Liang Fatzi, Zhang Lin, and Xiao Wu went outside to smoke.

Yang Ping edited the work of the first day into WeChat and reported it to Director Tian.

Mr. Yan's affairs were reported separately, and when the surgical plan was reported, there was no mention of intraoperative partial closure.

Director Tian replied: I agree with your opinion, operate according to the original plan, and pay attention to the use of methylprednisolone to partially seal the sciatic nerve entrapment segment during the operation.

A good doctor is indispensable for his mind and courage.

There is no courage, timidity, and it is difficult to become a tool; If you don't have a mind, you have courage and no strategy, and sooner or later something will happen.

In order to ensure the success of the operation, Yang Ping entered the system space and dissected several experimental subjects, in addition to the routine general dissection, he also focused on the local anatomy around the piriformis muscle.

Now he is slowly realizing the strength of the Super Cultivation Dafa, and every anatomical training is extremely helpful for surgery, and this improvement is spiraling.

Just like basic science and applied technology, the strength of basic science is strong, and only then can applied technology accumulate steadily, otherwise applied technology will become rootless and stagnate.

He has accumulated the anatomical knowledge of several experimental subjects, and the master trauma orthopedics is the foundation, this sciatic nerve release is just a minor operation.

The next day, after the shift rounds in the morning, Yang Ping took everyone to read the film, and then went to the operating room for surgery.

Director Zeng is very enthusiastic, and now he really wants to learn something from him: "I'll give you a help." ”

Yang Ping said: "Director Zeng, how embarrassing is this, just let Dr. Song help me, and you will have to communicate with your family at any time about your condition." ”

Yang Ping is the main knife, Song Zimo is helping, and Director Zeng came to the stage to take a look and move freely.

The protection of nerves during surgery is particularly important, once the operation is not careful, resulting in accidental injury or excessive traction, it will cause bad consequences after surgery.

The first time I had surgery with Director Zeng, I was not familiar with the operation, and I was afraid that the operation would accidentally damage the nerves. But it was not good to directly ask Director Zeng not to come to the stage, so Yang Ping arranged it like this.

The tracheal intubation was under general anesthesia, and Xiao Wu Zhang Lin had already put the patient in a position and was prone to lie down.

"Good morning, Director Yang!" Su Yixuan, with a nurse from Nanqiao Hospital, was sorting out the equipment, and saw Yang Ping come in and greeted her.

Yang Ping responded very seriously: "Nurse Su, it's troublesome, I want the head nurse to personally match the stage." ”

"Director Yang's surgery, it should be." Su Yixuan pursed her lips and smiled through the mask.

Everything is ready, wash hands and dress, disinfect the sheets, and open the table.

The lower edge of the gluteus maximus and the posterior gluteal fold incision avoid the formation of scars at the ischial tuberosity, and the scars at the ischial tuberosity are easy to leave the sequelae of sitting pain for a long time.

Lift the skin to expose the gluteus maximus, local fibrosis of the gluteus maximus, cut the fascial tissue at the lower edge of the gluteus maximus, without damaging the muscle fibers, lift the gluteus maximus upward, and protect the inferior gluteal cutaneous nerve and the posterior femoral cutaneous nerve.

The piriformis muscle was exposed, and sure enough, the lower third of the piriformis muscle was fibrous, that is, scarred, and it was not muscle tissue at all.

Instead of passing through the lower border of the piriformis muscle, the sciatic nerve passes through the fibrotic piriformis muscle in the form of a trunk, where it is entrapped by scarring at the outlet.

No wonder the symptoms of the sciatic nerve are so severe, and they are even worse when walking, because the piriformis muscle contracts when walking, squeezing the sciatic nerve, so the symptoms are more severe.

The nerve is carefully separated from the scar tissue, and the surrounding scar tissue is excised, leaving the epineurium intact.

The nerve forms a dent at the point of entrapment, and the dent is swollen far and near.

Yang Ping gently picked out his nerves: "Director Zeng, look! ”

Sure enough, with piriformis muscle entrapment syndrome, Director Zeng felt a little more relaxed, and his preoperative judgment was correct.

"Little Five take pictures!"

Everyone get out of the way, Xiao Wu uses his mobile phone to focus and take pictures, and is careful to prevent and control the pollution area.

The rubber strip gently retracts the nerve, at this time, must not interfere with the sciatic nerve, once the traction is excessive, it will cause nerve damage, although it can generally be recovered, but it is as short as a few days, as long as a few months, the lower limbs are numb and weak, and the patient will have a misunderstanding when the time comes, thinking that the operation has failed and aggravated the symptoms.

Doctors, always walking on thin ice.

"Doctor Song, protect your nerves!" Yang Ping reminded.

He is not worried about Song Zimo, he is afraid that Director Zeng will not pay attention to nerve protection, and casual and inadvertent actions, such as slipping the hook and damaging the sciatic nerve, will not be wrong to be cautious on the operating table.

Song Zimo understood, and one hand was separated between Director Zeng's hook and the nerve, and the nerve was tightly protected.

The nerve is retracted, and Yang Ping bluntly separates the normal muscle fibers surrounding the piriformis scar. Entering through the gap, the fingers separate a slit and then cut off the fibrotic piriformis muscle at the attachment point of the muscles at both ends. With a bit of normal muscle fibers, the fibrotic tissue is completely removed.

In this way, the nerve comes out from the lower edge of the remaining normal piriformis muscle, the sciatic foramen magnum, and is no longer entrapment, because the separation is separated from the natural muscle fiber gap, and there is no damage to the normal muscle, and there will be no scar adhesion in the future, which will prevent future problems.

Scarring must never form around the released nerve, otherwise the surgery will fail and the nerve entrapment will be re-formed.

