The location of this sinus tube is extremely secretive and it is close to the femur. If you don’t look carefully, you would think it is a normal structure of the periosteum!

Although it is difficult to find, it is relatively easy to clean, as long as it extends downward along the bone surface.

While Lu Cheng was operating normally, Lin Hui gave Ji Mo a look.

Ji Mo immediately understood and asked: "Junior Brother Lu, how did you discover this sinus duct? Is its opening too secretive?"

Ji Mo looked at the opening of the sinus tube, which was almost close to the femoral neck. Because this place is the plane of osteotomy, everyone sees it with their own eyes, and the general sinus tube or sinus tract is very large.

, very conspicuous, and generally people who don’t have an obvious sinus tube will not deliberately split a sinus tube out.

So Lu Cheng saw something that no one else had seen. It definitely didn't require special professional knowledge to discover this sinus tract, but there must have been some tricks.

What do you learn about surgery? After you memorize all the surgical procedures, you will learn the small details and skills. The more small details and skills you learn, the more successful the surgery will be!

While Lu Cheng continued to use the suction device to suck out the sticky pus inside the opened sinus tube, he said: "No matter how obvious the sinus tube is, there must be Mycobacterium tuberculosis passing through it. The bacteria and Mycobacterium tuberculosis pass through the passage of the soft tissue, or

It is a fluid liquid with volatility."

"Either a capsule will be formed, and outside of this capsule connection, our own tissues will have a defensive response to the eroding object, and will reactively produce inflammatory protection. If inflammation persists, there will definitely be scar healing.

.”

"This is also true in the far reaches of the sinus tract. The scar tissue penetrates the muscle tissue, and the density will be higher, so it can be felt."

"When I just performed the osteotomy, I felt the hardness of this sinus tube. I just wanted to deal with the sinus tubes one by one in order, so I didn't treat this one at the beginning."

"Come and feel the wall of this sinus tube. Does it feel hard to the touch?"

Lin Hui suddenly understood!

Deng Zhi, on the other hand, had a look of disbelief on his head.

Brother Lu, are you kidding me? You want to feel the hardness of the sinus tube through the surface of the muscle. Are you assuming that I have not undergone debridement surgery?

But Lu Cheng found out, and Deng Zhi couldn't tell directly that Lu Cheng was lying!

This little Brother Lu is either not telling the truth, or he is holding back!

And Lu Cheng himself can touch it. He has the passive skill of Dexterous Touch, and he can even feel the subtle fluctuations in blood vessels, let alone the hard knots inside.

In fact, when Lu Cheng discovered this sinus tube, he could take the initiative to call Ji Mo, Deng Zhi, and even his master Lin Hui to feel it. But Lu Cheng's identity destined him not to do this.

Teaching is what senior doctors should do. Lu Cheng's current identity is that of a student and junior fellow student.

He can tell others why without others knowing or asking him, but he cannot directly tell Lin Hui and Ji Mo what to do in the form of teaching!

After all, other people’s identities are there. Even if you treat them well, you still have to give them face. What if others find out? Isn’t this just because you are trying to show off?

And if Ji Mo is his junior brother, then there will be no problem.

At this time, the sinus duct has been opened by Lu Cheng. Naturally, there is no feeling of touching from the outside to the inside at the end of the season. I can only touch the sinus duct to feel it, but there is actually nothing I can do.

After Ji Mo finished touching it, he nodded, but it was still a bit regretful.

This kind of feeling from the inside is of course not as rewarding as feeling directly from the outside to the inside. It is like diagnosing a patient. When you know the diagnosis results, you can infer the symptoms of the disease, and through the patient's symptoms, you can follow the patient's symptoms.

The process of recommending a patient's diagnosis is different, and the rewards are also different!

At this moment, the door of the operating room was pushed open again, and it was Min Hong who walked in from the outside.

After approaching the operating table, he saw that Lu Cheng was removing the sinus tube, so he nodded and said, "Not bad, Xiao Lu is pretty good. For tuberculous hip arthritis like this, it is very easy for a sinus tube to form through the femur and go to the knee joint."

The sinus canal is very secretive and can be easily missed if you are inexperienced."

"Xiao Lu, please continue to extend it and see where the sinus tube ends. Has it broken the joint cavity of the knee joint?"

Min Hong is indeed Min Hong. Even without the dexterity, he immediately told the sinus tract direction that is easy to appear but difficult to find based on his own knowledge reserve.

Immediately, Lin Hui, Ji Mo and others understood.

After Lu Cheng heard this, he also felt that compared with Min Hong, he was still far behind. His current level was far from being able to teach: "Master, it's probably at the location of the adductor tendon tear, and it doesn't extend any further.

Yes, it’s a blind road.”

Teaching people is not just about demonstrating how to perform surgery or where to perform the operation, but telling them why they should do it in a way that the teaching target can understand, and proceeding layer by layer based on his knowledge reserve.

The following is recommended, this is teaching students in accordance with their aptitude!

Min Hong's control in this aspect is absolutely top-notch, and he is worthy of the name of professor!

