Hermès surgery is on the agenda, ready to be done next week, and needs to be discussed in the afternoon.

This is a very large operation, and most of the tibia is amputated and discarded, except for the proximal and distal healthy parts, and all the infected bone tissue in the middle is amputated.

Then, using the Irizarov technique, the healthy bone tissue at both ends is lengthened with an external fixator, from both ends to the middle, and finally the teacher is applied.

In order to complete the task of bone lengthening, an external fixator should be installed in the lower leg, and there are screws on the external fixator, and the external fixator will move with the bone tissue when the screws are rotated.

The lengthening began two weeks after the operation, with an extension of one millimeter per day, and Hermes needed to lengthen by more than thirty centimeters, which would take about a year.

This is only an ideal state, and if there is an osteogenic abnormality in the middle of the process, it needs to be stopped and extended.

Yang Ping finished Luo Xiaohu's surgery in the morning, and there was nothing to do in the afternoon, so he slept in the duty room, entered the system space, read books for a long time, dissected dozens of experimental subjects, and trained his ability to compose.

It also spent 5,000 points to purchase 500 cases of external fixator special surgery for training.

Director Tian returned to the ward from the first floor, and he had already translated Tan Boyun's opening speech into English and handed it to Zhang Lin.

Zhang Lin's poster was almost revised, sitting in front of the computer, going through it one by one, repeating it several times.

"Is this really a Japanese doctor? Confirm that there is no theft? Xiao Wu sat next to Zhang Lin and was still entangled in this problem.

Zhang Lin ignored him, Xiao Wu remembered that Director Tian was familiar with the guests, had also been to Japan, and had a wide range of knowledge, and asked him if he was right, pointing to the photo on the computer: "Is this really a Japanese doctor?" ”

Director Tian smiled and said, "Really, she is the guest of honor, a doctor at the University of Tokyo Hospital, Fujiwara, who is very good at sports medicine. ”

"Have you seen her in person?" Liang Fatzi was also very interested.

"I met her in person when I was a visiting scholar there." Director Tian did see her.

"Am I that pretty?" Xiao Wu still doesn't believe the photo.

Director Tian smiled: "I am more beautiful than this, do you know how tall she is?" ”

"How much?" Zhang Lin asked, because the information provided will not have height.

"One meter seven eight!" Director Tian reported the figures.

"So high? As tall as me! Only Song Zimo can suppress it, and the senior brother can barely suppress it! Zhang Lin was surprised.

Director Tian said so much, he was impatient: "Let me say, pour a glass of water, don't say it's dry." ”

Xiao Wu immediately accompanied the smiling face to offer a glass of water, and Director Tian continued: "This is nothing, what surprises you even more, what is her part-time part-time job, do you want to know?" ”

What? Everybody's very interested, this is a good thing, isn't it--

Island country! It always makes people think about it, who has not been young, and two letters have popped up in someone's mind.

Director Tian drank saliva: "Fatty, take out your weight loss meal replacement, give me a little, you also need energy to speak, ATP is seriously insufficient." ”

The fat man painfully took out a few chocolate balls from the bag and sent them over, Director Tian peeled off one and threw it in his mouth.

Everyone watched him eat, waiting for him to say what a part-time job is?

Director Tian drank saliva and said: "She is a part-time model, a Japanese supermodel, a top ten in the world's elite model competition, and has participated in the Victoria's Secret show in Paris. ”

"Get such a person, don't hold the academic meeting, just watch her catwalk." Liang Fatzi said.

Zhang Lin scoffed: "Fatty, do you think everyone is as vulgar as you?" Be a little more elegant. ”

Director Tian continued: "She is a rookie in the field of sports medicine in Japan, and his brother specializes in trauma orthopedics, so this time it is estimated that he will come out with his brother. It's rare to see people like her, but there are some of them. Norio Ohga, chairman of the board of directors of Sony Japan, is also the conductor of the Tokyo Philharmonic Orchestra; Hedy Lamarr, the inventor of CDMA telecommunications technology in the United States, is a Hollywood movie star and the first actress in the world to appear naked; Bohr, you know, right? Bohr's Law, learned in high school, he is not only a physicist, a Nobel Prize winner, but also a goalkeeper for the Danish football national team; Let me tell you, several gold medalists in the history of the Olympic Games have been doctors by profession! Invite me to dinner when you have time, and I'll tell you about it slowly. ”

Director Tian is knowledgeable and eloquent.

