Surgery Godfather
Chapter 700 - 624: De-feathering the Immortal, Part 2

Chapter 700: Chapter 624: De-feathering the Immortal, Part 2

Engaged in conversation, they arrived at the doctor’s operating room in the Magnetic Resonance Room.

As the host, Old Du arranged seats for everyone, then went outside to greet the nurses, asking them to arrange for the patients in the Comprehensive Surgery Department to have an MRI checkup. Since he has a good reputation, the nurses were quite cooperative and discreetly adjusted the order of patients.

The patients had already completed pre-examination taboo screening and signed the consent form. The nurse once again checked for any metal objects on their bodies. Once confirmed there weren’t any, two interns were asked to help the patient into the examination room, leaving the wheelchair outside.

Because wheelchairs contain metal parts, if left in the examination room, the metals may be attracted by the magnetic field and fly around once the machine is turned on.

As the patient entered the examination room, Dr. Ao and Dr. Luo immediately came from the operation room to assist in moving the patient onto the machine.

Although an MRI does not produce ionizing radiation, it fears magnetic metals. Hence for an MRI scan, not only can there be no magnetic metals inside the body, all magnetic metals on the body must also be completely removed to prevent them from being displaced by the powerful magnetic field, posing a danger.

Song Zimo signaled, and Dr. Ao and Dr. Luo exited the room. With the examination room’s door now closed, Old Du remotely engaged the machine to operate from behind the glass window, gently moving the patient into the scanning dark hole.

"Professor Yang?"

Smiling, Old Du made use of the free time to chat and foster relationships.

But Yang Ping was engrossed in awaiting the scanning images and didn’t hear Old Du speak.

A somewhat embarrassed Old Du had to tell Song Zimo instead: "Young Master Song, if you have any special patients in the future that require personal attention, just let me know. I’ll be available whenever needed."

This wasn’t just polite talk; Old Du truly intended to be available as needed.

Old Du analyzed Duan Bald’s success story and gleaned many insights from it.

The Philips 3.0 light-speed MRI scan is exceptionally fast, with scanning speed for different body parts several times to dozens of times faster than a regular MRI scan.

As the scanning gradually finished and the patient was moved out, Old Du shut down the machine. The examination room’s door was opened, and Dr. Ao and Dr. Luo promptly rushed in to help the patients.

If even these foreigners are working this hard, what excuse does Du Haibin have to be idle? Old Du immediately followed to help with the patient’s transfer.

Yang Ping closely examined the MRI images, which matched his initial diagnosis: the bilateral lateral femoral condyles cartilages were intact, the medial femoral condyles were bald and the anterior and posterior cruciate ligaments were fine. The lateral meniscus was intact, but the medial meniscus showed signs of degenerative tear, though it was still a few millimeters from the periphery, and synovitis was slightly present.

The cartilage on the distal tibia and talus of both ankles showed some wear, but the quality of the cartilaginous tissue surrounding a large area was excellent.

The intelligent Song Zimo began to have a vague outline in his mind. He pondered the treatment plan for this case; he even daydreamed about it yesterday and got up with a heated head in the morning.

Yang Ping attached great importance to the patient’s bilateral knees and ankle cartilages, personally redoing the MRI, and also applied some new methods for quantitative evaluation of the cartilage.

Also, he paid significant attention to the force line of the patient’s lower limbs.

If joint replacement was to be performed, paying attention to the force line of lower limbs before surgery is routine preparation. However, being so particular about the joint cartilage seemed unnecessary. During knee replacement surgery, all joint cartilage is removed, considering it before surgery is generally meaningless.

"Are you planning to perform osteotomy on the lateral fibula? Using Academician Zhang Yingze’s theory of uneven settlement, perform an osteotomy on the fibula? Let the tibial plateau undergo uniform settlement and shift the weight-bearing point inward?" Song Zimo finally understood Yang Ping’s intention, he wanted to perform a knee-saving surgery.

Academician Zhang Yingze’s theory suggests that osteoporosis in elderly people can cause differential or uneven settlement of the human skeleton, which plays a crucial role in the development and progression of degenerative knee joint disease.

The tibial plateau is a major part of the knee joint. Differential settlement of the medial and lateral tibial plateau often leads to the medial side settling faster, increasing weight-bearing on the medial side, thus applying pressure on the medial cartilage beyond its load-bearing limit. Consequently, if subjected to prolonged pressure, the cartilage degenerates, thereby causing knee osteoarthritis.

