Chapter 955 Don't Ask Me for Medical Expenses

The reason for the disappearance of the femur has now been revealed. What remains for us is to learn about this through discussion. Through this case, we have a preliminary understanding of idiopathic osteolysis. When we encounter this case again in the future, we will at least have a basic concept in our minds.

However, this kind of case is sometimes difficult to encounter in a lifetime of medical practice. It is more common to know it when reading literature. This urges everyone to study more and read more papers in daily life. This is the only way for doctors to break through the limitations of experience.

Song Zimo used imaging tools on the tablet to measure the distance of the femoral defect. Since the effect of Ilizarov's technique in treating this disease is uncertain, only one method with a certain effect can be used - customized prosthesis implantation, using customized metal to replace the defective femur.

There are also conditions for the replacement of the original defective femur with a metal femur. The residual femur at the distal and proximal ends must be able to provide good fixation for the prosthesis. This fixation is not only a temporary mechanical fixation, but also a reliable biological fixation in the long term.

This requires a certain length of residual distal and proximal ends. Song Zimo measured the remaining femoral distal and proximal lengths and barely met the requirements, so the method of implanting a femoral prosthesis is feasible.

The other method is to use the Ilizarov technique. This method is theoretically feasible and should be the best, but it takes a long time to treat. The most troublesome thing is that the patient's family is currently in dispute with the Municipal People's Hospital. In this case, no doctor dares to use the new method, even if the effect of this method may be very good.

At this time, the doctor will definitely use conservative treatment methods so as not to get himself into trouble. The implementation of the new method must require the active cooperation of the patient.

"Can the muscle attachment be solved by using a femoral prosthesis? If the muscle is not attached, will it still affect the lower limb movement on this side? There is only a bracket but no power?"

Li Guodong's thinking is still very active and he can see the problem.

Song Zimo's eyes stayed on the tablet in his hand: "I just measured that there are enough muscle attachment points on the femurs that remain far and near. As for the muscle attachment points of the femoral shaft, the current biological customized femoral prosthesis can provide attachment, but it takes a certain amount of time to form attachment."

One trainee was worried about another problem: "The patient currently has severe muscle atrophy. The difference in the thickness of the thighs on both sides is very obvious. The thigh on the affected side is as thin as an arm. Can it recover in the future?"

This graduate student was in the same group with Zhao Wenbo, who immediately explained: "Muscles are plastic and follow the law of use and disuse. He has not walked normally for a year, and muscle atrophy will definitely occur. As long as there is no muscle fibrosis, it can be recovered. With good and standardized rehabilitation training in the future, the muscle volume and strength can be restored."

"Yes, judging from the time, there is no fibrosis in the thigh muscles at present, and it can be recovered in the future. Don't forget that fitness athletes can train their muscles so strong, which is the best proof of muscle plasticity." Li Guodong took over.

The current topic does not involve traditional Chinese medicine. Li Guodong and Zhao Wenbo get along well and can discuss calmly. If it involves traditional Chinese medicine, the two will be at loggerheads and will not stop until they have a winner.

"Is fibrosis irreversible?"

Someone asked.

"Irreversible. Pathologically, muscle tissue is replaced by fibrous connective tissue."

Old Jin answered.

A graduate student seemed to have realized something: "I can't understand it this way. Some patients with high peripheral nerve injuries often have poor functional recovery after nerve anastomosis, while some patients with low nerve injuries recover better after surgery. Is it because the high nerves are far away from the innervated target, and the growth progress of less than one millimeter a day is too slow. When the nerves grow to the destination, the muscles have already become fibrotic, and it is too late to save the situation?"

"You are talking about motor nerves. Could it be that the terminal target organs of sensory nerves, such as sensory corpuscles, will also become fibrotic?" said another graduate student.

Song Zimo immediately cleared up their confusion: "Yes, the terminal structures innervated by sensory nerves will also degenerate after long-term denervation, which is irreversible degeneration, but it is obviously much slower than muscle fibrosis. This is why sensory nerves generally recover better than motor nerves in the same part of the nerve damage. In addition to the degeneration of the terminal structure, there is another reason that affects the recovery of nerves, that is, the mismatch and loss during the growth process. The farther away from the terminal, the greater the loss."