"Cowman!" Liang Fatzi shook his head helplessly.

"Fatty, you too, anesthesiologist, part-time chairman of the Sanbo Food Association." Zhang Lin said very seriously.

Liang Fatzi was not angry, but said with a retrospective taste: "The hero doesn't mention the courage of the year, and I won't tell you that when I was in college, I really formed the school's club-Food Association, and I am the first president of the association. ”

The fat man gestures to his waistline.

"Superior!" Zhang Lin Xiaowu gave a thumbs up to the fat man.

"Look, this is a picture of her Victoria's Secret show in Paris!" Zhang Lin searched for a photo of the Japanese female doctor on the Internet.

Recommend an app, comparable to the old version of the book-chasing artifact, can change the source of the book full \ Mi \ Mi \ reading\\!

"Wow!" Xiao Wu and the fat man have long necks.

"Keep your distance, don't spray a nosebleed on me." Zhang Lin dodged sideways.

"This is not a retoucher, it's so beautiful, these legs can kneel ninety percent of the men in the world!" The fat man swallowed a mouthful of saliva.

Fujiwara's photo, walking the catwalk, trench coat, super shorts, sunglasses, star-studded on the runway.

Suddenly, Director Tian stopped speaking and coughed a few times.

I don't know who, a palm slapped on Zhang Lin's shoulder, Zhang Lin didn't think about it, and immediately switched the screen: "Well, this patient is really troublesome." ”

"Well, it's troublesome!" Xiao Wu touched his chin.

"Quite a hassle!" Fat Liang also nodded, frowning.

A group of drama spirits, drama spirits who were delayed by studying medicine.

"A few of you are doing well today, are you looking at Wang Changxin's medical records?" Professor Zhang Zongshun walked in from the door.

Wang Changxin is the name of Hermes, and the name is so tyrant.

"Well, familiarize yourself with it in advance!" Zhang Lin stood up with a sense of gain.

I don't know whose damn claws touched the computer keyboard and actually called up Fujiwara's picture.

Professor Zhang looked through the cracks in their bodies: "What is this?" ”

Zhang Lin looked back, the picture actually jumped out, and said calmly: "Screensaver, screensaver pattern." ”

"Oh!" Professor Zhang did not pursue it either.

"What about Yang Ping?"

"Study in the duty room!"

In fact, sleep in the duty room.

"What about Song Zimo?"

"Arthroscopy in the lab!"

Indeed practicing arthroscopy.

"Everyone, right? Let's talk about Wang Changxin's medical records later. Professor Zhang nodded slightly.

"Director Han is in the administration building and hasn't come back yet." Director Tian moved a chair for Professor Zhang to sit on.

"It's okay, you guys prepare first, wait for Director Han, this case discussion was raised a few days ago, have you all read the book?"

"I've seen it, I've seen it!" Xiao Wu Zhang Lin said in unison.

Everyone went to the classroom to wait for Director Han, Director Tian called, Director Han was on his way back, and not long after, Director Han came back.

At the beginning of the discussion, the patients in the small five tubes, and the little five reported the medical records.

"Little Wu, a few of you have studied the medical records and read the book in advance, so you can talk about your views on this case." Director Tian presided.

Xiao Wu looked at the screen: "There is no problem with this patient's diagnosis, chronic osteomyelitis of the right tibia, imaging tests and bacterial culture are supported." The best method is to completely excise the tibia-infected bone tissue, and then use an external fixator to lengthen the tibia, and the defect is temporarily packed with calcium sulfate containing vancomycin. ”

Yang Ping told them about it, and he was a little forced in his heart.