Blunt separation and sharp separation, blunt separation is used for separation where there is a natural gap, and sharp separation is used for separation without natural gap, the former follows the existing road, and the latter has to open up a road because there is no road.

Flush the surgical area and stop the bleeding again completely.

"80 mg methylprednisolone with 20 ml of saline, syringe!"

Methylprednisolone is a glucocorticoid that has anti-inflammatory and edema-reducing effects.

The syringe needle is gently inserted obliquely into the nerve sheath, methylprednisolone is injected into the nerve sheath, and then some is sprinkled on the epineurium to partially seal the nerve and wait for about five minutes.

Then use 20mg of ropivacaine, diluted with normal saline, infiltrate the part that has just been severed by muscle scarring, and then infiltrate the incorporating edge in layers, which can reduce postoperative pain.

I checked again, the release was very thorough, the hemostasis was perfect, the whole operation was pleasing to the eye, there was almost no bleeding, and the gauze was not used.

Several orthopedic surgeons who observed privately discussed that the big hospitals were different.

The rubber strip is withdrawn and the nerve is put back in place.

The drain is placed, sutured in layers, and the operation is completed.

As soon as the operation ended, the sterile sheet was opened, and the patient woke up, and Liang Fatzi used a straw to clear the secretions of the patient's throat trachea, and the tube was extubated smoothly, and the cooperation was very good.

The anesthesia woke up, the patient was taken out of the operating room, the nurse called the family, and his son immediately came up.

Yang Ping took out his mobile phone and showed him the pictures taken during the operation: "Mr. Yan, look, this is the sciatic nerve, which is stuck like this, the middle is thinner, and the ends are swollen. ”

By the time they arrived in the ward, the patient was fully awake and could have a normal conversation.

Under general anesthesia, once awake, there is no problem with the movement of the limbs.

The patient moved his right lower limb, hey, it didn't hurt anymore, could it be that the anesthetic was working, anyway, now the pain is gone.

Pain has a very negative impact on patients, seriously affecting their lives, such as nightmares that cannot be gotten rid of, and some people are tormented by pain and have suicidal tendencies.

The mountain was removed, and even temporarily, the patient's heart was very comfortable, and there was a feeling of being reborn.

"It doesn't hurt anymore!" Teacher Yan's first words when he returned to the ward.

"Go and say thank you to the doctor!" Teacher Yan instructed his son.

The son said, "Don't worry, I know." ”

In order to avoid this phenomenon, Yang Ping used the hormone methylprednisolone to partially seal the nerves to eliminate inflammation, reduce nerve edema, avoid possible postoperative rebound, and improve the patient's postoperative experience, this experience is very important, the patient does not know whether the operation is beautiful or not, his intuitive experience is that the problem is solved, how much is solved.

For Mr. Yan, pain relief is success, and saying it 10,000 times is not worth his own experience.

It's been more than 10 years, and the first pain-free day is ushering.

Teacher Yan's hands trembled with excitement, and he held his son: "Remember, you must remember, say thank you to Director Yang." ”

Although the whole process went smoothly, Yang Ping did not relax for the time being, and the conclusion could not be too early, after all, the intraoperative partial closure was used, and it depended on whether there would be rebound symptoms in the next few days, although this probability was very low.

Yang Ping instructed the doctor in charge of the bed, pay attention to the stomach, use some drugs to nourish the nerves, and tell Xiao Wu to operate the wound dressing in person, and call himself when changing the dressing, he wants to see it himself.

After the operation, Yang Ping and Director Zeng rested in the office.

Teacher Yan's son came over, and this time the expression on his face was very normal, and he did not have a gloomy face.

"Thank you, Director Yang!" He took the initiative to shake hands with Yang Ping.

Yang Ping said: "Yes, doctors and patients are comrades-in-arms, and the common enemy is disease. ”

"Director Zeng, thank you too." The old man's son looked at Director Zeng beside him and expressed his gratitude.

I just had the operation, and although I saw the immediate effect, I don't know if I can maintain it like this, so the old man's son can't talk too much, can't turn too fast, and observe and see.

Dean Pan took Director Tian down to the department, and just came to the Department of Orthopedics, and heard Dean Pan's voice from a long distance, because he was missing a front tooth and some pronunciation leakage, so he spoke very distinctively.

"Director Yang, hard work! I heard that I just had an operation. Dean Pan shook hands with Yang Ping.

Director Zeng said: "The person who just had the operation was Mr. Yan, who had been entangled with us for a year, and now the pain has been relieved after the operation, and the patient's family has just thanked him." ”

Director Tian had already reported the matter to Dean Pan last night, this kind of patient is a special patient, and the operation cannot be done quietly.

Dean Pan: "Oh, just settled, let you do the thing of wiping your ass, this is too embarrassing, ugly, ugly." ”

Yang Ping said: "Dean Pan's words are serious, and Director Zeng still figured out the condition, because the misunderstanding between the two sides is deep, so let me come forward, not to help." ”

Dean Pan turned his head to look at Director Zeng: "Director Zeng, learn more from professors in provincial cities and dig deeper." ”

Director Zeng didn't know how happy he was, although he knew that Yang Ping was lying, but this lie was not obvious, so he said: "No, I pester Director Yang every day, I want to squeeze more real things, and this condition is also due to Director Yang's guidance, so I figured it out." ”

Let's chat, ask if you have any difficulties at work, accommodation and living habits, and then recommend a few more interesting places in Nanqiao.

Dean Pan and Director Tian left and were going to other departments.

"The one with osteomyelitis on the left femoral shaft?" Director Zeng took the initiative to bring it up.

During his ward rounds yesterday, he felt that Director Yang had something to say.