Chapter 1244: Chapter 955: Don’t Ask for dical Expenses Chapter 1244: Chapter 955: Don’t Ask for dical Expenses The cause of the femur’s disappearance has now been revealed, and what remains for everyone is to learn about this area through discussion. By examining this case, everyone has gained an initial understanding of idiopathic osteolysis. When encountering such a case again in the future, you will at least have a basic concept in mind.
However, this type of case is so rare that a physician may go through an entire career without seeing one. More often, it is understood through reading literature, which encourages everyone to study regularly and read papers, as this is the essential way for a doctor to break through the limitations of experience.
Song Zimo used imaging tools on the tablet to asure the distance of the femoral defect. Since the efficacy of the Ilizarov technique is uncertain for this disease, the only alternative is a thod with assured effectiveness—custom prosthetic implantation, using a custom tal to replace the missing femur.
Replacing the missing femur with a tal femur is also conditional. The remaining proximal and distal femur must provide good fixation for the implant, which includes not only temporary chanical fixation but also long-term, reliable biological fixation.
To achieve this, a certain length of both the proximal and distal ends must remain. Song Zimo asured the remaining lengths and found they just t the requirents, making the thod of implanting a femoral prosthesis viable.
Another thod—using the Ilizarov technique—is theoretically possible and should be the best option, but it requires a lengthy treatnt ti. The trouble is that the patient’s family is currently in a dispute with City People’s Hospital, and under these circumstances, no doctor would dare to use a new thod, even if it might be highly effective.
At this ti, doctors would definitely use conservative treatnt thods so as not to get themselves into trouble. The implentation of new thods requires the active cooperation of the patient.
“Can muscle attachnt be solved with the femoral prosthesis? If the muscles don’t attach, won’t it still affect the leg’s movent on that side? Just having a scaffold won’t provide the power, right?”
Li Guodong’s thinking was still very active, capable of pinpointing the issue.
Song Zimo’s gaze lingered on the tablet he held: “I’ve just asured, and there are enough muscle attachnt points on the remaining proximal and distal femur. As for the attachnt points along the femoral shaft, current biologic custom femoral prostheses can provide attachnt, though it takes so ti to form.”
A standardized training student worried about another issue: “The patient already has severe muscle atrophy, and there’s a very apparent thickness difference between the two thighs. The affected thigh is as thin as an arm. Will it be able to recover in the future?”
This graduate student was part of Zhao Wenbo’s group, who imdiately explained: “Muscles are plastic and follow the principle of ‘use it or lose it.’ He hasn’t walked normally for a year, leading to muscle atrophy for sure. As long as there’s no muscle fiber fibrosis, recovery is possible. With proper standardized rehabilitation training, the muscle volu and strength can both be restored.”
“Right, based on the timing, there’s no fibrosis in the thigh muscles yet, and they can still recover in the future. Don’t forget, the fact that bodybuilders can train their muscles so strong is the best proof of muscle plasticity,” Li Guodong chid in.
The current topic didn’t involve traditional Chinese dicine, so Li Guodong and Zhao Wenbo were getting along harmoniously, able to discuss calmly. But if it had involved traditional Chinese dicine, the two of them would be at loggerheads, not resting until a victor erged.
“Is fibrosis irreversible?”
Soone asked.
“Irreversible; pathologically, it is the replacent of muscle tissue with fibrous connective tissue.”
Old Jin answered.
A graduate student had a mont of realization: “Does this an that so patients with high-level peripheral nerve injuries who undergo nerve anastomosis often have poor functional recovery? And that patients with low-level nerve injuries recover better after surgery? Is this because the higher the nerve injury, the farther it is from its target, and the daily nerve growth of less than a milliter is too slow, so by the ti the nerve reaches its destination, the muscles have fibrosed beyond repair?”
“You’re talking about motor nerves; don’t sensory nerves have targets for their terminal organs too, like sensory corpuscles, and could they also fibrose?” another graduate student said.
Song Zimo imdiately dispelled their confusions: “Exactly, the terminal structures innervated by sensory nerves can also degenerate after a long period of lost neural support, and it’s irreversible degeneration. However, compared to muscle fibrosis, this happens much slower, which is why for the sa injury site, sensory nerve recovery is generally better than motor nerve recovery. Besides the degeneration of the terminal structures, another factor affecting nerve recovery is mismatch and attrition during growth—the farther from the end point, the greater the attrition.”
“I get it now; I’ve been thinking about this issue for a while, but it’s been quite vague. Now I finally understand,” the graduate student who asked the question earlier said, feeling relieved.
Through this open discussion, everyone also understood the treatnt thod for this disease: first, treat bone resorption with anti-osteoporosis drugs to inhibit bone absorption and improve bone density; then, use surgery to implant a femoral prosthesis, restoring the normal function of the femur.
“Does anyone else have thoughts about idiopathic osteolysis to bring up? Dr. Song! Let’s start this weekend’s rare disease awareness session with idiopathic osteolysis.”
Yang Ping felt that the discussion was sufficient and it was ti to move on to the next topic.
“Alright, we’ll add the topic of idiopathic osteolysis to this weekend’s lecture list. If nobody has objections, let’s discuss the solitary kidney we just ntioned,” Dr. Song instructed the graduate student operating the projector to switch the image.
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