Zhang Fan slept really well this night, it was estimated that he slept at one o'clock at noon, and he didn't even have time to fall asleep, so Zhang Fan fell into a deep sleep and slept until more than eight o'clock in the evening. How to say this thing, first of all, the amount of surgery is a bit much, and the partners are a little girl and Xue Fei, who is not a top business.

Steel plate orthopedics, even bone blocks, electric drill holes, and screws are almost all done by Zhang Fan alone, it sounds like a carpenter making furniture, the amount of labor is really not small, and he can't move around freely, which consumes a lot. Second, the hospital canteen is to blame, the lunch box at noon and the box lunch at night are directly boiled cabbage in white water, stewed potatoes in white water, not to mention meat, not even a little oil flower, it is really a healthy diet in this era.

But for Zhang Fan, they can't do physical work, this kind of diet without fat and no protein, the two steel plate orthopedics will be all consumed, if there is a high-quality diet, Zhang Fan is estimated that he will not be so tired, the system can quickly convert the energy, the dean can be replaced, and a canteen owner of the mother can't be replaced, which is also wonderful!

Zhang Fan shook his head, and after feeling a little better, he got up and went out. When I looked at it, the old couple and Shao Hua were like puppets, sitting on the sofa, not talking, not watching TV, just sitting blankly. "Why didn't you watch TV!" Zhang Fan asked before going to the bathroom.

"Shao Hua is afraid of making noise with you!" the old man pouted, not happy or unhappy, just a bit like a child complaining. After Shao Hua called, the old couple wandered around the community for an afternoon with food from the farm, and finally Shao Hua got off work.

As a result, when he got home, the old man said that he was watching the news and put his voice small, but Shao Hua disagreed. It's not that Shao Hua is unreasonable, Zhang Fan's state today really makes Shao Hua feel distressed, so he directly rejected his father's request. Zhang Fan got up, and the old man complained.

Zhang Fan cleaned up for a while, came 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, and I will sleep on the night shift in the future, what should you do, even if you sing at home, you can't make noise to me." ”

"If you don't watch TV, you won't lose a piece of meat, it's not okay to rest well, you're doing something that is vital to human life, you must not be careless. Let's eat first, let's be hungry. Today is a large plate of chicken, belt noodles, your favorite belt noodles. Chicken tastes good!" said the old lady, glancing at the old man.

"yes, I said how it smells so good. Someone gave me two bottles of Moutai, and my uncle gave me a taste to see if it was real!"

"Hey, he can tell the real from the fake. Before leaving, the old lady said that the old man's best skill was contemptible, and she almost fainted.

"I can't taste it, I tell you, I've drunk more wine than you've ever seen water. "The old man is going to chase after him. Zhang Fan hurriedly took out the wine sent by the medical representative during the department dinner a few days ago, "Uncle, you can take a look, this packaging is fine!"

Old children, old children, people are old like this, they have to be coaxed. The old man took the wine seriously and looked at it several times, "Well!

"Poof!" Shao Hua almost laughed, Zhang Fan glanced at Shao Hua, Shao Hua covered his mouth, stood up with a smile, and said to the kitchen: "Mom, get a little bit of skin teeth!" Then he hurried to the kitchen, and the two of them laughed secretly in the kitchen.

"Long hair and short vision. After the old man said a word, he said to Zhang Fan: "You have a great future, you can't make mistakes for this thing, in fact, I drink the same everything, as long as you are healthy and safe, I am better than drinking any wine." ”

"Well, don't worry, it's okay. ”

"Okay, it's okay, let's eat, today is a local chicken, I went to the farm to buy it, a small local chicken that is less than a year old. Very tender. "The old man didn't say much, just mention it. Shao Hua's family tastes a little bit of Jiangsu and Zhejiang, and their diet is sweet. Even the poached eggs are sweet and sweet. But Zhang Fan, who is from the northwest, can't eat this sweet.

Once Shao Hua's mother made sweet poached eggs, Zhang Fan ate them like drinking medicine, and since then, the family hardly eats sweets, and pasta accounts for most of it. The two old men really took care of Zhang Fan. At the beginning of the lanterns, the family sat together and had a lively meal of chicken and belt noodles. Zhang Fan was really hungry, a plate of chicken plus potatoes and belt noodles, the other three 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 side of the road. This night market in the frontier is very distinctive, haggis in winter, mutton soup is the mainstream, a hot bowl can drive away the cold of the whole body. As soon as the weather is a little hot, roast mutton will be the mainstream, as well as sheep's head, hoof tendons, and cold sour and hot lamb tripe, and you will know that it is quite good when you smell the smell. Their craftsmanship is really good, and the cold lamb is very tasty.

