Zhang Fan had a really solid sleep this time. He probably fell asleep at around one o'clock at noon. He didn't even have time to fall asleep. Zhang Fan fell into a deep sleep and slept until about eight o'clock in the evening. When he woke up, Zhang Fan felt dizzy. . What should I say about this matter? First of all, the amount of surgery is a bit too much, and the partners are a young girl and the incompetent Xue Fei.
Zhang Fan almost did all the steel plate orthopedics, joining the bone pieces together, drilling the holes with the electric drill, and installing the screws all by himself. It really sounded like a carpenter making furniture. The workload was really quite large, and he couldn't move around freely, and it consumed a lot of money. . Second, we have to blame the hospital cafeteria. The lunch boxes at noon and the lunch boxes at night are just boiled cabbage and potatoes stewed in plain water, not to mention meat, not even a bit of oil. It is really a healthy diet in this era.
But for Zhang Fan and others who do physical work, it won't work. This kind of diet without fat and protein will consume all the two steel plates for orthopedics. If there is a high-quality diet, Zhang Fan probably won't be so tired, and the system can The dean can be replaced by a quick conversion of energy, but a canteen owner can't be replaced, which is weird!
Zhang Fan shook his head, and after feeling a little better, he got up and went out. When I looked around, I saw that the old couple and Shao Hua were sitting on the sofa like puppets. They didn't talk or watch TV, they just sat there blankly. "Why aren't you watching TV?" Zhang Fan asked before going to the bathroom.
"Shao Hua is afraid of disturbing you!" The old man pouted, not saying whether he was happy or not, but just like a child complaining. After Shao Hua called, the old couple wandered around the community with food from the farm all afternoon, and finally Shao Hua got off work.
When I got home, the old man said he was watching the news and kept his voice low. Shao Hua disagreed. It's not that Shao Hua was unreasonable. Zhang Fan's state today really made Shao Hua feel distressed, so he directly rejected his father's request. When Zhang Fan got up, the old man complained.
Zhang Fan cleaned up for a while, walked out of the bathroom, and said to the old couple with a smile: "I'm a little tired today. I can't hear anything when I fall asleep. From now on, I will go to bed after night shift. What should you do? It's noisy even when I sing at home." Not mine."
"If you don't watch TV, you won't lose a piece of meat. It's okay if you don't get enough rest. What you are doing is a matter of life and death. You must not be careless. Let's eat first. You must be hungry. Today is a big plate of chicken and noodles. You are the best. My favorite belt noodles. The local chicken tastes so good!" the old lady said after taking a look at the old man.
"Really? I told you why it smells so good. Oh! Someone gave me two bottles of Maotai. My uncle will try it to see if it is real!"
"Bang! Medium special, he can taste the truth and lies." The old lady said before leaving. The old man's best skill was despised, and she almost fainted.
"Why can't I taste it? Let me tell you, I have drunk more wine than you have ever seen water." The old man wanted to chase after him and quarrel. Zhang Fan quickly took out the wine given by the medical representative during the department dinner a few days ago, "Uncle, please take a look, is there anything wrong with the packaging?"
Old children, old children, that’s what happens when people get old, they have to be coaxed. The old man took the wine seriously and looked over it several times, "Yeah! It shouldn't be a big problem!"
"Pfft!" Shao Hua almost laughed. Zhang Fan rolled his eyes at Shao Hua. Shao Hua covered his mouth, held back his laughter, stood up, and said to the kitchen: "Mom, do some skin teeth too!" Then he hurried to the kitchen, The couple laughed secretly in the kitchen.
"Long hair makes short sight." After the old man said this, he said to Zhang Fan: "You have a bright future, so you can't make mistakes for this thing. In fact, it doesn't matter what I drink. As long as you are healthy and safe, I It’s better than any drink.”
"Well, don't worry, uncle, it's okay."
"Okay, it's fine. Let's go and eat. Today is a local chicken. I went to the farm to buy it. It's a small local chicken less than a year old. It's very tender." The old man didn't say much, just mentioned it. The taste of Shao Hua's family is a little more Jiangsu and Zhejiang, and the food is sweet. Even the poached eggs are sweet and contain sugar. But Zhang Fan, who comes from the northwest, can't eat this sweet.
One time, Zhang Fan ate the sweet-poached eggs made by Shao Hua's mother as if he were drinking medicine. From then on, sweets were rarely eaten at home, and most of them were pasta. The two old men really took good care of Zhang Fan. At the beginning of the lanterns, the family sat together and had a lively meal of chicken and noodles. Zhang Fan was really hungry. On a plate of chicken, potatoes, and noodles, the other three people didn't eat more than half of what Zhang Fan ate.
