Chapter 2181: The mouth is open

Many operations in orthopedics are performed under X-rays, just like interventional procedures.
The C-arm X-ray fluoroscopy locates the L2 vertebral body and the bilateral pedicle position, and the assistant begins disinfection and lays a sterile surgical table.
No problem with the position, Professor Ma Tian and the assistant explained the whole process of the operation.
On the stage, Professor Tian used 1% lidocaine for local anesthesia, and cut about 05CM in the patient's second lumbar vertebrae.
Under the guidance of fluoroscopy, the puncture on both sides was taken, and the core puncture needle was placed on the outer upper edge of the L2 bilateral pedicle, and the needle was tilted by about 10°.
Skillful operation, this kind of difficult surgery is almost no difficulty for Professor Tian.
After the C-arm X-ray fluoroscopy enters the pedicle, the needle is pulled out into the guide needle, the guide needle is inserted into the front 1/3 of the vertebral body, the puncture needle is removed, and the working sleeve is inserted.
After drilling the hand to the 1/2 of the vertebral body, the hand drill and the guide needle are pulled out, and the expansion balloon is placed through the working sleeve. The oscillating balloon is in good position after fluoroscopy, and the C-arm is gradually opened by the expansion balloon. X-ray fluoroscopy sees the height of the vertebral body recovering close 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 bone cement was slowly injected through the working sleeve under the perspective of the C-arm.
The operation is about to end here. Professor Tian is also paying attention to the image of the bone cement while injecting bone cement.
"The operation here must be meticulous, be careful." Professor Tian, ​​while bone cement, explained to the assistant.

What is the biggest complication of bone cement?
asked Professor Tian.

Bone cement leaks,
the assistant replied.
Professor Tian is a kind of relatively academic type. The rivers and lakes are not heavy, like southerners.
For the doctor who came to his training, Professor Tian asked many questions every time he operated.
As a fellow doctor, I was not used to it at first, but I couldn’t be fooled by Professor Tian on the operating table with some simple questions.
Pre-study, endorsement, training doctors, although hard, but the level of progress is very fast.

Not sure.
Professor Tian slowly pushes the bone cement and explains:
The most serious complication is pulmonary embolism. Bone cement leakage is very common because the patient has osteoporosis, so 73% The patient did not respond after leakage."
Professor Tian did not continue to tell, because the patient is local anesthesia, if it is too serious, causing the patient to be nervous and causing a heart attack, then it is nothing to find something for himself.
"As long as you are careful, the needle tip of the needle should not touch the traffic vein." Professor Tian injected 2ml of bone cement. "In general, this is a very risky operation. The next one you want Hands-on, I am giving you an assistant."
The patient listened to Professor Tian, ​​saying that he was lucky, his luck seemed to be good, and he rushed to teach Professor Tian.
Professor Tian stunned when he injected about 25 mL of bone cement.
In the fluoroscopy, an upwardly extending strip of "bone cement X-ray developer" appears on the right side of the vertebral body. The image seems to be a small bug, constantly climbing.
Hey... Professor Tian is speechless, saying that the leak leaks, and that his mouth has passed through?
Nothing, nothing, Professor Tian comforted himself.
The literature reports that the incidence of venous leakage of bone cement accounts for about 24% of bone cement leakage, and the incidence of pulmonary embolism due to venous leakage is 46% to 68%. Most of them were small pulmonary embolisms with no obvious clinical symptoms.
Only 04% to 09% of patients with pulmonary embolism will develop clinical symptoms.
This probability is so small that there is little need to worry about it.
In clinical practice, Professor Tian also encountered bone cement and pulmonary embolism.
Most of the patients are lying for a while, and there are no special complications. There is not much treatment after surgery and it does not affect anything.
He comforted himself in his heart and cheered himself up—nothing would happen, nothing would happen.
The position of the developer shadow was continuously observed by continuous C-arm dynamic fluoroscopy, passing through the right atrium, the right ventricle, and finally staying in the right lung.
Professor Tian has stopped operating. He looked helplessly at the bone cement and entered his right lung. His hands were numb.
What a special thing! How did you encounter a pulmonary embolism? Professor Tian, ​​who has always had a temperate temperature, said in his heart that he can only pray that the patient has no clinical symptoms.
No surgery can avoid complications when you have surgery.
Even if you are careful, how to do it before surgery can not be avoided.
Nothing happens, the surgery is done less! This is a consensus in the medical community. As long as the surgery has achieved a certain amount, it is sure to face a variety of complications.
For example... today's pulmonary embolism.

Is it uncomfortable?
Professor Tian asked the bone cement to the right lung and asked softly.

No.
The patient replied,
It’s all very good. Professor Tian is really good at doing it, and he doesn’t feel any pain at all.

Professor Tian sighed in his heart, did he do it well?
The surgery should be good, but there are complications, how can I be cheeky and say that I am doing well.
The patient's image shows that the cement enters the right lung, but the clinical manifestations of pulmonary embolism are not present. EbookFREE.me~ Professor Tian considers that the bone cement overflows from the vertebral body, enters the paravertebral vein, and then moves to the lung to cause the pulmonary arteriole. Multiple embolism.
Let's stop the surgery. If you do it with your scalp, nothing will happen.
He immediately stopped the cement injection and sutured the incision.
After the completion, Professor Tian personally held the patient lying flat, for fear that the assistant operation error, resulting in aggravation of the patient's fracture or other accidents.
There are enough accidents, and fewer points can be less.
The patient was placed in a prone position for supine, and the oxygenated ECG was monitored to open the venous access.
For patients with asymptomatic bone cement pulmonary embolism, there is no recognized treatment plan at home and abroad. At present, there is a tendency to prevent anticoagulant drugs, and only close follow-up observation of disease changes.
Although the surgery failed, as long as the patient is okay, there can be no major problems. Professor Tian is a bit embarrassed and closely observes the patient's condition.
While closely observing the condition, he urgently asked the related departments of respiratory medicine, cardiothoracic surgery and other departments to enter the operating room for consultation.
After observation 1, the patient did not experience discomfort. Respiratory medicine and cardiothoracic surgery are also not recommended for excessive treatment, to observe changes in the condition, and if there is a change, then say it.
After intraoperative pulmonary embolism, the patient has not experienced the performance of gas exchange disorders in the lungs such as dyspnea, shortness of breath, and increased respiratory rate.
Professor Tian feels that he is still lucky. At least the patient has nothing to do.
It’s just that the operation has failed. Go back and do a lot of explanation work with the family, and strive for the understanding of the patient’s family. Don’t make any medical disputes.
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