2/7(水)
◆今日の気持ち
(整形外科 2週目)
・執刀! ばね指だけれど。
・癒着性イレウスの小腸が新鮮だった
●目指す医師像
まずは、医者
●今の目標
・整形外科を味わいきる
●今日の新患・診断
・OA
・LCS 馬尾症状
・上腕偽関節
・腸骨骨折
・恥坐骨骨折
●今日の病院滞在時間
9時〜18時半
●今日行ったこと・見たこと・知ったこと
・術後癒着性イレウスope
・外来見学
・OAにヒアルロン酸の関節内注射。感染など怖いので、頻回にはやらない
・LCSにリプルalprostadil(PGE1)とノイロトロピンが効く、という。
・恥坐骨骨折したら腸骨骨折も疑う(Malgaigne骨折)
・LCSのスコアリング ope後の満足度なども含めてフォローに使用
・脊髄除圧の後のinstrumentでの固定。必要というevidenceはない。上下に負担をかけるし、reopeも難しくなる
・opeのための四肢の虚血は1.5時間まで。手術の区切りが悪ければ2時間までは延ばすこともあるけれど。それ以上も耐えられるだろうけれど、限界に挑む必要はない
・ばね指ope
炎症を起こしている腱を触診しマーキング。腕の脱血。皮膚の腺にあわせて皮切。そこにハサミを入れて引き、剥離。抜くときはさみを閉じて内部を切らない。腱を見つける。その内側・外側を剥離。手掌面の遠位・近位を剥離。腱鞘を小さく切開し、そこから遠位・近位にハサミを入れる。せっかくなので広めに
・糸結びは両端を引っ張り続けて固定する方法と、力をかけずゆすらないで緩ませない方法と、がある
・舌打ちするな、下にうつすな悪い癖
・電気メスはなるたけcutを使う。コアグラつくらないと見やすい
・小腸は適当に結んでもくっつく。リークさえしなければ
・閉創器。力で閉じようとするとすっとび危険。叩いて閉じる。
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