Hills is a marginal figure in the whole operation. He does convey equipment and tools and other miscellaneous tasks and often leaves the operating table. Others are also paying attention to the operating area, so if there is no particularly important thing, he will not look at him.

If Hills is stupider and does not realize that the drop will carry bacteria, be selfish, or be more face-saving, and chooses not to say anything, such a small iliac bone flap will not attract others' attention at all.

Just simply squat down and pick it up, you can be an outsider without knowing it.

At that time, when the bone flap that touches the dirty towel will enter the old marshal's intervertebral disc with dense bacteria. The original chance of infection may be magnified to 100%. As for whether Ludwig can withstand the intervertebral disc infection, everything will become unknown.

I am not afraid of problems when I encounter surgery, but I am afraid of being bored if I encounter problems.

Now Hills said his mistakes very bluntly, and there was no escape, so there was still room for maneuver.

Kawei has taught countless students and knows that although it is useful to curse people at this time, it can easily hurt self-confidence. However, without saying a few words, it will make the other party feel that the problem is not serious. Therefore, the tone, attitude and subsequent operation methods are very important: "Why did you fall to the ground?"

Hills knew he was in a disadvantage and explained: "I slipped my hand when I took it."

"Where did you fall? On the ground?"

"I didn't touch the ground, I fell on the towel."

".Bone surgery has a high requirement for sterility." Kawei just looked up at the bone flap in his hand and continued to scrape the bone in his hand. "I repeatedly emphasized in the previous autopsy exercises that if you don't do sterile operations well, you are not qualified to perform surgery on the marshal."

Compared with the treatment of interns on modern surgical operating tables, this sentence is already very soft.

But Hills is also the surgeon at Graz Hospital. Kawi is equivalent to speaking to a senior in charge of the hospitalization, so he naturally seems very serious. Fortunately, this is not an operating theater but a marshal's bedroom, and there is no one around, so he has preserved his most basic self-esteem.

"It's my problem. Just now, my eyes and movements were staggered." Hills admitted his mistake, "What should I do now?" [1]

For bones, the four people present had three treatments: one was amputation, the second was drilling the skull, and the third was fracture and bone cleavage. There was no bone surgery in the strict sense, and there was no such fine and complex spinal surgery.

In their eyes, surgery itself is a blind spot.

After all, Hills has many years of clinical experience, so Carvey cannot pursue his mistake: "First find saline to rinse it, it is to rinse it, not soak it in it, otherwise the whole basin of water will have to be poured out."

"What?" Hills guessed the beginning.

"Then take the diluted methylene blue." Kavey said, "The thing is in my toolbox, put half a bottle in a liter of water, then soak for half an hour."

When he heard that it would take so long, Hills speeded up his hand: "You do something else first, I'll do it as soon as possible."

The surgery process was forcibly changed, and Carvey was unhappy, but this was also a certain fact. At least Hills did not hide it: "Before disinfecting and soaking, help me get a small leather bag out of my suitcase."

Hills saw the long leather bag in the box at a glance: "Is this?"

"right."

Kavi sutured the fascial skin of the posterior superior iliac spine to Masimov, and after the change of position, he spread a clean gauze: "Keep it open carefully, and then remove the white cloth bag inside."

Hills untied the rope from the bag and slowly took out a white cloth bag inside: "What should I wrap it in two layers."

Kawei didn't reply, just said, "Open as carefully as before, and slowly pour the things inside on the gauze. Be careful not to touch the things inside with your fingers."

Hills nodded.

The simple posterior lumbar interbody fusion surgery destroys the posterior bone structure and affects stability, so the long-term results of the surgery in the first few years when it appeared were not ideal. It was not until the orthopedics later pointed out the skill tree for internal fixation, and the addition of interbody fusion surgery combined with internal fixation promoted various LIFs that were widely used in modern times. [2]

The bag contains the screws needed for internal fixing. Because there is no stainless steel and the solid silver texture is too soft, Kawei can only choose silver alloy. [3]

"The worries of all teachers before were really necessary, so I chose to use screws to fix the lumbosacral after filling the intervertebral disc." Kawei briefly demonstrated, "The part of the attack."

As soon as he started speaking, Orgi felt it was inappropriate: "You mean to knock a nail into the marshal's bone?"

"Yes, I've measured the size before, it's just right." Kawei said as he found the opening cone from it, "As soon as possible, the longer the time, the more the infection risk."

Previous abdominal surgery on Fernan had already revealed Kavi's unique surgical ideas. He did not follow the rules at all, and was very willing to take the risk of doing some complicated operations. The current vertebral fusion surgery alone has opened their eyes. They have seen the skin flap, but they have never seen the bone flap.

Fusion techniques have been ahead of them for seventy or eighty years, but relying on clinical foundations, these can still be within their understanding.

But bone nail implantation is incredible. They have never had such a bold surgical idea and dare not think about it.

Wouldn't this operation destroy the stability of the bones?

After a long time, will the bones not break?

Is it harmful to the body to implant it?

Should I take it out again later?

There were too many problems that needed to be solved, and their minds were blank. They couldn't even imagine what would happen after the Silver Nail entered their bodies: "Cavi, why don't you discuss it?"

"No." Kawei pointed to the signed consent form on the table in the distance, "The old marshal has handed over the decision on the operation to me, and there is nothing to discuss."

"But will the surrounding bones be damaged by the penis like this?"

"As long as the angle is fine, it won't be." Kawei said as he chose the nail point.

"The pedicle is so thin that it won't be damaged?"

"Don't worry, this is the strongest part of the spine. I've tried it on the corpse, no problem."

"What's the time?"

