crazy scalpel

Chapter 79 Anatomy

Because the skin at the back of the neck is relatively thick and its mobility is relatively poor, it is not easy to stretch, which makes it very necessary to properly mobilize the skin and subcutaneous tissue before exposing the spine.

Xie Ke used a scalpel to cut the skin and subcutaneous tissue sharply until the trapezius fascia stopped, and then used an electric knife to cut the fascia.

It stands to reason that the process of incision of the fascia must be done very, very carefully along the midline, since the midline is a relatively avascular interface and provides a more convenient surgical access for exposure of the myofascia and cervical spinous processes.

2 minutes!

This kind of myth is probably only found in movies.And it's not because the film emphasizes the high skill of the surgeon that the time is shortened deliberately, most of it is because of the rhythm arrangement and the economical use of film to avoid the dullness of the film!

Although Xie Ke performed Tong Wenjie's craniotomy before, Zhu Ming and Wang Lei were shocked again!

Different from the superficial scalp and scalp muscles, the layers and interlacing of muscles and fascia in the neck are quite complicated.

The cervical paraspinal muscles can generally be divided into three layers, the most superficial layer is the trapezius muscle, and the middle layer includes the splenius capitis and splenius neck.The deepest layer can be subdivided into three parts, namely the superficial semispinatus muscle, the middle layer of the semispinatus cervicalis, and the deep multifidus and rotator muscles.

The so-called trapezius muscle is actually the largest muscle that expands from the neck all the way to the back. It also has a name called the mitral muscle.The main function is to drive the muscles at the scapula when the hand moves.

The splenius capitis is located under the trapezius muscle and runs upward along the back of the vertebrae until it connects with the outside of the back of the skull.If both sides contract at the same time, it can play the role of tilting the head back.If only one side is contracted, the head can be turned to that side.Sometimes if you experience muscle soreness and your neck cannot move, it is caused by the strike of this muscle.

The splenius capitis is a muscle in the middle layer, which is very close to the spinal nerves and blood vessels. In Scheck's research and analysis, it is one of the muscles that act on "muscle inhibitory parasympathetic plexus paralysis".

The semispinalis capitis is the muscle under the splenius capitis. It moves up and down vertically. It connects with the back of the skull and the outside of the back of the vertebrae, and plays the role of tilting the head back.Since it is connected to the back of the skull and vertebrae, Shayk speculates that if this muscle is stiff or abnormal, it may be the killer of the headache.

Muscles like the splenius capitis and semispinatus capitis are located in the middle and deep layers, so they are not easy to touch at ordinary times, but they are very important muscles, but many doctors don't even know about them!

It's not that their anatomy is not as good as Xie Ke's, but that they just memorize the models and atlases, and they can't connect with real people at all.

Maybe they are not very unfamiliar with the name of this muscle, but after cutting the skin and fascia, if they are asked to point out these muscles one by one, I am afraid they will be dumbfounded.

Not only is the location of these muscles unrecognizable, but their role is often overlooked.

When Xie Ke was learning anatomy, he was not just being stunned by various muscles and maps.

He carefully connects the starting and ending points of each muscle, and uses 3D thinking to imagine and memorize the shape and movement of each muscle.As for the role of muscles, in addition to endorsement, he must also figure out why.

In fact, the origin of anatomy, in addition to understanding the structure of the human body, the most important thing is to know why.Why is this bone so long, and why is that blood vessel distributed like that.The evolution of human beings has changed everything from genes to bones and organs.And the meaning and purpose of this change is the mystery that people most want to know.

Many doctors think that it is the job of scientists, and they just need to follow the picture to find out.But in fact, if there is less sense of exploration, many important things are often overlooked.Take, for example, the less noticeable muscles of the neck.

So Xie Ke's amazing speed and efficiency, in addition to his own special talent, are also inseparable from his usual enthusiasm for learning.

Back in the operation, Zhu Ming and Wang Lei were still immersed in surprise.

Everyone thought that this job would take enough time, so they all felt relieved when he finished the incision.

However, before they digested this breath, Xie Ke's progress had already fast forwarded to the point where they had to raise their hearts again.

Xie Ke's speed and movement frightened Zhu Ming and others.

But the clear vision revealed by the incision made them have to accept, bloodless operation!

The extremely standard midline and the fascia without bleeding at all, as well as the muscles that were freed to one side to form strands of twisted ropes, all of this seemed to be that what Xie Ke was dissecting was not a real human being, but a human model.

How could there be such a doctor? It's simply terrifying!

If there is a world championship in anatomy, Xie Ke must be a proper champion.

Never heard of such a minimally invasive dissection.

The bifurcated spinous process is shaped like a sphere. If it is cut along this line, it may stray into the paravertebral musculature, so it must be carefully stripped from the subperiosteum.

