Medicine is not a child's play, it is an extremely rigorous science.
The treatment of fractures requires the support of systematic knowledge.
First of all, we must start with the treatment principles of fractures. The treatment of fractures should pay attention to three major principles.
Reduction, strict immobilization, and recovery.
The first thing to pay attention to is reduction. The purpose of surgery is also to serve for fixation and reduction.
only.
Whether surgery is required after a fracture is not certain.
Any kind of surgery has its strict indications and contraindications for surgery.
Patients with relative contraindications will choose whether to undergo surgery depending on the situation. If there are absolute contraindications, surgery will definitely not be performed.
Only patients who meet the indications for surgery need surgical treatment, because some fractures can be treated conservatively with manual reduction and external fixation with a plaster.
This can also achieve the purpose of reset and fixation.
If we talk about indications and contraindications, we only determine whether the patient can undergo surgery and whether surgery is needed.
Then, in terms of the choice of surgical method, a more suitable surgical method must be selected based on the type of fracture.
This patient had a tibial plateau fracture. The tibial plateau is often classified using the Schatzker classification, which is divided into type VI.
Basically all tibial plateau fractures require surgical treatment. This basic principle will not change. Unless the patient is in very poor physical condition and cannot tolerate surgery and has to leave the operating table, all tibial plateau fractures are at risk of death.
All plateau fractures require surgical treatment.
This will be strictly determined before surgery.
Once the surgery is determined, the surgical plan must be determined, and the surgical plan is determined based on the classification.
Type V of Schatzker classification: bicondylar fracture involving medial and lateral plateau splitting, combined with vascular and nerve damage, this type accounts for 12.0% of tibial plateau fractures!
So the surgical method for V-shaped fractures is that all fractures split by medical and surgical departments need to undergo open reduction and internal fixation to firmly fix the fracture.
After the operation, the patient's treatment returned to the principles of fracture treatment.
Reset, fix, recover...
Moreover, after determining the surgical method of medial and lateral internal fixation, how to choose the surgical approach, how to expose the broken end of the fracture and then suture it out is also very particular. Different surgical approaches have an impact on the overall quality of the surgery.
,Can not be ignored.
The traditional approach for tibial plateau fractures is naturally the medial and lateral approach, but there are better approaches to choose from.
Of course, all of this is what Zhou Chengxin is thinking, and he dare not and cannot say it directly. After all, he is only a resident doctor now with a junior professional title, and there is definitely no way he can handle open reduction and internal fixation of tibial plateau fractures like this.
of Category IV surgery.
Zhou Cheng silently modified the exposed parts.
Cai Dongfan remained silent, and Luo Yun didn't say much.
Zhou Cheng has been in the team for a long time, and this year is already his third year of regular training. He is actually a very experienced and reliable junior doctor. Naturally, he cannot continue to prescribe medicine just because of one mistake.
hate.
Just a little reminder is enough.
Also watching Zhou Cheng modify the exposed space was Du Yanjun. Although his expression didn't seem to fluctuate, he was still smiling secretly in his heart.
Du Yanjun knew from the fact that Zhou Cheng came to the department so early this morning to read the medical records that Zhou Cheng must also be interested in competing for the place in the hospital.
Du Yanjun didn't think it was ridiculous for Zhou Cheng to compete for a place in the hospital.
The hospital admission quota is quite precious and everyone wants it. This is human nature.
But relatively speaking, Zhou Cheng really has no advantage in this competition, so the possibility is extremely slim.
In terms of connections, Zhou Cheng is just an ordinary social training person. He is not as good as Du Yanjun and Min Chaoshuo, who have mentors as strong connections in the department. Not to mention Xu Yanlin, who has relatives who are deputy directors in the hospital.
Better than connections.
Compared with academic qualifications, Zhou Cheng has no advantage. There are four graduate students in the department, two academic ones, and he has SCI articles in hand.
He was also preparing to publish a second article. Du Yanjun felt that if he wanted to compete with them, he would have to publish SCI. Zhou Cheng wanted to publish an article, but the chance was too low.
Than chance?
Needless to say, without the strong backing of a mentor in social training, who would trust Zhou Cheng to get started? Therefore, if Zhou Cheng wants to compete, he must first gain the trust of his superior doctors.
In other words, you should try your best to show yourself to be better and attract attention first.
However, it was obvious that Zhou Cheng acted too hastily this time and pretended to be awesome until he got into the cow's belly, and then the cow sat down.
The consequences will naturally be disastrous...
But Du Yanjun would not laugh at Zhou Cheng, because Zhou Cheng is indeed not easy, there is nothing to laugh about, and he himself does not have a 100% competitive advantage.
If Zhou Cheng knew what Du Yanjun was thinking at this moment, he would definitely feel that he was very wronged. Du Yanjun's ability to make up for it is too strong.
…
After Zhou Cheng organized the surgical field, preparations for the operation began, and Cai Dongfan came to the surgeon's position.
Luo Yun subconsciously wanted to stand opposite Cai Dongfan as a helper.
But Cai Dongfan said: "Luo Yun, you and Yan Jun change places, and you come to my service."
Luo Yun was stunned for a moment, then nodded and said, "Okay, Director Cai."
Then he and Zhou Cheng immediately turned back to back and walked around the operating table to Cai Dongfan's starting position.
The position during the operation is also very particular. The surgeon stands on the direct operating side of the affected limb.
It is easy to operate and has good vision. All assistants must serve the main surgeon.
Opposite the main surgeon is the position of an assistant, who can assist in the operation and has the second best surgical field of view.
Then there is the lower hand side of the main surgeon. This is the position of the second assistant. The field of vision is relatively poor, but it also requires auxiliary operations. The secondary assistant standing opposite the second assistant can be the third or fourth assistant, and is a complete tool man.
That is, from Zhou Cheng's current position, there is basically no surgical field of view. All he needs to do is pull the hook under the guidance of the surgeon.
After the position was adjusted, the surgery began step by step.
Cai Dongfan picked up the round knife and first incised the skin, then used the electric knife to cut through the subcutaneous tissue, and soon exposed the broken end of the tibial plateau fracture.
However, after the outer broken end was exposed, Cai Dongfan frowned.
Obviously, this fracture was not that simple. Even if he tried to reduce the fracture, it would still be difficult.
The three principles of fracture are reduction and fixation.
What the surgery completes is reduction and fixation.
It is clearly stated in the principle that it must be reset first.
The displacement of the fracture is very obvious, and it is pulled into a somewhat deformed displacement by the muscles that originate at the femur...
"Bone off." Cai Dongfan shouted to the hand-washing nurse, also called the equipment nurse.
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