''I understand. In fact, I have been thinking about this problem, but it has always been vague. Now I really understand it. "The graduate student who just asked the question was relieved.

Through this free discussion, everyone also understood the treatment method of this disease: first of all, bone resorption should be treated, anti-osteoporosis drugs should be used to inhibit bone resorption and improve bone density, and then surgical methods should be used to implant femoral prostheses to restore the normal function of the femur.

"Do you have any ideas about idiopathic osteolysis? Dr. Song! This weekend's rare disease literacy will start with idiopathic osteolysis."

Yang Ping felt that everyone's discussion was similar and could move on to the next topic.

"Okay, I'll add idiopathic osteolysis to the lecture this weekend. If you have no objection, let's discuss the solitary kidney we just mentioned." Song Zimo told the graduate student operating the projector to switch the image.

Solitary kidney is clinically classified as an anatomical variation. The so-called anatomical variation means that the anatomy of a certain part of some people's body is different from that of normal people, but it does not affect the function; the other concept is anatomical deformity, which is also different from the anatomy of a certain part of the body, which has affected the normal function.

Solitary kidney, as long as the only kidney is healthy, even if there is only one kidney, it can still complete the work of the original two kidneys, that is, people only need one healthy kidney to live healthily.

This is the medical basis of living allogeneic kidney transplantation. Healthy people can cut off one kidney and give it to others, and rely on the remaining kidney to maintain healthy survival.

Although having only one kidney does not affect a person's healthy survival, it is still insufficient. There is one less "backup". Once the only kidney has problems, there will be no other kidney to replace it.

Now the CT image of the patient's urinary system appeared on the screen. Yang Ping stood up and walked closer:

"You see, there is a clear difference between solitary kidney and nephrectomy. The basis of any image is anatomy. The biggest difference between them is that solitary kidney is a natural single kidney. The side without kidney originally has no kidney, and naturally there are no matching blood vessels and peripheral nerves; and nephrectomy, no matter what kind of surgical procedure is used at the time, will definitely leave the remnants of the original set of blood vessels and nerves. Look, on this side without kidney, can you see the remaining part of the matching renal artery and vein?"

Yang Ping likes to see the essence through the phenomenon, so when speaking, he also tries to grasp the most fundamental things. To grasp the most essential things must be to study the object very thoroughly.

Everyone immediately looked at the tablet in their hands. Because they all have proficient anatomical knowledge and are extremely skilled in reading images, it doesn't seem troublesome. Indeed, there are no remnants of renal arteries and veins on this side. The difference between the natural blood vessels and the cut blood vessel remnants is still very large, and they are completely different.

"Zhang Lin, talk to the urology department and ask them to help retrieve some images after nephrectomy, including images taken within one week, three months, six months, one year, and three years after nephrectomy. This will be representative. Let's see what the images of nephrectomy look like. It would be better if some images of solitary kidneys could be retrieved, so that there would be more comparison." Yang Ping ordered Zhang Lin to do this.

The principle of science is to seek truth and be realistic. Medical records are the best basis for explanation.

The HIS system is networked within the hospital, so Zhang Lin made a phone call on the spot. Teacher Zhang from the Surgical Research Institute still has authority. A graduate student on duty in the urology department immediately retrieved some images and sent them to Zhang Lin.

After everyone carefully read these images, they found that there was indeed such an essential difference between them. Solitary kidneys do not have matching blood vessels and nerves, while the remnants of the original blood vessels and nerves are still left after one kidney is removed. This difference is like the difference between men and women. Even if a man has undergone sex reassignment surgery, his chromosomes are still XY. This is the most essential thing and cannot be changed.

True teaching in one sentence! The doctors present immediately remembered what Yang Ping had just said.

"The Municipal People's Hospital is now in dialogue with the patient's family. The hospital requested a medical appraisal, saying that whether it was a single kidney or a bone defect after surgery, whether it was related to the hospital's surgery would be determined after the medical appraisal, but the family refused to go through the medical appraisal procedure and refused to take legal action." Song Zimo introduced.

"They knew that this matter had nothing to do with the hospital, so they pretended to be confused. Once the appraisal process was entered, not everything would be exposed. Similarly, as long as the legal process was entered, everything would be revealed. How could he still use this matter to ask the hospital for money?"

Zhang Lin said angrily.