Although there are many ethnic groups in the frontier tea, almost all of this kind of night market are Hui stalls, and people really have a set of catering. The food of the Sanchuan people is powerful enough, but in the frontier, that is, the world is divided with the Hui people. Definitely unlike other provinces, Sanchuan hot pot can directly destroy the local catering industry.

Early in the morning, after Zhang Fan got up, the old lady had already made Zhang Fan's breakfast and served it on the table, although the old man was very good to the old lady, the relationship between the two was good, there were heavy things, heavy physical work, the old man would never let the old lady do it. But this kitchen, he never interfered, after Zhang Fan came, he didn't let Zhang Fan interfere, and Shao Hua couldn't oppose it, his words were: A big man, always touching in the kitchen will smooth out the spirit of hard work! Zhang Fan can only respect the old man's opinion!

There is surgery today, and it is a relatively important operation, so Zhang Fan greeted the old lady in advance last night, don't drink milk, don't eat soy products, pickled products and other foods, Zhang Fan is afraid of diarrhea, this is a detail, human life is a matter of heaven, no small details are too much. Zhang Fan drank some porridge, ate an egg, and ate a little steamed bun before going to work.

In the department, the doctors also came early. Xue Fei didn't go to play mahjong last night, let Zhang Fan drag it to be a tired dog, go home and fall asleep, didn't eat dinner directly, and slept until dawn, his daughter-in-law was so happy, if it was like this for half a year, it is estimated that Xue Fei's mahjong would be stopped!

One of the difficulties in this operation is to determine whether the broken end of the fracture is butted to the physiological position. There are not many people who do this kind of surgery now, and the specific reason is hard to say, anyway, there are not many people. The mainstream is still cut and fixed, which is also a hurry, Lao Gao is willing to take the blame to carry out this surgical method, and it is estimated that there will be no such thing if the director is changed.

Blind beating, the feeling under the hand is very important, this feeling is not boasting, it is real, when the fracture line alignment is good, the experienced doctor has a feeling, but this experience is too difficult and too difficult, how can there be so many patients let you practice. It's just that there are patients who are willing to let you practice, and the department director and other doctors are not willing to do it, anyway, it's profit.

There is a difference between the anatomical position and the physiological position of the fracture, and the biggest advantage of incision and internal fixation is that it can reach the anatomical position, that is, it can be tightly closed, as if there is no fracture, which is for the broken end of the fracture. But the damage is also quite huge, and almost all the periosteum around the broken end has been destroyed.

The physiological position means that although it cannot be the same as the original, it does not affect the function and has no deformity.

The ancestors of orthopedics in Huaguo, this aspect is very good, Liu-style orthopedics, Chen-style orthopedics, these doctors have been able to reduce most fractures by hand for hundreds or even thousands of years ago, and then reach the physiological and anatomical position, but now the more advanced science and technology, this technique is becoming more and more rare, where is it?

The patient has been sent to the operating room, and after the morning meeting, Lao Gao led a group of doctors from the Department of Orthopedics and walked to the operating room in an orderly manner. Of course, Zhang Fan at this time was at the end of the team, no way, there was no hair on his mouth, and he had no title on his head.

The first orthopedic department should be blindly typed, or Zhang Fan should be blindly typed, and there are many people who know the three orthopedics. Self-motivated, curious, and lively people are very concerned, and there are all kinds of people with all kinds of mentality, but the operating room is the operating room, and the people who can go in are a few surgeons, and at most one or two observation doctors, if there are too many people, there will be no sterile environment.

However, this problem is not big, the operating room of the city hospital is divided into three floors, and there is an electric classroom on the lowest floor, which can be used to watch the operation process. "Director, let me go up and help lift my leg and eliminate the poison!" was about to enter the operating room, Xu Xian hurriedly found Lao Gao, this is a motivated person, otherwise a dignified graduate student, wouldn't he have face!

