The excruciating three o’clock in the afternoon finally arrived.
Director Han didn't come back, Director Ouyang and Director Bai went out to throw knives, and Director Ding was the dragon who saw the beginning but not the end.
Director Tian and Dr. Jin are here. Originally, this kind of small learning class was mainly for young doctors.
Professor Zhang’s surgery video is played repeatedly on the high-definition screen.
There were a lot of people coming, so Yao Ling quickly arranged for two nurses to help and add some folding chairs inside.
Zhang Lin sat at the outermost desk in the first row and spread out a notebook. Everyone signed and clocked in the notebook one by one.
"Sign and punch in, brothers, don't forget."
Zhang Lin shouted loudly, if you forgot, come over and make up for it.
Professor Zhang is not here for the time being. He asked Yang Ping to inform him near the end that he wanted to say a few words.
He said that as long as he was around, the children would not dare to speak, so he would not cause trouble.
"Professor Zhang, you are in good spirits today." Someone greeted Zhang Lin.
Everyone was shocked, "Nima, did you call me Professor Zhang casually?
"Hurry up, there are no seats left."
"In the elevator."
We are urging each other in the WeChat group.
Everyone has almost arrived. Zhang Lin Xiaowu maintained the order. Director Tian looked at his watch and told Song Zimo: "Start on time at three o'clock."
Among the attendees, Director Tian had the highest title, so he naturally presided over the meeting. He also wanted to listen to this lesson. Professor Zhang's surgery was so fast and bold, and he also wanted to participate in the discussion.
The seats were packed, and a lot of folding chairs were added around, but it was still not enough. Some people were standing.
In normal small lectures, some guys will try their best to get away for various reasons.
Today, except for those who performed emergency surgeries with the general resident, everyone else came. All the interns were here, and people from other departments also came. There are not too many people to join in the fun.
Three o'clock, start on time.
Song Zimo stepped onto the podium, wearing his iconic unbuttoned white coat.
He is a born star. In addition to his outstanding appearance, confident temperament, and his thunderous eyes, which are full of electricity, he has fascinated countless girls.
But today, most of the people present are men. It seems that no matter how full the power is, it is empty.
"Biomechanical Analysis of Hip Fracture"
Biomechanics is no stranger to orthopedic surgeons and is a required course for graduate students.
When everyone sees these words, they are familiar and unfamiliar. Regarding biomechanics, these are the only words left in the mind, and even the fragmentary concepts cannot be remembered.
"Everyone is very concerned about Professor Zhang Zongshun's surgery. Why did he walk so quickly and fully bear weight? Today, Dr. Yang and I used the lecture time to study and discuss with everyone." Song Zimo spoke at a medium speed and spoke clearly.
.
"Intertrochanteric fracture is no stranger to everyone, and it is a surgery that we often come into contact with. What everyone is confused about is that this intertrochanteric fracture, the fracture was crushed, and you can walk on the ground within 24 hours? Or is it full weight bearing? Is this a reckless act?
There is a scientific basis for it. I will tell you about it now. Please pay attention to the animation demonstration on the screen."
An animated demonstration of the hip joint appeared on the screen. Based on the three-dimensional CT reconstruction, it completely simulated Professor Zhang's fracture at that time.
"As you can see, Professor Zhang's intertrochanteric fracture was comminuted at that time, and it was also comminuted on the medial side. The stability of this fracture is completely supported by the medial cortical bone, which is the load-bearing wall. Now that the medial side is comminuted, everyone thinks that it cannot be repaired after surgery.
Walking with heavy loads in the early stages." Song Zimo quickly entered the focus of the problem.
The animation continues to demonstrate, and now it has become a simulation after fracture surgery, and the conduction of gravity is marked by red lines and arrows.
A few students, who were close to the desk where snacks were arranged, secretly reached out to grab a few candies to eat, but immediately retracted their hands. Don’t miss the knowledge point.
Song Zimo put his hands on the podium: "This involves mechanical knowledge in orthopedics, that is, biomechanics. Most of us only have a sporadic grasp of biomechanics, not even a sporadic grasp. If it weren't for this surgery,
It deeply stimulated me, and I didn’t realize that biomechanics was so important to orthopedic surgery. But our Dr. Yang was aware of it and actively applied it in surgery.”
Song Zimo walked down from the podium, turned his back to the screen, and walked between the rows. Yang Ping remembered that when he first came to the hospital and was interviewed, this guy had the same arrogant attitude, walking between the rows while talking.
"To achieve early weight-bearing walking with this kind of fracture, two conditions must be met: anatomical reduction to establish conditions for bony support; and stress shunting to reduce the burden on bony support. Look!" Song Zimo turned around and faced the screen. p>
"Needless to say anatomical reduction, several bone fragments have been completely reset, and everyone has no doubts. I will only talk about the second one, shunt stress. This is the focus of today, the application of biomechanics!" Song Zimo was very eloquent and insisted on talking about it.
A class turned into a speech.
Yang Ping slandered: I worked hard to do the surgery, but this guy is happy on the podium.
The classroom was completely silent, and everyone concentrated on acquiring knowledge.
"In order to divert stress, this surgery uses the principle of tension bands and barrel hoops."
Everyone is familiar with tension bands. They are often used for olecranon fractures and patellar fractures to convert tensile stress into compressive stress. This is the first time I have heard of this barrel hoop.
Someone started scratching their head and neck.
