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    Home > Medical News > Medical World News > From misdiagnosis to difficult surgery Folding people to restore upright erectity is behind an ecological change in a disease.

    From misdiagnosis to difficult surgery Folding people to restore upright erectity is behind an ecological change in a disease.

    • Last Update: 2020-08-02
    • Source: Internet
    • Author: User
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    Text . . . Jianwen Yang's chin against the chest, chest to the stomach, face to the thigh, known as the "3-on folding person", 47-year-old Li Hua is the world's most publicly reported post-convex malformation of the most serious severe severe spinal spinabitis (AS) patients.
    photo taken during a check-up by Li Hua.
    Although i have seen the photos before, but in the ward to see me, Shenzhen University General Hospital spinal disease department director Tao Huiren is still somesurprised.
    "spinal protrusion swell is severe, but the general head is above the back, like his head below the back, almost never seen.
    " June 13, 2019 to June 13, 2020, Shenzhen University General Hospital, after the first half of four major surgery, the second half of the rehabilitation treatment, cost more than 700,000 treatment costs, Li Hua folded for many years of body was finally opened, resumed upright walking.
    the outcome looks bright, but his life could not have folded, such a serious spinal deformity is not the inevitable end of the patient, but the result of many misdiagnosis.
    misdiagnosis rate is a problem that patients with strong direct spina bifida (about 4 million in China) need to face, and many patients need to be diagnosed five or six years or more.
    is known as "indie cancer" and there are no very effective drugs before the advent of biologics.
    in the past, the cost of treating biologics a year was two or three hundred thousand, which for a non-fatal disease, the cost of such a disease was prohibitive for many patients.
    in recent years, from diagnosis, drugs to costs, strong diagnosis and treatment of the ecological changes, Li Hua is one of the beneficiaries of this change.
    Source: The documentary "Open Folding Life" has four operations to open the folding life of Li Hua's surgery, known as the medical technology of Mount Everest.
    Tao Hui said to the eight-point health, "the more difficult surgery, the more can reflect the level of doctors and hospitals."
    " he has been engaged in spinal surgery at the Fourth Military Medical University Xijing Hospital (hereinafter referred to as Xijing Hospital) for nearly 30 years, with about 150 one-year operations, and more than 80 one-year operations since joining Shenzhen University General Hospital in June 2018.
    Li Hua in the group of patients saw a postoperative contrast of his surgery for spinal deformities patients, feel that they are saved, after the transfer of contact, from Yongzhou, Hunan Province to Shenzhen for medical treatment.
    spinal orthopaedic surgery requires placing the vertebral arch nail into the patient's spine, adjusting the deformed spine to normal physiological curvature with corrective devices, and fixing it with a built-in retention bar system.
    Li Hua's situation is special, the conventional corrective methods have been difficult to restore its normal curvature, the need to bend seriously several spinal bone truncated and then connected.
    and the spinal cord is encased, which can cause paraplegia if the surgery injures the spinal cord.
    it was a marathon operation.
    Tao Hui originally planned to correct one bone in order from bottom to top: first two-sided femur neck cut- bone, face and thigh separation, so that Li Hua can lie down for surgery;
    but the first surgery cut off the double-sided femur neck, did not smoothly open the thigh and face, due to long-term bowing, Li Hua's hip contraction in a state of stiff flexion, only opened 20, 30 degrees, and to allow Li Hua to lie down next to undergo surgery, at least 60 degrees.
    in this case, Tao Hui people can only change the surgical program, should be the third step of cervical amputation surgery ahead of time.
    breaks the neck at the junction of the neck chest, then lifts your head and reconnects.
    the second operation opened the angle between the face and thigh, Li Hua finally underwent the third session of the reclining lumbar malformation corrective surgery.
    's third operation lasted 10 hours and 25 minutes, cutting off Li Hua's chest 12 and waist 3.
    during the operation to reset, 6 male doctors drilled to the operating table, two dragged the thigh, two dragged the lumbar spine, two head, under the command of Tao Hui people, little by little to move, so that Li Hua's spine became a straight line.
    the doctor and nurse saw Li Hua's face for the first time after the operation.
    Source: The duration, amount of bleeding and dangerousness of a spinal correction surgery in the three-fold surgery of the documentary "Opening folding life" is equivalent to a joint transplant operation of a heart, liver and kidney.
