Chapter 332 Key points and key points! (Please subscribe)

"Well, these two are also gods! But you can't blame them. If you don't have enough realm, you can't discover the power of others." Qin Ming thought to himself and didn't say much.

In normal times, before Zhou Cheng came, Lu Bin had reminded him more than once in the department not to look down upon Zhou Cheng because of his young age.

However, people in the department still complained a lot because Zhou Cheng was young and did not do the work of junior doctors.

Later, after seeing Zhou Cheng's surgery, such rhetoric slowly disappeared. However, we cannot blame Yang Tao and others. They are only resident doctors and have not yet been promoted to attending surgeons, and they have not yet performed the surgery alone.

You still don’t know how many difficulties you have to face and how many details you need to pay attention to when you are actually doing surgery. At this time, when you want to study again, how precious is the opportunity to learn. It was a waste of time before to follow your own graduate tutor.

Time to study is so hard-won.

But we are all colleagues, so there are some things we can only say so much. Maybe these two have mines at home, or their dream is not to go up in the career ladder, and they have a mentality of just hanging around and waiting to die. You can't say that others are wrong.

After all, being a doctor is really just a job to support your family.

Zhou Cheng continued the operation, while Qin Ming continued to watch. After a while, Director Lu Bin arrived late and said he was sorry while washing his hands and getting dressed before going on stage.

The words were spoken to Zhou Cheng, and his tone and expression showed that he had been threatened by Zhang Zhengquan just before. The apology to Zhou Cheng was mainly for the purpose of truly apologizing.

When he was undergoing surgery, Zhou Cheng watched and escorted him all the way. Now that Zhou Cheng has just started to carry out his own surgeries and perform surgeries on his own outpatients, he is late and absent, and he has to explain to Zhou Cheng.

Zhou Cheng's thoughts were not focused on Lu Bin at all, he just continued to deal with the joints.

This surgery can be easy or difficult. The easy part is that it only needs to straighten the deformity and make it grow back. It can achieve the purpose of the patient's hospitalization, restore the deformity to a normal structure, and then have some functions.

It is not difficult to do this. All it takes is osteotomy. After returning to normal shape, the function will naturally be restored to some extent. There is no need to reconstruct the base of the phalanges and the pulley at all.

However, Zhou Cheng didn't want to treat the operation so lightly and just dismissed it.

Trying his best to do his best, he hopes to be able to functionally recover the patients after surgery and do a better job.

Professional rehabilitation guidance is only one part. The reconstruction of the original anatomical structure is the basis for functional rehabilitation. If the foundation is not established well, no matter how good the rehabilitation guidance is, the upper limit is still too low.

The degree of reconstruction of basic anatomical structures is the way to improve the lower limit of surgical quality. Assisted by rehabilitation guidance, it is possible to raise the upper limit while raising the lower limit.

Deformity osteotomy and orthopedic surgery are not uncommon, and Lu Bin usually performs them. However, when Lu Bin arrived at the operating table, his eyes were completely attracted to the surgery.

Then he tilted his head slightly and saw that Qin Ming's eyes were serious, so he looked at it carefully again and tilted his head to look at the flat film display on the reader.

"Hiss!" Lu Bin took a deep breath.

To outsiders looking at the excitement, Yang Tao and Guo Xiaobing were still hanging around the threshold, but Lu Bin understood what was going on.

"Dr. Zhou, did you do a good job in reconstructing the phalangeal base and pulley? It's a pity that such a good joint structure does not have a joint capsule and corresponding aponeurosis structure." Lu Bin immediately expressed regret.

Previously, in the deformed state, the patient's aponeurotic structure and joint capsule structure were pathological. After returning to normal structures, they were naturally useless and had to be removed.

If you have feet of size 40, you must wear shoes of size 35. If you don’t throw away these shoes, your feet will become useless sooner or later.

When Lu Bin said this, Yang Tao and Guo Xiaobing stopped talking in private and carelessly, and looked over seriously. They could probably understand the meaning of Lu Bin's words, but to really understand it thoroughly, they still lacked basic skills.

Meeting someone who understood, Zhou Chengcheng continued: "Director Lu, this is what I think. Although the joint capsule and aponeurosis structures are difficult to reconstruct, we can try to create a similar structure by repositioning the tendons.

Increases functional mobility of joints.”

These words were never spoken to Qin Ming and others before.

Because during this period, whether it was through simulations in the simulator or through some teaching experiences in reality, Zhou Cheng also knew that sometimes it was not good to go beyond the limit.

Qin Ming and others did not respond at all, which meant that this was beyond their knowledge system.

Is surgery simple?

It is not simple at all. In every place, what parents give us is the best. No matter how we repair it, it will never reach the level it was born with. This is an objective fact.

Even these structures in the thumb cannot be fully restored. It is quite difficult to fully understand, understand and apply them flexibly.

Hearing this, Lu Bin clicked his tongue slightly and asked: "Dr. Zhou, what do you mean? To replace the missing joint capsule and tendon sheath through tendon transposition or transplantation? Isn't this difficult?"

Zhou Chengze continued: "It's not easy. It depends on the person. Our thumb also has a metacarpophalangeal joint. I plan to explore the aponeurosis structure inside it later and see if I can wear it more."

A tendon passes."

"You can't create something out of nothing, so you can only make the best use of it." Zhou Cheng continued to observe the remaining structures while thinking about contingency strategies.

Lu Bin thoughtfully helped silently, then took the forceps from Qin Ming's hand and carefully assisted Zhou Cheng, his tone full of excitement: "This is another extraordinary operation.