"Don't think of people so badly! People are inherently good at the beginning!" Xiaowu was like a philosopher.

Zhang Lin immediately said: "Human nature is evil. It's not that I think it's bad, it's really bad."

Yang Ping was not interested in these irrelevant topics: "We only study the condition. Other things are the business of the Municipal People's Hospital. I am only responsible for studying the condition thoroughly and then trying to cure it. As for other things, it is not our job. This is a case discussion, only talking about the condition! However, during the diagnosis and treatment process, everyone must strictly follow the process. No step can be skipped. It doesn't matter if it's a little slow, but steps cannot be skipped. The doctor in charge will make an appointment with the patient's family. I will talk to him face to face about the patient's condition. The subsequent treatment costs are relatively high, the time is relatively long, and there is a certain risk of failure. It must be made clear in advance."

Although this case is a rare disease, it is not the most difficult to treat. The biggest problem is sociology. Yang Ping classifies this type of patient as a high-risk sociological patient, because this type of patient is likely to be harassed by the doctor after making great efforts.

After the case discussion, Yang Ping met the patient and his family in the meeting room. The patient was a twelve-year-old boy, and the family member was the boy's father. As soon as he saw Yang Ping, the boy's father began to complain incessantly about the various shortcomings of the Municipal People's Hospital and cursed the doctors as quacks and black doctors.

"This hospital is in a mess. I heard that the former director was arrested. The child's kidney must have been stolen by them. I will never let them go."

When the boy's father said this, he was gritting his teeth.

"Let's not talk about these things for now. Let's talk about the child's condition." Yang Ping reminded the boy's father to get back to the point.

"We need to know something from you now. Has the child ever had a CT scan or ultrasound of the kidneys?" Yang Ping asked.

The child licked his dry lips and wanted to speak. The child's father immediately glared at him: "I did! The ultrasound showed two kidneys before. I remember it clearly. It's not wrong. But one kidney disappeared after the operation. Look, even the bones here are gone."

"Where did the ultrasound before? Is the report still there?" Yang Ping asked.

"It was done a long time ago. The report has long disappeared, but I remember there were two kidneys." The boy's father was very sure.

"Do you know which hospital it was done in?" Yang Ping continued to ask.

"I don't remember! Who would remember it after such a long time? What is certain is that there were two kidneys at that time." The boy's father insisted.

It is logical that the father of the child could not forget such an important thing, because B-ultrasound cannot be done casually or frequently, and this experience must be very clear. Now the father of the child said that he did not remember it, and Yang Ping suspected that the father was lying.

In fact, from the image, it has been confirmed that it is a solitary kidney, but the father of the child insisted that he had two kidneys before and lost one kidney after the operation. If the previous examination results can be found, this matter will be much easier.

"Let's not talk about this matter for now. Regarding the problem of the child's right femur missing, we are now planning to do a puncture to take some bone for examination. Only after the examination can we finally determine what the disease is." Regarding the solitary kidney, Yang Ping just wanted to figure it out.

"What is the purpose of this examination?" The boy's father asked cautiously.

"To help find the cause of the child's femur missing." Yang Ping explained.

"Wasn't the bone stolen by the doctor? Do we need to diagnose it? We are not here to make any diagnosis, but to treat the disease. You just need to cure the child's disease. As for how it was caused, we know it in our hearts, so we don't need to bother you." The boy's father was very impatient.

"Look, this is the X-ray of the child just after the operation. The femur is still fine. Later, there was no follow-up examination. The X-ray one year later showed that most of the femoral shaft disappeared. We suspect that the child has a strange disease called idiopathic osteolysis, so we need to puncture and take bone tissue to confirm. At present, judging from the medical history and symptoms, it is very likely this disease."

"Well, the femur can be said to be absorbed and disappeared, and it is impossible that the kidney is also absorbed." The boy's father said while looking at the X-ray.

"Let's not talk about the kidney for now, because you also said that it is not within the scope of this diagnosis and treatment. Let's only talk about the problem of femoral loss." Yang Ping did not mention it for the time being.

Then Yang Ping roughly talked about the follow-up diagnosis and treatment plan. The boy's father thought for a while and said: "How much does it cost? It's a lot! I tell you, don't ask me for medical expenses, go to the Municipal People's Hospital to ask for money, I won't pay a penny."