Coming out of the ward and returning to the doctor's office, Yang Ping finished washing his hands.

Everyone sits down and discusses the treatment plan.

In fact, for patients with metal allergies, there are still certain ways to carry out artificial joint replacement.

If you simplify it, the problem is easy: severe metal allergies, conservative treatment.

When bilateral knee osteoarthritis reaches such a severe stage, conservative treatment is synonymous with abandoning treatment, which is not in line with Yang Ping's concept of going all out.

Before seeing the patient, go through the medical record, and after seeing the patient, review the medical record again, which is the habit of consultation.

Reviewing the past and learning from the past can sometimes lead to unexpected discoveries.

In the past, Yang Ping was a junior doctor, and now, as a senior doctor, he needs to give his junior doctors a chance to think.

He has countless cases to experience in the system space, but Song Zimo and Xu Zhiliang can only rely on the experience of real cases, so Yang Ping did not speak prematurely.

"Metal allergies, non-allergic reactions are more serious."

Yang Ping looked at the medical records and said with a slight squint.

Director Chang was on the side, holding the back of Yang Ping's chair with one hand and said: "That's right, because we heard from his family that he has a history of metal allergy, we are more cautious, and we have conducted allergy tests on several metals involving artificial prostheses, and the reactions are all strong positive, and we have never seen patients who are allergic to these metals." ”

There are fewer patients with metal allergies, and even fewer patients who are allergic to several at the same time.

Director Chang's words have a deep meaning: it's not that we are incompetent, but that the patient's situation is too complicated, and there is no way to change anyone.

In order to reinforce this deep meaning, Director Chang continued, "We are also considering using a gold joint prosthesis, but we are also worried about the strong positive allergy test. ”

Gold joints, in fact, are not joints made of gold, but the prosthesis has certain particularities in the process, using the physical vapor deposition process to deposit titanium niobium nitrogen into the cobalt-chromium-molybdenum matrix, and high-precision polishing.

Titanium niobium nitrogen (TiNbN) can effectively reduce the release of cobalt-chromium-molybdenum metal ions in the matrix, has better biocompatibility, and can also prevent metal allergies, providing a more reliable solution for metal allergy patients, and its bonding, strength, wear resistance, biocompatibility, fatigue resistance and safety are better than ordinary artificial knee joints.

Because the color of the surface of the implant is golden yellow, it is often referred to as the "golden joint" by doctors.

This prosthesis can be used for patients with metal allergies, but patients with such severe allergic reactions still dare not use it, because once this surgery is done, there is no room for regression.

Titanium niobium nitrogen can reduce the release of metal ions from cobalt, chromium and molybdenum, but it cannot completely prevent the release of metal ions.

As long as the metal ions are released, there is a possibility of allergies.

If the implant loosens due to allergies, severe inflammation occurs in the surrounding soft tissues, and the surgical incision does not heal, it can be catastrophic.

One less operation is nothing to Director Chang, but if it is an operation with catastrophic consequences, Director Chang may not be able to sleep well.

So, the "golden joints" are ruthlessly excluded!

Director Chang is also experienced as the chief physician of joint surgery, and he should have thought of all the ways he can think of.

"It would be nice if there was an all-ceramic knee prosthesis?" Xu Zhiliang couldn't help but say regretfully.

Ceramic artificial joints are more widely used in hip joints, whether it is ceramic to ceramic, or ceramic to high cross-linked polyethylene, because of its low friction coefficient, ceramic prostheses often exist as high-grade prostheses.

However, ceramic prostheses are very rare to be used in the knee joint, and ceramic prostheses, not to mention the knee joint, even the hip joint cannot be found, because the femoral stem of the prosthesis is still metal.

Ceramics are generally alumina and zirconia, or a combination of the two, alumina has been used in artificial joints for more than 40 years, and the application of zirconia has been more than 30 years, ceramics are hard, smooth, wear-resistant, wear and tear, is a good material for artificial joint prosthesis.

However, it also has its disadvantages, that is, it is brittle, and once damaged, it is easy to crumble, but the possibility of fragmentation of implantable ceramics is very small.

At present, the best medical implantable ceramics on the market is CeramTec in Germany, and almost all artificial joint manufacturers, regardless of the United States, the United Kingdom, or China, all purchase its ceramic blanks for artificial joint manufacturing.

There is no way, other countries can't make qualified such ceramics.

Selangtech medical implantable ceramics occupy 95% of the global market, a well-deserved monopoly.

"Tao's all-ceramic knee prosthesis must not be found on the market at present, that is, the ceramic-to-high cross-linked polyethylene knee prosthesis, and the tibial end is also a metal support." Song Zimo responded to Xu Zhiliang's regret.

Because the way of movement of the knee joint is completely different from the way of movement of the hip joint, ceramics are used more in the hip joint and less in the knee joint.

The hip joint is a ball-and-socket joint in which the femoral head rotates.

The knee joint is a complex joint based on flexion joint, its movement has flexion and extension, rotation, and fretting valgus, and the valgus of this fretting movement will form the impact of the articular surface, and this frequent impact is unbearable for ceramics, because it just hits his weakness - brittleness, and once the impact forms a subtle damage, it will also cause the cracking of ceramics.

