The patient has been anesthetized and is intubated under general anesthesia. Dr. Tao was ready to put himself in a position and waited for Director Tian to come in and give instructions.

This surgical position is very important, and the wrong position can make the surgery impossible.

The film was hung on the reading lamp in the operating room, and Director Tian read the film again. Although Dr. Tao marked the surgical site, Director Tian still personally determined the left and right of the surgical site.

"Professor Tian, how many people do you need?" Director Miao asked.

Director Tian said: "I and the director, you two, just return the first one, Doctor Yang will go up, and Doctor Song will rest." ”

Song Zimo is responsible for driving, and if he rushes back at night, he can't be too tired and needs to rest, so Song Zimo stays as a reserve.

Director Miao must come to the stage, he is the director, the patient is his acquaintance, even if he does nothing, it is necessary. So this arrangement is the most reasonable.

"Blood transfusion first!"

Director Tian gave medical orders to the anesthesiologist and the itinerant nurse, and then took everyone to position themselves in a prone position.

This complex fracture cannot be solved by either anterior or posterior approaches alone, and a combination of anterior and posterior approaches must be combined.

Director Tian has long been confident, the difficulty of the operation is indeed great, this kind of loose pelvis and acetabular comminuted fracture, not many hospitals can win, representing the peak level of trauma orthopedics.

For doctors in county hospitals, going out for further study is an opportunity to learn, and it is also an opportunity to learn when a professor from a higher hospital is invited to perform surgery.

Orthopedic doctors, as long as they are free, all come to the operating room to observe.

Everyone was impressed by Director Tian's professionalism when they were in the ward, and now they all want to see the professor's superb surgical skills.

There were already three people on the stage, and Dr. Tao didn't know if he was on stage, and it was normal for him to have four pelvic fractures, and he was in a struggle.

"Xiao Tao, you are pushing the C-arm machine under the stage." Director Miao helped him make a decision.

The position has been set, and Director Miao took Director Tian Yang Ping to wash his hands.

But everyone who can do things is full of energy, Director Miao is fifty years old, he is still full of energy, with a round waist and thick shoulders, and he walks with a tiger's style.

"How much blood is on board?" Director Tian asked.

"12 units of red blood cells in suspension, and 1,200 ml of plasma!" Dr. Tao said.

Enough, wash your hands and get dressed.

This kind of surgery is out of reach for Dr. Tao, who usually only does simple surgery, and complex fractures are all performed by Director Miao.

At present, Director Miao can't take the patient's surgery, not because the patient's identity is special, but because there are indeed technical difficulties.

Surgery is not child's play, this kind of operation, you can't take it, you have to kill it.

Doctors can usually brag, brag and brag, no one is stupid enough to do their own bottomless surgery, that is pure death. One operation ruined his life.

To be a department director, in addition to being able to technically support the department, you also need to have a certain amount of support. Like Director Miao, the operation is too difficult to deal with, a phone call, Director Han sent a heavenly group to the countryside to provide strong support, and if he is replaced by another person, I am afraid it will not be possible.

Disinfection shop sheet, routine process, the same as large and small hospitals. Yang Ping is the first assistant, and Director Miao is the second assistant.

The posterior wall fracture of the posterior column of the acetabular was reduced and fixed.

Director Tian is extremely skilled, making standard incisions, cutting layer by layer, and steadily advancing.

Director Tian did the operation and lifted weights lightly, and it seemed that the movements were unhurried and unhurried, and there was no feeling of being in a hurry, but there were no superfluous and ineffective movements, and the front and back were closely connected, so the operation time was very fast.

Usually Director Miao does pelvic surgery, and the big gauze is one after another, and the white gauze goes in and comes out with blood.

Now I only handed over a large piece of gauze, and I only saw a faint red flower on it, and I wondered if I was having pelvic surgery, or if the operation had not started yet.

Several doctors walked around, looking for the best view of the view, but no matter how they looked, they couldn't see anything, and they didn't dare to approach.

Unlike Sanbo Hospital, which also has high-definition cameras to watch videos, the operating room of Shipo People's Hospital does not have these equipment.

"Steel plate, prepare the drill!"

It was only a long time, ten minutes, and the posterior wall of the acetabulum was reset, and the steel plate was about to be put on.

Look at him unhurriedly, why is it so fast?

When several doctors were talking in private, the steel plate had been pre-bent and the screws were starting to be applied.

Director Miao is amazing, and he invited such a powerful professor to the provincial capital.

Dr. Tao was a little disappointed, at the same age, people won such a major operation so easily, and he was still spinning around in the second level surgery.

In just half an hour, the posterior wall fracture of the acetabular posterior column has been reduced, irrigated, drained, and sutured.

Perspective!

The posterior wall of the acetabular posterior column on the screen has been completely reset, and the plate screws are in good position.

"Turn over and do the way forward!" A faint sentence has attracted countless admiring eyes.

The gap in technology is insurmountable in this life in the eyes of the observing doctors.

Re-disinfect the sheets, wash your hands and get dressed.

