Yang Ping looked at the images one by one and said: "L5/sacral 1 intervertebral discogenic pain. ”

He put on the gloves handed by Song Zimo and examined the patient.

Wearing gloves for physical examination, this is Yang Ping's habit, not pretending to be forced, nor disliking patients, this is stricter hand hygiene to prevent cross-infection.

After a round of physical examination, Yang Ping knew it in his heart.

The right groin is two centimeters from the anterior superior iliac spine, with local tenderness, positive Tinels' sign, worsening with hip extension, and a positive pelvic crush test.

At that time, the systematic super culture plan cultivated anatomy, physical examination, instruments and laboratory examinations, and the super culture plan laid a solid clinical foundation for Yang Ping.

"Lateral femoral cutaneous neuritis! Call the ultrasound department to come over and bring a bedside color ultrasound machine. Yang Ping took off his gloves.

Song Zimo immediately contacted the ultrasound department, and soon, a beautiful doctor from the ultrasound department took the emergency elevator and pushed the bedside color ultrasound machine over.

She set up the color ultrasound machine and prepared to do it, Yang Ping said, "Shall I come?"

Are you coming? Does an orthopedic surgeon do color ultrasound? Unheard.

Yang Ping didn't say much, and under the suspicious eyes of the sonographer, he began to move, apply the couplant, and probe along the lateral femoral cutaneous nerve path, that technique, it was simply a senior sonographer with decades of experience.

"Dr. Yang can do color ultrasound?" The beautiful doctor stood aside and asked Song Zimo, she was very curious, she had never seen an orthopedic surgeon do color ultrasound.

It is not surprising that orthopedic surgeons will take X-rays, a small number of doctors are very involved in the study of business, and they are also involved in specialized marginal disciplines, and some doctors are more proficient in X-ray projection than radiologists, but there are not very few orthopedic surgeons who can do color ultrasound.

Song Zimo was silent on the side, the ultrasound probe was fluent, the probe stayed in the groin two centimeters away from the anterior superior iliac spine, Yang Ping pointed to the image of the color ultrasound screen: "You see, this is the lateral femoral cutaneous nerve, which was compressed when it passed through the inguinal fascia, and the nerve was edema, there should have been a contusion here before, this is scar adhesion and entrapment." Surgery was arranged to perform minimally invasive radiofrequency ablation of the right lateral femoral cutaneous nerve under local anesthesia, and angiography and radiofrequency ablation of the lumbar 5/sacral 1 intervertebral disc were performed at the same time. ”

In just ten minutes, a color ultrasound machine established the diagnosis and the treatment plan was clear.

Looking at the color ultrasound image like flowing water, who can understand color ultrasound?

For color ultrasound, as a professor of Concord, Professor Hu Guolin knows some basic knowledge, but is not proficient, others, Song Yun also knows a little, except for Song Zimo and Xu Zhiliang who have been trained by Yang Ping, no one is proficient in this thing.

Even the doctors in the ultrasound department were surprised, this kind of nerve entrapment, to be honest, few senior doctors in the ultrasound department could see it.

Dr. Yang walked back and forth a few times before coming to a conclusion.

Song Yun blushed and said: "Dr. Yang, I don't know much about this color ultrasound, I can talk to me when I have time, starting with zero foundation." ”

"Song Zimo, you take out the printed book and show them first." Yang Ping put the probe away, took out two tissues from the cart of the color ultrasound machine and gave them to the patient, and a trainee helped the patient wipe the couplant clean.

The patient pulled up his pants, and the previous scolding was completely gone: "Dr. Yang, you are right just now, I fell on a motorcycle before, and I have a bruise here, it has something to do with this?"

"Related! Let's do a minor surgery, minimally invasive surgery, and solve your problem in ten minutes. Yang Ping's non-negotiable tone.

The patient hummed and didn't speak, as if he was transparent and couldn't hide anything in front of Dr. Yang.

As for the printed books, there are several, but they are all Song Zimo's treasures, which are Song Zimo's explanations to him according to Yang Ping's usual explanations, sorted out and printed, and bound into a book.

One of them is the application of color ultrasound in orthopedics, which is the popular musculoskeletal ultrasound, Yang Ping's explanation summary.

Director Hu also opened his eyes, and at Xiehe, the clinical foundation of doctors is second to none in the country.

They usually deal with the underlying diseases of orthopedic patients, such as diabetes, hypertension, and coronary heart disease, and generally do not need consultation.

Why, with a good clinical foundation.

If it were in other hospitals, the surgeon would look at the electrocardiogram, that was a myth for a long time.

At Concord, a surgeon who does not see an ECG is not a qualified doctor.

Comprehensive and solid clinical training, whether it is a common disease or a rare disease, so that the doctors of Union Medical College can handle it with ease.

