godfather of surgery

Chapter 423 The Orthopedic Doctor Doing Color Doppler Ultrasound

After reviewing the images one by one, Yang Ping said: "L5/S1 discogenic pain."

He put on the gloves Song Zimo handed over to examine the patient.

It is Yang Ping's habit to wear gloves for medical checkups. It is not pretending, nor does it mean that he dislikes patients. It is more strict hand hygiene to prevent cross-infection.

After a round of physical examination, Yang Ping knew it all.

Two centimeters from the anterior superior iliac spine in the right groin, local tenderness, positive Tinels sign, aggravated by hip extension, and positive pelvic compression test.

The systematic super-training program at that time focused on anatomy, physical examination, instruments, and laboratory tests. The super-training program laid a solid clinical foundation for Yang Ping.

"Lateral femoral cutaneous neuritis! Call the ultrasound department and bring a bedside color ultrasound machine." Yang Ping took off his gloves.

Song Zimo immediately contacted the ultrasound department, and soon, a beautiful doctor from the ultrasound department took the emergency elevator and came over with a bedside color ultrasound machine.

She set up the color ultrasound machine and was ready to start. Yang Ping said, "Shall I do it?"

You come? An orthopedic doctor does a color ultrasound? Unheard of.

Yang Ping didn't say much. Under the suspicious eyes of the sonographer, he started to apply couplant and probe along the lateral femoral cutaneous nerve. The technique was simply that of a senior sonographer with decades of experience.

"Dr. Yang can do a color Doppler ultrasound?" The beautiful doctor stood aside and asked Song Zimo. She was very curious, and she had never seen an orthopedic doctor do a color doppler.

It is not surprising that orthopedic surgeons take X-rays. A small number of doctors are very devoted to their research and have dabbled in specialized borderline subjects. Some doctors are more proficient in X-ray projections than radiologists, but there are not very few orthopedic surgeons who can do color Doppler ultrasound. , but no.

Song Zimo remained calm, and the ultrasound probe moved smoothly. The probe stayed in the groin two centimeters from the anterior superior iliac spine. Yang Ping pointed to the image on the color ultrasound screen: "Look, this is the lateral femoral cutaneous nerve, which passes through the inguinal tendon. The membrane was entrapped and the nerve edema. There should have been contusions here before. This is scar adhesion entrapment. Arrange for surgery, and perform radiofrequency ablation and release of the minimally invasive right lateral femoral cutaneous nerve under local anesthesia. At the same time, lumbar 5/sacral 1 Angiography and radiofrequency ablation of the intervertebral disc."

In just ten minutes, a color ultrasound machine, the diagnosis is established, and the treatment plan is also clear.

Looking at the colorful and flowing color ultrasound images, who can understand color ultrasound?

As for color ultrasound, as a professor of Xiehe, Professor Hu Guolin knows some basic knowledge, but he is not proficient. Song Yun also knows a little about others. Except for Song Zimo and Xu Zhiliang who have received training from Yang Ping, no one is proficient in this thing.

Even the doctors in the ultrasound department were astonished. To be honest, few senior doctors in the ultrasound department could see this kind of nerve entrapment.

Dr. Yang casually wandered back and forth a few times before reaching a conclusion.

Song Yun blushed and said, "Dr. Yang, I'm not very good at this color Doppler ultrasound. If you have time, you can tell me about it, starting from the basics."

"Song Zimo, show them the printed book first." Yang Ping put the probe away, took out two tissues from the trolley of the color ultrasound machine, and gave them to the patient. agent,
The patient pulled up his pants, and the previous cursing disappeared completely: "Dr. Yang, you were right just now. I fell on a motorcycle before and got scratched here. Is this related?"

"Relevant! Let's do a minor surgery, a minimally invasive surgery, and it will solve your problem in ten minutes." Yang Ping's tone was not negotiable.

The patient hummed and said nothing, as if he was transparent and couldn't hide anything from Dr. Yang.

As for the printed books, there are several, but they are all Song Zimo's treasures. This is Song Zimo's arrangement, printing, and binding into a book according to the explanations given to him by Yang Ping.

One of them is the application of color ultrasound in orthopedics, that is, the popular musculoskeletal ultrasound, a summary of Yang Ping's explanations.

Director Hu also opened his eyes. In Xiehe, the clinical foundation of doctors is second to none in the country.

They usually deal with basic diseases of orthopedic patients, such as diabetes, high blood pressure, and coronary heart disease. Generally, they do not need consultation, and any bed doctor can handle them with ease.

Why, with a good clinical basis.

In other hospitals, surgeons will look at electrocardiograms, which is a long-standing myth.

In Xiehe, a surgeon who cannot read an ECG is not a qualified doctor.

