I Spent Those Years In the Operating Room Fighting Monsters

The joint capsule of the hip joint has been broken open.

The muscles around the joint capsule are dark red and dead flesh color, covered with pus, flowing out like mud.

If this is the case, there are at least three sinuses extending in all directions.

Sinus is a channel created after bacteria eroded the soft tissues. Wherever the sinus leads, there will be germs remaining. Moreover, the sinus is a closed cavity with no blood vessels permeable inside, so it is difficult to reach even with antiseptic drugs. !

The direction in which the sinus is generated is also random, not straight. It is impossible to know where it goes, extending the finer gaps, as if you don’t know where the tuberculosis refuge is. This will give a thorough debridement. It's very difficult.

At the same time, if the joint capsule is damaged, the recovery of joint stability after surgery is also a big problem.

Debridement does not mean that as long as the necrotic tissue is cut off, the follow-up of the operation is ignored.

In an instant, Lin Hui and Deng Zhi at the end of the season took a breath.

Lin Hui frowned and said, "Xiao Lu, can you win this situation? Or call Professor Min down directly."

This patient has tuberculous arthritis, and the expected operation time is quite long, so he was given general anesthesia directly. That's why Lin Hui spoke more bluntly without being too scrupulous.

Of these sinuses, one goes backward and inside, and the other goes forward toward the proximal end.

What does this mean? The anatomy of the hip joint has the sciatic nerve going to the back, and the femoral canal when it goes to the heart. The femoral tube surrounds the femoral nerve, femoral artery, and femoral vein.

These things are not so easy to circumvent.

"Teacher Tour, please call Professor Min. I'll try it first!" Lu Cheng didn't say anything directly. In this special situation, he still had to call Professor Min aside.

Lin Hui thought for a while. It seemed that he was not sure about this situation, so he didn't ask me to come and say something like this.

The itinerant nurse immediately called.

Lu Cheng held an electric knife in his hand. After straightening out his thoughts a bit, he began the debridement operation.

The debridement of the joint capsule is still relatively routine. The wall of the joint capsule is completely removed, and the round ligament of the femoral head is also removed.

Lu Cheng chose to peel off the round ligament, and then slid the acetabular socket very neatly with an electric knife, and then took out the rotten and ugly round ligament.

This thing is a bit like purulent appendicitis, but it's not the stench produced by bacterial infection like appendicitis, it looks like the flesh of a dead fish.

Lu Cheng didn't throw away the round ligament either, but to be on the safe side, he still had to send the round ligament along with the femoral head that was cut off. Long-term infection and stimulation are likely to cause malignant changes in tissues.

Although this probability is small, it must be considered that this is a thorough consideration for the patient's prognosis.

Then there are the muscles near the hip joint.

Lu Cheng replaced the electric knife with a round knife, because the electric knife was a bit too blunt, which was not conducive to rapid resection, but it stopped the bleeding during the resection process. This kind of large-scale initial debridement is significantly faster with a round knife.

Lin Hui's eye circles shrank a little when Lu Chengcai had just taken the knife.

Because Lu Cheng swiped it down with a single knife, it happened to be exactly at the edge of the dead flesh color of the muscle and the normal bright red muscle, probably only one millimeter of the normal muscle was removed!

Lin Hui had never seen this kind of control.

At the end of the season, he didn't see anything, Deng Zhi took a breath: "Brother Xiao Lu can be a chef with this knife, so he can be so accurate!"

Just kidding, where has Deng Zhi seen this kind of control? They do debridement, that's where they are broken. They would rather cut three thousand more than one.

Then Lu Cheng was like a butcher chopping meat again. Following the shape of the muscle, he cleaved the part of the necrotic tissue and basically restored 90% of the original shape of the muscle.

This kind of control made the scene extremely quiet for a while.

Probably when the first piece of dead meat was chopped off, he said at the end of the season: "Brother Hui, according to the principle of normal post-infection surgery, the debridement should not be at least 0.5 cm away from the infected site. Try to give the infected tissue to the site. Remove it?"

"The cut is less than 0.2cm, is it not up to the standard of thorough debridement?"

At the end of the season, this was a question and a kind reminder. Because that's what it says in the book.