"No, because the old marshal will be restricted from moving in three months after the operation. Even if he can move in the future, the curvature of the waist will be affected. You cannot exercise vigorously, you cannot bear weights, and you still need to squat down to pick up things, and you cannot bend down directly."

Kawei did not hide the trouble caused by internal fixation: "But you should know that this is much more comfortable than the previous pain in the waist and legs."

"Will the implant just stuffed into the body like this affect the body?"

"Just don't get allergic. As for whether to take it later, I think it's not necessary to take it as long as there are no special circumstances." Kawei answered all the last two questions, picked up the opening cone, and started exerting force at the determined nail point [4], "Oh, by the way, you can just look at this surgical method. Don't use it easily, as something goes easy."

Four people: "."

"I'm not saying that you are not capable, but the angle is not easy to grasp and need to be practiced." Kawei said, "When I was a child, I thought that fractures should be solved by surgery, so I often use awls to drill bones, so there will be no problem in judging angles."

The structures of the spine vertebrae are different. Although they are all called spine, the nail entry point is different, the inclination angle and the depth length are all different.

The open cone just drills an opening in the bone cortex. After entering the bone cancellous, a probe is required to determine the entry direction of the screw.

In fact, the old marshal's posterior laminar has been completely removed and can enter the pedicle screw under direct vision. It is much better than those cases of complex trauma fractures. Kawei has a lot of experience in spinal trauma surgery, and it is not only the concept of modern surgery, but also the feel.

The angle of the nail entry is not fixed. For the lumbar spine, it is possible from 5-30°, which is just a difference between people.

Modern surgery may use imaging image navigation to increase accuracy, but using image navigation will increase the cost of surgery, and also increase navigation learning costs and equipment costs. For surgical medical teams, image navigation means taking rays.

Kawei doesn't like this. Putting nails with bare hands has always been something he emphasized that he must learn thoroughly. Even if optical navigation, electromagnetic navigation, robot navigation, and blind wearing appear later, they are still one of the items he often emphasizes when teaching newcomers. [5]

Since you are blindly wearing with bare hands, the feel is particularly important. When the probe is entered into the cancellous bone of the pedicle, it will make people feel like gravel rubbing. When you enter the needle and continue moving forward, you will also feel "pinched" inhalation.

"It's like a stick is inserted into sand, but you will know it after you are proficient in the operation."

Kawei quickly poked the nail path on both sides of the pedicle of the 4 and 5 vertebrae on the waist, and the speed was like a familiar old carpenter: "Next, two more will be needed on the sacrum S1."

The shape of the sacrum is completely different from other spines. In addition, the complex anatomical structure in front of the sacrum has caused the position of the nail into the sacrum to be very particular, and the angle of the nail into the nail also requires serious inclination. [6]

Before he knew it, more than three hours had passed in the operation, and Kawei had all the waist 4-sacral 1 drilled out of the tunnel. Hills, who carefully disinfected the bone flap, also brought about disinfection results: "The disinfection time has come."

"Rinse it twice with normal saline."

"OK"

When the operation reached this level, I had no time to care about the situation in the bedroom. Because there was no wash basin, the rinsing of normal saline could only be carried out on the ground, relying on a few absorbent towels. Hills asked the butler several times in the middle, but in the end, when it was not enough, he could only rely on the carpet to absorb water.

The splash of blood, the remaining gauze, bone debris, and surgical instruments that accidentally fell, were not cleaner than the surgical theater.

"I'm now cutting the bone flap into three pieces and put it flat into the space of the intervertebral disc." [7]

Kawei calculated the height, removed the reamer, and stuffed the bone flaps into it piece by piece.

In fact, the ilium bone is Kawei's choice in his helplessness. The better is the disc filling block [8]. As long as the bone is stuffed inside, there is no need to worry about the risk of height and postoperative deformation. Now, the disc filling height has become the most troublesome problem in front of them.

"The height is not enough." Even Watman, who has no experience in spinal surgery, can see that the discs between waist 4 and 5 are thinner than other places. "Not only the lumbar spine, I don't think the discs above sacral 1 are enough."

"What should I do? Do I need to make an incision on the other side before I get the bone flap?"

"Or you can choose other metals, and the bone nails are all hit, so that's not bad."

Kawei was also using a reamer to measure the height of the gaps of the intervertebral disc. Suddenly, he lifted up a clean gauze pile next to him, and inside were the newly cut pieces of laminar plates: "It doesn't matter, you can use these useless laminar plates."

From a shape perspective, they lack sufficient thickness and are not suitable for filling main material. However, if the bone cortex is cut off and the bone inside is scraped off, the discarded bone can be reused.

If the original ecological disadvantage is probably that it is waste of time.

"Come on, we each chiseled bones to separate the bones."

The downstairs continued to talk about the operation and sometimes gossiping. When the clock officially passed 12 o'clock, some people silently put lunch on the topic column: "It's so late, why is the operation not over yet?"

"Wait a little longer, there is no news now that the operation is going well."

"It's a brand new spinal surgery after all."

Everyone was talking about the operation, but their eyes were looking at the servants around them. They all had rich experience in serving, and the three meals were engraved in the biological clock. Someone immediately reminded him: "Everyone, if anyone is hungry, you can go to the restaurant first. The kitchen has prepared a sumptuous lunch."

With this sentence, everyone looked at Franz and sought the king's advice. Because in the palace, even eating had to obey His Majesty the Emperor's orders before they could start.

"I want to say a few more words to Mr. Edward, you can go and eat first."

Just as Franz waved his hand and was about to continue waiting for the operation to be performed, the sound of rapid footsteps came from the corridor.

The voice came from far to near, and finally the old housekeeper who had been waiting upstairs was the one who had been waiting for him: "The operation is over!"

【Wait for me to take a shower and write this chapter】
Chapter completed!