After eating and drinking, Zhang Fan and Shao Hua took a walk on the roadside. This night market in the border area is very unique. In winter, haggis and mutton soup are the mainstream. A hot bowl of it can drive away the coldness in the whole body. When the weather gets a little warmer, roasted lamb becomes the mainstream, as well as sheep heads, tendons, and cold and spicy lamb tripe. You can tell by the smell that they are quite good. Their craftsmanship is really good, and the cold mutton is very delicious.
Although there are many ethnic groups in the border area, most of these night markets are local stalls, and they really have their own way of cooking. The food of the people of Sanchuan is good enough, but in the frontier, the world is divided between the people of Sanchuan and the Hui people. Definitely unlike other provinces, Sanchuan hot pot can directly destroy the local catering industry.
In the early morning, after Zhang Fan got up, the old lady had already prepared Zhang Fan's breakfast and put it on the table. Although the old man was very kind to the old lady and they had a good relationship, the old man would never do heavy things or heavy physical work. I'll let the old lady do it. But in this kitchen, he never interfered. After Zhang Fan came, he would not let Zhang Fan interfere, even if Shao Hua objected. What he said was: A grown man who keeps wandering around in the kitchen will wear away his fighting spirit! Zhang Fan can only respect the old man's opinion!
There is a surgery today, and it is a relatively important surgery, so Zhang Fan said hello to the old lady in advance last night. He will not drink milk, eat soy products, pickled products and other foods. Zhang Fan is afraid of diarrhea. This is a detail. When life and death matter, no details, no matter how small, can be overstated. Zhang Fan drank some porridge, ate an egg, and some steamed buns before going to work.
In the department, the doctors also came early. Xue Fei didn't go to play mahjong last night. Zhang Fan was so exhausted that he went home and fell asleep. He didn't eat dinner and slept until dawn. His wife was very happy. If this continued for half a year, I guess I can make Xue Fei quit playing mahjong!
There is only one difficulty in this operation, which is to determine whether the broken ends of the fracture are connected to the physiological position. Not many people are doing this kind of surgery now. It’s hard to say why. It’s just that there aren’t many people doing it anymore. The mainstream method is still incision and fixation. This is just a quick talk. Lao Gao was willing to take the blame to carry out this surgical method. If the director were changed, it would probably not be possible.
When typing blindly, the feeling under the hand is very important. This feeling is not a boast, it is real. When the fracture line is well aligned, doctors with extraordinary experience will feel it. However, this experience is too difficult and too difficult. There are so many patients for you to practice on. Even if there are patients who are willing to let you practice, the department director and other doctors are not willing. Anyway, it is just for profit.
There is a difference between the anatomical position and the physiological position of a fracture. The biggest advantage of open internal fixation is that it can reach the anatomical position, which means it can be tightly closed, just like there is no fracture. This is for the broken end of the fracture. But the damage was also quite huge, and almost all of the periosteum around the broken end was destroyed.
The physiological position means that although it is not the same as the original, it does not affect the function and has no deformity.
The ancestors of orthopedics in China were very good at this aspect. Liu style bone setting and Chen style bone setting. These doctors have been able to reduce most fractures with bare hands hundreds or even thousands of years ago, and then achieve physiological results. As for the anatomical position, as technology becomes more advanced, this technique becomes increasingly rare. Where has it gone? Who wants to know!
The patient has been sent to the operating room. After the morning meeting, Lao Gao led a group of doctors from the orthopedics department and walked to the operating room in an orderly manner. Of course, Zhang Fan was at the end of the team at this time. He had no choice but to have no hair on his lips and no professional title on his head.
Whether it is the Department of Orthopedics that requires touch typing, or whether Zhang Fan requires touch typing, there are many people who know about the three orthopedics departments. Those who are motivated, those who are curious, and those who watch the excitement are all very concerned. There are all kinds of people with different mentality, but the operating room is an operating room, and only a few operators can enter, and at most one or two observing doctors. If there are too many people, a sterile environment cannot be achieved.
However, this is not a big problem. The operating room of the city hospital is divided into three floors. There is an electronic classroom on the bottom floor where you can watch the progress of the operation. "Director, let me go up and help you lift your legs and disinfect them!" When he was about to enter the operating room, Xu Xian hurriedly found Lao Gao. He was a motivated person, otherwise a dignified graduate student would have no face!
