When you first enter the society, you are full of ambition and want to fight hard, but what you encounter is all kinds of delays, all kinds of unspoken rules, all kinds of constraints, and all kinds of strife. Then you feel that this industry is hopeless! Everyone is inferior to you, and the leader is just an egg.
Then when you stay in this industry for four or five years, you will slowly realize the truth behind it. For example, this is the case now. An operation needs to be discussed and discussed, and then two enemies sit down together to formulate a plan. Is it procrastinating? It's very procrastinating, but this is indeed the normal way. It's for one reason only: safety. After all, geniuses don’t come around often!
In the small conference room of Department of Orthopedics, Lao Gao, Lao Wang and Zhang Fan were sitting together. How should I put it, these two people are very strange. In front of everyone, they are incompatible with each other, but when there are only three of them left, the relationship between Lao Gao and Lao Wang does not seem to be that bad. At least Lao Gao would take the initiative to add water to Lao Wang. Zhang Fan couldn't understand. He really couldn't understand what was going on with the two old guys, but he didn't have the heart to gossip.
"Tell me how you prepared." Lao Gao said to Zhang Fan.
"I plan to choose a posterior approach to perform a predictive correction of Bart's lumbar spine from the posterior approach."
"You mean, soft correction?" Lao Wang asked.
"Yes!" Zhang Fan replied affirmatively.
Then he said: "Two directors, look."
Zhang Fan stood up and opened the film viewer, placing all of Bart's image examinations on it. Then "Ka" opened the caliper, as if he had pulled out a dragon-slaying knife, he clicked on the image on the film viewer and said: "The apical vertebra of the child with scoliosis is the vertebral body. What we have to do is to fuse the upper and lower vertebrae. A vertebral body, the Cobb angle here is greater than 50°. During the operation, the two upper and lower vertebral bodies are fused, and then an open intervertebral disc at the end vertebra does not need to be fused, so that the upper and lower segments can compensate for the excessive correction. The distal vertebral body should be parallel to the sacral vertebra. When the two are inconsistent, the longest segment should be selected for fixation and fusion.
After spinal fusion, the balance of the spine is maintained by the unfused movable segments rather than by the fusion site. These can be determined by dynamic The terminal vertebral endplates are parallel in the curved image, and the axial surface of the curved direction should reach the neutral position. It is absolutely guaranteed that Bart will slowly change the deformity in the future. "
Speaking of which, let’s talk about the spine first. The spine is curved. Especially for slender women, their soft waists are like willows, making people want to hug them. This is the result of the spine, which has a slight S shape overall. Generally, the cervical and lumbar spine are the most prone to problems.
The mobility of the spine in these two places is relatively large. And especially the lumbar vertebrae, which are directly the pillars of the body, must bear both weight and range of motion, so people often suffer from neck pain and low back pain. Few people complain about back and spine pain. Once you experience pain or numbness in your waist or legs, you must pay attention. Sit less, lose weight, eat less, and exercise more.
What is the shape of the spine? Let’s use a metaphor. It's like an S-shaped cylinder stacked with chess pieces. There is a latex cushion between the chess pieces. This cushion is the lumbar intervertebral disc. Then, several rubber bands from top to bottom are attached to the front, back, left and right of the chess piece to stabilize the chess piece cylinder. These are ligaments. Moreover, these chess pieces are divided into front and back. The front is bare, with two wings called transverse processes on the sides, and a tail on the back called spinous processes. The chess pieces are stacked up, and then the tails and tails are laid out in layers like roof tiles.
There is a hole between the chess piece and the tail, which runs from top to bottom. There is also a smaller hole that penetrates from the top down between the two pairs of wings and the chess pieces. The hole between the chess piece and the tail runs through the extension of the brain: the spinal cord. What runs between the wings and the chess pieces are nerves like silk threads coming from the spinal cord. The human spine is probably such a structure.
The spinal cord is like a water pipe, or a signal transmission line. The stimulation received by the muscles is fed back to the brain. The brain makes calculations and then feeds back to the muscles, and then the muscles respond. Or the brain calculates and directly issues commands to the muscles to make movements.
In fact, this thing is very simple. For example, if you touch the butt of a beautiful girl, the muscles on the girl’s butt will transmit this feeling to the brain, huh! Feeling uncomfortable, your brain gives the command to slap you, and then you are slapped by a beautiful woman. Or, well! Feel comfortable, your brain gives the command, give it a kiss, and then you are kissed. This information is transmitted through the water tube of the spinal cord.
