The mere removal of broken and free pivots and shattered bone cement is tedious and tedious. What's worse is that Wang Yifei can only bend over and operate the endoscope in a very awkward posture. And this action can't have any shapes and mistakes, once the soreness of the waist shakes slightly, the high-speed rotating hand drill may cut Song Hualin's internal carotid artery, or pound his spinal cord into a paste.

"It's going to be tiring to do this. After working without saying a word for two hours, and after stopping for the ninth time to let the nurse wipe his sweat, Wang Yifei temporarily put down the endoscope in his hand and stretched his stiff neck and sore shoulders. "Who's that...... Yaran, take my phone over and play a tune. ”

The instrument nurse nodded, took out the plasticized mobile phone from Wang Yifei's pocket, and skillfully turned on the Bluetooth to connect to the speaker.

In this demonstration operating room, there is a BOSE Bluetooth speaker. The speaker is not small, and it is placed on a wall stand away from the side of the anesthesiologist. In order to ensure sterility, a nurse will change the plastic suit before each operation.

"This song?" The instrument nurse named Yaran clicked on Director Wang's mobile phone, and the lyrics of "Wanquan River is clear and clear" immediately rang in BOSE.

"This kind of crook is not suitable for surgery. Director Wang shook his head as if he relaxed his neck, "Keep looking down, the rock list is good." ”

"Then ...... Listen to this?" the nurse clicked on her phone a few more times, and a rock music that most of the young people were familiar with sounded. A famous song from the Australian rock band AC/DC, "Highway to Hell" hits.

"That's a good one. Wang Yifei laughed, "We are really on the highway of hell, and we are still driving in the opposite direction on the overtaking lane with patients." He stopped his relaxation, raised his hands slightly, and looked at Song Hualin, who was lying on the bed with his mouth wide open, "Go on!"

The sound of bones being ground off by hand drills was harsh and tooth-sore, bone meal and bone cement were beaten into powder, and the nurses next to them continued to be busy following Wang Yifei's instructions. "Hemostat forceps, prepare bone wax!" Wang Yifei suddenly stopped what he was doing. Sun Lien, who was standing on the side until his feet hurt, opened his eyes suddenly.

The state of "arterial rupture" appeared on the top of Song Hualin's head, and Sun Lien looked at the operating table with a worried face, could it be that the electric abrasion injured the internal carotid artery just now?

"Unknown arteriole rupture. Wang Yifei operated for a long time, and then he relaxed a little. Human arteries sometimes grow with small arterial branches, which often give a little scare to the surgery. When Wang Yifei cut a relatively large piece of bone cement just now, a small piece of bone cement fragment bounced back, cutting through the hyperplastic artery. Although the blood gushes out, the diameter of the arteriole itself is very limited, and even if the hyperplastic arteriole is ligated, it will not affect the original function of the human body.

Wang Yifei also breathed a sigh of relief, although he was very sure about the operation itself, this kind of arteriole did always give the doctors a surprise attack. Fortunately, at the beginning, the surgical field was completely exposed, and the artery was in a position where it was easier to be ligated. After Wang Yifei clamped the arteriole with a hemostat, the alarm was lifted.

"The bleeding is estimated to be around 150ml. The instrument nodded towards Wang Yifei, "Just suck the blood away, and you don't need to put on plasma for the time being." ”

The alarm was lifted, and everyone present breathed a sigh of relief. Sun Lien looked at Hu Jia, who was a little shaky on the side, and then remembered that his girlfriend had basically been running back and forth outside all day today. And it's not like I've taken a nap. He touched Hu Jia gently, "If you're tired, just lean on me for a while." ”

Hu Jia glanced at Sun Lien and nodded. Then he rested his head on Sun Lien's shoulder.

"Go on. Wang Yifei breathed a sigh of relief, almost five hours had passed since the operation was carried out. The fracture line at about 10:20 a.m. in the pivot spine and behind the anterior longitudinal ligament at 12 o'clock were almost all of the vertebral bodies and cement. To continue cleaning the remaining pivotal bones, you have to dispose of this ligament first.

Life is a magical thing. In developmental evolution, organisms have evolved skeletal systems to support and protect themselves. In order for bones not to interfere with movement, it is necessary to evolve systems that allow the skeletal system to move without dislocating each other. Ligaments are an important part of the system.

It's a pity that even with such advances in science and technology, people still can't make ligaments that work as well as they originally would, and even the connection between ligaments and bones can't be replicated. There is only one way to reconnect the ligaments that will be used in surgery, except for suturing after the middle rupture - using a nail to nail the ligament directly to the bone. It is impossible for an ordinary nail to work at this angle, after all, it is physically impossible to swing a hammer in this space. Therefore, orthopedic carpenters have adopted a combination of titanium alloy screws + orthopedic drills + prosthetic reserved mounting holes. Use a retractor to temporarily separate the longitudinally cut ligaments. Then grind off the remaining pivotal vertebrae, replace the prosthesis, and then loosen the ligament, replace it with a suitable titanium screw, and twist the ligament into the reserved hole in the prosthesis.