There are some rare diseases that doctors in other hospitals don't have in their heads, but Xiehe even residents know it clearly.

This is the confidence that Concord's comprehensive strength ranks first in the country.

This patient, in other hospitals, will generally fall into the trap, but for Director Hu of Xiehe, whether it is diagnosis or treatment, it is not very difficult, and he will not easily fall into the trap, but if he really wants to make a clear diagnosis, it will definitely take a lot of time to analyze and compare.

It is absolutely impossible to be like Yang Ping, who can hit the nail on the head in more than ten minutes, especially the color ultrasound operation just now, which reflects the general clinical strength.

With such a solid clinical foundation, it is no wonder that Professor Liang will never forget an operation.

If Yang Ping's knowledge is a sea, Director Hu feels that he is just a lake.

Professor Liang saw people accurately, Director Hu couldn't help but sigh, he didn't understand at the time, it was just an operation, so he never forgot it, and told himself that in addition to further study, he must also complete another task to dig people!

I heard that 301 has already acted, and Concord will also take action, compared to the strength of 301, Concord is more moderate.

When it comes to the academic atmosphere, Director Hu has more confidence in Concord, and talents like Yang Ping will like Concord.

Back at the doctor's office, Song Zimo called up the image again, and Yang Ping took the opportunity to explain lumbar disc herniation to the young doctor.

"This is not lumbar disc herniation, but lumbar discogenic pain and right lateral femoral cutaneous neuritis, lateral femoral cutaneous neuritis, which is very easy to be regarded as lumbar intervertebral disc herniation, has deceived many doctors, plus lumbar discogenic pain, most doctors will jump into the trap." Yang Ping returned to the office to speak without scruples.

Lumbar intervertebral disc herniation is a syndrome manifested by intervertebral disc degeneration, annular fibrous rupture, and herniation of the nucleus pulposus irritating or compressing the spinal nerve root and cauda equina nerve.

It can be seen that lumbar disc herniation cannot be diagnosed in the absence of symptoms of spinal nerve roots or cauda equina.

That is, it is just low back pain and cannot be diagnosed as lumbar disc herniation.

Lumbar disc herniation must have symptoms of spinal radicular or cauda equina nerve compression and irritation.

But often a large number of patients with only low back pain are easily diagnosed with lumbar disc herniation.

Many manifestations of radicular pain are symptoms of sciatica, but there are many other causes of sciatica, and the two are not the same concept.

Therefore, even if there is a sciatic nerve manifestation, it is not necessarily a lumbar disc herniation.

This patient is an example.

If you compare the spinal cord to the main gate, the spinal nerve is the wire that comes out of the main gate, and the sciatic nerve is the wire that has left the main gate and is placed in the room.

There are several kinds of pain caused by lumbar intervertebral disc disease, and there is discogenic pain, which is the pain caused by the stimulation of the nerve of the intervertebral disc itself, the sinus vertebral nerve, which is manifested as lower back pain.

Radicular pain is a problem with the bus part of the wire exiting the main gate, which is compressed or stimulated by the lumbar intervertebral disc, causing pain in the distribution area of this nerve.

There are also referred pains, where the pain is not in the same place as the onset of the disease, but because their sensory nerves are transmitted to the spinal cord at the same level. It can be understood that when the nerves in one part are stimulated, the signal is transmitted to the spinal cord, and then up to the brain, the brain will be misjudged, and it is not clear what is wrong, and the pain signal is sent to two parts, and the other part that is not a problem is also painful.

The pain caused by the lumbar disc can be roughly divided into these three types, the first of which is called lumbar discogenic pain, and the second is lumbar disc herniation.

As for sciatica, it can be caused by a herniated lumbar disc or it can be caused by its own problems, if it goes out of the main gate and has problems in the walking route, it has nothing to do with the herniated lumbar disc, it cannot be said to be lumbar disc herniation.

For example, piriformis syndrome, Mr. Yan is like this, and he has been making trouble for two years because of this, which makes both doctors and patients unhappy.

Yang Ping said while drawing the anatomy of the lumbar vertebrae on the whiteboard, which is easy for everyone to understand when combined with the diagram.

A casual drawing, more beautiful and detailed than an anatomical atlas.

Even if a herniated lumbar disc compresses and stimulates nerves, there is a pattern to follow, you see, the most common lateral lumbar disc herniation affects the walking roots.

What is a walking root is that it goes down through the intervertebral disc and goes out through the next intervertebral foramina.

On the other hand, the extreme lateral intervertebral disc herniation affects the exit root, which is the nerve root that comes out of the corresponding intervertebral foramen.

The central type of disc compression is cauda equina, which is the most troublesome symptom.

"This type, men are the most afraid!" Director Hu is very humorous.