"Oh, ok, you do it first. After I take the stage, we will look at the other two sinus ducts together." Min Hong also believed in Lu Cheng's professionalism. If he could find this sinus duct, he would naturally find it.

The approximate location it arrived at.

"One leads to the sciatic nerve, and the other leads to the femoral canal. This case is very interesting."

As Min Hong spoke, his expression became slightly excited, as if he had encountered something interesting.

When he heard Min Hong's words, Lin Hui suddenly felt a little bad. Looking at Min Hong's behavior, it seemed that he was pursuing something different from him now.

When Lin Hui, Zhu Lihong, Chang Weilong and others perform operations, they all hope that the operation will be as simple as possible, and the patient's condition will be as simple as possible. This can maximize the effectiveness of the operation and their sense of gain after the operation.

Min Hong, on the other hand, seems to prefer more challenging surgeries.

Regular joint replacements, or even more difficult joint replacements for joint deformities, all seem to be just routine surgeries!

Even if the postoperative results for patients are very good, it seems that this kind of thing has become commonplace, and in fact the sense of gain is not that sufficient, so I like to accept some interesting patients, such as re-evaluating the surgical indications for hip replacement.

Ah these.

Currently, the oldest person to undergo joint replacement surgery in the four wards of the Department of Orthopedics is 96 years old!

As a rule, for people of this age, many hospitals and places will recommend conservative treatment. After all, his life expectancy may be only a few years, so it feels unnecessary. Moreover, the risk is extremely high, and it is easy to be unable to survive.

But that's not actually the case.

Life can be divided into two types: quality life and qualityless survival time.

If a ninety-six-year-old man fractures a bone and undergoes conservative treatment, no matter how good his pre-operative physical condition is, he will hardly need to think about being able to stand up again. This kind of life is just about survival time, or the length of torture.

That's all.

However, if he can stand up through surgery within a month and even go for a walk in the community, it will be a kind of salvation for him as an individual...

Lu Cheng directly removed the sinus tube adjacent to the femur along with the periosteum to avoid leaving any residue.

But after the resection, Lu Cheng said again: "Brother Zhi, when you suture later, remember to suture this place completely. Otherwise, the remaining blood in the joint cavity will flow along the residual tube of the sinus tube.

Location of adductor tendon hiatus.”

"The adductor tendon tear is where the femoral artery runs. In this way, in addition to possible pain after surgery, it may also cause obstacles to the distal blood supply. If it is difficult to suture, put the irrigation and drainage outlet pipe in this direction.

, and then cut the holes.”

Lu Cheng will definitely be there for this patient's postoperative suturing. However, this patient has too many sinuses and many places to be closed, so it will definitely require several people to operate at the same time.

Deng Zhi's suturing speed is the fastest except for Professor Min Hong and himself. This operation itself takes a long time, so it will definitely save time to the greatest extent, so Deng Zhi will definitely be asked to suture.

"Okay!" Deng Zhi nodded.

At about this time, Professor Min Hong had washed his hands, put on his clothes and came to the stage.

Lu Cheng moved away from his position as the surgeon, and then took the initiative to stand on the opposite side as the first assistant, Lin Hui moved to the second assistant position, and so on.

Min Hong probably used tweezers to check the situation in the surgical field and then said: "This patient still has a lot of sinus ducts. If it continues to develop, it is very likely that sinus ducts will develop in the buttocks."

"As for the sinus duct location of hip joint tuberculosis, the most common location is in the buttocks, and then on the inner and outer sides of the thighs."

"Situations like this where tuberculosis travels upward are relatively rare. However, once the tuberculosis moves upward, we must be alert to a problem."

"That is whether this hip tuberculosis is primary!"

As soon as Min Hong came up, he said something that made everyone look stunned.

Everyone immediately looked at each other!

"We all know that the flow direction of pus is generally downward. The possibility of going retrograde is not impossible, but this chance is too small. And if it happens to lead to the femoral canal, then there will be

Maybe the origin of this patient’s hip tuberculosis is not in the hip joint.”

"Of course, that's just what I said."

Min Hong saw that Lin Hui's expression changed a bit, and comforted him again.

How could Lin Hui not change so much?

If the hip joint tuberculosis is not the primary tuberculosis location, then it may reach the lumbar area of ​​the spine!

Does this surgery need to be extended upward to the lumbar spine? And during the MRI process, because of the influence of the femoral canal, the location of the sinus tract is not so easy to find!

The Spine Department has been separated from the Orthopedics Department. If a spinal surgery is really required, a temporary consultation will be required and the family members will be informed of the actual situation.

This can make surgery more difficult.

"Everyone changes surgical gowns and gloves again, goes around, and changes to a set of surgical instruments. Just an ordinary lower limb debridement bag is enough. Don't throw away this set of surgical instruments yet. Keep them for later use, and then bring up another set of instruments!

"

While Lin Hui was thinking about this, he saw that Lu Cheng and Min Hong had joined forces to start 'playing' with stock management.

This is preparation for reopening an incision on the abdominal wall!

Because the current instruments have been used to treat infected joints, they are contaminated instruments, and the current incision made on the abdominal wall is a clean cut surface, and it is necessary to wear gloves and change clothes again.
To be continued...