Comprehensive and solid clinical training, whether it is a common disease or a rare disease, allows Concorde doctors to handle it with ease.

There are some rare diseases that doctors in other hospitals have no idea at all, but Xiehe even the resident doctors are clear about them.

This is the confidence that Xiehe's comprehensive strength ranks first in the country.

This patient, in other hospitals, usually falls into the trap, but for Director Hu of Xiehe, no matter the diagnosis or treatment, it is not very difficult, and he will not fall into the trap easily, but it will definitely cost a lot to make a clear diagnosis Time to analyze and compare.

It is absolutely impossible for Yang Ping to hit the nail on the head in ten minutes, especially the color ultrasound operation just now, which does not reflect ordinary clinical strength.

With Yang Ping's solid clinical skills, it's no wonder that Professor Liang never forgets an operation.

If Yang Ping's knowledge is like a sea, Director Hu thinks he is just a lake.

Professor Liang is accurate in seeing people. Director Hu couldn't help but sigh. At that time, he didn't understand that it was just a surgery, but he couldn't forget it.
I heard that 301 has taken action, and Xiehe will do my part. Compared with 301's strength, Xiehe is more moderate.

When it comes to the academic atmosphere, Director Hu has more confidence in Xiehe, and a talent like Yang Ping will like Xiehe.

Back at the doctor's office, Song Zimo called up the video again, and Yang Ping took the opportunity to explain lumbar disc herniation to the young doctor.

"This is not lumbar disc herniation, but lumbar disc-derived pain and right lateral femoral cutaneous neuritis, femoral lateral cutaneous neuritis, which is very easy to be regarded as lumbar disc herniation, has deceived many doctors, plus lumbar disc source Sexual pain, most doctors will jump into the trap." Yang Ping returned to the office, so he could speak without any scruples.

Lumbar disc herniation is a syndrome manifested by intervertebral disc degeneration, annulus fibrosus rupture, and nucleus pulposus protrusion stimulating or compressing spinal nerve roots and cauda equina.

It can be seen that when there are no symptoms of spinal nerve root or cauda equina, it cannot be diagnosed as lumbar disc herniation.

That is, it is only low back pain, which cannot be diagnosed as lumbar disc herniation.

Lumbar disc herniation must have spinal nerve root or cauda equina compression stimulation symptoms.

But often a large number of patients with only low back pain are easily diagnosed with lumbar disc herniation.

Many manifestations of spinal nerve root pain are symptoms of sciatica, but there are many other causes of sciatica, and the two are not the same concept.

Therefore, even if the performance of sciatic nerve is not necessarily lumbar disc herniation.

This patient is an example.

If the spinal cord is compared to the main gate of the circuit, the spinal nerve is the wire from the main gate, and the sciatic nerve is the wire that has gone out of the main gate and is distributed in the room.

There are several types of pain caused by lumbar disc disease. There is disc-derived pain, which is the pain caused by the stimulation of the nerves of the intervertebral disc itself—the sinus vertebral nerves. This pain is manifested as low back pain.

Radical pain means that there is a problem with the bus part where the wire exits the main gate, and it is compressed or stimulated by the lumbar intervertebral disc, causing pain in the distribution area of ​​this nerve.

There is also referred pain, the pain site and the onset site are not in the same place, but because their sensory nerves are transmitted to the spinal cord, they are in the same segment.It can be understood that the two parts are led and supervised by the same center. When the nerves in one part are stimulated, the signal is transmitted to the spinal cord and then up to the brain. Send pain signals to two parts, and the other good part also hurts.

The pain caused by lumbar intervertebral disc can be roughly divided into these three types, the first one is called lumbar discogenic pain, and the second is lumbar disc herniation.

As for sciatica, it can be caused by the herniated lumbar intervertebral disc, or it can be caused by its own problems. If it goes out of the main gate and has problems on the walking route, it has nothing to do with the herniated lumbar intervertebral disc, so it cannot be said to be lumbar disc herniated.

Take piriformis syndrome, for example, Mr. Yan is one of them. He has been arguing about it for two years, making doctors and patients unhappy.

Yang Ping said while drawing the anatomical diagram of the lumbar spine on the whiteboard. It is easy for everyone to understand when combined with the diagram.

Easy to draw, more beautiful and detailed than anatomical atlas.

Even if the herniated lumbar disc compresses and stimulates the nerves, there are rules to follow. You see, the most common lateral lumbar disc herniation affects the walking root.

What is a deformed root is that it goes down through the intervertebral disc and goes out from the next intervertebral foramen.

The extreme lateral disc herniation affects the exit root, which is the nerve root that comes out of the corresponding intervertebral foramen.

The central intervertebral disc compression is the cauda equina, and this type of symptom is the most troublesome.

"This type is what men are most afraid of!" Director Hu said humorously.

