After multiple blood transfusions, Lu Jiangbei's hemoglobin has increased to 70 g/L and has not decreased again, indicating that the hemodynamics have stabilized.

Next, preparations began for Lu Jiangbei's surgery, and the inner plant used to fix the headrest and upper cervical vertebrae has been successfully printed by a 3D printer, and the details of the operation have also been finalized.

But there is still an unanswered question-—— how to safely reposition the body during surgery.

Lu Jiangbei's surgery needs to be fixed anteriorly and backward, and to complete the operation, the anterior and posterior approaches are naturally required, the anterior route needs to be supine, and the posterior road needs to be prone position, because there is no reliable fixation, the switching of the two positions faces many difficulties, and Lu Jiangbei has multiple rib fractures and pelvic fractures, which makes the prone position impossible to implement at all.

Another preoperative discussion around this question begins.

August and Robert, who were temporarily borrowed from the trauma ICU, have returned to the organization, and Lu Jiangbei has been able to smoothly get through the waiting period for surgery, and the two of them have contributed a lot.

An animation is playing on a high-definition screen in the general surgery conference room, simulating a change of position during surgery.

For this surgery, it was very dangerous to change from supine to prone during the operation.

Some surgeons who are good at the upper cervical spine have encountered this fatal problem, after completing the road surgery, in the process of turning over, the patient dies unexpectedly, so many spine surgeons have feared the turning of the upper cervical spine surgery.

In order to avoid turning over, some experts boldly use the anterior transoral approach, that is, entering through the oral cavity, cutting the posterior pharyngeal wall, exposing the upper cervical vertebrae, and implementing the firm fixation of the anterior route.

Unfortunately, this patient not only has a traumatic atlanto-occipital joint dislocation, but also a comminuted fracture of the atlantoscope, and the fracture fragment may invade the spinal canal at any time, so it is necessary to use the anterior-posterior combined approach to completely remove the atlantoscope, and then fix the anterior and posterior jointly.

"I also lack experience in this area, and I used to rely on turning over to solve the cases that needed to be fixed together, and this case was really tricky." August habitually shrugged his shoulders, indicating that there was no good way for the time being.

"Is it so difficult to turn over?" A graduate student whose newborn calf is not afraid of tigers raised doubts.

The graduate student participated in several discussions, and his mind was full of doubts as to why everyone was so cautious about turning over during surgery, and they had to discuss it specifically.

No one laughed at him because he was a student and was able to ask questions that showed that he was thinking deeply.

"This case must use a combined anterior and posterior approach, if according to the conventional surgical method, the first half of the operation is completed in the prone position, and the second half is completed in the supine position, so that the crushed atlas vertebrae can be removed, and firm fixation can be implemented, in the process of changing the position, we cannot use a brace to fix, and the conventional head fixator cannot provide firm fixation, so there is no guarantee that there will be no accidents in the process of turning over, and it is speculated that the probability of turning over and dying during the operation is 50%, our doctors are not gamblers, So this must be addressed before surgery. Yang Ping patiently explained to the student.

The graduate student nodded, then jotted it down in his notebook.

"In fact, we can use the improved stent fixation, redesign the existing head fixer, and extend the fixation point back to the cervical spine, so that the fixation needle of the stent is distributed in the head and cervical vertebrae, the head is fixed by the skull, the cervical spine is fixed by pedicle, and even the scapula and clavicle can be found to find the fixation point to create a firm fixing stent, of course, the design of the stent must leave ample space for surgical operation." Xu Zhiliang spoke very fluently.

Song Zimo nodded, agreeing with this idea, but there is a hurdle that cannot be bypassed: "Lu Jiangbei has multiple rib fractures and comminuted pelvic fractures, and there is still an external fixation bracket left on the front side of the pelvis, this stent must be kept during the operation, think about it, even if a special brace can be used to fix the head and cervical spine, how can he achieve the prone position?" Can the ribcage be supported? Does the external pelvic fixation brace block the prone position? ”

"What about the lateral decubitus position? Can the problem be solved with the lateral decubitus position? Zhang Lin boldly proposed.

Song Zimo shook his head: "The lateral decubitus position is not only difficult to implement the transoral approach, but also difficult to operate the posterior path, not to mention that it is the same as the prone position, because the rib fracture and the external pelvic fixator cannot be implemented." ”

It's a real headache, I didn't expect this operation to get stuck in the position.

August touched his head, Robert didn't say a word, and the discussion reached a dead end, which is not good, that is not good.

"Can you do the surgery while you sit down?"

Yang Ping has been listening carefully to everyone's speeches and is now starting to speak.

Everyone looked at them in surprise-—— Sitting?

"The sitting position is a bit difficult to operate, but at least it can be implemented, it perfectly avoids the trouble caused by rib fractures and pelvic fractures, and there is no need to turn over during the operation, if you use the sitting position, let the area above the shoulder expose the operating table and be fixed by an external fixator."

"Fantastic surgical position!"

August admired that even if he had a joint anterior and posterior fixation in his previous surgery, he had only changed the position and never considered sitting.

"The advantages of this position are obvious, there is no need to change positions during surgery, because gravity makes it easier to remove blood and irrigation fluid from the surgical area, and venous and cerebrospinal fluid return is also easier."

Song Zimo has no reason not to support Yang Ping, experience tells him that whatever Yang Ping puts forward, it can be realized.

"There are also advantages in anesthesia, I can get closer to the patient's face, assess whether the airway is safe, whether the endotracheal tube is always in place, better monitor the cranial nerves, and in case of cardiac arrest, it is also easy to compress, and if there is cardiac arrest in the prone position, I am afraid it is much more difficult."

Liang Fatzi felt that this position was indeed more beneficial to anesthesia.

August sighed: "Although the idea is good, the surgical operation will become difficult, and there may be many problems with sitting surgery, such as abnormal venous air embolism, intraoperative hypotension, symptomatic pneumoencephalopathy, acute subdural hematoma, peripheral nerve damage, laryngeal or tongue edema, and quadriplegia aggravation." So a lot of neurosurgeons hate this position. ”

However, Yang Ping is full of confidence: "Compared with the 50% uncontrollable in the process of turning over, the problems faced by this position are controllable, such as intraoperative hypotension, Dr. Liang should have a way to avoid it." ”

Liang Fatzi crossed Erlang's legs: "Intraoperative blood pressure control technology is my unique skill, don't worry." ”

"Venous air embolism, we operate gently during the operation, try not to damage the venous -——" Yang Ping proposed a solution to each problem.

I sat down and did the surgery!

For this case, theoretically, sitting is indeed the best choice.

As a master of spine surgery, Auguste has performed countless surgeries, but he has never used the sitting position to complete this kind of anterior and posterior joint approach surgery, and he is looking forward to seeing how Yang Ping can complete this kind of surgery.

"So this problem has been solved?" Yang Ping wants to know if you still have questions.

Song Zimo muttered in his heart, everyone discussed how to turn over and how to change positions, but Yang Ping wanted to sit and have the operation done, Dr. Song felt that he couldn't keep up with the rhythm and was always one beat off.

(End of chapter)