"The steel cables on the outside are tension bands, and these three steel cable rings that fix fractures are barrel hoops." Song Zimo returned to the podium again, and the mark symbol transformed by the mouse moved on the screen.
"Pay attention to the animation. When a person walks upright, the normal line of gravity runs from the spine to the second sacral vertebra, then to the hip joint, and from the femoral head downward along the vertical line of gravity of the lower limbs."
The animation is extremely beautiful and intuitive, and the red gravity lines generally flow along the route just mentioned.
"For ordinary simple intertrochanteric fractures, the bony support can bear the weight, so for simple trochanteric fractures, after anatomical reduction and PFNA fixation, you can rest assured to walk with weight within 24 hours. But for comminuted intertrochanteric fractures, the bony support cannot
What should I do if I bear the weight?"
What to do? Cold salad! I’m here to listen to the lecture, you ask me. Everyone’s thinking was mobilized by Song Zimo.
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"This is the best way to shunt gravity. Watch this animation."
It used to be an animation of normal people’s gravity conduction, but now it’s an animation of Professor Zhang’s post-fracture model.
"Gravity starts from the femoral head and is divided into four routes. The bony support conducts a part downward, the intramedullary nail conducts a part downward, a part is converted into the tension of the lateral tension band steel cable, and the other part becomes three steel cables.
The expansion force of the hoop. This reduces the load on the bony support to avoid fracture displacement, and reduces the load on the intramedullary nail to avoid fatigue fracture."
The animation is simple and easy to understand. The red gravity shunt line, one goes down along the femoral shaft, the other goes down along the intramedullary nail, and the two finally merge; the two red arrows on the outer steel cable ring go in opposite directions along the steel cable to form an up and down pull.
Pulling force; three steel cable hoops, surrounded by arrows, seem to be expanding and exploding in all directions.
Got it, got it, everyone suddenly understood, some were still puzzled, and the audience started whispering to each other.
Dr. Jin and Director Tian sat together: "This is really clever. I usually use steel cables, but my understanding is not so deep. You need to be familiar with various parameters of bone blocks, steel cables, and intramedullary nails."
Do you dare to combine it like this? The position and thickness of the three steel cable rings should be very particular, especially when locking the ring, the tightness of each ring is different?"
Director Tian turned sideways and said, "You are right, the three rings are different in thickness and tightness. In this way, under the action of compressive stress, it is ensured that the tip of the distal end of the medial main bone block is always slightly toward the medullary cavity to resist the gap.
Otherwise, once it faces outside the medullary cavity, it will slide out in a short time, and the barrel hoop will become ineffective. The mechanical knowledge contained in this operation has exceeded the knowledge of orthopedic surgeons. Lao Jin, I have gained experience. It turns out that steel cables can
That’s how it works.”
"This guy is a bit evil. Director Han has a very evil eye. I heard that he was picked up by this group of newcomers during their interviews," Dr. Jin said.
Director Tian smiled and said: "Do you still remember? He embarrassed me on the first day he went to work. It's all thanks to him, otherwise I would have really fallen into a trap."
Dr. Jin remembered: "The hidden femoral neck fracture you mentioned, I went out for a meeting that day and came back to listen to what the doctor under my command said."
Privately, Director Tian and Dr. Jin also got along well. Dr. Jin is much older than Director Tian. Although he is still the attending physician, Director Tian respects him very much and does not treat him as an attending physician at all.
There was a lot of discussion in the audience and it was a mess. Everyone's cognition was somewhat severely shaken.
Everyone is in this major and has received professional education. With such an explanation and animation demonstration, there is basically no obstacle.
There are so many mechanical principles in this orthopedic surgery. Did Newton also study medicine? I really doubt that his enlightenment was not because of the apple, but because of the fracture.
Song Zimo knocked on the podium, and the audience gradually became quiet: "I want to emphasize that the next similar operation will fail if you use the same method!"
When I asked this question, I just woke up and was confused again.
Song Zimo explained: "Why? If the principles of biomechanics are not grasped, satisfactory results cannot be achieved. The number, thickness, position, tightness, and intertwined structure of the cerclage steel cables cannot be placed casually, otherwise it will become an ordinary
The fixed ring cannot change the direction of force and cannot maintain the stability of the fracture."
Are you so particular about wearing a ring?
Everyone knows that the tension band is often used for fractures of the ulna, olecranon and patella. I didn’t expect it to have such a wonderful effect.
The same goes for the steel cable ring. Isn't it sometimes used to tie up the fracture and fix the fracture? What kind of stress should be converted?
It really hurts my head!
"It's not that complicated. If you feel your brain is burning, your brain capacity is too small. When you have time, take a look at the body structure of the car, especially Volvo and Subaru, and see how the frame disperses the stress after a collision."
A faint voice sounded, and everyone looked around to see who was so arrogant. It turned out to be Xu Stuttering from the emergency department.
This man was born with a stutter. He was well-known in the hospital and often performed shocking actions. It is said that once, the emergency department received a patient with severe multiple rib fractures, blood gas, chest and lung contusions, and cardiac and respiratory arrest. This man killed him.
Decisively, he opened his chest on the spot, held his heart in his hands and massaged it - the patient was saved.
At this time, the venue was like a pot of porridge, but now the pot of porridge is boiling even more.
Song Zimo asked everyone to be quiet: "Now let's take a break for ten minutes, eat something, and discuss it later."
***The author has something to say***
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