The road ahead begins.

"There will be a lot of bleeding ahead! Therefore, it is necessary to give blood transfusions in advance, replenish blood, and thin the blood. Director Tian explained.

Because CT angiography showed that many blood vessels in the pelvis were damaged, and the blood pressure was stabilized by blood transfusion and fluid reproduction at the time of the injury, and now it is necessary to go directly to the fracture site, and the bleeding that has stopped is bound to be awakened again.

"The dead artery has broken and retracted, and the next hand should be fast, and the blood vessel must be found within ten minutes." Director Tian reminded Yang Ping that the two of them should cooperate well in the key steps.

The death artery is the anastomosis branch of the obturator artery and the external iliac artery, also known as the death crown, once it breaks and bleeds, it will retract, just like a snake burrowing into the grass, it is difficult to find, unable to stop the bleeding, and the patient is in danger of death, so it takes a terrible name, which is a roadblock that pelvic surgery must pay attention to.

Director Tian has rich experience and transfuses blood and fluids in advance, which not only replenishes the blood, but also dilutes the blood, so as to reduce the blood loss of the patients themselves. This patient is anemic and can't afford to lose too much, otherwise his blood pressure will plummet.

The surgeries are all done with real knives and guns, and the more experience you have, you can predict the risks. It's like a captain navigating the sea, with a wealth of experience to avoid reefs and storms.

The road ahead is not only to do the acetabulum and iliac wing, but also to do the sacroiliac joint and sacrum, which is very difficult.

In order to take care of several fractures, Director Tian used an incision of his own design.

Director Miao stayed on the sidelines, feeling like he was sitting next to a racer, sweating in his hands.

There are many blood vessels and nerves here, be careful! But Director Tian avoided it perfectly; Once you accidentally cut the blood vessels, you won't be able to stop the bleeding, slow down! was perfectly avoided by Director Tian again.

It just so happened that Director Tian wanted to expose it upwards, and the hook had changed its position to help reveal it; The blood had just come out a little bit, and the assistant had already clamped it with a vascular clamp, and Director Tian had a touch of the electric knife to stop the bleeding perfectly.

Just as he was trying to draw attention to the vascular nerve, the assistant's vascular clamp had been gently provoked to help him separate the vascular nerve.

Originally, Director Tian was highly skilled, and Yang Ping cooperated so well, the operation was simply a perfect performance.

I didn't pay much attention to the posterior surgery just now, but now it seems that this assistant is too perfect, no wonder Director Han let himself take him, and Director Tian glanced up at Yang Ping.

Director Miao was already dazzled and couldn't keep up with the rhythm at all, so he had to do nothing on the sidelines.

The surgery goes into the critical step and immediately encounters the artery of death! Before coming to Shipo, Director Han repeatedly reminded Director Tian to pay attention here!

"Controlled bucking!" Director Han ordered the anesthesiologist.

Intraoperative controlled blood pressure, also known as low-pressure anesthesia, can control blood pressure in a low but safe range, low blood pressure, less natural bleeding, just like the low pressure of a water pipe, the weaker the water spray.

"The dead artery is bleeding, it has retracted, I don't know if it has embolized itself?" Director Tian reminded Yang Ping.

Although it is a discoloration to talk about, it must be faced and solved, otherwise the operation will not be revealed, let alone fracture reduction and fixation.

The left and right hands work dexterously, and the scissors skillfully and sharply separate.

When the adhesions open, blood spurts out immediately, and you can't see where the blood vessels are.

Sure enough, the death artery retracted, and broke through the fragile self-clotting clot, but Director Tian was very calm, and if it were someone else, he would have completely collapsed at this time, or he didn't have the courage to continue.

But he is Director Tian, blood transfusion, only need to rely on blood transfusion to help him buy ten minutes, he can find the death artery, and successfully stop the bleeding.

It is not a problem to rely on the speed of blood transfusion for ten minutes, which he has considered long before the operation.

The suction device in Yang Ping's hand quickly attracted to keep the surgical area clean and create the best surgical field for Director Tian.

"Blood pressure has come down, shock!" The anesthesiologist shouted, his voice a little flustered.

Shock?

Gauze, quick, gauze!

Director Tian immediately stopped the operation, temporarily gauze tamponade, his hands moved very quickly, and Yang Ping had already taken over and pressed it tightly. Let Director Tian free up his hands to do other things.

The blood pressure on the monitor screen of the monitoring instrument dropped to 70/30, and it was really in shock, and it was still dropping.

There wasn't much bleeding just now, even if the death artery was bleeding, it had just been bleeding, and blood transfusion and rehydration had already started over there, so why did he suddenly go into shock?

Could it be that the posterior reduction has just involved a large artery or vein, such as the abdominal aortic artery, or the internal and external iliac artery? Causing tears?

No, the whole process was clear just now, none of the movements were blind operations, and I carefully studied the film before the operation, and the bone pieces were not adjacent to the large blood vessels.

Some possible hypotheses quickly crossed my mind.