Many orthopedic surgeries were similar to interventional surgeries, which required X-rays.
C-arm X-ray was used to locate the L2 vertebral body and bilateral pedicles. The assistant began to disinfect and lay a sterile surgical drapes.
Once the position was set, Professor Tian and his assistant explained the entire surgery process.
On the stage, Professor Tian used 1% lidocaine for local anesthesia and made a 0.5cm incision on the patient's second lumbar vertebral body.
Under the guidance of X-ray, the needle with a core was inserted at the upper and outer edge of the L2 vertebral pedicles, and the needle was inserted at a 10 ° angle.
The operation was skillful. This kind of surgery was not difficult at all for a surgeon of Professor Tian's level.
After the needle was inserted into the vertebral pedicles under the C-arm X-ray, the core was removed and the guide needle was inserted. The guide needle was inserted into the first 1/3 of the vertebral body, the needle was removed, and the working cannula was inserted.
After the hand drill was inserted into the first 1/2 of the vertebral body, the hand drill and guide needle were removed, and the expanded balloon was inserted through the working cannula. The X-ray showed that the expanded balloon was in a good position. After the expanded balloon was gradually expanded, the C-arm X-ray showed that the vertebral body returned to normal height.
Professor Tian took out the balloon and the assistant had already prepared the bone cement.
After 1 minute and 30 seconds, the C-arm X-ray started to slowly inject the bone cement through the working cannula.
The surgery was about to end. Professor Tian injected the bone cement while focusing on the image of the bone cement.
"You have to be careful and meticulous here," Professor Tian explained to the assistant while injecting the bone cement.
"What's the biggest complication of injecting the bone cement?" Professor Tian asked.
"Leakage of the bone cement," the assistant replied.
Professor Tian belonged to the more academic type. He was not a gangster and was more like a southerner.
Professor Tian would ask a lot of questions every time he worked under him for in-service training.
As a doctor for in-service training, he was not used to it at first, but he could not possibly be dumbfounded by Professor Tian's simple questions on the operating table.
Although it was tough for in-service training doctors to prepare and memorize, their skills improved quickly.
"Not exactly." Professor Tian slowly injected the bone cement while explaining, "The most serious complication is pulmonary embolism. Leakage of the bone cement is very common. Because the patient has osteoporosis, 73% of the patients do not have any reaction after leakage. "
Professor Tian did not continue explaining as the patient was under local anesthesia. If he was too serious and caused the patient to be nervous and suffer from myocardial infarction, he would be looking for trouble for himself.
"Just be careful and don't let the tip of the needle touch the communicating artery or vein." Professor Tian injected 2mL of bone cement, "Under normal circumstances, this is a low-risk surgery. You'll have to operate the next one yourself. I'll be your assistant. "
When the patient heard what Professor Tian said, he was glad that he was lucky enough to get Professor Tian to treat him personally.
Professor Tian was stunned when 2.5 mL of bone cement was injected.
The fluoroscopy showed that there was a strip of "bone cement X-ray contrast agent" on the right side of the front edge of the vertebral body. The image was like a little bug, constantly crawling.
Uh … Professor Tian was speechless. How could it leak just like that? Was his mouth blessed before?
'It's okay, it's okay.' Professor Tian comforted himself.
The literature reported that the incidence of venous cement leakage was about 24%, and the incidence of pulmonary embolism due to venous leakage was 4.6% to 6.8%. Most of them were pulmonary embolism with no obvious clinical symptoms.
Only 0.4% to 0.9% of patients with pulmonary embolism develop clinical symptoms.
The probability was so small that it was almost negligible.
In clinical practice, Professor Tian had also encountered cases of pulmonary embolism after bone cement injection.
Most patients would recover after lying down for a while, and there were no special complications. There was not much postoperative treatment, so it did not affect anything.
He comforted himself and encouraged himself, 'It's going to be okay, it's going to be okay.'
Through continuous C-arm fluoroscopy, the location of the contrast agent was constantly changing. It passed through the right atrium, right ventricle, and finally stopped at the right lung.
Professor Tian had already stopped the operation. He watched helplessly as the bone cement entered the right lung. His hands were numb.
'What the f * ck! How did he encounter a pulmonary embolism? ' Professor Tian, who was usually mild-tempered, cursed in his heart. He could only pray that the patient did not have any clinical symptoms.
No one could avoid complications during surgery.
No matter how careful one was, or how much preparation was done, it was unavoidable.
The only thing that would not happen was that they did not perform enough surgeries! This was a common understanding in the medical field. As long as a certain number of surgeries were performed, there would be all sorts of complications.
For example … the pulmonary embolism today.
"Is there any discomfort?" Professor Tian asked softly as the bone cement entered the right lung.
"No." The patient replied. "I'm fine. Professor Tian, you did a great job, I don't feel any pain at all."
Professor Tian sighed in his heart. Did he do a good job?
The surgery should have been done well, but there were complications. How could he shamelessly say that he did a good job?
The patient's imaging showed that the bone cement entered the right lung, but there were no clinical symptoms of pulmonary embolism.
Professor Tian speculated that the bone cement overflowed from the vertebral body, entered the paravertebral vein, and then migrated to the lung, causing multiple pulmonary embolisms.
He decided to stop the surgery. If he forced himself to continue, nothing would happen.
He immediately stopped the bone cement injection and sutured the incision.
After that, Professor Tian personally helped the patient lie down. He was afraid that his assistant would make a mistake, causing the patient's fracture to worsen or other accidents.
There were enough accidents. It was better to minimize them.
The patient was placed on his back, given oxygen, ECG monitoring, and venous access.
There was no publicly recognized treatment for asymptomatic pulmonary embolism patients. Currently, they preferred not to use anticoagulants, but to follow up closely to observe the patient's condition.
Although the surgery had failed, as long as the patient was fine, there should not be any major problems. Professor Tian was anxious as he closely observed the patient's condition.
At the same time, he urgently invited respiratory medicine, cardiothoracic surgery, and other related departments to the operating room for consultation.
After one hour of observation, the patient showed no signs of discomfort. Respiratory medicine and cardiothoracic surgery also did not recommend excessive treatment. They would observe the patient's condition and speak again if there were any changes.
After the pulmonary embolism, the patient did not show any symptoms such as dyspnea, shortness of breath, or increased breathing rate.
Professor Tian felt that he was lucky. At least the patient was fine.
However, since the surgery had failed, he still had to explain to the patient's family to gain their understanding. He did not want any doctor-patient disputes.
You've already exceeded your reading limit for today. If you want to read more, please log in.
Login
Select text and click 'Report' to let us know about any bad translation.