"Prolapse of lumbar intervertebral disc will also affect sexual function?" Some students responded quickly.

That's right, it's just that men are hard to talk about this issue. Even if they ask, many people are unwilling to admit it and evade their words, so everyone doesn't pay attention to this issue.

"No wonder, if the waist is good, so is she." Zhang Lin teased.

Xu Zhiliang glared at him, Zhang Lin immediately suppressed the smile on his face, didn't dare to say more, and complained in his heart: Adjusting the atmosphere, this buddy is so serious.

Lumbar pain was sorted out clearly by Yang Ping, just like the mind map of elementary school students, simple and clear

"Why does this patient need to undergo discography during the operation?" Li Guodong asked very studiously.

"If it is discogenic low back pain, intervertebral disc angiography, contrast medium can induce low back pain, or anesthetics can eliminate low back pain, so that the diagnosis of lumbar discogenic pain can be confirmed, the responsible part of low back pain can be found, and then radiofrequency ablation can be performed to destroy the sinus vertebral nerves, pain It will be eliminated naturally." Song Yun helped explain.

Song Yun admired Yang Ping's ability to think like a cocoon. This patient has low back pain and radiating pain in the lower limbs. It seems that there is no doubt about the diagnosis of lumbar disc herniation.

This is the source of diagnostic errors.

"Dr. Song told everyone about low back pain caused by lumbar intervertebral disc." Yang Ping encouraged everyone to discuss.

Song Yun was guided by Yang Ping, and his mind was opened: "Lumbar intervertebral disc herniation and lumbar muscle strain are becoming an abused diagnosis, allowing patients and doctors to be caught on this diagnosis."

"Follow-up diagnosis technology has improved, and it is believed that the most common chronic low back pain is discogenic low back pain, which makes the diagnosis of low back pain clearer."

"Dr. Yang just said that, in fact, the most accurate diagnosis of this patient should be: [-]. Discogenic low back pain, [-]. Right lateral femoral cutaneous neuritis."

"Using discography, disc-derived low back pain can be divided into endplate-derived and annulus-derived. The so-called source is the source of pain."

Song Yun's professional knowledge is very good, but when it comes to comparing MRI films, he lacks experience and asks Yang Ping for help.

Yang Ping asked everyone to get closer and look at the picture on the electronic image reading screen: "Look, on this cross section, the lumbar intervertebral disc hyperintensity zone (HIZ) intervertebral disc HIZ hyperintensity, look at this image T1-weighted image and T2-weighted image, You can’t just look at one phase, if T1 localized low or isointensity, T2 localized high signal, it means that the fibrous annulus of the intervertebral disc is ruptured, and granulation tissue grows into the interior, and this granulation tissue signal is a landmark image.”

"Indeed, I understand." Song Yun suddenly realized.

I have read a lot of books and studied things that I have not understood for a long time. Dr. Yang now clarifies them in one sentence.

Then Yang Ping told Song Yun, from the perspective of pathology, the composition of granulation tissue, the imaging principle of MRI, the principle of artifacts, the signal of granulation tissue on MRI, why this signal appears, and how to judge the onset time of the disease from the signal , how to identify artifacts and so on.

Especially when it comes to the principle of MRI imaging, it is estimated that the MRI maker will not understand it so deeply, and then speak it in such an approachable language.

This is the right time to study!
Song Yun watched Song Zimo keep taking notes, so he quickly took out his notebook and took notes.

Lectures here, the operating room upstairs is ready, and Li Guodong sends the patient to the operating room.

Song Zimo is the chief surgeon, Yang Ping guides, and everyone observes.

The operation only took ten minutes, and the results were immediate. The patient was pain-free and could actually get up from the operating bed and walk back to the ward by himself.

A dispute was easily resolved by Yang Ping.

Director Qin of the spinal surgery department breathed a sigh of relief when he heard the news, and hurriedly called Yang Ping to thank Yang Ping, reminding himself constantly that he should be cautious about wiping his ass in the future.

The patient sent a silk banner to Director Qin. It is said that he was going to go back at that time. Fortunately, Yang Ping helped resolve it.

Director Gao of the Sports Medicine Center rushed over to practice arthroscopic micro-sculpture.

Hearing about the patient in spinal surgery, he shook his head.

Lao Qin, this kind of patient, just leave it alone? No matter what, you have to come here in person, follow up from beginning to end, and listen to Dr. Yang's explanation. You need help when you are on the stage of surgery, so that you can learn something, otherwise you will fall into the trap next time.

Hearing that Dr. Yang used a new technique for cruciate ligament reconstruction in the United States, Director Gao waited for the opportunity to learn from Yang Ping the curved drilling technique for cruciate ligament reconstruction in children.

Laptops and U disks are always on the body.

(End of this chapter)