Lao Gao looked at Xu Xian, who looked at the director with sincere and clear eyes. "Okay, you come on stage too, Sansuke. Go change your clothes quickly." Upon hearing this, Xu Xian hurriedly entered the dressing room. To be honest, he had never heard of this kind of surgery. The cases were all in the textbooks.
This surgery sounds simple and looks very simple. It seems difficult before the incision and internal fixation. However, this surgery requires great touch and awareness. A slight deviation can mean a loss of a thousand miles, because the skin and soft tissue at the broken end will not be cut, and everything cannot be directly seen. It is difficult!
In the operating room, the anesthetist, circulating nurse, and surgical nurse were all ready and waiting for the doctors to enter. In the electronic classroom, almost all the doctors from the Department of Orthopedics were here. Although Zhang Fan did not notify the Department of Orthopedics 2 and Department 3, almost all the doctors who could come came. Even the medical office sent people. Although they did not understand the difficulty of this operation, as long as the operation was successful, a colorful article would immediately appear in the hospital newspaper.
Although Lao Gao said at the morning meeting that he would take Zhang Fan for surgery, Zhang Fan was still the surgeon. There are two senior doctors, Lao Gao and Lao Chen, and two residents, Zhang Fan and Xu Xian. After the anesthetist completed the anesthesia, he said to several doctors: "Start." Xu Xian neatly brushed his hands and began to disinfect. Before Zhang Fan went into surgery, he took one last X-ray carefully. Although the X-ray was already engraved in his mind, Zhang Fan still read it carefully.
Lao Gao and Lao Chen stood aside, silently and not speaking. There was very little they could do to help with this operation, and Lao Gao was also prepared to perform incision and internal fixation immediately if the blind injection failed. Wash your hands and put on surgical gown, "It's okay, don't be stressed, the worst is to cut it open and fix it internally, it's nothing." Lao Gao said when Zhang Fan put on his clothes, put on his gloves, and picked up the sharp knife.
"Hmm!" Zhang Fan is not good at this. Once he undergoes surgery, he won't speak unless he can, and he doesn't like other people talking. Therefore, as long as it is an operation performed by Zhang Fan, the air pressure in the operating room is quite low, and the anesthetist and Even the circulating nurses dare not speak. This is a matter of personal temperament.
"Start." After Zhang Fan finished speaking, he began to prepare to cut the skin. How this surgery works? To put it roughly, the femur is the human thigh, and then the thigh is broken in the middle, and the broken end does not shift much. Zhang Fan now needs to open a small opening at the uppermost end of the femur, then use an electric drill to open the bone, and insert a long alloy rod through the opening. There are two holes at the lower end of the alloy rod and two holes at the upper end. , these are holes for screws. After it is fixed and the broken ends are in good alignment, the four screws are then tightened to fix the fracture and the operation is over.
It's that simple, a simple surgery that 80 to 90 percent of orthopedic surgeons cannot perform. Not to mention touch typing, just incision and fixation. A less skilled doctor might not even be able to find the screw hole of this alloy! Zhang Fan opened a small incision and used an electric knife to stop the bleeding. In the past, when there was no electric knife, he would use silk thread to tie it up.
Zhang Fan was the surgeon, Lao Gao was smoking with a suction device, Lao Chen was gently using a small retractor to open the skin, Xu Xian was fine now, so he just stood and watched. The electric knife is actually very simple, just like a soldering iron. The human body has evolved so much that there are almost no large blood vessels in the superficial layer. When the skin and dermis are incised, the bleeding is not obvious. It is only when the fat layer and muscle layer are reached that there are larger capillaries. The electric knife directly electrocoagulates and nourishes! Zhi! No more bleeding.
The closer to dinner time the surgery becomes, the more painful it becomes. Especially when using the electric knife, the blood vessels are being burned and the fat is being burned at the same time. The fat will smoke instantly. Even though I am wearing a mask, the smell of barbecue comes right away. Really. , when you are hungry, you can salivate when you smell this smell.
"Electric drill." Zhang Fan said after opening a small opening in the skin, separating the muscle and fascia layers with his bare hands, stopping the bleeding, and exposing the bone. The surgical nurse stood aside and installed the electric drill early. After the adjustment was completed, she calmly handed the drill to Zhang Fan.
"Squeak! Squeak! Squeak!" The hard bones opened an opening like tofu. Everyone has eaten bones, especially large bones, which contain marrow and red soft bone like a honeycomb. When the electric drill is drilled, the bones are like coffee with milk. White bone powder, dark red blood, and milky white bone marrow are stirred together, and then mixed quickly, and finally become a bit whitish milk. Same as soup.