Lao Gao looked at Xu Xian, and Xu Xian looked at the director with a sincere and clear gaze. "Okay, you also come to the stage, Sansuke. Let's go change our hand clothes. When Xu Xian heard this, he hurriedly entered the dressing room. To be honest, he had never heard of this kind of surgery, and the cases were all in the textbooks.

This surgery is easy to say and looks very simple, and it looks difficult to fix before the incision, but this surgery is too particular about feel and awareness. A slight deviation is a mistake of a thousand miles, because the skin and soft tissues at the broken end will not be cut, and everything cannot be directly visualized, which is difficult!

In the operating room, anesthesiologists, itinerant nurses, and surgical nurses are all ready and waiting for the doctors to enter. In the audio-visual classroom, almost all the orthopedic doctors came, although the second and third orthopedic departments were not notified, but Zhang Fan wanted to type blindly, and almost all of them came, and even the medical department sent people. Although they did not understand the difficulty of the operation, as long as the operation was successful, a flowery article immediately appeared in the hospital newspaper.

Although Lao Gao said that he would take Zhang Fan for surgery at the morning meeting, the chief surgeon was still Zhang Fan. Two Zhenggao, Lao Gao and Lao Chen, two resident doctors, Zhang Fan and Xu Xian. When the anesthesiologist finished anesthesia, he said to several doctors, "Begin." Xu Xian Lisuo brushed his hands and began to disinfect. Before going through the operation, Zhang Fan went through the X-film carefully for the last time, and although the X-film was already engraved in his mind, Zhang Fan still looked at it carefully.

Lao Gao and Lao Chen stood aside and didn't speak quietly. There are too few places they can help with this operation, and Lao Gao is also prepared, once the blind typing fails, he will immediately cut the internal fixation. Wash your hands, put on a surgical gown, "It's okay, don't be stressed, it's a big deal to cut and fix, it's nothing." When Zhang Fan got dressed, put on gloves, and picked up the sharp knife, Lao Gao said.

"Hmm!" Zhang Fan is not good at this, once he has surgery, he will not speak if he can speak, and he does not like others to speak, so as long as Zhang Fan is the main surgeon, the air pressure in the operating room is quite low, and the anesthesiologist and the itinerant nurse dare not speak, which is a matter of personal temperament.

"Let's go. After Zhang Fan finished speaking, he began to prepare to cut the skin. What is this surgery like, roughly speaking, the femur is the human thigh, and then the thigh is broken from the middle, and the broken end is not much displaced. Zhang Fan is now going to open a small opening at the top of the femur, and then use an electric drill to open the bone, and stuff a long alloy rod into this mouth, the lower end of this alloy rod has two holes, and the upper end has two holes, which are all holes used for screws. After fixing and the broken end is well aligned, then the four screws are tightened, the OK fracture is fixed, and the operation is over.

It's as simple as that, 890% of orthopedic surgeons can't do simple surgery. Not to mention blind typing, just cut and fix, and the doctor who is a little lower level can't even find the screw hole of this alloy if he can't figure it out! Zhang Fan opened a small incision, and then used an electric knife to stop the bleeding.

Zhang Fan was the main knife, Lao Gao was smoking with a suction device, Lao Chen gently used a small hook to open the skin, Xu Xian was fine now, so he stood and watched. The electric knife, in fact, is very simple, it is the appearance of an electric soldering iron. The human body is too evolved to be too good, and there are almost no big blood vessels in the superficial layer. When the skin is cut, the dermis is not bleeding obviously, but when it reaches the fat layer and the muscle layer, there is a larger capillary tube. The electric knife is directly electrocoagulated, and there is no bleeding.

The more you go to the meal for surgery, the more tormented, especially when you use an electric knife, the blood vessels are also scalding the fat at the same time, and the fat is instantly smoking, although you wear a mask, but a smell of barbecue comes directly, really, when you are hungry, you can smell this smell, and your saliva can come down.

"Electric drills. After opening a small opening in the skin, separating the muscles and fascia layers with bare hands, stopping the bleeding, and exposing the bone, Zhang Fan said. The surgical nurse stood aside and installed the electric drill early, and after the debugging was completed, the electric drill was calmly handed over to Zhang Fan.

