Chapter 219 Big brother, you still know how to play
Chapter 219 Brother, you still know how to play! (Please subscribe!)
The Sports Medicine Department of Kyoto Third Affiliated Hospital is a very mature department that operates very quickly. There is a pre-anesthesia room between the turnover of the previous patient and the next patient.
Moreover, after leaving the operating room, there are multiple recovery rooms that can be used to resuscitate patients under general anesthesia, which greatly speeds up the turnover of operations.
As soon as the last patient left, Peng Peng said to Su Min, who was about to perform the surgery: "Do you want to confirm the patient's diagnosis and surgical procedure before the operation?"
Peng Peng will ask this question before every operation. Everyone has checked it very carefully in the previous few times.
The diagnosis is definitely fine.
Their current academic system is to learn theory first, then perform bedside rounds, and then perform surgery immediately.
It is equivalent to having only three patients at a time. All the medical history and examination results of each patient are known by heart, so there is no possibility of mistakes or misremembering!
Of course, Su Min once again went through all the patient's pre-operative examination results as the chief surgeon!
"No problem, Teacher Peng. I'm going to start preoperative preparations." Su Min's tone of voice was completely different from before.
Before, he had some scruples, but in fact, he had dealt with quite a few similar patients, and he was actually standing next to the bedside and operating table, and he was no longer so nervous.
Maybe this surgery can't reach the level of Peng Peng, but I can still guarantee good quality and do it to the best of my ability, and it won't be embarrassing!
After being fully mentally and physically prepared, Su Min continued: "Zhou Cheng, Yu Heng, thank you for your help."
Masks and hats can cover Su Min's long hair and short beard, but they cannot cover his white skin and eyes. And if you look closely, you will find that Su Min's eyelashes seem to be a bit long.
He doesn't look quite like a man.
However, his voice is actually that kind of particularly rich.
"Okay." Zhou Cheng nodded, and then looked at Yu Heng beside him.
I noticed that Yu Heng's eyes suddenly became very sharp, as if he wanted to feel better than Su Min.
I don’t know if it was because of the first meeting last night that Yu Heng’s aloofness was ruthlessly torn to pieces by Peng Peng. Today, he has become much kinder. Although he speaks very little, at least he does not dare to leave the crowd.
too far.
It's just that he still has a sense of superiority that he doesn't know where it comes from, and a feeling of not giving in or admitting defeat.
However, in addition to the complexity of his eyes, the gaze he cast on Zhen Xing was also very complicated. He seemed to realize that Zhen Xing's last operation was better than him, and he also realized that Zhen Xing could avoid it.
The mistakes were mistakes he had made, and there were also some minor flaws that Zhen Xing did not understand.
But overall, it's better than him.
Based on this, it is possible that he has the worst foundation among the five people.
He didn't know Zhen Xing and Zhou Muyun very well, and this was the first time they met, but Su Min, from Jiaotong University in Shanghai, had never dealt with them head-on before, but Yu Heng could tell during the quota competition.
Although in the end, Su Min's ranking was slightly lower, Yu Heng actually didn't know what Su Min's comprehensive ability was.
Therefore, although he was not convinced, he still had an unknowing hint in his heart——
What Peng Peng said may not be false.
Routine sterilization and draping, sterile gauze tied with hands and hanging, and sterile film applied externally.
Only after such an operation can the shoulder arthroscopy operation truly begin.
Both shoulder arthroscopy and knee arthroscopy require filling the joint cavity before starting the operation. However, there are about ten common approaches to the shoulder joint.
Su Min finally chose to insert the needle from the posterior approach to fill the joint cavity.
The posterior approach is often used as an observation approach and is the first approach established in shoulder arthroscopic surgery. It is located about 1.5 cm downward and 1~1.5 cm inward from the posterolateral edge of the acromion, which is the "soft spot" behind the shoulder joint.
Therefore, before the operation, the first thing to do is to find the acromion. Finding the acromion is the simplest basic skill for a sports medicine doctor. Zhou Cheng just touched it a little and then moved 1.5cm along the posterior and lateral edges, 1.5cm below and inside.
, chose to insert the needle.
