Many surgeries in the orthopedics department were similar to interventional surgeries, and they had to be performed under X-rays.
He used his C-arm X-ray to locate the L2 vertebrae and the vertebral arch on both sides. The assistant began to disinfect the wound and laid out a sterile surgical sheet.
There was no problem with the positioning. Before the surgery, professor Tian explained the entire process of the surgery to his assistant.
After the surgery, professor Tian used 1% lidocaine to anaesthetize the patient and made an incision of about 0.5 cm at each of the marking points on the patient’s second lumbar spine.
Under the guidance of x-ray vision, the puncture was done on both sides. The inserted needle was placed on the outer upper edge of the L2’s lateral pedicles with a 10° angle.
He was skilled in the operation. For a surgeon at professor Tian’s level, this kind of difficult operation was almost not difficult.
Under the X-ray scan of the C-arm, after the tip of the needle entered the base of the vertebral arch, the needle was pulled out and the guide needle was inserted. The guide needle was inserted into the front one-third of the vertebral body, the puncture needle was removed, and the work tracheal was inserted.
After the hand drill was drilled to 1/2 of the vertebral body, the hand drill and guide needle were pulled out, and the inflated balloon was inserted through the working tracheal tube. The X-ray vision showed that the inflated balloon was in good position. After the inflated balloon was gradually opened, the height of the vertebral body was restored to normal.
Professor Tian took out the bag, and the assistant had already prepared the bone cement.
After 1 minute and 30 seconds, he began to slowly inject the bone cement through the working casing under the X-ray vision of the C-arm.
The surgery was coming to an end. Professor Tian injected the bone cement while he focused on the image of the bone cement.
“The operation here must be meticulous and careful,” Professor Tian explained to his assistant as he worked on the cement.
“What’s the biggest complications when it comes to bone cement?” Professor Tian asked.
“Bone cement is leaking.” The assistant replied.
Professor Tian belonged to the academic type. He did not have much of a pugilist aura and seemed to be from the South.
Professor Tian would always ask many questions to the in-service training doctors under him during each surgery.
As an in-service training doctor, he was not used to it at first, but he could not possibly be rendered speechless by professor Tian’s simple questions on the operating table.
Although it was hard for in-service training doctors to prepare and memorize, they improved very quickly.
“Not exactly.” Professor Tian slowly injected the bone cement while explaining,”The most serious complication is pulmonary embolism. It’s very common for bone cement to leak because the patient has osteoporosis. Therefore, 73% of the patients do not have any reaction after they leak. “
Professor Tian did not continue to explain because the patient was under local anesthesia. If he explained too much and caused the patient to be nervous and have heart problems, he would be asking for trouble.
“As long as you’re careful and don’t let the tip of the injection needle touch the Aragami of the communicating vessel, you’ll be fine.” Professor Tian injected 2 ml of bone cement.”Under normal circumstances, this is a surgery with very low risk. You’ll have to operate the next one yourself, I’ll be your assistant. “
When the patient heard what professor Tian said, he rejoiced in his heart. His luck seemed to be pretty good, as professor Tian had to personally treat him.
When about 2.5 ml of bone cement was injected, professor Tian was stunned.
X-ray vision showed that there was a strip of “bone cement X-ray imaging agent” that extended upward on the right side of the front edge of the vertebral body. The image was like a small worm, constantly climbing up.
Uh … Professor Tian was speechless. Did he have a blessed mouth?
“It’s fine, it’s fine,”professor Tian comforted himself.
Research papers reported that the occurrence rate of vascular leak in bone cement was about 24%, and pulmonary embolism occurred in 4.6% to 6.8% due to vascular leak. Most of them had mild pulmonary embolism, with no obvious clinical symptoms.
Only 0.4% to 0.9% of patients with pulmonary embolism would develop clinical symptoms.
This probability was so small that there was almost no need to worry.
In clinical operations, professor Tian had also encountered situations of bone cement leakage and even pulmonary embolism.
Most of the patients would recover after lying down for a while, and there were no special complications. There was not much postoperative care, so it did not affect anything.
He consoled himself in his heart and encouraged himself that Yingluo would be fine. She would be fine.
Through dynamic x-ray vision of the C-shaped arms, the position of the developing shadow was observed to change constantly. It passed through the right atrium, the right ventricle, and finally stopped in the right lung.
Professor Tian had already stopped the operation. He helplessly watched as the bone cement entered his right lung. His hand was numb.
Really F * cking hell! How did he encounter a pulmonary embolism? Professor Tian, who had always been mild-tempered, cursed in his heart. Now, he could only pray that the patient had no clinical symptoms.
No one could avoid complications during surgery.
No matter how careful they were or how well-prepared they were before the surgery, they could not avoid it.
The only thing that did not go wrong was that he did not perform many surgeries! This was a common understanding in the medical world. As long as he performed a certain number of surgeries, he would definitely have to face all kinds of complications.
For example … Today’s pulmonary embolism.
“Are you feeling uncomfortable?” Professor Tian asked softly as he looked at the bone cement reaching his right lung.
“No, I didn ‘t,” The patient replied,”they’re all fine. Professor Tian, you did a really good job. They don’t feel any pain at all.”
Professor Tian sighed in his heart. Did I do well?
The surgery should have been well done, but there were complications. How could he be thick-skinned and say that he did a good job?
The patient’s X-ray image showed that the bone cement had entered his right lung, but there were no clinical signs of pulmonary embolism.
Professor Tian considered that the bone cement had overflowed from the vertebral body, entered the parasyclarian vein, and then moved to the lungs, causing multiple embolism in the pulmonary arteries.
He decided to stop the surgery. If he forced himself to continue, nothing would happen.
He immediately stopped the injection of bone cement and sutured the incision.
After he was done, professor Tian helped the patient lie down. He was afraid that the assistant would make a mistake, which would aggravate the patient’s fracture or cause other accidents.
There were already enough accidents, so it was best to avoid them.
The patient lay on his back instead of on his face. He was given an electrocardiogram during oxygen respiration, and a venous access device was opened.
There was no recognized treatment plan at home and abroad for patients with traceless bone and pulmonary embolism. At present, there was a tendency for non-preventive use of anticoagulants, and only close follow-ups to observe the changes in the condition.
Although the surgery had failed, as long as the patient was fine, there should not be any major problems. Professor Tian was a little nervous as he closely observed the patient’s condition.
While he was closely observing the patient’s condition, he urgently invited the Respiratory Medicine Department, cardiothoracic Department, and other related departments into the operating theater for consultation.
After one hour of observation, the patient showed no signs of discomfort. The Respiratory Medicine Department and cardiothoracic Department also did not recommend excessive treatment. They would observe the changes in the patient’s condition and decide if there were any changes.
After the patient suffered from pulmonary embolism during the surgery, the patient had not shown signs of breathing difficulties, shortness of breath, increased breathing frequency, or other gas exchange disorders in the lung.
Professor Tian felt that he was quite lucky. At least the patient was fine.
However, if the operation failed, he would have to explain it to the patient’s family members when he went back. He had to strive for the understanding of the patient’s family members so that they would not cause any doctor-patient disputes.