"Squeak, squeak!squeak!" The hard bones were like tofu, and they opened a mouth. Bones, especially large bones, have been eaten by everyone, and they contain bone marrow, red carnate bones that resemble honeycombs. When the electric drill is opened, the bones are like coffee with milk, white bone meal, dark red blood, and milky white bone marrow are stirred together, and then quickly mixed, and finally it becomes a little whitish milk soup.

The early method of this kind of surgery was very cruel, when there was no electric drill or when the electric drill was not yet popular, this kind of operation, like a meat stall, bone chisel, bone hammer, bang, bang, bang, And the early intramedullary fixation is very troublesome, the femur is not an unobstructed cavity, it is with a spiral, and there are various trabeculae, this shape can make the femur very hard, and it can also make blood.

So when fixing, you should first use a small myelodilator, insert it into the femoral cavity, and smash it into it with a hammer, how strong is it, if you stand behind the operating table, you can see the patient number, and the whole body of the tied patient number is shaken!

The myelodilator is very much like a triangular bayonet, but it is not sharp, but very heavy. Trumpet, medium, large, one by one to expand the bone marrow cavity, expand unobstructed, you can imagine, you use chopsticks to eat bone marrow, in fact, the principle is similar, but the chopsticks can not make the cavity a little bigger, the power of chopsticks is a little smaller, not with a hammer to smash the chopsticks head!

When the hammer hits the dilator. When I smashed it, the blood carried the bone marrow, and white and red blood spots splattered everywhere. At this time, if a blood flies into the doctor's eyes, and the patient has a blood-borne disease, it is very troublesome! With the development of science and technology, there are now instruments that do not need to dilate the marrow, which also makes this kind of surgery more elegant.

Opening the medullary cavity, Zhang Fan gently inserted the intramedullary nail and slowly descended. This operation, regardless of whether it is blind or not, must be compared with the X-ray to calculate the length, not long or short. Slowly descending, "the lower end of the femur is externally rotated ten degrees." 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 surgeon, a good orthopedic surgeon has a strong sense of space and good knowledge of geometry, when Lao Lu couldn't draw, geometry couldn't be, painting a blood vessel would make his head big, and he was persuaded to retire before he learned bones.

The various angles of orthopedics are really difficult to grasp. Not to mention the operating table, ordinary people have two chopsticks crossed, you don't need measuring tools, put a ten-degree angle, it is estimated that not many people can pose, let alone this situation that cannot be seen directly.

"Stop! Internal rotation twice with pulldown, slight pulldown. Zhang Fan commanded the assistant to reset, if the assistant couldn't do it at this time, Zhang Fan couldn't get it alone, so the team, the surgical team was very important. Lao Gao and Lao Chen rotated slowly, and Xu Xian grabbed his calf and pulled down slowly.

Why pull down, is to let the fracture end of the slight separation, this force can not be large or small, too large, maybe it will be pulled and displaced. It's too small to allow the broken end to separate. Zhang Fan gently touched the broken end with the inner medullary nail, just like his hand, and the changes at the broken end were clearly presented in his mind.

That's what it feels like, that's what practice makes perfect. Lao Gao has never felt this way in his life, but it is conceivable how much liver Zhang Fan has to have! I don't know how many surgeries he has done in the system. "Click!" a slight vibration came, and this was the sound of the stubble resetting.

"Okay, don't move, stay in this position for now. "Fracture reduction is a change in movement, because it is an oblique fracture, there is an angle when it is reduced, and at this time, the patient's affected lower limb is suspended, that is, an old lady, and the thigh is not heavy. If you are a big fat man, this position can keep the three assistants until the muscles are sore.

This hold is not simply lifted and finished, but must be maintained in a fixed position. To put it simply, the chopsticks are broken, you have to tie them up, do you have to align them, and then use a force to tie them together to tie them, a reason.

And this is to be coordinated by three people, Zhang Fan commands, five minutes, ten minutes, twenty minutes. It's really too much to keep a fixed position all the time, and to continuously output a smooth force. Although he is an old man, he has a little weight in his lower limbs.

Zhang Fan inserted, slightly deviated, slowly slid down, dodged the broken end, slowly clinging to the bones, and couldn't be impatient at all, this thing is not something that can be impatient. The sweat of Lao Gao and Lao Chen Dou has appeared. Tour, originally a tour, the head nurse sent another one, and gently wiped the two old doctors.

"Director, why don't you turn down the temperature of the air conditioner? The head nurse came in, and when she saw the two old men sweating, she asked.

