

It wasn't until this moment that Guo Cai'er realized that he and Tang Lou had performed such a difficult operation.

After that, it's just aftermath.

"Placement of Chest and Retroperitoneal Drains"

After completing this step, Tang Lou showed another stitch of the diaphragm, closed the chest and sewed up the wound.

At this time, Captain Huang was in the office of Vice President Yang Xiaodong, Chen Qilong, the director of the orthopedics department of the Provincial Military Hospital, and Liu Shiliang, the director of the orthopedics department of the Municipal First Hospital, rushed back to the hospital.

As soon as Captain Huang saw the two experts, he immediately shook hands and greeted him: "Director Liu, Director Chen, I've been waiting for you. Thank you, thank you."

Director Chen smiled slightly: "Captain Huang, it's a shame to say that. It's also my honor to be able to operate on our little firefighter hero. Now, let's stop talking nonsense and go to the operating room."

"Yes, yes, before I came, the doctor on duty had already arranged various inspections and preoperative preparations, and I just waited for the two experts."

Captain Huang himself was very anxious. Seeing that the two directors were indeed people doing practical things, they were not pretending to be polite.

Accompanied by Dean Yang, two experts, Captain Huang, rushed to the operating room.

Along the way, seeing Captain Huang's anxious appearance, Director Liu said: "Captain Huang, don't worry, Director Chen is very experienced and professional in thoracic fracture surgery. I can say this, as long as Director Chen performs surgery, We are sure to restore the little hero to more than [-]%."

"Yes, and Director Chen has a lot of experience in the approach. In addition to the conventional percutaneous nail placement, he has successfully tried the more optimized approach through the paraspinal muscle space many times in recent years. This method can It greatly avoids the shortcomings of the traditional approach. It can be said that there are less than three people in the whole province who can do this approach well.”

Yang Xiaodong, as an old colleague of Chen Qilong, of course knows his research well.

"That's fine, that's fine."

After Captain Huang heard this, he finally felt relieved. Xiao Du, wait for Captain!

Soon the group arrived in front of the treatment room. Captain Huang saw Ma En at a glance and asked, "Doctor Ma, how is the preparation for the operation? The chief surgeon has arrived."

Ma En was taken aback when he saw Dean Yang and Director Liu, then looked at the strange Chen Qilong, and paused: "The operation has already started."

(End of this chapter)