It’s like a car; if the internal weight-bearing is always higher than the external side, the internal tires naturally wear out faster.

Differential settlements, also known as uneven settlements, are a type of mechanical phenomenon that occurs due to the influence of gravity and are common in nature.

For example, if the foundation of a building collapses, causing the house to tilt to one side, this is an uneven settlement phenomenon.

Human bones are also affected by gravity, resulting in uneven settlements. When bones become porous, the porous parts may have microfractures due to body weight pressure. Overtime, these microfractures can cause the bone to sink and deform the joints.

This phenomenon is most noticeable and typical in the spine and proximal end of the tibia, which are the bones most subject to concentrated stress.

The internal side of the tibial plateau bears two-thirds of the body’s weight, the external side bears one-third, and the external side is supported by the fibula, which almost never undergoes bone degeneration.

It’s as if there’s a pillar supporting the external side of the knee joint, but none on the internal side.

Therefore, when the internal plateau’s bone density decreases and uneven sinking occurs, its height drops below the external plateau, causing uneven distribution of pressure. This accelerates the wear of the internal cartilage, leading to osteoarthritis.

With Song Zimo’s explanation, Xu Zhiliang immediately understood.

Yang Ping nodded slightly: "Although this patient is in the late stage of osteoarthritis, from his medical history, physical examination, and MRI results, his synovitis symptoms are not severe, and pain is mainly concentrated in the medial compartment. If accurately managed, a unicompartmental replacement can be performed."

A unicompartmental replacement is when not the entire knee joint is replaced, but only part of it, usually the inside part.

"However, a unicompartmental replacement cannot escape the metal content, so only the knee can be preserved. To preserve the knee, we have to apply Academician Zhang’s theory," he added.

Indeed, he’s a smart guy, thinking of this isn’t a big deal, but thinking of it in this case indicates that Song Zimo has a very deep and broad understanding of knee osteoarthritis.

"But if the medial condyle cartilage is completely lost, even if you perform a fibular osteotomy to correct the varus deformity and move the weight-bearing point internally, it still won’t work because the key weight-bearing point still lacks cartilage?" Xu Zhiliang raised a new question.

This is why no doctor wants to preserve the knee in this case - the case isn’t suitable for Academician Zhang’s theory.

"Perform an autologous cartilage transplant after the fibular osteotomy?" Song Zimo tentatively asked.

"Redo the MRI to determine the distribution of the cartilage wear? Because after the fibular osteotomy, the tibial plateau will evenly sink on both sides, so the stress will move externally. This requires determining whether the lateral condyle cartilage can withstand this change, and a new stress point needs to be found on the medial condyle for the cartilage transplant?"

Song Zimo pursued his point.

"Also, arthritis already exists in his bilateral ankle joints, causing chronic pain for many years that can’t be cured. Do you plan to transplant the ankle joint’s cartilage to the knee joint, then fuse the ankle joint?"

Song Zimo finally understood the whole plan, every theory, every surgery; everyone knows, but no one thought to flexibly combine them and apply to this case.

This requires integration of all knowledge, and every step needs to be calculated accurately; otherwise, it will backfire.

Song Zimo couldn’t help but sigh. He treats every case as a research subject, striving for excellence, even for cases others have given up on. He racks his brain to utilize all available techniques to complete the surgeries.

If Academician Zhang’s knee-preserving surgery could be combined with autologous cartilage transplantation, and adjusting the force on the foot during ankle fusion to adjust the force line of the lower limb, then the problems of four joints can be solved at once.

Song Zimo felt absolutely thrilled. He couldn’t figure it out yesterday, feeling something was not quite right, but today it all clicked into place.

Xu Zhiliang was still pondering over Song Zimo’s words.

"Prepare for surgery the day after tomorrow, and talk with the patient’s family tomorrow," Yang Ping finalized the surgical plan.

After careful evaluation, this plan is feasible and quite promising.

"Professor Yang, the MRI technique you just used to quantitatively evaluate the joint cartilage, could you teach me? If everyone in the Comprehensive Surgery Department is like you, we’ll all be out of work. I just don’t understand why you’re so familiar with MRIs?" Old Du asked, leaning on his round belly.

Yang Ping modestly said, "We’re just amateurs compared to you professionals. We’ve only read a few books and papers. Come, let’s study together."

He’s really pulling out the feathers of a god!

Old Du leaned over and almost rolled off his chair.

Search the lightnovelworld.cc website on Google to access chapters of novels early and in the highest quality.