"Intramedullary nail internal fixation, do you know the general process?" Fang Ziye was fully armed to the operating table, and Associate Professor Xie Jinyuan checked and checked the various instruments to be used in the operation to the curved plate, and asked in advance while handing it to Fang Ziye.

This is the last time before the operation, I don't know what to say, the superior can give you another free mention.

Fang Ziye nodded, took a deep breath, and glanced at Professor Deng Yong and Associate Professor Xie Jinyuan: "The main process will not be mistaken, but the operation may not be so smooth." ”

Just kidding, the removal of the internal fixation device is the most entry-level and goldless surgical operation in orthopedics, and the surgical process cannot be remembered, and Fang Ziye's master's degree has been in vain in the past few years.

"Intramedullary nail removal is more difficult to perform than plate screw internal fixation device removal, but the main step is exposure."

"The intramedullary nail in this patient is an intramedullary nail with an inverted femur, so the intramedullary nail fixation blade is in the intercondylar fossa of the knee joint, and the fixation screws are at the proximal end of the femur and the superior border of the medial and lateral femoral condyles at the distal end."

"What you have to do is actually take out the blade of the fixing nut first, and then take out the fixing screws of the intramedullary nail fixation device separately." Associate Professor Xie Jinyuan said it simply.

Fang Ziye nodded again, without excitement, without particular nervousness, holding the knife with a pen in his right hand, and stroking the scar of the patient's lateral patella original incision approach with his left hand, showing that he was fully prepared.

"The operation begins." Professor Deng Yong was even more stressed, and with a command, his own itinerant nurse and anesthesiologist began to record the time of the skin incision.

Fang Ziye was not entangled, and according to the original surgical incision on the lateral side of the patella, he used a lancet to cut the scar skin, and followed the bottom with a knife, which was clean and neat.

A pair of tweezers was handed to Professor Deng Yong, a pair of tweezers were held in the palm of his hand, and after Associate Professor Xie Jinyuan wiped a small amount of blood stains from the first incision with a cotton pad, Fang Ziye and Professor Deng Yong opened one side of the skin with tweezers and used an electric knife to penetrate layer by layer.

The first incision is to break through the surface of the skin scar, and the electric knife is the beginning of the real incision approach.

"Don't be nervous, the scar formed by the surgical incision is tougher than the normal tissue of ordinary people, the speed of the electric knife cut is slower, and it doesn't matter if it lasts a little longer." Deng Yong told Fang Ziye to be a little afraid to go under the knife, and opened his mouth to point.

Immediately afterwards, many people in the operating room began to move to watch.

Fang Ziye's mind was retracted, and he peeled it off layer by layer.

This operation is very simple, in the exposure stage, there are not too many subtle operations, all of them are whether the basic skills are solid, and if the basic skills are not solid, the surgical field is a mess, and the solid basic skills are relatively refreshing.

Fang Ziye's Shuye is a relatively refreshing group of people.

The incision and hemostasis techniques practiced in the practice room, at this moment, the exposure of the refreshing surgical field was just right, and when the scar was removed, Fang Ziye was still able to grasp the trajectory of the knife very accurately and not deviate.

And this is the benefit of cutting tofu and even engraving fonts in the incision technique, and the control of strength and depth of the knife has already been able to be done with ease, and the speed is not slow!

Seven or eight minutes later, Fang Ziye broke open the joint capsule where the scar had healed, exposed the intercondylar fossa of the femur, and removed the excess small amount of scar tissue like carved tofu, leaving a relatively neat edge.

Fang Ziye breathed a sigh of relief slightly, and then continued to use the electric knife to rotate the scar near the tail cap of the intramedullary nail internal fixation device.

This kind of excision, in fact, is a kind of debridement, compared to the carving of three-dimensional characters, it is simply easy, after Fang Ziye slipped his hand, he looked at Xie Jinyuan and Professor Deng Yong, and knew the benefits of setting those standards in the practice room.

At this moment, Fang Ziye experienced it vividly.

One assistant and two assistants are both professors, and after seeing that Fang Ziye exposed the tail end, he immediately handed over the corresponding follow-up equipment, and explained the word feeding clearly.

Next, it is a very critical step to remove the intramedullary nail tail cap screw, also commonly known as the blade.

This step of operation, practiced in the practice room, needs special attention, once the silk or teeth slip, the two professors may be angry.

Firmly connect with the tail cap with the screwdriver to increase the vertical pressure stress with the joint surface, and then feel the mating of the screwdriver and the tail of the screw, slowly exert force and increase the force evenly!

Until!

There was a "click", a rather crisp sound sounded, and everyone breathed a sigh of relief.

Looking at Fang Ziye's gaze, the tension was restrained.

And Fang Ziye didn't dare to be happy and careless, and continued to slide the driver until the screws of the tail cap were completely removed, and carefully studied it three times in the palm of his hand.

And I also twisted it with my thumb and forefinger to take a good look, and I didn't find that the screws were cracked or broken, so I breathed a sigh of relief.

"Teacher instrument, please check it carefully again, whether it is a broken tooth." Fang Ziye described it quite professionally.

Slippery silk and sliding teeth are the most feared when taking internal fixation.

But there is a difference between the two. Slippery wire means that the part of the screw and the screwdriver butt is damaged and cannot be twisted. Slippage refers to damage to the contact part of the screw and the object, resulting in the screw being able to be twisted, but not in and out.

It is difficult to deal with, and even if there is no slip wire and slip teeth, it is still necessary to pay attention to whether the thread of the screw is broken and broken, and whether it is necessary to find residue.

Otherwise, after the internal fixation device is removed, if you find that something has not been taken out, the problem will be even more troublesome.

After the transfer, the next step is the more difficult part, which is to take the fixing screws for the intramedullary nails. The fixing screws are found at both the proximal and distal ends of the thigh, and they are relatively free.

If you continue to follow the original incision approach, you can only see a loneliness, which can only be used as a reference, not absolutely deep.

This requires careful comparison of the patient's skin surface through film reading, and then through blind puncture to break the surface of the skin, and then take the muscular space route to avoid the important vascular neuromuscular, in order to reach the screw tail cap position.

Naturally, there are also people who are not particular, only avoid blood vessels and nerves, and take screws from the end of the bone with a knife, and there are not a few, but such rough operations are generally not allowed to appear in the orthopedic operating room of Zhongnan Hospital.

Therefore, although there are only five set screws, this is the most difficult point, not only does it require you to position it accurately, but you also need to reach the screw hole in the most relatively non-invasive way.

In the early preparations, Fang Ziye had already placed it outside the operating room, so after taking out the tail fixing screw, Fang Ziye roughly compared the length of the patient's thigh, and muttered: "There is a scar stripe tissue near the front of the thigh, and there is one below the thigh." ”

"These two screws should be taken directly, but the other few ......"

When Fang Ziye was still thinking, his eyes suddenly lit up.

If it is on the inside of Zhongnan Hospital, the previous operation of Associate Professor Xie Jinyuan and others is absolutely decent, and there will be no scars blocking the way, as long as you walk the muscle gap normally.

Just follow the original approach as soon as possible, and don't worry about some of the difficulties mentioned in some literature or forums.