Ah, Qin Ming, Yang Tao, you should look more and think more."

This is definitely a good thing. Thumb deformity actually affects the patient no matter how serious it is. However, if the patient's original function can be restored to the greatest extent through surgery, this surgery will not be simple.

Zhang Zhengquan was relieved when he saw that Lu Bin and Zhou Cheng were cooperating with each other and had no intention of selling him out.

Lu Bin's ability to understand things meant that he would stop explaining unnecessary things to Zhou Cheng. Lu Bin would be fine if he did, but Zhang Zhengquan also had other considerations.

Ten minutes later.

Lu Bin asked: "Dr. Zhou, do you plan to do tendon transplantation? Or do you plan to do transposition?"

At this time, both methods can be chosen and both can achieve results, but which one is better cannot be specified. In fact, when the patient’s functional improvement requirements are not high, a transposition can be more effective.

good.

After surgery, the patient loses some other functions, but it is great to be able to replace functions in more directions and complete basic operations of the hand.

"Our thumb has the highest range of motion. Transposition on this finger is impossible. I thought about it and decided that we should do a transplant. The extra extensor pollicis longus tendon can still be used.

It works."

"If it doesn't work, let's see if we can get it from other parts." Zhou Cheng continued to lower his head, slowly resting the exposed extensor pollicis longus tendon and flexor pollicis longus tendon in front of him, and then hesitated for a moment.

Zhou Chengcheng chose to cut the proximal end of the flexor pollicis longus tendon, but left the distal insertion point intact.

Lu Bin quickly saw what Zhou Cheng meant. His scalp tightened and he asked: "Dr. Zhou, the length of this flexor pollicis longus muscle is very limited. If you cut off the proximal end, will there be two sutures or two?"

In the middle section, there is a high risk of breakage after surgery."

Lu Bin was confused.

Generally speaking, tendon transplantation is mostly done at the insertion point. At the insertion point, one end is fixed by fixing the tendon and bone, and then the whole deformation only needs to be sutured in a single place, so the risk will be reduced.

a lot of.

When getting used to an operation, no matter how elaborate the pre-operative discussion is, the details during the operation cannot be perfect, but are decided temporarily based on the actual situation and the surgeon's own skills.

It is right to comply with the basic theory and adapt to changes according to circumstances. Rather than accepting the rules to death.

"It's not bad. As long as the tendon is sutured properly, the risk of rupture is not high. Moreover, the natural muscle insertion point will be more conducive to mobility. On the contrary, it will deform in the middle and is just a borrowing structure." Zhou

Cheng said his inner thoughts.

What Lu Bin said is certainly true, the risk is high.

But Zhou Cheng is right, the income is high.

Moreover, the risk can be compensated to a certain extent through suturing technology and postoperative rehabilitation guidance!

Lu Bin stopped pressing, and instead turned his head and said to Qin Ming: "Qin Ming, when you have time, go check the corresponding literature. I think it might be good to write a case about this patient."

A case is a case report.

Qin Ming immediately nodded: "Director Lu, I think so too."

Zhou Cheng glanced at Lu Bin and Qin Ming, smiled and said nothing. In this regard, Lu Bin's scientific research acumen was higher than Cai Dongfan's.

When Zhou Cheng was with Cai Dongfan in the past, Cai Dongfan never thought about writing articles, but Lu Bin was able to capture this point keenly, and he still had the mindset to think and share.

This is also a type of scientific research thinking. Although it is simple thinking, it is also a kind of consciousness.

The reason why Lu Bin attaches great importance to cases is that no one mentioned this matter when he was in the Ninth Courtyard of the Magic City. It is because in the Ninth Courtyard of the Magic City, several cases were completely boring. They were too lazy to publish such articles.

I'm too lazy to write, there's no need.

The key is to work directly on the topic and publish RCT papers.

A case is a personal surgery show, and a randomized controlled trial is a sublimation and promotion of a theory. The starting point of the two will be different. Teaching hospitals like Modou Ninth Hospital are no longer willing to show off their individual

The surgical technique of the case.

In this way, more than forty minutes passed.

Two new tendons reappeared in public view, and with the assistance of Kirschner wires, the patient's thumb changed from a passive flexion of fifty degrees to a straight state.

Lu Bin finished reading and sighed with emotion: "Wang Limin, you are really lucky to have met Dr. Zhou. From the current point of view, your thumb is worth looking forward to after the operation. The quality of this operation is definitely not good."

As good as any professor you'll find in the country."

"You can achieve this level of success with us, you've made a lot of money."

What Lu Bin said was a bit exaggerated, but Qin Ming also agreed: "This surgery is indeed exquisite. The anatomical structure can be reconstructed to such a level. The postoperative function will definitely not be too bad."

“And there are no blood vessel or nerve problems, so it’s worth looking forward to.”

"Wang Limin, you must cooperate with the exercises after the surgery. Otherwise, it will be a pity that Dr. Zhou has put so much effort into preparing you for so many basic conditions."

Wang Limin didn't understand that much, but these words sounded comfortable to him and he said solemnly: "Hey, thank you Dr. Zhou, thank you Director Lu, Director Qin, you are all good people."

"Don't worry, I will definitely cooperate and live up to your efforts and hard work. If you recover well after the operation, it will be a good thing for me."

"Thank you all doctors." Wang Limin did not forget to thank the others at the end.

The atmosphere in the operating room instantly became much warmer, and everyone felt relaxed.
To be continued...