Lin Hui answered directly: "This is the principle of debridement, but why this principle is so established? It is necessary to understand that when the distance from the infection edge is about 0.5 cm, it is to maintain the blood supply and leave the soft tissues. The remaining bacteria inside can be killed by antibiotics in the blood system."

"The blood supply inside our joints is not abundant, so we should try to clean up the soft tissues inside the joints, but the blood supply in the surrounding soft tissues is relatively abundant, so we can keep it as much as possible."

"And did you see that the joint capsule of this patient has been completely destroyed. After we have completed the joint replacement, we must restore the stability of the joint capsule, otherwise it will easily slip off even if the replacement is done."

"In this case, we must try our best to preserve the function. Otherwise, if there is not enough soft tissue to protect the stability of the joint, then even if this operation is done, it will only treat the infection. It is not very meaningful. Big."

"And you can see that there is no wound cut now, just a small amount of blood oozes out. This is a good thing. It proves that the blood supply of the remaining muscles is very normal. Tuberculosis drugs and antibacterial drugs can be reached."

"And after the operation, we will indwell the joint cavity for irrigation and drainage, which can kill the residual tuberculosis in the joint cavity to the greatest extent."

At the end of the season, he suddenly realized that he nodded quickly.

Looking at Lu Cheng's profile, what I thought was that when Lu Cheng was under the knife, he thought of this?

Lu Cheng nodded in his heart, and didn't say much. If his master said this, he would just praise him. Then this is not a boast, it is an insult.

Soon, Lu Cheng had excised the surrounding muscles, and put out the femoral head easily.

The residual femoral moment will not affect the subsequent joint replacement.

After this, Lu Cheng continued to clean the necrotic soft tissue inside the acetabulum and around the hip bone with a round knife.

In this way, after the muscle wound is completely stopped bleeding, it is finally the most important step in debridement.

Resection and clean up the sinus tract.

The current description of the sinus tract is not accurate, it should be the sinus tube, and the sinus tract should be directly connected internally and externally. It's just that it will become a sinus duct in the end, so it is customary to call this sinus duct a sinus duct.

And this kind of sinus duct, because there is no blood supply inside, and it is still a unilaterally closed dead space. Once it remains, the antibiotics in the blood after the operation cannot be reached, and the antibiotics in the washing fluid cannot be reached.

It is the best refuge for Mycobacterium tuberculosis, as long as it finds an opportunity, it can recur again!

There are three in total. The first one that Lu Cheng deals with is the relatively safe sinus.

After carefully opening the opening of the sinus, Lu Cheng found that the sinus is not very deep, and the sinus canal attached to the sinus can be directly removed from the inside of the infected part, and then temporarily vacant. After the operation is over, the excised cavity can be removed. The gap is completely closed by suture.

Next, only the more difficult sinus ducts at the posterior medial and proximal proximal ends are left.

Lu Cheng took a deep breath, and then called the itinerant nurse to change a round knife. Excision of muscle tissue for a long time before has dulled the current round blade.

There is a saying in cross talk. Unclear words are like killing a person with a blunt knife. When cutting meat, the knife is not good and you need to tear it apart. Now you are performing an operation on someone, so the weapon in your hand must be very sharp and not muddy.

The operation has to continue before Min Hong comes.

Lu Chengcheng chose the relatively simple posteromedial sinus canal, after a little thought, he opened it in.

After the sinus tube was cut, a steel needle was used to probe the bottom slightly, at least five centimeters above. This requires that the sinus does not turn.

Is it five centimeters long?

It depends on where it is.

This kind of debridement is not as simple as just cutting five centimeters away.

There are several options, the easiest is to add another incision, which is very safe, but the trauma is large. After the trauma is large, the chance of recurring infection after surgery is greater.

If it weren't for the last resort, Lu Cheng still didn't want to go this way.

When the hip joint is opened, both the gluteus maximus and gluteus medius muscles block the field of vision. If they are cut directly, it may cause the patient's hip muscles to atrophy and deform after surgery, or a large number of hip muscle scars will proliferate, resulting in lumps. Can't sit still.

Lin Hui also seemed to see Lu Cheng's current hesitation and difficulties, and he was also thinking about countermeasures for Lu Cheng.

However, almost a minute later, Lu Cheng suddenly looked bright and said, "Give me the gluteus medius hook."

