Many orthopedic surgeries, like interventional surgery, must be performed under x-ray.

C-type arm x-ray fluoroscopic positioning the l2 vertebrae and bilateral pedicle position, the assistant begins disinfection and lays a sterile surgical sheet.

The location was no problem, so Professor Maeda explained the entire operation process to his assistant.

After taking the stage, Professor Tian took 1% lidocaine local anesthesia and incited about 0.5 cm at the patient's second lumbar vertebra marking point.

Under the guidance of fluoroscopy, two sides are punctured, and the needle is inserted at the outer upper edge of the bilateral pedicle with a core, and the needle is inclined about 10°.

Proficient in operation, this kind of difficult operation is almost no difficulty for a surgeon at the level of Professor Tian.

After the needle tip enters the pedicle under x-ray perspective of c-arm, remove the needle core and put it in the guide needle, insert the guide needle 1/3 of the front of the vertebrae, remove the puncture needle, and insert it into the working cannula.

After the hand drill is drilled to 1/2 of the vertebral body, the hand drill and guide needle are pulled out, and the expansion balloon is placed through the working cannula. The position of the expansion balloon is shown in the smoothness. After gradually stretching it with the expansion balloon, the c-arm x-ray perspective shows that the vertebral body height returns to the normal height.

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

After 1 minute and 30 seconds, bone cement was slowly injected into the working sleeve through the working casing under the perspective of the c-arm.

The operation is about to end here. Professor Tian is injecting bone cement while focusing on the image of 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 cement?" Professor Tian asked.

"Bone cement leaks." The assistant replied.

Professor Tian belongs to the more academic type, and he is not very arrogant, like a southerner.

Professor Tian asks many questions every time he takes the doctor who comes to study under him.

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

Although it is hard to prepare, memorize, and learn about doctors, their level has improved rapidly.

"Indefinite." Professor Tian explained while slowly injecting bone cement: "The most serious complication is pulmonary artery embolism. Bone cement leakage is very common. Because patients have osteoporosis, 73% of patients have no reaction after leakage."

Professor Tian did not continue to tell because the patient had local anesthesia. If this is too serious and causes the patient to be nervous and cause a myocardial infarction, it would be a matter of nothing to make trouble for himself.

"Just be careful, don't touch the tip of the injection needle." Professor Tian injected 2ml of bone cement. "Usually, this is a very small risky operation. You have to operate the next one by yourself, and I will be your assistant."

The patient was glad that he seemed to be lucky when he heard Professor Tian say this, so he rushed Professor Tian to do it himself.

When about 2.5 ml of bone cement was injected, Professor Tian was stunned for a moment.

From perspective, I saw a strip-like "bone cement x-ray developer" that extended upwardly next to the right vertebrae on the front edge of the vertebrae. The image was like a small insect, constantly climbing.

Uh... Professor Tian was speechless and said that it would leak. Has his mouth been opened?

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

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 caused by venous leakage is 4.6% to 6.8%. Most of them are small amounts of pulmonary embolism and have no 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.

During clinical operations, Professor Tian also encountered pulmonary embolism caused by bone cement.

Most patients will recover after lying for a while, and there will be no special complications. There will be no treatment after the operation, which will not affect anything.

He comforted himself and cheered himself up - there would be no trouble, no trouble.

Through continuous C-arm dynamic fluoroscopy, the developer's image position was constantly changing, passing through the right atrium, right ventricle, and finally staying in the right lung.

Professor Tian had stopped operating. He watched the bone cement enter his right lung helplessly, his hands numb.

What a fuck! Why did you encounter a pulmonary embolism? Professor Tian, ​​who has always been gentle, cursed in his heart. Now he can only pray that the patient has no clinical symptoms.

No one can avoid the occurrence of complications when undergoing surgery.

No matter how careful you are, no matter how sufficient the pre-operative preparation is, it cannot be avoided.

If nothing happens, the surgery is done less! This is a consensus in the medical community. As long as the number of surgery is done, all kinds of complications will definitely be faced.

For example... today's pulmonary embolism.

"Are you feeling uncomfortable?" Professor Tian asked softly when he saw the bone cement reaching his right lung.

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

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

The surgery should be done well, but after complications, how could I say I was doing it well with shame?

The patient's image showed that bone cement entered the right lung, but there were no symptoms of pulmonary embolism in clinical practice.

Professor Tian considered that bone cement overflowed from the vertebrae, entered the paravertebral vein, and later moved to the lungs to cause multiple embolisms in the pulmonary artery.

Stop the surgery. If you keep doing it with your teeth, it will become something that is fine if you have nothing to do.

He immediately stopped the injection of bone cement and sutured the incision.

After the work, Professor Tian personally helped the patient lie down, for fear that the assistant would make the patient's operation error, which would lead to the patient's fracture worsening or other accidents.

There are enough accidents, so fewer ones.

The patient changed to prone to flat lying, and was subjected to oxygen inhalation electrocardiogram monitoring, and venous access was opened.

For patients with asymptomatic bone cement pulmonary embolism, there is no recognized treatment plan at home and abroad. Currently, it is tending to not use anticoagulants in preventive use, and only closely follow-up is carried out to observe the changes in the disease.

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

While closely observing the condition, he urgently invited relevant departments such as respiratory medicine, cardiothoracic surgery, etc. to the operating room for consultation.

After 1 hour of observation, the patient did not experience discomfort symptoms. It is not recommended to treat too much in respiratory and cardiothoracic surgery. Observe the changes in the condition. If there is any change, let’s talk about it.

After the patient suffered from pulmonary embolism during the operation, the patient did not experience symptoms of gas exchange disorders in the lungs such as dyspnea, shortness of breath, and rapid respiratory rate.

Professor Tian felt that he was still lucky, at least the patient had nothing to do.
Chapter completed!