    Tao Hui people summary: anesthesia, infection, osteoporosis, is the surgery of the three major difficulties.
    anaesthetic is the premise of the operation, the conventional full hemp, the patient is first inhaled by the breathing mask of the drug, in a state of unconscious ness is inserted into the trachea intubation.
    but Li Hua's facial space forced, mask can not be fed, can only be in a sober state using fiber bronchoscopy intubation, which requires the close cooperation of anesthesiologists and patients.
    in addition, due to Li Hua's physical condition is limited, can not understand his airway conditions, making the intubation difficult, if the process of asphyxiation, there may be life-threatening, and the gap in the face is too small, resulting in oxygen maskand other rescue equipment can not be sent.
    so once the intubation starts, there is little room for failure.
    The Director of Theaesthetic Department of the
    , Sun Wei, is intubating, Source: The documentary "Open Folding Life" Anesthesiology Department Director Sun Wei under great pressure, the trachea smoothly inserted into Li Hua's lungs, through the most difficult pass. the second major problem
    is postoperative infection.
    once the infection occurs, the nail that has to be entered into the spine must be removed one by one, and after taking the nail, Li Hua's spinal bone is broken, "this is very contradictory, the consequences will be catastrophic, " Tao Hui said.
    the third operation, Li Hua fever, everyone's heart is hanging, fortunately finally ruled out the infection. the third difficulty of
    is osteoporosis.
    years-round deformity makes Li Hua osteoporosis very serious, nails hit down is easy to pull out, and if pulled out, there is a risk of paralysis.
    , osteoporosis also caused a lot of difficulty with the fourth hip replacement, loose bone is very easy to fracture, and once the hip fracture, the patient will not be able to resume walking.
    in the spinal surgery, joint surgery, anesthesiology, infection department, ICU and other disciplines of cooperation, all four operations were carried out smoothly.
    the total cost of surgery more than 700,000, health insurance can report more than 500,000, specializing in the treatment of family poor spinal deformities patients of the Intellectual Good Public Welfare Foundation donated 140,000, Li Hua himself bear tens of thousands.
    a photo taken before he fell ill at the age of 18.
    benefit from the development of social media, misdiagnosis in recent years in reducing Li Hua's disease to such a extent, is the result of many misdiagnosis misdiagnosis.
    According to Ice Point Weekly and The Sun News: At the age of 10, Li Hua first felt pain in his right joint and there was yellow water in his knee.
    doctor closed his swollen knee and pulled out the yellow water, the knee and foot did not hurt.
    eight years later, the same pain appeared on the other foot, but with the same treatment, the pain did not go away as it did eight years ago.
    quickly, the waist is weak; then, walking with his hands pressed on the hip to barely walk; and then, when he sleeps, the hip scares him, can't lie flat, can only sleep sideways.
    from the age of 18, Li Hua around to seek medical advice - urban hospitals, Miao medical clinics, Qigong master's home, said to be able to burn incense treatment alternatives, nothing.
    doctors say it's arthritis, others say it's walking arthritis, and another says it's rheumatoid arthritis.
    later, Li Hua pain can only bend down to walk, not long, the neck began to bend.
    seeking medical treatment around no results, Li Hua learned to use cold medicine analgesics, "cheap and useful", until the whole person bowed into a "folding knife."
    Li Hua's misdiagnosis is related to strong ecology.
    qiang has been an auto-inflammatory disease, the incidence rate in China is 0.3% (according to the Chinese Medical Association rheumatism credit association statistics), the number of people about 4 million, many stars such as Zhou Jielun, Zhang Jiatranslation, Cai Shaofen have openly said that they are strong patients.
    , actor Zhang Jiaxuan in "Open Talk" about their own experience of strong.
    for half a century, with the refinement of disease classification, rheumatologists have a gradually clear understanding of aggressive spina bifida: in 1966, the American Rheumatoid Association for the first time separated the form of spina bifida from rheumatoid arthritis, and in 1977, 1984, 2001 and 2009, respectively, revised the diagnosis and classification criteria of AS.
    in the newly published classification standard, strong-straight spina bifida has been renamed "mid-axis spinal arthritis".
    but the new name has not yet been widely used, people are still used to calling it "strong straight".
    there is a serious shortage of rheumatologists in China, zeng Xiaofeng, president of the rheumatologist branch of the Chinese Physicians Association and director of the rheumatology immunology department at Beijing Concord Hospital, said that the number of rheumatic immunology registrations increased from more than 7,000 to 12,000 in 2015-2018, but only 7,000 were rheumatologists.
    2,427 tertiary hospitals in China, with only 770 independent rheumatic immunology specialties, less than one-third.
    pain involves bones and joints, so many patients will go to other specialties for consultation, easy to lead to misdiagnosis.
    the situation is about to improve.
