Chapter 2178 Open Your Mouth

Many orthopedic operations, like interventional operations, must be performed under X-rays.

C-arm X-ray fluoroscopy locates the L2 vertebral body and bilateral pedicles, the assistant starts disinfection, and lays sterile surgical drapes.

There was no problem with the location. Before the operation, Professor Tian explained the whole operation process with his assistant.

After taking the stage, after using 1% lidocaine for local anesthesia, Professor Tian made an incision of about 0.5 cm at each marker point of the patient's second lumbar vertebrae.

Under the guidance of fluoroscopy, both sides of the puncture were adopted, and the cored puncture needle was inserted at the outer upper edge of the bilateral pedicle of L2, and the needle was inserted at an angle of about 10°.

Proficient in operation, this kind of difficult operation is hardly difficult for an operator of Professor Tian's level.

After the needle tip enters the pedicle under C-arm X-ray fluoroscopy, the needle core is pulled out and the guide wire is inserted into the anterior 1/3 of the vertebral body. The puncture needle is pulled out and inserted into the working cannula.

After the hand drill reached 1/2 of the vertebral body, the hand drill and guide pin were pulled out, and the expansion balloon was inserted through the working cannula. The position of the expansion balloon was found to be good through the fluoroscopy. After being gradually expanded with the expansion balloon, the C-arm X-ray fluoroscopy shows that the height of the vertebral body returns to be close to the normal height.

Professor Tian took out the balloon, and the assistant had prepared the bone cement.

After 1 minute and 30 seconds, bone cement was slowly injected through the working cannula under C-arm fluoroscopy.

The operation is coming to an end here, Professor Tian is concentrating on watching the image of the bone cement while injecting the bone cement.

"The operation here must be meticulous and careful." Professor Tian explained to his assistant while making bone cement.

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

"Bone cement leaks." The assistant replied.

Professor Tian belongs to the more academic type, not serious, like a southerner.

For the doctors who come to study under him, Professor Tian will ask a lot of questions every time he performs an operation.

As a trainee doctor, I was not used to it at first, but I couldn't be left speechless by Professor Tian asking some simple questions on the operating table.

Although the preview, endorsement, and doctor training are hard work, the level of improvement is very fast.

"Not sure." Professor Tian explained while slowly injecting bone cement: "The most serious complication is pulmonary embolism. Bone cement leakage is very common, because patients have osteoporosis, so 73% of the patients did not respond to the leak."

Professor Tian didn't continue to narrate, because the patient was under local anesthesia. If the story was too serious, causing the patient to become nervous and cause myocardial infarction, then it was nothing to do and find trouble for himself.

"As long as you are careful, the needle tip of the injection needle does not touch the communicating artery and vein." Professor Tian injected 2ml of bone cement. Do it yourself, and I will be your assistant on the side."

Hearing what Professor Tian said, the patient was glad that he seemed to be lucky, so he rushed Professor Tian to do it himself.

When about 2.5mL of bone cement was injected, Professor Tian was taken aback.

On fluoroscopy, a strip-shaped "bone cement X-ray contrast agent" shadow appeared on the right side of the anterior vertebral body. The image is like a small bug, constantly climbing.

Uh...Professor Tian is very speechless, he leaks when he says it leaks, has he opened his mouth?

It's okay, it's okay, Professor Tian comforted himself.

The literature reports that the incidence of bone cement venous leakage accounts for about 24% of bone cement leakage, and the incidence of pulmonary embolism due to venous leakage is 4.6% to 6.8%. Most of them were a small amount of pulmonary embolism without obvious clinical symptoms.

Only 0.4% to 0.9% of patients with pulmonary embolism will develop clinical symptoms.

This probability is so small that there is almost no need to worry about it.

In clinical operations, Professor Tian also encountered the leakage of bone cement and even concurrent pulmonary embolism.

Most of the patients just lie down for a while, and there are no special complications. There is not much treatment after the operation, and it does not affect anything.

He comforted himself in his heart and cheered himself up—it will be fine, it will be fine.

Through continuous C-arm dynamic fluoroscopy, it was observed that the position of the contrast agent shadow was constantly changing, passing through the right atrium, right ventricle, and finally staying in the right lung.

Professor Tian had already stopped the operation. He watched helplessly as the bone cement entered his right lung, and his hands were numb.

What the hell! How did you have a pulmonary embolism? Professor Tian, ​​who has always been mild-tempered, scolded in his heart, and now he can only pray that the patient has no clinical symptoms.

Surgery, no one can avoid complications.

No matter how careful you are, no matter how well you prepare before surgery, it cannot be avoided.

Nothing happened, it was because the operation was done less! This is a consensus in the medical community. As long as a certain number of operations are performed, various complications must be faced.

For example... today's pulmonary embolism.

"Is there any discomfort?" Professor Tian asked softly when he saw that the bone cement had reached the right lung.

"No." The patient replied, "It's all good. Professor Tian, ​​you did a great job. You didn't feel any pain at all."

Professor Tian sighed in his heart, did he do well?

The operation should be good, but there are complications, how can I say that I did a good job with the cheek.

The patient's imaging showed that bone cement had entered the right lung, but clinically there were no symptoms of pulmonary embolism.

Professor Tian considered that the bone cement overflowed from the vertebral body, entered the paravertebral vein, and then migrated to the lungs, causing multiple embolisms of the pulmonary arterioles.

Terminate the operation, if you bite the bullet and continue, nothing will become a problem.

He immediately stopped the bone cement injection and closed the incision.

After finishing the work, Professor Tian personally supported the patient to lie flat, for fear that the assistant's misoperation would lead to aggravation of the patient's fracture or other accidents.

There are enough accidents, and there are as few as possible.

The patient was changed from prone to supine, oxygen inhalation ECG monitoring was given, and venous access was opened.

For patients with asymptomatic bone cement pulmonary embolism, there is no recognized treatment plan at home and abroad. Currently, anticoagulant drugs are not used prophylactically, and only close follow-up is used to observe the changes in the condition.

Although the operation failed, as long as the patient is fine, there can be no major problems. Professor Tian felt a little apprehensive, and closely observed the patient's condition.

While closely observing the condition, he urgently invited related departments such as respiratory medicine and cardiothoracic surgery into the operating room for consultation.

After 1 hour of observation, the patient had no symptoms. Respiratory medicine and cardiothoracic surgery do not recommend doing too much treatment, observe the changes in the condition, and talk about it if there are changes.

After the pulmonary embolism occurred in the patient during the operation, the patient had no symptoms of intrapulmonary gas exchange disorders such as dyspnea, shortness of breath, and increased respiratory rate.

Professor Tian felt that he was lucky, at least the patient was fine.

It's just that the operation failed, and I have to do a lot of explaining work with the family members when I go back, so as to win the understanding of the patient's family members, so as not to cause any disputes between doctors and patients.