The hand-washing nurse immediately handed the gluteus medius retractor, and then, Lu Cheng continued the existing opening a little bit towards the anterior superior iliac spine, and then peeked the gluteus medius retractor inside.

Suddenly, a magical scene appeared. The gluteus medius and gluteus maximus, which were originally very tightly blocked, were unexpectedly pulled apart by Lu Chengji, and the gluteus musculus that had been cut off by Lu Cheng before was again. turn.

Eh hey.

The girl who was not out of the pavilion waited for the cellulite in her boudoir and ran out. Of course, the cellulite was followed by the yellowish hard goods.

In a pile of fat tissue, it is the sciatic nerve that runs through, which is slightly outside the back of the femur, and is divided into two bundles!

Fat accumulates and becomes very hard at the place where the sinus tube is out of shape, and one end just falls on the sciatic nerve.

Lin Hui didn't have time to think about how Lu Cheng did what he is now, frowning and said: "This is a bit troublesome. If the sciatic nerve is also strained, it may be difficult to recover for a long time after surgery."

What is the sciatic nerve? It is the largest nerve in our body.

The sciatic nerve is the motor nerve of the posterior femoral muscles, calf and foot muscles, and is also an important sensory nerve of the calf and foot.

Many people have heard of sciatica. Once it is damaged, it is difficult to squat down on the toilet or sit down on a stool. This function is lost, and it is no different from disability.

"Give me the bone strip first!"

"Master, this kind of sinus is most afraid of getting in or directly wrapping the sciatic nerve in a circle, and then we tear off the outer envelope of the nerve during the avulsion process. But I think this is now This situation is not the most complicated, we can try it a little bit."

"Although the sequelae of nerve damage are large, one characteristic of the nerve is that it is relatively tough, not slippery, or brittle like muscle fibers."

"I tried to push it with a bone peeler to see if I could move it, if I could move it! That's okay."

Use a bone peel to scrape the nerve. What kind of nerve is this? At the end of the season, the eye circles are full of confusion. Under normal circumstances, everyone avoids nerves.

Still use the bone to provoke?

Lin Hui also touched the back of his head.

And at this moment, Lu Cheng was already on his hands, and saw Lu Cheng grabbed the sciatic nerve with his left hand, and then pushed it gently with a bone peel!

The hard lumps on it, hey, really slipped a bit.

Lu Chengcai stopped.

This action really scared Lin Hui's back into a cold sweat.

Finish the bird, finish the bird, finish the bird.

The things Zhu Ge and Wei were worried about appeared. The old monster and the little monster were combined, they really held the sciatic nerve and the popliteal nerve was playing in their hands.

When he saw this scene, Lin Hui finally waited for Lu Cheng to withdraw his hand, and after both hands left the patient, he caught Lu Cheng's hand!

To Lucheng shook his head.

Lu Cheng hadn't understood what Lin Hui meant before, so he would throw away Lin Hui's hand slightly, hoping that his help would not interfere with his chief sword.

But Lin Hui added strength and immediately said: "Xiao Lu, wait a minute, the sciatic nerve area is a common ‘exercise restricted area’ in our orthopedics department."

"The sequelae to the patient are too great."

At the end of the season, Deng Zhi and Deng Zhi immediately nodded to Lu Cheng, as if saying, eldest brother, you are the eldest brother, okay, let's be gentle, and leave this difficult operation to the professor.

You have done the debridement so carefully, there is no need to take this risk to show off your skills.

Lu Cheng thought for a while, then nodded, and then withdrew his operating vision from the depths. UU reading www.uukanshu. com

Immediately follow the femur to the distal end of a ‘poke’!

A brand new sinus tube, like a shy girl showing her face for the first time, flushed with shyness.

There was also a ‘torn’ blood.

The blood is mixed with sticky pus...

Looking at this scene, Lu Cheng didn’t care. He had discovered this hidden sinus tube a long time ago. There is a panel system that can display various monster blood bars. This hidden sinus tube is naturally hidden. Unstoppable.

Once the sinus tube is found, it must be broken open. This is something written in the textbook, which is very natural.

Lin Hui picked up his eyes and formed a barbed hook with his nose. His mouth was open. Hey, it was really just a question mark written on his entire face!

?

This is definitely a unique job!

Haishu

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