When the latex mat between the chess pieces is squeezed by the huge weight or long-term bad posture, it loses its elasticity and then protrudes like pulpy latex. When the protrusion reaches the spinal cord, this thing Although it is pulpy when facing the bones, it is much harder when facing the spinal cord. It begins to oppress and bully the spinal cord, and the spinal cord begins to make an aggrieved sound. Then you start to have back pain and leg numbness. This is the so-called lumbar disc herniation. When one or more of the chess pieces are displaced, the lumbar spine will herniate or bulge. This bulge is also considered a deformity, but it is only local.
Spine surgery is considered the top surgery in orthopedics because there are so many things to consider. General fracture surgery also considers plane issues, whether the joints are tight and whether they conform to the physiological position. The spine is very troublesome. It must be considered from at least three coordinates in three directions.
Median, coronal, and sagittal. The median position is easy to understand. In layman's terms, the coronal position is just a glass plate, facing the same direction as the eyes, and then cut directly from the head. This position is the coronal position. The sagittal position is the plane formed after a bow and arrow is inserted into the face. This thing is really anti-human, and it is very troublesome to explain it in words. Therefore, such professional words must be explained with pictures and then memorized by rote. For spine surgery, these three positions must be considered. As long as one position is inappropriate, sequelae can occur. Because it does not conform to the physiological position, it will lead to a chain reaction of problems with the stability of the human body.
Spinal deformity, to put it simply, is a cylinder built up of chess pieces. One or more chess pieces are placed in the wrong direction, causing the overall shape to change. Orthopedic surgery is to straighten the wrong direction of the chess piece. But there is another very, very difficult thing. Children's development is about growth. After the deformity is adjusted through surgery, if the position or orientation does not conform to the future growth trend, then the operation will be a complete failure.
Failure of the operation will lead to even more terrible secondary injuries. Not only does the symptom not improve, it may worsen the condition, which is such a terrible thing. Therefore, once some uncertain factors are added to something, the difficulty of the matter will increase by an order of magnitude. Therefore, Lao Gao and Lao Wang had no choice but to be cautious about this operation.
In the early years this treatment was symptomatic. It means forcibly adjusting the wrong posture of the spine, and there are many postoperative complications. Because it is forced correction, pseudoarthrosis, recurrence of deformity, and huge incision trauma often occur. Later, with the development of materials science and the emergence of various new materials, doctors slowly conquered this disease.
But this disease is so common that many orthopedic surgeons will never encounter it in their lifetime. To put it mildly, it accounts for a large proportion among teenagers, and the majority are women. And there is no way to quantify this surgery. For example, appendix surgery is from the iliac bone to the middle and outer third of the navel. No matter how weird the location is, as long as the incision is larger and the cecum is pulled out and searched, sooner or later it will be found.
But this surgery is not possible and must be combined with the actual situation. Different doctors have different understandings of the patient's future growth, and different surgical methods or orthopedic methods. For example, Lao Gao believes that the child can grow to 1.8 meters in the future, but Lao Wang believes that the child can grow to 3 meters in the future. This is something that cannot be directly quantified, so if you don’t have a master to teach you, if you want to perform this kind of surgery, you can just think about it.
This kind of surgery has been performed since 1914. But so far, most hospitals still can't do it, and most spine and orthopedic doctors can't do it. You can imagine how difficult this kind of surgery is.
Zhang Fan's very detailed and convincing surgical plan made the two directors nod involuntarily at the same time.
"Did you ever encounter this kind of surgery when you were in Jade Bird?" Zhang Fan said it so clearly that Lao Wang could not refute it, so he could only look for other reasons to reassure himself. At the same time, Lao Gao also paid attention.
"I did!" Lies, especially lies like this, were told so often that Zhang Fan felt that he was telling the truth, and he almost caused himself to suffer from schizophrenia.
"How about~~" Lao Wang looked at Lao Gao and said uncertainly.
"Director, really, there must be no problem. You will definitely do well." Zhang Fan had to say in a very positive tone in order to confirm the two people's thoughts.
"Do it!" Lao Gao glanced at Zhang Fan and agreed.
"Okay, in that case, let the three of us sign the surgical plan together. I am the director of spine surgery, so let me sign the first name."
"The patient belongs to our department." Lao Gao said unceremoniously.
At this time, Zhang Fan was in tears. Really, how lucky he must be to meet such a good teacher, such a protective teacher. The first thing here is not honor or profit. If the operation is done well, it is the right thing to do. If it is not done well, you have to take responsibility, and you have to take the main responsibility.
"I'll sign the first one." Zhang Fan started crying.
"Haha!" The two old men looked at him at the same time and sneered! Naked look down upon!
