Both Sun and Professor Pascal were a little uneasy. Sun Lien has not been in the operating room a few times, and the last time he visited the operating room, he met Director Zheng Guoyou, who had a heart attack. Professor Pascal hadn't been in the operating room since he got his M.D. An emergency department trainee and an immunology physician with a certain reputation, just like Grandma Liu who had just entered the Grand View Garden, craned their necks to watch the operation progress.

Unlike Sun Lien and Pascal, Xu Yourong and Hu Jia are as relaxed as if they had returned home. Needless to say, Hu Jia is in the operating room five days a week to assist with various surgeries. She was very familiar with the constant temperature of the operating room and the surgical instruments that flashed with cold light, and there was no discomfort at all. Xu Yourong is a step further than Hu Jia's attitude - she is an excellent neurosurgeon, although in the Fourth Central Hospital, spine surgeries are basically handled by orthopedics. However, this does not prevent her from making use of her expertise in this area, where spinal cord and bulbar are one of the key areas of neurosurgery.

It is precisely because Xu Yourong is good enough that she can understand better than Sun Lien and others how important the operation that is being carried out in front of her eyes in an orderly manner - the previous doctors can only use titanium mesh and various titanium alloy strips of unsuitable length to reluctantly replace. And these hard-bent titanium mesh and alloy strips are indeed not up to the task of the atlantovertebral pivot. And each person's atlantoaxial vertebrae are different in size, shape, and even inclination. 3D printing technology, and only 3D printing technology, can truly become a long-term replacement for the atlantoaxial vertebrae. Although such a prosthesis still has a huge drawback - with ligament damage, the patient may lose almost all of the ability to rotate the head. In layman's terms, Song Hualin may never be able to shake his head in the future.

But it would still be a great feat – not shaking your head is better than being burned to ashes and put in a box. As long as the operation is successful, he can still hug his family and walk in the warm sunshine and spring breeze.

Therefore, Xu Yourong couldn't take his eyes off it. Rachel next to her didn't show much excitement and excitement about this, she just secretly held Xu Yourong's hand, and most of her face was covered by a mask, so she couldn't see too many expressions. But there is a hint of a smile between his eyebrows and eyes from time to time.

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The opening and closing of the human mouth is limited, so there is not a lot of operation space left for Wang Yifei. The surgical assistant used the opener to pull open Song Hualin's mouth, exposing his soft palate as much as possible. Then he used a tongue depressor to press his tongue as hard as possible. The action was a little rough and forceful, and the tongue depressor was even pressed out of an arc under the operation of the assistants.

"The movement is a little lighter, this tongue will be used in the future. Wang Yifei smiled and criticized his assistant, "Don't be so nervous." ”

The operating table gradually rose, but due to Song Hualin's fracture of the axial vertebrae, Wang Yifei's angle of operation was still very limited. He tried several times in a row, and finally could only lie on the operating table, and in a very awkward position, he probed the scalpel into Song Hualin's mouth.

After confirming that Song Hualin's uvula was biased to the left, he paused slightly and began to cut with the knife. When the blade is almost at the position of the uvula (small tongue), the scalpel goes around the left side of the uvula and continues to cut along the midline of the uvula, and the scalpel cuts back along Song Hualin's soft palate towards the front teeth until it touches the hard palate margin.

The first small step is complete. Director Wang Yifei moved out of the way and turned to look at the MRI and CT pictures taken earlier. The assistants took advantage of this opportunity to quickly stop the bleeding of the incised soft palate, and used a small traction hook to pull open the part of the soft palate that had been cut. made Song Hualin's posterior pharyngeal wall more completely exposed.

It may seem unnecessary to make an incision in a completely disease-free area just to get a better operating space and open vision. But in fact, it is already the least invasive option – in fact, if the patient has a congenital condition such as limited jaw movement, resulting in poor vision and insufficient space for surgery, doctors may even make the decision to split the jawbone. As long as the fear for life can be solved, additional damage is perfectly acceptable.

The exposed posterior pharyngeal wall, although still small, was able to proceed with further surgery. Wang Yifei once again stood in the position of the chief knife. The scalpel is cut from the posterior pharyngeal wall and the posterior pharyngeal wall is cut along the median slit. After stopping the bleeding and traction again, what is exposed is the upper and middle pharyngeal constrictor muscles and part of the cephalic longus muscle.

The reason why the atlantoaxial area is called the "surgical exclusion zone" is highlighted here. The mouth itself has a certain depth, and this area is in turn rich in muscles, nerves, ligaments and blood vessels. These important and fragile tissues can be easily injured during surgery.

Injuring muscles can lead to movement obstruction or infection, nerve damage can lead to a number of consequences including facial paralysis and long-term pain, and ligaments can lead to joint instability, which can lead to more serious spinal cord or even bulbar problems.

