After the bleeding was successfully stopped, the boy passed the first ghost gate.

He will then be transferred to the trauma intensive care unit (ICU) for further treatment, and after his condition is stabilized, he will undergo second-stage surgery.

In addition to fixing the head and neck, it is necessary to perform surgery on pelvic fractures and multiple fractures throughout the body.

"Get ready to get out of bed, everyone is in place!"

Song Zimo instructed everyone to begin to carry the boy from the operating table to the transport flat car.

Because of the weakened muscles, the boy had to rely on a ventilator to assist his breathing, and the tracheotomy was inserted into the cannula connected to the ventilator to make a rhythmic snorting sound.

"1, 2, 3, up!"

With Song Zimo's order, everyone worked together to smoothly transfer the boy to the flat car.

Normally, ordinary surgical patients usually only need two or three people to complete the bed, but this time is different, in order to carry the patient safely, seven experienced and strong doctors go into battle together.

Because the atlanto-occipital joint plane spinal canal is the beginning of the cervical spinal cord and adjacent to the medullary respiratory center, a slight carelessness may cause secondary damage to the spinal cord, and the outcome of the secondary damage is respiratory arrest.

Xiao Su and Tang Fei helped clean up the table, and Yang Ping, Song Zimo, Xu Zhiliang, August, Robert and others began to discuss the case again.

Trauma results in the separation of the joints between the head and cervical vertebrae, and the head and neck lose their reliable bone and ligament connections, which are maintained only by soft tissues.

"If a custom prosthesis is used, the crushed atlas vertebrae need to be removed, and it is difficult to completely remove the atlas vertebrae, and there will be unpredictable bleeding during the operation, and it is even more difficult that the operation needs to be in the prone position, and it is necessary to switch to the supine position in the middle, and the switching of body positions makes it very difficult to fix the head and cervical vertebrae, and it is impossible to fix it with a brace during the operation, and the traditional cranial traction and various stents are also powerless." August added new worries.

"Blood oxygen is dropping?" The anesthesiologist immediately alerted.

Robert's brows tightened, and he relaxed again for a moment: "Professor-—— I promise to complete the task -—— - can I have a request?" ”

"A hollow cage structure filled with autologous bone allows the prosthesis to take on the dual task of temporary fixation and head and neck fusion?" August said in surprise.

"Atlas, this noun is taken from the Greek mythology of the titan god Atlas, just like this giant god carries the earth, the atlas carries the entire head, the joint formed between the atlas and the head-—— the occipital joint, is the only connection between the head and the cervical vertebrae, and our huge human heads rely on this small joint to connect with the cervical vertebrae and the torso-——"

Yang Ping said lightly: "The brace is perfect, not a problem with the brace, any external fixation is elastic fixation, it is impossible to be absolutely stable, as long as the micromotion is within a safe range, don't worry, now you can send it to the ICU, if there is blood oxygen fluctuation again, stop and rest to stabilize and then transport." ”

On the screen of the monitoring instrument, the oxygen saturation dropped from 100% all the way down to 80%, causing this fatal fluctuation in a single move.

The idea is bold and easy to say, but very difficult to do.

But Zhang Lin and Xiao Wu have been silent, not because they are unwilling to participate in the discussion, but because this discussion is too high-end, they can't intervene at all, and they can only learn as bystanders.

So, cases where you can see a doctor are very rare, and the same is true around the world.

"That's right!" Yang Ping said with certainty.

Yang Ping approached the flat car of the transfer, reached out and touched the brace, Director Wei hurriedly followed, looking at Yang Ping worriedly, the blood oxygen fluctuation just now indicates that the cervical spine is still unstable, indicating that the respiratory center is disturbed in some way.

Indeed, how to allow the patient to switch positions freely without damaging the cervical spinal cord during surgery is a huge problem.

Everyone's eyes were on Yang Ping, hoping to get some kind of rescue instructions from his mouth.

There are not many such injuries, but the cases that doctors can see are very rare.

Robert patted his chest excitedly: "Don't worry, trust me." ”

"There is edema in the spinal cord, there is no transection, indicating that it is only a contusion, the muscle strength of the limbs is now at the first level, as long as the operation is timely, it is very likely to recover, traumatic atlanto-occipital dislocation-—— I have had similar surgery, but there are only a few cases, there are not many cases of similar surgery reported throughout Europe, and this wounded, there is a comminuted fracture of the atlas vertebrae, I have never encountered this case."

Sometimes, when faced with such a problem, it is necessary to have innovative thinking to solve the problem.

It's already off-duty time, but the life of a doctor has never had the concept of "normal commuting".

Yang Ping thought for a moment and said: "You can do a lot of things, but I have decided to give you the most important and core task, and I hope you can do it." ”

The scattered lunch boxes are placed on the desk, these are empty boxes, whether it is vegetables or rice, they are swept away, and there is nothing left.

After about fifteen minutes of oxygen stabilization, the group pushed the flat cart and began to take the boy to the trauma ICU.

——

General Surgeon's Office.

Auguste pointed to the 3D reconstruction of the head and neck CT image that rotated automatically and slowly on the screen.

