If you look at the anatomical diagram, you will find that the bone plane of the posterior superior iliac spine is larger than that of the anterior superior iliac spine. The larger the bone plane, the easier it is for the needle tip to implant. Unlike a small bone plane, the needle tip will easily rub against a wheat awn and it is difficult to insert the needle vertically.
It is very important to insert the needle vertically. Bone puncture itself is to insert the needle into the bone, and the bone is hard, which means it takes a lot of effort. Inserting the needle vertically is like hammering a nail. The vertical force is easy to insert, and the force can be used to the minimum to cause the least damage to the child's bones.
It is common to see some bones that are difficult to penetrate in clinical practice. When the clinical teacher is drilling the bone, if the teacher's expression is like drilling the bone, he is exerting force. This kind of force is not only laborious but also afraid of overexertion. Zhang Desheng was afraid of death when he was drilling for the first time, so he didn't dare to start drilling hard all at once. If the needle cannot be inserted vertically and cannot be inserted, the psychological frustration of the novice is far less than that of the veteran who will collapse instantly.
Secondly, in clinical practice, the bone marrow dilution rate is quite high when extracting bone marrow. What is bone marrow dilution? It means that no bone marrow can be extracted or too little bone marrow is extracted, and the sample extracted is mostly blood. Such a sample will definitely fail the bone marrow test when sent to the laboratory. It needs to be re-extracted, which is equivalent to a bone marrow biopsy failure.
The problem is that if the posterior superior iliac spine is chosen, the child will need to sleep on his stomach, which will inhibit his breathing. Perhaps based on this consideration, Zhang Desheng was reluctant to choose the posterior superior iliac spine. The main reason was that the child's parents were too difficult to deal with, and the doctor was not willing to take the risk.
Instead of letting the child lie prone, another method is to let the child lie on his side with his knees hugged to expose the posterior superior iliac spine. This position is not easy to fix. For this reason, Zhang Desheng respected Xie's opinion.
It may be a little difficult to get into a good position, but it is better than the anterior superior iliac spine being difficult to penetrate as Xie said, and the needle swinging in the middle for a long time, which will have even more serious consequences.
There is no need to be too scared as there are classmates to help you.
I reported to Teacher Tian and chose the posterior superior iliac spine, and Teacher Tian and Teacher Wang agreed.
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Several classmates began to help the child adjust his position. Two other surgical students came up to help.
Carefully change the child to a side-lying position, and when controlling the child, control the joint movement position instead of pressing hard on the child.
The location is said to be the posterior superior iliac spine, but in fact the puncture point is the protrusion between the posterior superior iliac spine and the fifth lumbar vertebra.
After changing the child's position, Zhang Desheng felt something different. He could feel a relatively flat bone surface with his gloved hand, which showed that this position exposed the bone position for surgery well. It was different from the initial feeling of the anterior superior iliac spine, which was just a bump and difficult to insert the needle.
Considering that the child's current position was arranged by Xie, Zhang Desheng praised Xie in his heart: Xie is amazing.
Doctors will naturally feel more confident when they can feel the acupuncture points that are generally easy to insert.
Zhang Desheng then continued to work hard, injecting the anesthetic into the periosteum with high accuracy, and it was done with ease. He pressed the area where the local anesthesia was applied, and when he inserted the needle again, he felt confident and pushed the bone piercing needle straight down. He could quickly feel something coming up when he pulled the syringe plunger. The process was incredibly smooth.
If the doctor acts quickly, the child's pain and discomfort will definitely be relieved. Children, like adults, are most afraid of long-term pain.
Seeing that the students had extracted the bone marrow in a few seconds, the two supervising teachers nodded vigorously: These students did a good job and they can do it on their own without the teacher's guidance.
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