As for damaged blood vessels...... If the artery is injured and the bleeding cannot be stopped quickly, then even the rescue can be avoided - once the vertebral artery near the atlas vertebral vertebra ruptures, it can spurt out basically all the blood in the body within a minute, and in the narrow operating space of the mouth, the rupture of the vertebral artery is equivalent to the loss of all vision in an instant. Based on memory and feel, the doctor finds the ruptured vertebral artery in the bright red blood gushing out, and sutures the ruptured artery within a minute. This kind of rescue, which is almost no different from luck, will naturally not have a high success rate. For this reason, this area has always been referred to as the "surgical exclusion zone".

Director Wang Yifei glanced at the exposed muscle tissue, but there was no nervousness. He moved his shoulders and neck, motioned to his assistant to get a small camera for video shooting, and explained the structure of this part of the dissection on the spot.

"Normally, you don't have a lot of opportunities to see the muscles in this area, and basically you can only see it in the general teacher. Professor Wang's tone is calm, steady and confident. "However, the muscles in this part of the body have basically atrophied a little, and there are fewer opportunities to see the fresh muscles, so please experience the structure more. ”

This operation is not only a challenge to the authority of the Grim Reaper, but also a very important lesson. Like many excellent medical schools, Tongxie's teaching style is not only rigorous, but also actively encourages the application of new technologies and procedures. Medical technology is a technology that is always evolving itself. The sooner the medical value of new technologies is discovered, and the sooner new surgical methods are designed around them, the more patients can be saved.

Saving lives and improving the quality of life of patients is the most important core content of every doctor's career - realizing self-worth.

Wang Yifei is not only the director of the Department of Orthopedics at Tongxie Hospital, but also a professor at Tongxie Medical University. He had a heavier task on him, and he wanted to get these techniques mastered by the students as soon as possible. There is no such thing as a broom in medical technology, and only when a technique is constantly spread can it be further improved. There can be no medical progress without a broad and active exchange of medicine. He knew this very well. Therefore, Wang Yifei chose to emphasize the anatomical structure to the doctors who visited the operation at this time. He can still fully grasp the current situation, and when the blunt separation of the muscles and the exposure of Song Hualin's broken pivotal vertebrae, he will probably not have the energy to teach.

After waiting for a minute or two, after confirming that the doctors who visited the operation had seen this part of the muscle, the assistants picked up the surgical forceps and pulled Song Hualin's tongue out. And Wang Yifei picked up the scalpel again, this time instead of using a sharp blade, he turned the scalpel and used the handle to remove the two cephalic longus muscles that were blocking him. As for the upper and middle pharyngeal constrictors, they need to be incised along the median suture.

After the middle pharyngeal contraction muscle hidden behind the upper pharyngeal contraction muscle was pulled away with the separator again, Song Hualin's anterior longitudinal ligament part was finally exposed. This is the main ligament that connects the anterior side of the cervical spine. As the longest ligament in the human body, the main function of the anterior longitudinal ligament is to limit hyperextension of the spine and prevent the disc from protruding forward.

After blunt separation again, the hypopharyngeal constrictor and cephalic muscles were pulled apart, and now, the C1 cervical atlas and C2 cervical pivot were completely exposed to the air. After layers of traction, the operating space left for Wang Yifei has become very small.

"Upper endoscope. For this result, Wang Yifei had long expected it. The reason why the transoral approach is used is to minimize the intraoperative trauma to the patient. And in order to reduce trauma, it is inevitable to lose some vision and operating space. But the good thing is that there are still endoscopes. If the previous surgery was the pinnacle of traditional surgery, then what Wang Yifei wants to show next is one of the main development directions of future surgery - endoscopic surgery.

Because the other tissues have been separated, the endoscope and the two operating arms for observation and manipulation are fixed by an external scaffold. Wang Yifei half-bent over and began to operate. Through endoscopic observation, through two control arms about 20 cm long, as well as the grinding tools on the control arms, Wang Yifei slowly cut Song Hualin's pivotal vertebrae, which had broken into a free state, into small pieces, and then took them out one by one. Each piece of pivotal bone, as well as the bone cement that had been filled in fifteen years earlier to increase its strength, had been carefully cut into pieces of less than a centimeter. It is then taken out by the manipulator arm.

This process proceeds extremely slowly. Song Hualin's pivotal vertebra fracture shape is very irregular, there are three fracture lines on his pivotal vertebrae, except for the posterior odontoid fracture, there are two fracture lines on the pivotal vertebrae, if the coordinate system is established in the direction of 12 o'clock with the tip of the human nose as the clock, the two fracture lines are roughly equivalent to the hour hand at 4:50 and 10:20. In the frontal approach, the range of the axial vertebrae that can be directly exposed is about 9:00 to 3:00. That is, with a frontal transoral approach, only one of the fracture lines can be observed, while the other fracture line does not appear in the field of view of the endoscope.

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