The early methods of this kind of surgery were very cruel. When there were no electric drills or when electric drills were not yet popular, this kind of surgery was like a butcher's stall, with osteotomes and bone hammers, bang! Bang! Bang, forcefully smashed a hole in the bone. Moreover, the early intramedullary fixation was very troublesome. The femur is not a smooth cavity. It has spirals and various bone trabeculae. This shape can make the femur very hard and produce blood.
Therefore, when fixing, you must first use a small expander, insert it into the femoral cavity, and use a hammer to pound it in. How strong is this? If you stand behind the operating table, you can see the patient, who is tied up. The patient's whole body was shaken!
The marrow expander is very much like a triangular bayonet, but it is not sharp, but very thick. Small size, medium size, large size, one by one, the bone marrow cavity is expanded and smoothed. You can imagine how you eat the bone marrow with chopsticks. In fact, the principle is similar, but the chopsticks cannot make the cavity wider. That's it, the force of inserting the chopsticks is just a little smaller, instead of hitting the chopstick head with a hammer!
When the hammer hits the expander. Smash it, and the blood will carry the bone marrow, and white and red blood spots will splash everywhere. At this time, if blood flies into the doctor's eyes and the patient has a blood-borne disease, it will be very troublesome! With the development of science and technology, there are now instruments that do not require reaming, making this kind of surgery more elegant.
Opening the medullary cavity, Zhang Fan gently inserted the intramedullary nail and slowly lowered it. In this surgery, regardless of whether it is done blindly or not, the length must be calculated by comparing it with the X-ray, and it cannot be longer or shorter. Slowly go down, "Rotate the lower end of the femur ten degrees externally." Zhang Fan held the intramedullary nail with one hand and pressed the upper end of the femur with the other, and said to Lao Gao and Lao Chen.
Orthopedic surgeons, a good orthopedic surgeon must have a strong sense of three-dimensional space and good knowledge of geometry. Back then, Lao Lu couldn't draw, let alone geometry. Drawing a blood vessel made his head big. Before he even learned about bones, he was persuaded Return.
It’s really difficult to grasp the various angles of orthopedics. Not to mention the operating table. Ordinary people would put two chopsticks crossed at a ten-degree angle without using measuring tools, and not many people would be able to do it, let alone in such a situation where they cannot see directly.
"Stop! Two degrees of internal rotation and pull-down, slight pull-down." Zhang Fan directed the assistant to reset. If the assistant is not good at this time, Zhang Fan alone cannot do it, so the team, the surgical team is very important. Lao Gao and Lao Chen slowly rotated, Xu Xian grabbed his calf and slowly pulled it down.
The reason why you need to pull down is to slightly separate the broken ends of the fracture. The force should not be too strong or too small. If it is too strong, it may be pulled and displaced. Too small and unable to separate the broken ends. Zhang Fan took the intramedullary nail and gently touched the broken end, as if it were his hand, and the changes at the broken end were clearly presented in his mind.
This is what it feels like, this is how practice makes perfect. Lao Gao has never felt like this in his whole life. You can imagine how anxious Zhang Fan must be! I don’t know how many surgeries are performed in the system. "Click!" A slight vibration came over, which was the sound of bone stubble resetting.
"Okay, don't move, keep this position now." The fracture reduction changes during movement, because it is an oblique fracture, there is an angle during reduction, and at this time, the patient's lower limb on the affected side is hanging in the air, that is, an old lady, the thigh not heavy. If you are a fat man, this holding position can keep the three assistants until their muscles get sore.
This maintenance is not just about lifting it up, it must be maintained in a fixed position. Three people need to have a strong force to hold it together. To put it simply, if the chopsticks are broken, you have to tie them up. They have to be aligned, and then push them together with a force to tie them up. This is the same principle.
And this requires the cooperation of three people, Zhang Fan directs, five minutes, ten minutes, twenty minutes. It's really exhausting to keep a fixed position and continuously output a steady force. Although he is an old man, his lower limbs still have some weight.
Zhang Fan inserted it, tilted it slightly, and slowly slid it down, avoiding the broken end, and slowly pressed it against the bone. He couldn't be impatient at all. This was not something that could be impatient. The sweat of Lao Gao and Lao Chen has appeared. During the rounds, the head nurse sent another one after the original round to gently wipe the two old doctors.
"Director, why don't you turn down the air conditioner temperature?" The head nurse came in and asked when she saw the two old men dripping with sweat.
