Sisi's father's examination results came out, the right ankle fracture, supination and external rotation of the fourth degree, anterior and posterior internal and external four points were damaged, medial malleolus fracture, lateral malleolar fracture, posterior malleolus fracture, tibiofibular symphysis ligament rupture, ankle point widening, talus outward displacement, ankle subluxation, this kind of fracture, must be surgical, manual reduction, even if it can be reduced satisfactorily, it can not be well fixed.

Every treatment has an indication, and it is against scientific principles to detach from the indication and mythologize any kind of treatment.

"Lange-Hanson parting--- supination and external rotation of the fourth degree, AO parting ---C!"

Song Zimo turned on the electronic reading screen, Sisi's father's X-ray and CT were presented on the screen, and several trainees and interns surrounded him, and Song Zimo explained the knowledge of ankle fracture to everyone.

The ankle fracture classification is the most complex of the limb fracture classification, especially the Lange-Hanson classification, which many senior orthopedic surgeons are confused and cannot understand.

In this parting, what is the pronation and what is the state; What is external rotation and internal rotation, what is the state, and why is it so combined, Song Zimo explained to you in detail.

In order to make it easy for everyone to understand, Song Zimo drew a hinge diagram to simulate the mechanism of an ankle injury.

Most of the students are highly motivated to learn, especially in the academic meeting, Yang Ping took Song Zimo to show his skillful surgical skills, beating the Japanese trauma surgery heroes, making these young people enthusiastic and worshipful, and strengthening the belief of these students to be a good doctor.

The power of idols should not be underestimated, it is a kind of spiritual pillar, like a lighthouse, giving you hope, giving you direction, and giving you the confidence to move forward in the distance.

It is a great honor to be able to study in integrative orthopaedics for a period of time; It's also a great honor to be held strictly by the teachers here, and they all think so.

In terms of teaching, Yang Ping advocates learning centered on clinical cases, using a case to thoroughly understand all the relevant knowledge. Even if you are an intern from the Department of Comprehensive Orthopedics, you must understand the knowledge you should master thoroughly and firmly grasp it.

Usually, the interns and trainees are Zhang Linguan, and some basic knowledge is taught by Zhang Lin, and Song Zimo talks about more complex professional knowledge.

Yang Ping usually gives lectures to Song Zimo, Zhang Lin and Xiao Wu, and he will also explain cases to regular trainees and interns during teaching rounds, ask some questions, and check the practical effect of clinical teaching in the department.

"The swelling is reduced first, and then the surgery is arranged." Yang Ping instructed Song Zimo.

This kind of fracture cannot be operated on during the swelling period, otherwise it is easy to cause incision complications, such as inability to suture, necrosis, infection, etc., and it is necessary to wait for the swelling to subside before surgery.

Song Zimo's mobile phone vibrate, and it was Duan Xiaoming, the director of the Haifudao operating room: "Song Gongzi, will you do liver tumors in the operating room tomorrow?" "Yes!"

"The medical department just called and said that you have exceeded your authority, and the authority of this operation is only available to the Department of General Surgery, the Department of Oncology and our department, and your Department of Orthopedics has no authority."

"Sisi's surgery, tomorrow we will do liver metastases, this surgery is not the scope of our orthopedics, it is general surgery and oncology surgery, Brother Ming just called and said that we were monitored by the medical department and wanted to cancel the operation." Song Zimo hung up the phone and said.

has been focusing on the treatment of Sisi's disease, Yang Ping and Song Zimo didn't care, indeed, this operation crossed the line.

"Why don't we deal with the primary tumor of the left femur first?" Song Zimo suggested.

Yang Ping shook his head: "The current treatment is all palliative, and priority should be given to solving the most painful part, you also saw it during the ward round, Sisi's painful expression lying on the bed." ”

"Can you hang Brother Ming's name, you can operate?" Song Zimo thought about it.

The matter of surgical authority is very serious, just like asking for a driver's license to drive.

Brother Ming, whose real name is Duan Xiaoming, is the director of the Haifudao department, no matter what tumor is in the body, as long as there are indications for Haifudao, you can do it.

It's a good idea, but people don't necessarily agree to name it because it's risky.

"I told him, and he agreed." Song Zimo is very confident.

The matter of Duan Xiaoming's child's degree was solved by Song Zimo, and this friendship, it should be no problem to ask him to help put up a name.

With Yang Ping's trust value in Sanbo, since he dared to do this operation, he must be very sure, and Duan Xiaoming would not have too much worry.

"Don't worry, I'll talk to Director Han!" Yang Ping called Director Han to explain the situation.

It didn't take long for Director Han to call: "Xiao Yang, you go to do it, I just communicated with the medical department, give you a one-time temporary authorization, I signed and endorsed with Dean Xia, I greeted and explained to the Department of General Surgery and Oncology, this is a special situation, this patient is the object of charity funding in our department, it belongs to scientific research cases, and they will not have any opinions." ”

In a few words, and without asking Yang Ping too much, Lao Han solved the matter.

Lao Han's idea is very simple, since you have to do it, do it, I will remove the obstacles, and I will bear the risks.

"Director Han has already straightened everything out." Yang Ping put down his mobile phone and let Song Zimo not have to go around.

In the hospital, doctors are divided into departments, each doing things in their own fields, and they can't exceed their authority without authorization, this special situation can be done at a time, but it must not be normalized, and any surgery must be done, nonsense.