"This tibial bone should be lengthened by at least 30 centimeters, which is very rare, will there be neurovascular complications? Zhang Lin, tell me about it. Director Tian asked.

"Well, this, that-" Zhang Lin scratched his head.

Song Zimo took it and said: "This is different from the lengthening of deformed short limbs, and there is no need to consider the extension limit of neurovascular, because it only lengthens bone tissue, and vascular nerves do not need to be extended." Theoretically, there is no limit to how long it can be extended. ”

Song Zimo has solid knowledge and was once known as the problem terminator of the director's ward rounds.

"There are two options for lengthening instruments, external fixator and intramedullary nail, these two, the external fixator is more suitable for this patient, and the proximal and distal tibia can be preserved, and two sets of fixation needles can be placed, and there is no problem with the installation of the external fixator." Director Tian added.

Most people only know that the external fixator can be extended, and they don't know that there is a special intramedullary nail that can also be extended.

"What does Yang Ping think?" Professor Zhang named, and Yang Ping's speech was always not very positive.

Yang calmed down and said, "Everyone has said in detail, there is nothing to say." When threading the needle, pay attention to the choice of intermuscular space needle insertion, so that during the extended period, there is minimal interference for muscle strength training. ”

Song Zimo looked at the past and wore it from the intermuscular space, saying it lightly, but it was difficult to operate completely. Everything seemed simple to him.

Director Han collected everyone's opinions, made a didactic summary, and put the finishing touch: "Irizarov's theory of stretch tissue regeneration: the slow traction of biological tissues produces a certain tension, which can stimulate the regeneration and active growth of tissues, and its growth mode is similar to that of fetal tissues, all of which are the same cell division. In layman's terms, use slow and continuous traction to return the tissue to a state where it can grow during the fetal period. This technique is a subversive of traditional compression fracture healing theory. ”

Yang Ping greatly admired the founders of these medical theories, these people had big brains and rich imaginations.

Professor Zhang wants to talk about the origin of this theory: "Irizarov, a village doctor in Siberia in the former Soviet Union in the fifties and sixties of the twentieth century, was born by accident. The original purpose of his design of the external fixator was to treat a fracture patient, and to promote fracture healing by tightening the screws on the external fixator every day to tightly compress the broken end of the fracture. Once he had to take a leave of absence and asked the nurse to adjust the screws on the outer fixture every day. The nurse was very conscientious and strictly followed his doctor's orders, but reversed the direction of the screws. When Irizarov returned, the patient's fracture was separated, but he found that even if the fracture was separated, callus had grown. Inspired by this phenomenon, he devoted a lot of time and energy to research, and finally proposed the law of tensile stress, that is, the theory of tensile tissue regeneration. Later, the Soviet Union invested a lot of manpower and material resources in research and perfected this theory, and only then did it have the theory that is now mature. This theory was fully qualified for the Nobel Prize, but at that time, the United States and the Soviet Union were in the Cold War, so naturally they could not win the prize. China began to carry out this technology in the eighties, and there was a period of time when this technology was abused to increase the height of normal people, bringing many complications, skin necrosis, muscle weakness, bone nonunion, nerve damage and so on. In October 2006, the Ministry of Health issued an order prohibiting the use of broken bone enhancement for "medical cosmetology projects", that is, it cannot be used for the height of normal people, but only for bone defects and limb unequal lengths caused by congenital deformities, trauma, infection, tumors, etc., as well as limb deformities caused by diseases. ”

Discussion can not only make the patient's diagnosis and treatment plan clearer and more perfect, but also a good opportunity for young doctors to learn, through clinical case learning, accumulate experience, a typical case can master the knowledge of a class of diseases.

After such a discussion, everyone had a basic understanding of the magical Ilizarov technique.

When the meeting ended, Yang Ping received a WeChat message from Su Nanchen, asking Yang Ping to go to the attached consultation.

Go to the consultation or attach one!

Make no mistake!