"No, no matter how low, patient, cold!" Lao Gao was inconvenient to speak continuously, he was afraid that the continuous speech would cause vibration, which would lead to the displacement of the fracture and the broken end of the reduction.

Enter, Zhang Fan a knob, "Reset." Knife!" The surgical nurse immediately pointed the handle of the knife at Zhang Fan, and the blade was pointed at herself, and handed it to Zhang Fan. Zhang Fan took a knife to cut it, then cut a hole, and prepared to put on the screw. This is also a difficult point, not to mention blind typing, sometimes, in the case of incision and direct vision, the doctor who is not in place can not even find this screw hole.

"I've got a hole, so I'm going to have to keep it up. 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 too awesome, after drilling the bone, it is directly a screw hole, and there is no need to adjust the position, this is the feel of the awesome, the technology of the awesome. Xu Xian was dumbfounded, he estimated that Zhang Fan still had to adjust, and he had to find a position, after all, this was a blind type, even if it was not a blind type, this kind of positioning, a one-time success, he had never seen much.

Upper screw, "OK." Director, alright!" Zhang Fan finished speaking, and he had already begun to rinse and prepare for stitching. Lao Gao secretly rubbed his sour and numb hands, and said to Zhang Fan, "Why don't you take a look under the C-arm?"

"It's just, there's no hurry, it should be fine, but let's take a look, rest assured. Lao Chen also said. This is Zhang Fan, if it is other resident doctors, it is directly "to push the C-arm!" and to Zhang Fan, both of them have a tone of discussion.

In the audio-visual classroom, a group of orthopedic surgeons looked at the water and fog, this operation was originally nothing to see, and there were only two small incisions that were incised, and the whole process was done by the feeling and feeling of the chief surgeon. But Zhang Fan, who is so good to die, is like a mute when he has surgery, he can't talk if he can't speak. Zhang Fan didn't explain his feelings, and only the other three doctors on the operating table felt a little.

And the doctor in the electric classroom was entangled, "This is the end, Zhang Fan too, how to fix it, how to confirm it, don't say anything, hey! ”

"Hey, wait, let's see the results of the C-arm!"

"Look at the fart, didn't you see that Zhang Fan was ready to stitch up! Even if you see the result, you will do it? Really, let's go!" A group of doctors left with a feeling in their hearts.

It's not that Zhang Fan doesn't say it, sometimes, this feeling, especially this mysterious and mysterious feeling, really can't be expressed in words, you can only understand!

The little nurse pushed the C-arm over, and the doctors and nurses all stood behind the lead plate next door to observe. Gently pat, OK, the fracture on the monitor is very good alignment.

"Cow! Lao Chen raised his big finger and said to Zhang Fan.

"Teacher Zhang, how did you determine that you needed to rotate ten degrees in that situation. After Xu Xian was shocked, he began to seek advice, which is a learning mentality.

"Yes, tell me about it. Lao Gao also said.

"Well, this, feel it. You look at this original X-ray, although the angle is slightly larger, but after the downward rotation is pulled, the internal rotation of the muscles corrects this angle a little, and you see the strength of the old man's muscles, which has been relaxed, so this angle should be about ten to twelve degrees, I used a probe, when I touched it, I felt that it was at this point, these two points together!" Zhang Fan pointed to the original film and said.

"Eh!" Xu Xian's cold sweat came down, and he could feel it. When Xu Xian was about to open his mouth to speak, the anesthesiologist spoke, "Hey! Why are you talking, I can tell you, the old lady is about to wake up." ”

"Haha, go down and say, go sew it up. Lao Chen goes, let's go to surgery, let this kid give instructions for a long time, his hands are sore, and the rest will be handed over to them!"

"That's it, you guys should rest quickly. Doctor Xu, you can go down too, and I'll do the rest." Zhang Fan said.

"It's okay, it's okay, you go down and rest, and I'll take care of the rest. ”

Can Zhang Fan go down? No, so Xu Xian didn't even get stitched up. Xu Xiandu got the needle holder and wanted to sew, but Zhang Fan grabbed it, "This knife edge, when I cut it, it seems that a small blood vessel has been cut, I sew, you don't know the place!"

"Why is this thing so lonely, it doesn't even allow stitches, besides, your sister, what blood vessels are here!" Xu Xian's face was cute!

The surgery is over!

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