The Godfather of Surgery

The excruciating three o'clock in the afternoon finally arrived.

Director Han didn't come back, Director Ouyang and Director Bai went out to fly knives, and Director Ding was the dragon who saw the beginning but not the end anyway.

Director Tian and Dr. Jin are here. Originally, this kind of small learning class is mainly for young doctors.

The high-definition screen played repeatedly Professor Zhang's surgery video.

There were a lot of people coming, so Yao Ling quickly arranged for two nurses to help and add some folding chairs inside.

Zhang Lin sat at the outermost desk in the first row, spread out a notebook, and everyone signed and punched in the notebook one by one.

"Sign the card, brothers, don't forget it."

Zhang Lin shouted loudly, and if he forgot, hurry up and make up for it.

Professor Zhang was not here for the time being. He wanted Yang Ping to inform him when he was about to finish. He wanted to say a few words.

He said that with him, the children dared not speak, so he did not cause trouble.

"Professor Zhang, you are in good spirits today." Someone greeted Zhang Lin.

Everyone was startled, Nima, did Professor Zhang call him casually?

"Come on, there are no seats left."

"In the elevator."

Wechat groups are urging each other.

The people were almost there, Zhang Lin Xiaowu maintained the order, Director Tian looked at his watch and explained to Song Zimo: "It starts on time at three o'clock."

Among those attending the meeting, Director Tian had the highest title and naturally presided over the meeting. He also wanted to listen to this class. He also wanted to participate in the discussion of Professor Zhang's surgery, which was so fast and bold.

The seats were full, and there were many folding chairs around, but it was still not enough, and some people were standing.

Usually small lectures, some guys for various reasons, there are always people who will try to get away.

Today, except for the one who performed emergency surgery with the hospital manager, all the others came, all the interns arrived, and people from other departments also came. Not too many people join in the fun.

Three o'clock, start on time.

Song Zimo stepped onto the podium, his iconic white lab coat unbuttoned.

He is a natural star. In addition to his outstanding appearance, confident temperament, and the pair of Thor's eyes, he is full of electricity, which has made countless girls fall in love.

But today, the vast majority of the people present are men. It seems that no matter how much electricity is available, it is still empty.

"Biomechanical Analysis of Hip Fractures"

Biomechanics, no stranger to orthopedic surgeons, is a required course for postgraduates.

When everyone sees these words, they are both familiar and unfamiliar. For biomechanics, these words are left in their minds, and they can't even remember fragmented concepts.

"As for Professor Zhang Zongshun's surgery, why did he walk down the ground so quickly and he was completely weight-bearing? Everyone is very concerned about this issue. Today, Dr. Yang and I took advantage of the lecture time to learn and discuss with everyone." Song Zimo speaks at a medium speed and speaks clearly. .

"Intertrochanteric fractures of the femur are no strangers to surgery, and they are often exposed to surgery. What everyone is wondering is, this intertrochanteric fracture is comminuted, and it is possible to walk on the ground within 24 hours? Or is it full weight-bearing? Is this reckless, or There is a scientific basis, I will tell you now, everyone pay attention to the animation on the screen."

An animated demonstration of the hip joint appeared on the screen. Based on CT 3D reconstruction, it completely simulated Professor Zhang's fracture at that time.

"Look at that time, Professor Zhang's intertrochanteric fracture was comminuted, and it was also comminuted on the medial side. The stability of this fracture was completely supported by the medial cortical bone, which is the load-bearing wall. Walking with weight in the early days." Song Zimo quickly entered the focus of the problem.

The animation continues and is now a post-fracture simulation, with the conduction of gravity marked by red lines and arrows.

A few classmates, who were close to the desk where snacks were arranged, secretly reached out to grab a few candies to eat, and immediately retracted their hands. Don't miss the knowledge point.

Song Zimo put his hands on the podium: "This involves the knowledge of mechanics in orthopaedics, that is, biomechanics. Most of us have only sporadic mastery of biomechanics, and even sporadic mastery is not even counted. If it weren't for this operation I was very stimulated, and I didn't realize how important biomechanics is to orthopaedic surgery. But our Dr. Yang is aware of it and actively applies it to surgery."

Song Zimo stepped down from the podium, turned his back to the screen, and walked between the lines. Yang Ping remembered that when he first came to the hospital, during the interview, this guy's arrogant attitude was also like this, talking and walking between the lines.

"For this kind of fracture to be able to carry out early weight-bearing walking, two conditions must be met: anatomical reduction, which establishes conditions for osseous support; and shunt stress, which reduces the burden on osseous support. Let's see!" Song Zimo turned around and faced the screen.

"There is no need to say more about anatomical reduction. Several bone fragments have been completely reset, and everyone has no doubts. I will only talk about the second one, shunt stress, which is the focus of today, the application of biomechanics!" A class turned into a speech.

Yang Ping scolded: I worked hard for the operation, this guy is cool on the podium.

Showing that the classroom is silent, all focus on grasping knowledge.

"This procedure uses tension bands and barrel hoops to divert stress."

Tension bands are familiar to everyone, and olecranon fractures and patella fractures are often done to convert tensile stress into compressive stress. This wooden barrel hoop is the first time I have heard of it.

Someone started scratching their heads and necks.