Yang Ping looked at the values on the monitoring screen, and spoke after a while: "No matter how careful you are, you can't guarantee that the cervical spine does not have any rotation and translation, even if it is a small rotation and translation, it will interfere with the cervical spinal cord that has been edematous and affect the respiratory center, thereby causing a drop in blood oxygen, which is a transient blood oxygen fluctuation, and I will talk about it after observing for a while." ”

"Please!" Yang Ping replied easily.

"Only the prosthesis can be customized, the prosthesis supports the occipital part of the skull, connects the pivotal vertebrae below, and simulates the atlantoaxial vertebra in the middle, that is, to shape an artificial atlantoscope, atlanto-occipital joint and atlantoaxial joint." Song Zimo expressed his opinion.

After some fumbling, Director Wei said suspiciously: "The fixation is very reliable, what's going on?" ”

"Starting today, you join the nursing team in the trauma ICU, and they need a member who is well-versed in orthopedics and is physically fit, because turning over in nursing work is too important, and the slightest carelessness can lead to a misaligned head and neck." Yang Ping said very seriously.

"Now that there is no Atlas, who will carry the earth, and without the atlas, I don't know how to place this head?" August shrugged.

"According to common sense, this case will not appear in front of us, but he did, we have to do something, right?" Xu Zhiliang was silent for a long time and began to join the discussion.

"This method can be improved, the artificial atlantosis uses a mesh structure similar to a titanium mesh, and the mesh structure undertakes the temporary fixation mission, and the mesh structure is filled with autologous bone, such as ribs or ilium, or the patient's existing crushing atlantoscope, so that the autologous bone can complete bony fusion with the upper head pillow and the lower axial vertebrae, so as to kill two birds with one stone." Yang Ping leaned back in his chair and expressed his opinion.

Yang Ping said approvingly: "The thinking is very rigorous! Whether the bone cyst is a bone cyst or not is uncertain is not yet certain, and pathological examination must be performed during the operation, but in any case, the purpose of our current surgery is only to complete the fixation of the head and neck, and the only purpose is to keep him alive. ”

"There are still single-digit cases of simple atlanto-occipital joint dislocation, and there are no precedents in the world for comminuted fractures of the atlas vertebrae." August was disappointed.

Director Wei also stretched out his hand and stroked the surface of the brace to determine whether it was conformable, especially the place where it turned, whether it was soft, and along the edge of the brace, explore the gap between the brace and the skin, whether it was too wide.

In the case of death caused by cervical spine trauma, about 1/3 is caused by the dislocation of the atlanto-occipital joint, which is very unstable, and the vast majority of such patients either die on the spot due to injury, or during the transportation process, the atlanto-occipital joint is further dislocated, compressing or pulling the vital center in the spinal cord, resulting in respiratory arrest and death.

"Imaginative solutions, what can I do?" Robert snapped his fingers.

"It's a good idea to use a prosthesis for fixation, but if the surgery is done with an atlas prosthesis, how can a stable long-term fixation be achieved between the occipital part of the head and the prosthesis, and between the prosthesis and the pivotal vertebrae? Of course, we don't have to think about the long term, after all, as long as we can complete the surgery, no matter how long it can be stable, it will be a victory in medicine. ”

Because they are difficult problems because there is no solution to the existing knowledge, and you need to use your imagination to come up with a completely new solution.

"Bone cyst is now only an imaging diagnosis, and pathological biopsy is needed during the operation to clarify the nature of the atlas tumor, if it is malignant, we not only cannot use the atlas as a donor bone, but also face more trouble." Xu Zhiliang raised new questions.

The oxygen saturation level of 80% was maintained for less than 30 seconds, and it began to rise until it climbed above 95%, and everyone breathed a sigh of relief.

August once participated in an academic exchange meeting between Europe and the United States, and an American doctor tried to complete the operation in this way, but in the end, due to the loosening of the screws, the connection between the patient's headrest and the cervical spine was loosened, and finally breathing stopped.

If the oxygen saturation does not rise, but continues to fall, it means that the cervical spinal cord has been fatally injured twice, and the boy may not have a chance to survive, fortunately the oxygen saturation returns to normal, thanks to the good fixation of the brace and the professional cooperation of everyone when handling.

"During the mission, the working meals are arranged for two people?"

Director Wei's hanging heart was put down, he was still very confident in his brace, he had done this thing in his life, and he thought that he had done it to the extreme.

August, a top spine surgeon whose experience is important, wiped the corners of his mouth with a tissue over and over again as he spoke.

Robert said helplessly: "The separation of the atlanto-occipital joint is really an unbearable separation in life!" ”

"No problem, not only double standard, but also chicken thighs!"

"This is a difficult and sacred task, this is the most critical and core part of the entire treatment plan, there must be no mistakes, as a brother, I would like to fight side by side with you, but the situation does not allow, I will silently cheer for you in my heart, believe in myself, I will definitely be able to, come on." August encouraged his roommates.

"The nursing team also needs a specialist who is well-versed in spine surgery, and I can fight for you if needed." Yang Ping sent another task to August.

August straightened his chest and swallowed a mouthful of saliva: "Professor, I don't want to embarrass you. ”

"It's okay! You have touched me, no matter how difficult it is, I will try my best to fight for it! Yang Ping said indifferently.