    October 31, 2019, the General Office of the National Health and Health Commission issued a Circular on the Issue of Guidelines for the Construction and Management of Rheumatic Immunisation Departments in General Hospitals (Trial), calling for the strengthening of the construction and management of the Rheumatic Immunisation Section. "In the future, we will set up independent departments in 1657 tertiary hospitals to train more than 10,000 specialists, and strive to make the second-level hospital at least one specialist, so that patients can get professional treatment without leaving the county, "
    zeng said in an interview with the media. Huang Zhengping, a rheumatologist at the Second People's Hospital of Guangdong Province, told Eight News that he had observed that the probability of severe spina bifida being misdiagnosed in recent years was getting smaller and smaller, thanks to the development of social media.

    for example, 37-year-old Zheng Jun has been diagnosed with strong scoliosis for 24 years, early 2019 began to share their own experience of illness, from their own experience to do strong knowledge of science.
    as a "senior strong patient", Zheng Jun often to come to the identity of the reader to answer questions.
    many readers in his suggestion to go to the rheumatology department, and was diagnosed.
    Huang Zhengping said that with the development of rheumatology in hospitals and network development, in recent years has developed to the spinal bone, affecting life of the strong patients are very few, he in 2019 to see more than 200 patients, such patients less than five.
    the birth of innovative drugs, strong straight is no longer "undead cancer" now, the network is often called strong straight as "undead cancer."
    , Xie Wei, a rheumatologist at Jiangsu Provincial Hospital, thinks this statement is exaggerated, "In the scientific diagnosis and treatment, strong straight has been able to be effectively controlled."
    " and Wuhan Jinyintan Hospital rheumatologist, science writer Yan Shun, believes that before the emergence of biological agents TNF-alpha inhibitors, this statement is not exaggerated.
    TNF-alpha inhibitors (including inphyxetainate, Adamu monoidatagain, inaxiu, Cetocipu, etc.) can neutralize the substance TNF-alpha, which causes abnormal activation of the immune system, preventing it from exerting immunological effects and preventing immune cells from attacking its own tissues.
    2007, when the biological agents in the domestic initial surge, but also in the study of the first time to see its "magic effect", a long-term trapped patients in the ward, after a shot quickly improved, actually the next day can be discharged from the hospital, which is known in medicine as "dramatic improvement", the whole department was greatly excited.
    " the emergence of biologics can be said to have changed the face of our rheumatic diseases.
    "Until then, up to 90% of the patients he treated were exposed to the bias outside the scope of modern medicine, " and "when patients go nowhere, they usually turn to God and the partial side."
    " in all patients with severe scoliosis, mild patients accounted for 60% to 80%, this part of the patientonly only need to regularly take nonsteroidal anti-inflammatory drugs;
    ," he added.
    the cost of treatment, from 30,000 a month to 300 can accurately diagnose, with the drug, the cost has become a third problem.
    , remember, around 2007, the first generation of imported biological agents Enley, two injections a week, a month spent 16,000 to 32,000, the vast majority of patients can not afford.
    domestic biologics are slightly cheaper, costing two or three thousand yuan a month.
    2007, when he interned at Xiangya Hospital of Central South University, the majority of patients who played domestic biologics were.
    but there are still many patients can not insist, doctors call to inquire, the reason for giving up is basically "no money."
    evidence that Sumera's global sales reached $20.5 billion in 2018, but sales in the Chinese market have been poor for a long time, with sales of only 21.2 million yuan and 14.6 million yuan in 2018 in China's sample public hospitals and sample drugstore chains, respectively.
    during the long period of illness, Zheng Jun experienced three stages of drug treatment: "first of all, slow-acting anti-rheumatic drugs, such as ljuxanox;
    " Zheng Jun remembers, more than a decade ago, imported biological agents grams (Inphysei monoantinos) a team to 6, 7,000, every two weeks of needles, 12,000 to 14,000 a month, Xiu Meile is similar, the burden of patients is great.
    2019, Xiu Meile and The Class have entered the national health insurance directory list, Xiu Meile from about 3000 yuan a drop to 1290 yuan a.
    according to the patient every two weeks injection, the proportion of medical insurance reimbursement 70% to calculate, included in the medical insurance before the patient spent about 6000 yuan per month, after the inclusion of medical insurance patients only need to pay 774 yuan per month, can save more than 5000 yuan per month.
    Zheng Jun is now injecting is a domestic biological inhibitor, the original price of more than 500 yuan a, the first week to play two injections, first three months, and then under the guidance of doctors gradually reduce the frequency of injections.
    this drug was included in the scope of medical insurance reimbursement in Xiamen City, one month.
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