"Does lumbar disc herniation still have imaging function?" There are students whose brains respond quickly.

That's right, it's just that men are difficult to talk about this issue, and even if they ask, many people don't want to admit it, so everyone doesn't pay attention to this issue.

"No wonder, the waist is good, and so is her." Zhang Lin teased.

Xu Zhiliang glared at him, Zhang Lin immediately restrained the smile on his face, didn't dare to say more, and complained in his heart: Adjust the atmosphere, this guy is so serious.

The low back pain was sorted out by Yang Ping clearly, like a mind map for elementary school students, simple and clear

"Why does this patient have a discogram during the operation?" Li Guodong is very studious and asked.

"If it is discogenic low back pain, intervertebral discography, contrast can induce low back pain, or anesthetics can eliminate low back pain, so that lumbar discogenic pain can be diagnosed, find the responsible site of low back pain, and then perform radiofrequency ablation to destroy the sinus nerve and eliminate the pain naturally." Song Yun helped explain.

Song Yun admired Yang Ping's ability to think like a cocoon, this patient had low back pain, as well as radiating pain in the lower limbs, and it seemed that there was no doubt about diagnosing a herniated lumbar disc.

This is where the diagnostic error comes in.

"Dr. Song will tell you about lumbar discogenic lower back pain." Yang Ping encouraged everyone to discuss, academic things, the more debated, the clearer.

Song Yun was guided by Yang Ping, and his thinking was also opened: "Lumbar disc herniation and lumbar muscle strain are becoming an abusive diagnosis, so that patients and doctors are allowed to be caught in this diagnosis." ”

"Advances in follow-up diagnosis technology have made the diagnosis of low back pain clearer by considering that chronic low back pain is most commonly discogenic low back pain."

"As Dr. Yang said just now, in fact, the most accurate diagnosis of this patient should be: 1. Discogenic low back pain, 2. Right lateral femoral cutaneous nerve carcitis."

"With intervertebral discography, discogenic low back pain can be divided into terminal origin and fibroannular origin, the so-called source is the source of pain."

Song Yun's expertise was very good, and then when it came time to control the MRI film, it was inexperienced and turned to Yang Ping for help.

Yang Ping asked everyone to get closer and look at the picture on the electronic reading screen: "You see, on this cross-section, the lumbar intervertebral disc hyperintensity area HIZ intervertebral disc HIZ hyperintensity, look at this image T1 weighted image and T2 weighted image to see, not just look at one phase, if T1 is limited to low or equal signal, T2 is limited to high intensity, it means that the fibrous ring of this intervertebral disc is ruptured, and granulation tissue grows inside, and this granulation tissue signal is a landmark image. ”

"Indeed, understood." Song Yun suddenly realized.

I have read a lot of books and studied things that I haven't understood for a long time, and Dr. Yang now points out in one sentence.

Then Yang Ping told Song Yun that from the pathology, the composition of granulation tissue, the imaging principle of MRI, the principle of artifacts, the signal presented by granulation tissue on MRI, why this signal is presented, how to judge the time of disease onset from the signal, how to identify artifacts and so on.

Especially when it comes to the principle of MRI imaging, it is estimated that MRI makers will not understand it so deeply and then say it in such an approachable language.

It's the right time!

Song Yun saw that Song Zimo kept taking notes, and hurriedly took out his notebook and hurriedly wrote it down.

The upstairs operating room is ready, and Li Guodong sends the patient to the operating room.

Song Zimo is the main knife, Yang Ping is guided, and everyone observes.

The operation only took more than ten minutes, and the results were immediate, and the patient was no longer in pain, and he could actually get up from the operating table and walk back to the ward by himself.

A dispute was easily resolved by Yang Ping.

Director Qin of the Department of Spine Surgery got the news, breathed a sigh of relief, and hurriedly called to thank Yang Ping, constantly reminding himself in his heart that he would be cautious about wiping his buttocks in the future.

The patient sent a pennant to Director Qin, and it was said that he was going to go back at that time, but fortunately, Yang Ping helped resolve it, otherwise it would really make trouble, and where would the old face go.

Director Gao of the Sports Medicine Center rushed over to practice arthroscopic microsculpture.

When I heard about the spine surgery patient, I shook my head.

Lao Qin, this kind of patient, just throw it over and don't care? In any case, you have to come in person, from beginning to end, listen to Dr. Yang's explanation, and help with the operation, so that you can learn something, otherwise you will fall into the trap next time.

When he heard that Dr. Yang was using a new surgical method to reconstruct the cruciate ligament in children in the United States, Director Gao waited for an opportunity to learn the curve drilling technique of cruciate ligament reconstruction in children from Yang Ping.

I always have a notebook and USB flash drive with me.

The first is the latest.