Superficial venous plexuses may be encountered during dissection, and electrocoagulation should be used if bleeding occurs accidentally.

Xie Ke's fingers didn't know why they were so flexible, and he hardly used an electric knife from the beginning to the end.

The spinous processes, lamina, lateral mass, and facet joints were exposed by subperiosteal muscle dissection at each level.

Theoretically, multiple dissections or lateral dissections may injure the nerve roots and vertebral arteries, which lie anterior to the laminae connecting the transverse processes.But the muscles Shayk groomed are not at all, because they have not been overstretched.

Zhu Ming looked on with admiring eyes, while Wang Lei looked straight at him.

Where the hell did Nima Shek come from, the little monster!How did he manage to free his muscles!Ahhhhhhhhhhhhhhhhhhhhh Jiefang University School of Medicine is indeed one of the best medical schools in the country, this kind of method is comparable to that legendary hand that splits tendons and bones.If Wang Lei learned it, it must be passed on from male to female!

Wang Lei looked at those neat muscles and spinous processes with bright eyes, and he must dig them from Xie Ke after the operation!Even if it's a sack, no, even if it's a confession to be a father, I won't hesitate!

At this time, Xie Ke also came up with a sigh of relief. He had fully exposed the bone, and the next stage was the real operation stage.

The first thing Xie Ke saw was the first vertebral body of the spine, the atlas.

There are a total of seven cervical vertebrae. In current textbooks, they are generally marked from c1 to c7.

C is the first letter of their English name bra.

And c1 also has a name called atlas.

Huan, the world also.This is similar to what the Europeans call atlas.

Perhaps not everyone knows that the word anatomical atlas in medicine originally comes from geography.

In 1569, a man named Mercator drew a map of the world using a projection method he himself pioneered.This process was extremely time-consuming, so it was not finally completed by his son Mercator Jr. until the year of his death.Following his father's wishes, Little Mercator published a map of the world, using a picture of the Greek Titan, Atlas.

In Greek mythology, after Zeus expelled his father Cronus, a group of giant gods who called themselves Titans fought back against Cronus with Cronus and fought against Zeus in every possible way.In the end, however, Zeus won and sent all the Titans to hell forever.During this period, in order to punish Atlas, the king of the Titans, Zeus let him carry heaven on his shoulders because he disturbed heaven.

At that time, the Greeks believed that the Strait of Gibraltar on the west coast of the Mediterranean Sea facing Atlas was the end of the world.The Atlas Mountains in North Africa were transformed from this Titan, and the ocean west of the Strait of Gibraltar is the Atlantic Ocean.

Starting from the little Mercator, in world geography, it has gradually become a trend to be associated with atlas.Since then, atlases have also come to be known as atlases.

As this trend developed, illustrations and anatomical pictures for medical school became known as atlas, or atlases.This is because anatomy, like geography, is in a sense always looking for the best way to get to a certain area of ​​the body, so an anatomical illustration is like a map in human geography.

In addition, below the skull, the first vertebra of the spine is also called atlas.Because the first cervical vertebra supports the head, just like it supports the spherical form of heaven or earth.

Therefore, c1 is as important as the atlas that shoulders the heaven, even though it is just a ring-shaped bone block without vertebral body, spinous process and superior articular process, but only composed of anterior arch, posterior arch and two lateral masses.

The reason why Xie Ke attaches so much importance to the atlas in front of him is of course not only the remembrance of history, but more importantly, it is the object of Xie Ke's operation.

The first step in this operation is occipital-cervical fusion, that is, to fix the atlanto-occipital joint.

Atlas has no vertebral body, its anterior tubercle is the insertion point of the longus colli muscle, the posterior tubercle is the insertion point of the rectus capitis minor and the suboccipital membrane, and the larger transverse process is the insertion point of the superior and inferior oblique muscles , the vertebral artery passes through the transverse foramen, and the superior articular surface forms the atlanto-occipital joint with the occipital condyle.

The atlanto-occipital joint completes flexion, extension and lateral flexion with the participation of the anterior and posterior occipital membranes, continuous anterior longitudinal membrane, ligamentum flavum and joint capsule.

The high flexibility of the occipital-cervical joint itself makes this part of the fusion surgery face many challenges.After a period of development, the classic wire fixation was gradually eliminated, and most doctors chose screw and rod-plate fixation instead.Because the "fixing" effect of screws and rods is much better than that of steel wires.

However, Xie Ke didn't agree. He made people's eyes catch the abandoned steel wire.

Before the operation, both Zhu Ming and Wang Lei were puzzled, but Xie Ke just smiled and said, "You will know when the time comes."

But now it was obvious that this time had come, Xie Ke took a step back and exposed Shu Ye to Zhu Ming and Wang Lei.