X-rays showed obvious osteolytic changes, and I felt like something was wrong.
I can’t put it into words, but just looking at the bone imaging on the film, I always feel that it is a bit uncoordinated and inconsistent.
After repeated inspections, Li Jingsheng was slightly frightened. No wonder he always felt something was wrong.
He touches people's bones every day and has a very clear impression of the proportions and diameters of most bones in the human body.
Bone palpation automatically forms a bone map in the brain.
This is an 'image' created by the collaboration between the touch and the brain. It has the same effect as watching a movie directly with your eyes.
To be precise, the image formed by touching the bone is more three-dimensional.
Just now I felt that the bone imaging on the X-ray film was a bit inconsistent. It was because there were abnormalities after comparing it with the bone images he usually felt.
In patients with diseased areas, the bones are obviously thicker, but not all thickened.
Instead, it is thick in the middle and gradually shrinks at both ends.
If I wasn’t very experienced, I wouldn’t have been able to detect this anomaly.
"Dr. Ruan, look at the X-ray taken by the patient today. Is there any bone expansion at the location of the osteolytic lesion?"
Li Jingsheng shared this discovery with the other party.
After Ruan Xiaoqin looked at it carefully for a moment, he was surprised and said, "Don't tell me, it seems to be a little bit bigger."
After hearing this, Li Jingsheng nodded, "The patient's lesion has clear boundaries and plaque-like calcifications. I think if a CT scan is performed, it is likely that there will be expansion of soft tissue density bone destruction and a characteristic calcified matrix. According to my personal experience Based on diagnostic experience, this patient’s illness may be serious!”
The other doctors just listened quietly.
They were also very impressed that Li Jingsheng could see from the X-ray film that the patient's bone lesions were slightly swollen.
"I'm going to the ward to see the patient!"
Li Jingsheng stood up and said.
"Um...I won't go with you. When the patient sees me, it's like meeting his ninth-generation enemy. I really didn't do anything to him!"
Ruan Xiaoqin said apologetically.
"It's okay, I'll just go find him."
Li Jingsheng went to the ward and saw the patient's girlfriend peeling bananas and feeding him.
Fortunately, he is not a bachelor now, otherwise his back teeth would be sore after eating this wave of dog food.
"Didn't I disturb you?"
Li Jingsheng said to the two of them with a smile.
The difference between having it and not having it is really big.
He also has a girlfriend now, and she is very beautiful, so he doesn't envy others at all.
When you come up to say hello, your expression is natural and the smile on your face is relaxed.
"No, no, are you going to do some tests on my boyfriend?"
The girl put away the bananas, stepped away a little, and then responded to Li Jingsheng with a slightly shy smile.
"Yes, I want to check the bones in his hand."
Li Jingsheng looked at the patient.
"How to check? I will cooperate fully."
The patient had a pretty good impression of Li Jingsheng. When he made trouble in the ward, Li Jingsheng didn't say anything harsh to him.
"Just give me your hand. It will hurt a little during the examination, please bear with it."
"no problem."
The patient extended his hand for Li Jingsheng to check.
When Li Jingsheng touched the bone, he moved closer to the lesion little by little.
Because the patient's right thumb is now swollen, and the closer it is to the diseased joint, the more painful the patient's expression becomes.
As soon as he touched the joint, Li Jingsheng frowned.
Considering that this kind of examination would cause great pain to the patient, he did not touch it again.
"How's it going? Can my boyfriend's bone injury be cured?"
"You may need to do anesthesia exploration. It feels like there is something wrong in the joint."
The results Li Jingsheng found out were actually very bad.
It's a bit like cancer, but the bone quality and surface feel are better than those of cancer patients.
But he knew very well that it was not an ordinary tumor or simple lesion that could cause such a big change in bone quality. It's even less likely to be arthritis.
He had touched the bones of arthritic patients, and they were completely different from this one.
There are many types of arthritis, such as osteoarthritis, rheumatoid arthritis, septic arthritis, etc. Each bone pattern is different from this patient's.
Therefore, he had an ominous premonition in his heart.
"Do you need a surgical examination?"
The patient and his girlfriend asked in unison.
