Those years when I hung up and upgraded in the hospital

Chapter 101 Taking the initiative to give way (please collect, please read)

Director Shen Tao is also a very cautious person. He knows that Fang Yun's ability must be extraordinary if he is sent by Director Hu Jun.

During the previous surgery, Fang Yun’s meticulous guidance demonstrated Fang Yun’s solid operational and theoretical skills in sports medicine.

This operation has not yet started. The synovitis that is planned to be operated on today surprised Fang Yun. It must be quite complicated.

Therefore, before the incision has been made on the patient, for the sake of safety, Shen Tao can still apply to cancel the operation. However, before that, Shen Tao still asked Fang Yun clearly for his opinion. Fang Yun did not refuse, so Shen Tao dared to do it. The first arthroscopic exploration field channel.

There is a saying that goes well, if you don’t dare to be bold enough even when someone gives you the full scoop, then you will never be able to take the first step when you are the only one dealing with a matter.

When Shen Tao was skillfully inserting the arthroscope barrel, he also said something special: "Dr. Fang, if I see difficulty in the operation later, I will thank you for taking over!"

Fang Yun was not a fool. If it was really just a simple synovitis, it would definitely not make him so shocked.

However, after the sleeve of the observation scope is inserted, the next step is to insert the field scope of the arthroscope and adjust the field scope.

Just when he adjusted his field of view to see clearly the synovitis inside, the situation inside made Shen Tao's back feel cold.

Synovitis is synovitis, but the synovitis inside has become a localized villous lesion, similar to the color of fat, but darker than fat, dark yellow.

Almost everywhere in the field of vision, there is granulation tissue like this.

Shen Tao seemed a little panicked.

Ordinary synovitis and synovial folds are all membranous. This was the first time he had seen nodular synovium like this. After all, such nodules sometimes look more like tumors. .

And it is not uncommon for such "lumps" to appear inside the knee joint.

Shen Tao only hesitated for five seconds, then looked sideways at Fang Yun, asking for help in his eyes.

Fang Yun saw the embarrassment in Shen Tao's eyes, but he didn't feel embarrassed in reality. After taking the sight glass, he gave Shen Tao the space to leave the main surgeon's position back to back, and he could move flatly to the main surgeon's position. Can.

After Fang Yun took the mirror, he inspected the patellofemoral joint and said, "It's the same as what the MRI showed. It's localized nodular synovitis, not diffuse synovitis."

"If it is diffuse, then open surgery should be performed. Under arthroscopy, it is difficult to clean up diffuse synovitis. At least we in Xiangzhou may not have such ability."

"Brother Jin, first bend your knee joint slightly. After I explore the intercondylar fossa, help me open up the medial field of vision." Fang Yun proactively told Xie Jin the order in which he wanted to explore.

He didn't plan to follow the conventional outside-in approach, because he saw on MRI that there were a large number of synovial villous nodules in the medial joint space, while the lateral space was not obvious, so Fang Yun wanted to take a look at the most proliferative part. What is this awesome place like?

In the intercondylar fossa, synovial villi climb up the anterior cruciate ligament, almost covering the ligament.

Seeing this, Fang Yun paused for a moment and looked for a view to find the posterior cruciate ligament. He also saw the deformation of the posterior cruciate ligament, and then he breathed a sigh of relief.

If the anterior cruciate ligament seen on the MRI is pseudo-deformation, then even if the surgery is cleaned up, it will take more time to explain to the patient after the surgery. Fortunately, there is no such rare event.Pigmented villonodular synovium itself is a rare disease. If it is rarer than rare, you will be out of luck.

Xie Jin opened the medial gap of the knee joint step by step. Shen Tao did not help. Instead, he focused his eyes nervously on the display screen of the arthroscope, as if he was weighing whether Fang Yun would be able to survive without Fang Yun today. You can step down safely.

As we saw a large number of chorionic villi in the medial joint cavity, they not only grew on the meniscus, but also on the cartilage. Even the lateral edge of the medial posterior horn meniscus was covered with chorionic synovium. inflammation.

Shen Tao's heart sank.

The position that can be seen may not be able to be cleaned. This is an attempt. After all, this is a tool, not an open synovectomy of the knee joint, and you cannot go wherever you want.

"The villous nodules on the inside are very abundant. The meniscus may also be damaged. Have you discussed with the patient the possibility of meniscus suturing?" Fang Yun did not use a probe hook to explore the stability of the meniscus. After all, no operating holes have been opened yet. .

Moreover, one cleaning operation hole may not be enough for this patient. It may be necessary to open an operation hole above or behind the knee joint to assist the operation, so that the entire operation can be completed.

Shen Tao said: "Dr. Fang, if there is a need during the operation, we will discuss it immediately. The main reason is that there was no sign of meniscus rupture before the operation."

Fang Yun nodded: "But in fact, for most diseases in sports medicine, the gold standard for diagnosis is the findings of arthroscopy."

While speaking, Fang Yun had already arrived at the outer gap. Compared with other places, the outer side seemed much cleaner with only the occasional "bump".

After looking around, Fang Yun felt a little uneasy. Such an operation would definitely take a long time. It would take an hour or two to completely clean it up. This is still a conservative estimate.

After all, Fang Yun had never operated on such a disease before. He only learned about it while watching videos on the Internet to learn about it.

"Synovitis is easy to relapse, and after cleaning such villous nodules, it will cause tissue damage, and the pain reaction will be relatively severe in the few days after the operation. During the cleaning process, there will be more bleeding."

"Sharp knife!" Fang Yun began to make the second traditional operating hole.

The instrument nurse immediately handed over the sharp knife, and also handed over the blunt puncture instrument.

Fang Yun used a sharp knife to break open the lower edge of the medial knee eye as an operating approach to facilitate cleaning of the synovial membrane at the posterior corner of the medial space. After all, if it is further up, the compression with the medial femoral condyle will be greater.

It is not conducive to the operating field and vision.

After the operation hole was completed, Fang Yun returned to the patellofemoral joint again. From here, he began to polish the villous synovial membrane bit by bit, using planers, plasma electric scalpels, electrocautery, electrocoagulation, and various instruments. Once replaced, strive to remove all these villous synovial membranes from the joints.

Speaking of which, the difficulty of this operation is synovial debridement, but the number, thickness, and breadth of synovial membranes cleaned are at least dozens or even hundreds of times greater than ordinary synovial debridement.

"Click, click!" The sound of the planer's rotation is accompanied by the beating of time, progressing second by second.

(End of this chapter)