"No! No, no matter how low it is, the patient will have a cold!" It was inconvenient for Lao Gao to speak continuously. He was afraid that speaking continuously would cause vibration and cause the reset fracture end to shift.
After entering, Zhang Fan turned the knob and said, "Reset. Knife!" The surgical nurse immediately turned the handle of the knife to Zhang Fan, the blade to herself, and handed it to Zhang Fan. Zhang Fan cut it open with a knife, then made holes to install screws. This is also a difficulty. Let alone blind drilling. Sometimes, under the condition of incision and direct vision, doctors with insufficient skills cannot even find the screw hole.
"I've made a hole, be sure to keep it well." Zhang Fan said to the three assistants with an electric drill.
"Okay!" Xu Xian said.
Lao Gao and Lao Chen just nodded.
Open the hole, "click!" Zhang Fan's positioning is so awesome. After drilling the bone, it is directly the screw hole, and there is no need to adjust the position. This is an awesome feel and awesome technology. Xu Xian was dumbfounded. He guessed that Zhang Fan still had to adjust and find a position. After all, this was touch typing. Even if it was not touch typing, he had not seen many successful positionings like this at one time.
Install the screws, "OK. Director, it's ready!" After Zhang Fan finished speaking, he had already started rinsing and was ready to suture. Lao Gao secretly rubbed his sore and numb hands and said to Zhang Fan, "Why don't you take a look under the C-arm?"
"That's right, don't worry, it should be fine, but let's take a look, don't worry." Lao Chen also said. This is Zhang Fan. If it were any other resident doctor, he would simply push the C-arm! When facing Zhang Fan, both of them spoke with a tone of discussion.
In the audio-visual classroom, a group of orthopedic surgeons were confused. There was not much to see in this operation. There were only two small incisions, and the whole process relied on the touch and feel of the surgeon. But Zhang Fan, who was so immortal, became as mute as soon as he underwent surgery. He would not speak if he could. Zhang Fan did not explain his feelings, and only the other three doctors on the operating table had some feelings.
The doctor in the electronic classroom was confused, "That's it. Zhang Fan is the same. He didn't say how to fix it or how to confirm it. Hey! It was in vain. It was like a pantomime. He left to write medical records. "
"Hey, wait a minute, let's see the results of the C-arm!"
"What the heck, didn't you see that Zhang Fan was ready to be sutured! Even if you saw the results, would you do it? Really, let's go!" A group of doctors left with a feeling in their hearts.
It's not that Zhang Fan didn't say that sometimes, this feeling, especially this mysterious and mysterious feeling, really can't be expressed in words, it can only be understood!
The little nurse pushed the C-arm over, and the doctors and nurses all stood behind the cylinder next door to observe. Pat it lightly, OK, the fractured ends of the monitor are aligned very well.
"Awesome! The angle judgment is too good." Old Chen said to Zhang Fan with his thumb raised.
"Teacher Zhang, how did you determine that in that situation, how did you determine that it needed to be rotated ten degrees." After Xu Xian was shocked, he began to ask for advice. This is a learning mentality.
"Yes, tell me." Lao Gao also said.
"Well, let's feel it. Look at the original X-ray. Although the angle is slightly larger, the internal rotation of the muscles corrects the angle a bit after the downward rotation. And look at the old man's The muscle strength has been relaxed, so the angle should be about ten to twelve degrees. When I used the probe to probe, it felt like it was at this point, and these two points were together!" Zhang Fan pointed out Said while talking about the original film.
"Uh!" Xu Xian broke into a cold sweat and could feel it. When Xu Xian was about to open his mouth to speak, the anesthesiologist spoke, "Hey! Why are we talking? Whether or not the stitches will be stitched, I can tell you that the old lady is about to wake up."
"Haha, let's go down and suture it. Let's go, Old Chen, let's do the operation. I've been letting this guy instruct me for a long time, and my hands are sore. I'll leave the rest to them!"
"That's right, you guys should take a rest quickly. Doctor Xu, please go down as well, and leave the rest to me." Zhang Fan said.
"It's okay, it's okay. You can go down and rest. Leave the rest to me."
Can Zhang Fan go down? No, so Xu Xian didn't even get sutures done. Xu Xian got the needle holder to sew, but Zhang Fan snatched it away, "This incision seems to have cut a small blood vessel when I cut it. I sew it, but you don't know the place!"
"Why is this thing so unique? It won't even allow you to sew it up. Besides, your sister, what kind of blood vessels are there!" Xu Xian looked cute!
The operation is over!
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