"Yes, this test must be done."
Li Jingsheng affirmed with a serious expression.
"Then is this arthritis?"
"I don't know the specifics, but I'm sure it's more than just arthritis. Have you been injured multiple times, not just twice?"
Li Jingsheng asked the patient.
His current bone palpation skills are very good, and he can find out the approximate time of bone injury.
Just like when a tree trunk is injured, it will leave a scar.
Bone injuries will also leave traces such as callus. If it is severe, bone spurs and hyperplasia may even develop.
Even though he just touched it briefly, he still felt that the patient's diseased bones were injured more than twice.
"Yes! I have indeed been injured many times."
When the patient faced Li Jingsheng's eyes, he could not deny it.
Finally he lowered his head slightly.
"Doctor, you said that my injured part is always bad. Is it related to the repeated injuries while I am taking medicine?"
He finally couldn't help but ask.
While taking the medicine, I suffered a new injury, and it was the same part. I really don't know what to say about him.
"Why does the same part continue to be injured repeatedly while taking the medicine? Is it because of the special job?"
"His work has nothing to do with the injury. My boyfriend loves to play ball. Even if he is taking medicine, he can't help playing ball with his friends, which eventually leads to more injuries. I try to persuade him, but he always doesn't listen to me."
The girl said the reason next to her.
"Play basketball?"
"Um."
They both nodded at the same time.
"I've guessed it. With such a tall body, you must like to play basketball. Don't feel any psychological pressure for the time being. I will ask the director for feedback later. If the superior agrees, I will perform surgical exploration on you."
Li Jingsheng comforted the patient.
It's not a bad thing to like sports.
It's just that this buddy needs to control himself. If the thumb joint is injured, it is very easy to get a second or third injury while playing basketball, which will cause the bone injury to be difficult to heal.
"If I don't do this surgical examination, can't I find the cause?"
"That's not necessarily true. It's just that the most economical and accurate method is surgical exploration after anesthesia. It's best not to delay this. If it's a big problem, solve it as soon as possible. Otherwise, if you delay it for a long time, it may affect the entire body. By then there will be no chance of surgery.”
Li Jingsheng would never say such words to a patient.
The patient was too young to realize the seriousness of the problem.
"Doctor, what's the big problem you're talking about?"
The girl's mind was very delicate, and she immediately understood the deeper meaning of her words.
Her expression also became a little nervous.
"It's hard to say, let's check first!"
After saying that, Li Jingsheng walked out of the ward.
When he returned to the office, Ruan Xiaoqin looked at him expectantly.
"Dr. Li, have you found any problems? Your bone palpation skills are the best I have ever seen. It has completely subverted my understanding of medical examinations."
Ruan Xiaoqin didn't forget to flatter him at this time.
"Touching the bones is actually not a brilliant technique, it is similar to practicing the feeling of a knife during surgery. The most amazing thing about Chinese medicine is pulse diagnosis. Touching the patient is equivalent to a full-body examination. That is really awesome."
Li Jingsheng does not know much about traditional Chinese medicine.
Bone palpation and manual bone setting and reduction can be regarded as inheriting part of the bone injury treatment technology of traditional Chinese medicine, and at the same time, it incorporates the latest Western medicine examination technology and medical knowledge.
It can be regarded as a practical medical skill that integrates traditional Chinese medicine and Western medicine.
"I don't believe in those things about traditional Chinese medicine. It's just as good as the ancient dance masters and Zhurong techniques. Taking the pulse, I think it's very metaphysical."
Ruan Xiaoqin despises traditional Chinese medicine.
"Then let me ask you, pulse diagnosis can determine whether a woman is pregnant. How do you explain it? I have witnessed this with my own eyes. The Chinese medicine doctor felt the woman's wrist pulse and then told her that she was pregnant."
The Chinese medicine doctor Li Jingsheng was talking about was Boss Ye.
The bone injury medicine from Jingui Clinic is very useful, and he has never drank the herbal tea.
Once when I went to Jingui Clinic, I happened to see Boss Ye taking the pulse of a woman in her thirties. After just feeling it, he said that the woman was pregnant.
