Chapter 213： Follow the feeling

"Wear a 10-gauge silk thread!" Ling Ran said without raising her head during the stitching process.

The equipment nurse agreed without hesitation, quickly opened a 10-gauge silk thread, and attached it to a needle holder. Then, she patted Ling Ran with a slightly heavy but not too heavy force, and just issued a light "pop "Sound, blushing white cheeks.

But Ji Tianlu looked up instantly, realized what, and asked, "What's wrong?"

In the Achilles tendon suture, the 10th thread is considered to be a thicker thread, which is more than three times thinner than the 4-0 suture previously used by Ling Ran. There must be a reason for the sudden change of the main knife.

When discussing technology, Ling Ran was still willing to say a few more words.

Sitting at the end of the double microscope, Ling Ran pointed directly under the microscope with tweezers and said, "The broken end is not uniform. If you continue to pull with a 4-0 wire, there will be defects after trimming."

The pulling force of the thin line is not strong. If it is added finely and closely to a cross section, the total pulling force will increase, but if it is separated, the pulling force of each two, two or three is not as good as the single 10 line .

On the other hand, the tendon is elastic, and the Achilles tendon is particularly elastic, which causes a problem. When the doctor forcibly pulls the broken Achilles tendon together, it will yield. However, after the operation is over, the elasticity of the Achilles tendon is still very large, so it will retract more powerfully.

If the broken Achilles tendons are the same length, they will rebound similarly, and the Achilles tendon function will be maintained. However, if the disconnected Achilles tends to be uneven, the strong Achilles tendons will have different lengths and shorts ... So the long stress is small and the short stress is large, and the Achilles tendon will break more easily.

This is like sewing five rubber bands of the same length. Compared to sewing five rubber bands of different lengths, the former has better suture effect and higher strength.

The solution is also very simple, that is, the use of different strength of sutures, the strength of the sutures to make up for the lack of strength of the tendons, as much as possible to ensure that the postoperative tension.

However, the solution that Ling Ran took for granted was shocked Ji Tianlu, and even scared Qu Doctor and others who looked at the screen in the classroom.

"Did you see that the broken ends are not neat?" A resident doctor couldn't help asking.

Another resident sneered sneer: "There is so much blood, the surgical field is not clear at all, and you can see some hair tips at most."

"It should be possible to use other conditions to make judgments. The field of view under the microscope will not be clearer than our field of view. Our screen is so large and there is no need to operate ..." As he said, he was close to the screen, almost It was scanning the screen, looking for signs a little bit.

"It may be judged based on magnetic resonance imaging." Zhu Tongyi said, thinking and explaining: "It is also possible to consider the distribution of blood vessels, but it is more complicated."

"This has become metaphysics." As soon as Dr. Qu's words fell, a group of doctors turned back to look at him.

Dr. Qu regretted it and said, "I mean, he just stitched it so fast, how could it be more detailed than what we saw, and even if he saw unevenness, how did he know what to use? How many lines to make up for? This is a complete bet, or is his intuition or something. "

Dr. Qu forcibly swallowed the evaluation of "reliably unreliable", a little hesitant.

He was not prepared to speak, so he had been standing at the end of the classroom, and wanted to see the situation before slipping away. However, Dr. Qu didn't expect that Ling Ran's operation was performed very quickly, and he quickly entered the state. A group of doctors who saw him could not stop.

Dr. Qu himself was the doctor of Achilles tendon repair. How could she leave without watching Ling Ran doing this operation?

To some extent, Dr. Qu was even somewhat conquered by Ling Ran's surgical operation.

However, the thread changing operation was neither understood by Dr. Qu nor recognized by him.

It was like the sentence Dr. Qu swallowed forcibly: He felt that Ling Ran's judgment on the spot was not reliable at all, and Zhu Tongyi's explanation was equally unreliable.

He himself is a surgeon doing the kessler method, and he does not believe that anyone can see the integrity of the Achilles tendon from the perspective of blood vessel distribution. Even magnetic resonance films cannot be refined to this extent-at the very least, it is impossible to make judgments on the spot for postoperative analysis, or if the patient dies unexpectedly. It is still similar to say these words when doing a death analysis.

When the surgeon is at the scene, he must have a clear understanding of the tension of the suture.

Now, Ling Ran has changed from the 4-0 line to the 10 line, which means that he knows that the Achilles tendon to be sutured by the 10 line is much shorter and requires a lot of pulling force. However, whether it is blood vessel distribution or Magnetic resonance cannot provide such information.

At least Dr. Qu didn't know how he judged such information, and he didn't hear which imaging department of Danah could do it.

Zhu Tongyi looked at the crowd and laughed: "Since we can't guess, we just ask, it's teaching surgery."

After speaking, Zhu Tongyi moved the call button without hesitation, and said, "Ling Ran, how do you judge the broken ends are uneven, and then how much tension to use?"

Compared with the previous question, the latter question is more targeted.

To pull a shorter rubber band, you need more pulling force. If it is an engineering experiment, this is a very simple problem. Some instruments can test the tensile force of a material, the tensile strength and yield strength of a material, and so on.

However, the living Achilles tendon cannot play in this way, and the corresponding equipment is not prepared in the operating room.

So, how does Ling Ran judge how much tension to use?