Song Hualin's anterior longitudinal ligament was cut longitudinally with a scalpel, and Wang Yifei used a retractor to separate the ligaments on both sides, and the final cleaning work was relatively easy. In about an hour's work, Wang Yifei removed the remaining part of the pivotal vertebra that could be seen through the oral approach. The posterior longitudinal ligament hidden in the vertebral body was also treated according to the rules, and two retractors were used to separate it.

"Okay, bring the prosthesis at the front end. "Highway to Hell has been looping in the operating room for an unknown number of times, and Dr. Pascal's journey from a somewhat quaint nature to a slight indifference now speaks volumes—not many people like to listen to a song over and over again for more than two hours. And Wang Yifei is probably tired of listening to it, so he wants to change the song by name, "Put "Back In Black"." ”

Wang Yifei, a rock carpenter, hummed a song while continuing his surgery. He had already undergone six hours of surgery in a position that was difficult for ordinary people to hold. Although he is much younger than his teacher, Academician Qiu, Wang Yifei is also almost fifty years old. All the muscles were screaming and roaring at him, warning the rock doctor - "We're going to strike!"

"Anesthetist, bring me a stool. The prosthesis has undergone many rounds of polishing and sterilization, but Wang Yifei insists on checking it again with the naked eye before installing it. "Just behind my butt. ”

Academician Qiu frowned, and Sun Lien also noticed something abnormal.

"Wang Yifei, male, 47 years old, muscle lactic acid accumulation. The status bar prompts that Wang Yifei, who is undergoing surgery, has basically reached the limit of his physical strength.

"Yifei, I'll take over. Academician Qiu walked up to Wang Yifei and said in a low voice, "You have been doing it for too long, and your physical strength can't keep up." ”

"I've struggled to do this angle, and I can't stand it even more if you do it. Wang Yifei rejected his mentor's suggestion. "I know my physical strength, and I don't have any problems with the implant. ”

Academician Qiu no longer insisted, but continued to observe Wang Yifei's surgical laparoscopic perspective through the screen. Nearly halfway through the dismantling of the vertebral body, the spinal dura inside is exposed. This part of the body appears to be in good condition at the moment, with no signs of damage or edema at all.

Half of the implant was carefully placed diagonally over the exposed dura. The little space exposed is just enough for Wang Yifei to fix the posterior longitudinal ligament on the prosthesis with a universal screwdriver.

The universal screwdriver was originally only used in the field of aircraft maintenance. The principle is actually very simple, replacing the extension rod on the screwdriver with a soft but extremely torsion-resistant soft rod. As long as you pay attention to fixing the bending head when using, you can tighten the screws that cannot be directly twisted with a rigid screwdriver. If it weren't for the existence of such good things, the 3D printed pivotal prosthesis would not have been installed in the first place.

The two screws were quickly twisted on the inside of the prosthesis, and Song Hualin's posterior longitudinal ligament was screwed on the prosthesis. Then it's a matter of quickly returning to the front and screwing the anterior longitudinal ligament onto the prosthesis. Wang Yifei only took one minute for this action.

When the last screw was installed in place, Wang Yifei steadily took out the electric screwdriver in his hand, and carefully looked at his surgical gown to see if it was not in contact with the endoscope stent. Only then did he let go and stuffed the electric screwdriver in his hand into his assistant's arms. He wrapped his arm around a somewhat loose surgical gown to prevent it from scratching the surgical instruments, and then sat down.

"I'll take a break. Wang Yifei said weakly to his student, who was also the first assistant of this operation, "Bring a bottle of water." ”

Academician Qiu stood behind Wang Yifei, "Go lie down for a while, I'll fix it." ”

Wang Yifei had the intention to let Academician Qiu save some effort, but the current situation really did not allow him to continue to be strong. The precision of the surgery in the pivotal region was so demanding that his hands were now shaking, and it was almost impossible to continue the fixation of the prosthesis and the atlas and the C1 segment. He could only nod, "I'm sorry for you." ”

"It's just a matter of four screws. Academician Qiu patted his apprentice on the shoulder, "When I had the operation, you were still sleeping in the junior high school classroom!"

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In fact, the most troublesome part of the whole operation has passed. Academician Qiu used nucleus pulposus forceps to remove Song Hualin's C02-C03 intervertebral disc, and then fixed the lower end of the prosthesis on the C03 vertebral body with two screws. The anterior atlantoaxial ligament and atlantoaxial capsule are also fixed to the prosthesis. Finally, two screws were used to fix the upper end of the prosthesis on the atlas vertebrae, and the operation of the transoral approach part was officially completed.

"Alright. "Academician Qiu is old after all, and maintaining this weird angle is also a difficult task for his waist. "You come and stitch it up. Academician Qiu instructed Ichisuke, "Remember to sew slowly." ”

3D printed prosthetic pivotal spine replacement, the transoral approach is officially over.

Nine hours have passed since the operation.