"The steel cable on the outside is the tension band, and the three steel cable loops that fix the fracture are the barrel hoops." Song Zimo returned to the podium again, and the mouse marker moved on the screen.

"Pay attention to the animation. When a person walks upright, the normal line of gravity, from the spine to the second sacral vertebra, to the hip joint, goes down from the femoral head along the vertical line of gravity of the lower limb."

The animation is very beautiful and intuitive, and the red gravity line is generally conducted along the route just mentioned.

"In ordinary simple intertrochanteric fractures, the bone support can bear the weight. Therefore, for simple trochanteric fractures, after anatomical reduction and PFNA fixation, you can safely walk with weight within 24 hours. However, for comminuted intertrochanteric fractures, the bone support cannot Bear the weight, what should I do?"

What to do? Salad! I'm here for a class, you ask me. Everyone's thinking was mobilized by Song Zimo.

"It's the best way to divert gravity. Watch this animation."

It used to be the gravity conduction animation of a normal person, but now it has been replaced by the animation of Professor Zhang's post-fracture model.

"Gravity starts from the femoral head and is divided into four routes. The bony support conducts a part downward, the intramedullary nail conducts a part downward, and a part is converted into the tension of the lateral tension belt cable, and the other part becomes three cables. The expansion force of the hoop. In this way, the bony support reduces the load, avoids fracture displacement, reduces the load on the intramedullary nail, and avoids fatigue fracture.”

The animation is simple and easy to understand, the red gravity shunt line, one goes down the femoral shaft, the other goes down the intramedullary nail, and the two eventually merge; the two red arrows on the outer steel cable loop reverse along the steel cable to form an upper and lower traction Pulling force; three steel cable hoops, surrounded by arrows, as if they were about to expand and explode.

I understand, I understand, everyone suddenly realized, and some people were still puzzled, and the audience began to whisper.

Dr. Jin and Director Tian sat together: "This is really ingenious. I usually use steel cables, but I don't understand them so deeply. It requires a good familiarity with various parameters of bone blocks, steel cables, and intramedullary nails. Dare to do this combination? The position and thickness of the three cable rings should be very particular, especially when the rings are locked, the tightness of each ring is different?"

Director Tian turned sideways and said, "You're right, these three rings have different thicknesses. In this way, under the action of compressive stress, ensure that the tip of the distal end of the inner main bone block is always slightly in the direction of the medullary cavity to withstand the gap. Otherwise, once it goes out of the medullary cavity, it will slide out in a short time, and the barrel hoop will fail. The mechanical knowledge contained in this operation is beyond the knowledge scope of orthopedic surgeons. Lao Jin, I have gained a lot of knowledge. So useful."

"This guy is a bit wicked. Director Han's eyes are too poisonous. I heard that this group of newcomers picked it up during the interview." Dr. Jin said.

Director Tian smiled and said, "Do you remember? He embarrassed me on his first day at work. This guy is also thanks to him, otherwise I would have fallen into the pit."

Dr. Jin remembered: "The hidden femoral neck fracture you mentioned. I went out for a meeting that day and came back to listen to what the doctor under my hand said."

In private, Director Tian and Dr. Jin can also talk. Dr. Jin is much older than Director Tian. Although he is still the attending doctor, Director Tian respects him very much and does not care about it at all.

There was a lot of discussion in the audience, and it turned into a pot of porridge, and everyone's cognition was severely brushed.

Everyone is in this major and has received professional education. With such an explanation and animation demonstration, there are basically no obstacles.

There are so many mechanical principles in this orthopaedic surgery. Could it be that Newton also studied medicine? I really doubt that his enlightenment was not because of the apple, but because of the fracture.

Song Zimo banged on the podium, and the audience slowly became quiet: "I want to emphasize one point, the next similar operation, if you use the same method, it will fail!"

When I asked this question, I just woke up and was confused again.

Song Zimo explained: "Why? If you don't master the principles of biomechanics, you won't be able to achieve satisfactory results. The number, thickness, position, tightness, and interwoven structure of the cerclage cables should not be placed casually, otherwise it will become a common The fixation ring cannot change the direction of force and maintain the stability of the fracture.”

Is it so important to put on a ring?

The tension band, as everyone knows, is often used for olecranon fractures and patella fractures.

The same is true for the cable ring. Isn't it used to tie it sometimes to fix the fracture? Convert what stress.

What a headache!

"It's not so complicated. The brain is too small. If you have time, go to see the body structure of the car, especially Volvo and Subaru, to see how the frame disperses the stress after the collision."

A faint voice sounded, and everyone looked at the sound, who was so arrogant, it turned out to be Xu Jieba from the emergency department.

This person is born stuttering, and is well-known in the hospital. He often acts astonishingly. It is said that once, the emergency department received a patient with severe multiple rib fractures, blood gas, chest and lung contusions, and cardiac and respiratory arrest. Decisively, he opened his chest on the spot, stretched out his hand and held a heart massage—the patient was rescued.

At this time, the venue was originally like a pot of porridge, but now this pot of porridge is even more boiling.

Song Zimo asked everyone to be quiet: "Now everyone rest for ten minutes, have something to eat, and discuss later."

Thank you for your reward, thank you for your recommendation tickets and collections, thank you for your comments, and the data has risen again today. Shut up! bow!