Advances in implantable ceramics will solve this problem, but there are at least no fully ceramic knee joints on the market.

"We have also considered ceramics, there are no all-ceramic knee prostheses on the market, how about it? Is there any other way? Director Chang asked innocentially, saying that he had already considered everything and there were no loopholes.

You Professor Yang have to think of ways within this framework, Director Chang has thought about these methods, Director Han has recently been very satisfied with the two departments of trauma orthopedics and sports medicine, but not very satisfied with the two departments of spine and joints.

Director Chang was a little unconvinced, anyway, the operation was done every day, and my level was not bad, what tricks could I do.

Yang Ping didn't speak, waiting for them to speak freely.

If there really is a knee joint prosthesis that is completely free of metal, the only way to find it is to go to Germany, and the Germans will sit next to it, as long as they say a word, the Germans will make a few phone calls, and this ceramic joint can be delivered.

Even if there is, it cannot be used, which will involve some medical regulatory issues, not to mention that there is no mature product yet.

This road didn't work, Yang Ping looked at the X-film repeatedly, and he was thinking about it.

"Professor, CeramTec, Ringer, I'm familiar with them, let me ask if they have any products for this at the moment?" August understands keeping up with Yang Ping's thinking.

Robert didn't speak, because he knew that even several major joint manufacturers in the United States were processing from CeramTec's ceramic blanks, and it was definitely impossible to develop faster than CeramTec. ”

Regardless of Director Chang or the doctor of joint surgery, he is envious, CeramTec, a manufacturer like CeramTec, this foreigner said to call and ask, this row is quite large.

"You ask!" Yang Ping agreed.

It doesn't hurt to ask, learn about the latest progress of ceramic artificial joints.

Professor Zhang famously said--- if you don't buy a plane ticket, you have to think about going to the imperial capital, Yang Ping is thinking now, how to get to the imperial capital, you can't walk there.

"Why don't you transfer this patient to us? Let's take our time and figure it out? ”

Yang Ping is not a patient of digging joint surgery, this thing does not exist.

If you are transferred to the Department of General Surgery, many things are much more convenient to do, such as family communication, treatment plan discussion, consultation in other departments, after all, it is the identity of the recommender.

Originally, the patient could be discharged after the consultation process, but the family had to ask to do their best, and in Sanbo Hospital, the ceiling was comprehensive surgery.

I can't do comprehensive surgery, and I'm not incompetent.

"Okay, when is it going to turn?"

Director Chang is refreshing.

Yang Ping was also unambiguous: "Turn now!" I went to talk to his family. ”

The patient's daughter has been dangling at the door of the doctor's office several times, waiting for a reply from here, and if it doesn't work, she will be discharged tomorrow.

Song Zimo went to call the patient's children, and Xu Zhiliang went to the meeting room to fiddle with the chair.

In the meeting room, Yang Ping met one of his daughters and two sons.

The daughter is the oldest child of the old man, so naturally as a representative, it seems that this lady is also happy to be a representative.

"Who are these two?"

The lady looked at the two foreigners also sitting next to her, a little uncomfortable.

Yang Ping explained: "These are two doctors in our department, you don't mind, they also follow me to learn." ”

The lady looked at the two foreigners before sitting down reassuringly.

"Do you think this is okay, today I will be transferred to our comprehensive surgery, I am improving some examinations, both knee joints and ankle joints should be MRI, I want to see how the cartilage of the old man is a large joint, after doing this examination, I have the bottom in my heart, whether it can solve your problem, if not, I will be discharged from our department, if there is a way, I will talk to you in detail."

"Based on the current inspection situation, I am not sure if I can help the elderly solve the problem."

Yang Ping added the basis.

The patient's daughter was refreshed and did not hesitate: "Of course we can, we are not in a hurry for this day, we are going to the hospital to help my dad solve the problem of joint pain, if it can be solved, it is better, if it can't be solved, there is no way, Professor Yang, I know your reputation, you have recently developed a very miraculous device for the treatment of spinal curvature, isn't it?" ”

Do these people know about this external spinal fixator?

Yang Ping nodded yes.

The patient's daughter said: "There is a child in our class with scoliosis, who has been trying to make an appointment for your surgery, but he has not made an appointment for a long time, and he said that he will wait for the third batch. ”

"What is the teacher's surname?" Yang Ping said with a smile.

The teacher, who was about 40 years old, said, "My surname is Wu, and I teach at the high school attached to the National Normal University. ”

"Hello Mr. Wu, then it's settled, we will arrange the specialist immediately, can you come up with a plan and wait for tomorrow's inspection." Yang Ping saw that they had no objections, so he arranged it like this.

Teacher Wu is very talkative: "You are experts, we fully cooperate, Professor Yang doesn't have to think about the cost, our three sisters and brothers are evenly shared, we are willing to pay as much as we want, my father has worked hard for us all his life, we are now married and started a business, it is time to return." ”

The two sons of the patient next to him kept nodding their heads and echoing their sister's opinion, it seems that when they were young, they were disciplined by their sister.

After the meeting, Song Zimo began to call the doctor on duty in the ward to accept the patient.

At the same time, he and Xu Zhiliang were also thinking about what plan Yang Ping was going to come up with, and since he proposed to transfer to another department, he must have been a little sure in his heart.