Cheng Liquan sent a message, and the medical tour group on his side had arrived at the hospital and asked when the operation could be arranged, and there were eighteen patients for the operation.

Eighteen?

At first it said eleven, but later it was increased to sixteen.

Now the exact number is eighteen, and two patients from Southeast Asia have joined the group on an ad hoc basis.

Do you have surgery or do you want to form a group? Will there be a group purchase price? Yang Ping was very curious, but it was inconvenient to ask Cheng Liquan.

If this continues, it will only accumulate more and more, and we must find a time to clear it, and take advantage of the fact that there are not many patients in our department at present, and hurry up to clear these eighteen patients, just Sunday.

If Professor Zhang were to work at full capacity in the outpatient clinic, he would be able to fill the ward in less than two weeks, and at that time, it would be difficult to find time.

Mr. Zhang is well-known and very responsible, and many patients from outside the province come to register his number.

His patients, some of whom have been in the operation for twenty or thirty years, are still being followed.

A patient with congenital hip dysplasia who had surgery when he was two years old and is still following up with his children in middle school.

At that time, there was no WeChat, even phone calls were not popular, and follow-up was completely dependent on letter visits, which persisted, what kind of sense of responsibility was it.

The serious and rigorous attitude of the older generation makes most doctors embarrassed, which is why many patients trust him and come to him thousands of miles to see him.

The nurse station called the doctor on duty, Professor Zhang accepted the patient in, a girl, in her twenties, Professor Zhang considered tuberculosis of the thoracic spine.

Tuberculosis is now rare, but in recent years there has been a trend of resurgence because of the mutation of tuberculosis bacteria.

Zhang Lin was on duty, he went to see the patient, and Yang Ping didn't have anything, so let's go and see it together.

The patient's name is Fang Xiaoyun, female, 24 years old, with low back pain for 3 years, numbness and weakness in half of the lower limbs for 3 days. On examination, skin sensation is decreased in both ventral thighs, and muscle strength in both lower extremities is grade 4.

Professor Zhang considered that patients have medical insurance, and they can be reimbursed for inpatient MRI, but the reimbursement for outpatient MRI is too low.

Therefore, Professor Zhang only gave the patient an X-ray of the thoracolumbar spine in the outpatient clinic, which showed that bone destruction could be seen at the upper and lower edges of the thoracic 9th vertebrae, the gap between the upper and lower vertebrae was narrowed, and the widened soft tissue shadow could be seen next to the vertebrae.

Professor Zhang, who has extensive experience and made a diagnosis based on medical history, physical examination and X-rays, called Zhang Lin on duty and instructed him to do a further MRI of the patient.

This is thoracic tuberculosis and paraplegia, and emergency surgery is required to relieve the compression of pus, granulation tissue, caseous necrotic tissue and dead bone on the spinal cord in the spinal canal, so that nerve function can be restored.

At present, the compression time is not long, and the paraplegia can be completely recovered by removing these compressive substances in time.

Judging from the X-ray, the compressive material has entered the anterior half of the spinal canal, and once the anterior artery of the spinal cord is embolized, it will lead to permanent damage to the spinal cord, so that even if the operation is done perfectly, it will be left paralyzed in the future.

Zhang Lin arranged an emergency thoracolumbar MRI for Fang Xiaoyun, and when the results came out, sure enough, it was the same as the speculation based on X-rays.

The compressive substance was at the level of the 9th vertebral body of the thorax, which had already entered the front part of the spinal canal, and Yang Ping immediately took Zhang Lin to Fang Xiaoyun to talk about the condition, and it was best to have emergency surgery.

Fang Xiaoyun's eyes were a little red, as if he was very aggrieved and secretly cried.

"Doctor, do I have to have surgery for this disease?" Fang Xiaoyun asked.

Yang Ping said with certainty: "It must be operated, otherwise the lower half of the body will be paralyzed in the future." ”

"From the magnetic resonance point of view, the compressive material has entered the front half of the spinal canal, and once the anterior artery of the spinal cord is embolized, it will lead to permanent damage to the spinal cord, so that even if the operation is done perfectly, it will be left paralyzed in the future. You're still so young, don't delay, we'll arrange emergency surgery for you. Yang Ping was not a scare, but an objective informant of the condition.

Fang Xiaoyun's face was obviously hesitant, and it was difficult to make up his mind: "I think about it, is it okay, I'll give you an answer tomorrow morning, and it's okay to wait for the night, right?" ”

"Wait for one night, there will definitely be an impact, this risk can't be determined, if you can't make a decision now, try not to delay it for too long, give us an answer as soon as possible, and tell us at any time if you have any questions."

"Okay, thank you, Dr. Yang, I'll give you an accurate answer at eight o'clock tomorrow morning."

"If you think about it, tell me, don't delay, if there is any difficulty, you can tell us." Zhang Lin felt that her demeanor was a little abnormal, her eyes were red, as if she had quarreled with someone and cried.

She came here on purpose to have surgery, and now the emergency department is doing it for her, but she is hesitant, is there something hidden behind it.

The doctor couldn't ask questions, so he could only leave her a sentence.

Out of the ward, Yang Ping told Zhang Lin: "This patient should follow closely, and it can't be delayed for too long." ”