If you cannot make a corresponding judgment on this, it is not meaningful to just judge that the broken ends are not uniform.

In fact, ordinary doctors do not care about the amount of pulling force when performing such an operation. They just need to sew up. Regarding the problem of uneven ends, more people use methods such as replantation, such as autologous gracilis muscle transplantation, autologous fibula short muscle transplantation, etc., to bring the short Achilles tendon to a section of the tendon and let both sides The length is almost the same, or the transplant is a little longer, which can relatively reduce the possibility of fracture.

The doctors who do this step cannot be said to be ordinary doctors, or at least Dr. Qu, who is the backbone of the country's well-known medical institutions.

Ji Tianlu's standard should be higher, but he couldn't understand Ling Ran's operation, and looked at Ling Ran with a confused look.

Ling Ran didn't answer immediately, until the 10th thread just arrived was sewn, and slowly said, "I felt it with my hand."

"Feel?" Dr. Qu laughed, couldn't help but walk two steps to the front, pressed the call button, and said, "How can I use it as a reference for surgery."

Ling Ran said "En", "I often do massages, tendons or fascias, or muscles for people. With one hand in hand, I can estimate the pulling force, and it won't be too different. "

"You're kidding me." Dr. Qu said only to remember that he didn't press the call button, so he pressed it again and said it again.

Ling Ran's answer was very simple: "No."

This skill belongs to Ling Ran.

In massage, there are pushes and hair extensions, which are specifically aimed at "tendons", while in the narrow sense, "tendons" refer to tendons and ligaments.

When doing broken finger replantation or the tang method, Ling Ran's tendons were very weak. Even if he was a master-level manipulator, he could not accurately estimate the strength. In other words, it is useless to estimate it. The tendon of the thumb is thinner than chopsticks. If it is split open, the best way is not to sew them separately, but to cut them and sew them.

The Achilles tendon on the foot can't do that. The Achilles tendon is the thickest tendon, and its length has a great impact on athletic ability. In addition, the degree of fracture is different. If the shortest Achilles tendon is used as the standard, the Achilles tendon is basically useless. Still have to transplant it.

Correspondingly, the Achilles tendon is the thickest tendon in the human body. All the muscles grasped by Ling Ran will not be thicker than the Achilles tendon. Then he can push the other tendons to understand the Achilles tendon. the power of.

Ji Tianlu looked up at Ling Ran: "Really feel?"

Ling Ran also answered "yes" again and reached out: "3-0."

He was going to sew another Achilles tendon.

Ji Tianlu looked at Ling Ran's confident expression, and said, "If you can really feel it, then that's great."

Ling Ran still said "En" and did not respond.

Ji Tianlu looked at his operation and was already convinced by eight.

Doing things based on sensation seems to be foolish from a patient's perspective. How can my precious body be manipulated by sensation?

However, this is the level of human science and technology. The more high-end surgery, the more time it feels. Especially when it comes to internal organs. For example, Ling Ran used the hand to stop bleeding in the liver at that time. Of course, there is experience such as anatomy behind the feeling, but after all, it is not a matter of seeing the truth or digitizing.

Similarly, heart surgery is always full of unusual "feelings", so there are so many so-called miracles. As for brain surgery, let alone, humans' functional division of the brain is not completely accurate, but when it is time to operate, surgeons are not soft.

There are even more comrades who go by feeling in physicians. Take the large rounds of Xiehe Hospital as an example, each physician can make a sound opinion, but there is only one truth.

Finally, talented physicians are often doctors who "feel" better.

When Ji Tianlu himself performed Achilles tendon surgery, he often operated by feeling. When he felt that the elasticity of a Achilles tendon was too large, he would transplant it a little longer.

It doesn't work without feeling. So far, there is no instrument to help the surgeon test the tensile force of the Achilles tendon. Furthermore, what is the measured tensile force? The Achilles tendon is very different from person to person. Take the simplest length as an example. The length of the Achilles tendon of ordinary yellow people is 15 cm, Iverson's Achilles tendon is said to be 25 cm, and Jordan's is 30 cm. The tension will naturally vary.

However, when Ji Tianlu felt that he was undergoing surgery, he would not specifically say it, and he had never been asked about it.

Ji Tianlu at this time somewhat appreciated Ling Ran's candor.

At this time, Dr. Qu, who had never "feeled" during the operation ~ www.novelhall.com ~, felt angry, and then pressed the call button in angrily, saying, "Dr. Ji, shouldn't I stop the operation now?"

In the classroom, there is a highly respected Academician Zhu Tongyi, and there is a young and promising Chief Physician Ji Tianlu in the operating room. Dr. Qu is rational and does not dare to order. He only dares to use inquiries.

Ji Tianlu was dismissive of Dr. Qu Ququ, and said in color: "You just follow the study."

Dr. Qu's face turned red then.

The two were similar in age, but their status was very different. When Ji Tianlu, a senior doctor, did not want to give Dr. Qu his face, he lost all face.

Dr. Qu silently left the microphone for the call and returned to the end of the classroom.

He didn't want to leave immediately, especially when Liu Weichen was still there, and Dr. Qu would not take the initiative to admit defeat. He would at least see the final result.

"No. 4 silk thread." Ling Ran asked for a thinner suture, and continued to sew without lifting his head. For such a simple Achilles tendon suture, he only cared about how well it could sew. may.