This incident shocked Li Jingsheng.
"Uh... Well, this is a bit mysterious! Let's discuss the patient's bone disease!"
Ruan Xiaoqin really couldn't refute.
Although modern Chinese medicine is in serious decline, many Chinese medicine practitioners know how to feel the Ximai pulse.
"That patient seems to have a serious problem with his bones and joints. I suggest you report it to Professor Wu immediately, and then give the patient anesthesia and surgical exploration."
"Is it that serious?"
After hearing this, Ruan Xiaoqin's expression changed slightly.
"very serious."
Li Jingsheng confirmed again.
"Okay, I'll find Professor Wu immediately."
Ruan Xiaoqin went to find Professor Wu in a hurry.
After all, the patient was treated by Ruan Xiaoqin. According to the hospital's first consultation system, he needs to be responsible to the end.
Not long after, Professor Wu came over.
"Dr. Li, how sure are you that the patient has a serious problem?"
Under the current examination results, surgical exploration is actually not supported.
But doctors are not dogmatic. As long as they think it is helpful to diagnose or treat the condition, and then obtain the patient's consent, they can proceed.
"More than 80%! It's very strange. It doesn't look like cancer, but it is somewhat similar to cancer. It may be in the early stage, or it may be other lesions."
Li Jingsheng said.
"Okay, I'll do the patient communication work."
Professor Wu showed his responsibility as a team leader at this time. This was not the first time he showed such responsibility.
"When I went to the ward just now, I briefly talked to the patient. As long as you make it more serious, the patient should agree."
Li Jingsheng is on the same page as Professor Wu.
Doctors are like parents.
In order to get the patient to agree to the operation, they can only join forces to deceive the patient.
Within a few minutes, Professor Wu came out.
"The patient agreed. Why don't we do this exploratory surgery for the patient now while you are here and there is still some time before the outpatient office starts work in the afternoon. It is also better to send the specimen for testing as soon as possible."
"I'm OK."
Li Jingsheng was very happy to hear that surgery was available.
Exploratory surgery mainly involves incision, suturing, and hemostasis. He is now proficient in all of them and is fully capable of doing it.
As long as nothing unexpected happens, the operation can be completed soon.
"There is no need to find an anesthesiologist for brachial plexus anesthesia. We can do it ourselves. Xiao Qin, please arrange for the patient to be taken to the operating room immediately."
"Will the operating room agree?"
Doctor Qin was a little worried.
The operating room is a unified arrangement of the hospital, and now it can be regarded as jumping in line.
"Many doctors have gone to eat and rest at noon, and many operating rooms are empty. Why don't they agree? Just let me contact you, and you hurry up and prepare."
After all, Professor Wu is a chief physician, and behind him stands the entire orthopedic surgery department.
Although many chief physicians looked down upon him, no one in the orthopedic surgery department would agree if he was really bullied over the use of the operating room.
It went smoother than expected.
Arrangements were quickly made in the operating room.
It is a small operation in itself and does not take long.
The most that can be done is to trouble the traveling teachers to clean and disinfect more often.
In the operating room, after the patient completed brachial plexus anesthesia, Li Jingsheng performed an incision and performed tumor exploration.
In the second group, including Professor Wu, no one has better surgical ability than Li Jingsheng.
Therefore, when performing surgery, in most cases, as long as he is present, there will be many opportunities to use his hands.
Even directly doing the surgery like this.
With one knife cut, he relied on his keen knife sense to avoid larger blood vessels and nerves, and the amount of bleeding was very small.
"Why is there so little blood?"
a facility nurse asked.
"It's our orthopedic surgeons who are very skilled, do you understand?"
Professor Wu said with some pride.
He really envied Li Jingsheng's cutting ability.
This kind of anatomy ability can only be possessed by veteran chief physicians who have practiced in the operating room for 20 to 30 years.
He almost watched Li Jingsheng grow up to new heights every day.
Now, Li Jingsheng's incision is really too strong.
By cutting open the cortex, subcutaneous fat layer, etc., the patient's proximal phalanx base can be clearly seen.
There is significant ulnar cortical destruction.
(End of chapter)