Place your hand on top of the shoulder, press the coracoid process with your index finger or middle finger, press the soft point behind it with your thumb, rotate the humerus with the other hand, and feel the position of the glenohumeral joint line behind it with your thumb.
After filling the joint cavity with about 60ml, a sharp knife breaks the skin, and straight forceps bluntly separate the subcutaneous tissue and penetrate it to the glenohumeral space, which is the gap between the humerus and the shoulder glenoid.
During shoulder arthroscopic surgery, there are two gaps, one is the glenohumeral space, and the other is the subacromial space...
As a routine surgical procedure, we always start with the glenohumeral space.
After the posterior approach of shoulder arthroscopy is completed, the core of the arthroscopic sleeve is inserted into the glenohumeral space and inserted behind the lens under the protection of the arthroscopic sleeve.
The first thing is to find the location of the biceps tendon. At this position, first observe the upper part of the shoulder joint or the articular cartilage part of the biceps tendon and the shoulder glenoid.
After Su Mincheng entered the glenohumeral space, he first adjusted the angle, and then slowly advanced it. His operation seemed to be very familiar with what he was going to do next, observing the humeral head and the cartilage part of the shoulder glenoid.
Then rotate the shoulder internally and externally and observe fully.
Then move forward and observe whether there are partial tears on the upper and lower surfaces of the biceps tendon, the attachment point of the biceps tendon and the superior labrum.
At this point, Su Min's operation was still very smooth, without any pause.
This is a basic skill, so!?
but!?
As soon as the camera was pushed in, what was visible was the long head tendon of the biceps brachii 'sleeping' there.
That’s why it’s called sleep!
This is because there is no connection between the insertion point of the long head tendon of the biceps brachii and the lower part of the tendon.
The insertion point and tendon seem to be separated.
Everyone plays their own game.
Seeing this scene, Zhou Cheng paused the operation and was stunned!
In addition to Zhou Cheng, Su Min, the surgeon in charge, was confused at the time, and Yu Heng, who was in charge of the first assistant, had his eyes a little erratic and his mind was confused.
The faces of the 'bladder' ones - Zhen Xing and Zhou Muyun immediately changed. Zhou Muyun's eyes widened and he covered his mouth with his hands. Zhen Xing next to him immediately moved his eyes to Peng Peng, as if
Asking why?
Then, Zhen Xing saw it.
Peng Peng was also stunned on the spot, but his stunnedness was different from theirs. He was like a wooden stake. He only stared and did not respond to their strange expressions. He seemed not to know these people.
As if looking at him.
The psychological quality is very strong!
"Teacher Peng, this patient's preoperative diagnosis???" When Peng Peng, Zhou Cheng, and even everyone else could sit still, Su Min couldn't sit still for the first time!
Now, he is the chief surgeon.
But now?
The intraoperative diagnosis does not match the preoperative diagnosis, and the intraoperative surgical method will also change. What should I do?
This is acromial impingement syndrome that has worn away the long head tendon of the biceps!
However, the tendon did not separate too much, and due to interference from other soft tissues, the fractured end cannot be seen on MRI!??
This is not a simple acromion injury surgery!
This is a major surgery that cannot be completed by ordinary students! It can even be said that it is one of the most difficult teaching surgeries in the department.
"You continue." Peng Peng continued to tell Su Min.
However, Peng Peng's words made Su Min feel a little numb.
no?
Teacher Peng Peng, have you not understood the current situation?
This patient’s current diagnosis is wrong!
The method of pre-operative conversation is also wrong. You should find someone to talk to you, right?
Shall I continue?
Should I switch to open surgery now?
Once it was opened, it became a level IV surgery, and Su Min did not dare to continue.
He said with a smile: "Teacher Peng, the actual condition of this patient is much more serious than expected. I feel that the current difficulty of the operation is beyond my ability, so I may not be suitable to continue to perform the operation."
.”
"Teacher Peng, how about you do the surgery?"
Biceps tendon rupture is a condition requiring open surgery.
Cerclage fixation under shoulder arthroscopy is a technique that requires extremely high operating skills. There are not many such patients in his own professional group.
Because if such patients are discovered before surgery, most of them will be sutured open for safety reasons. Or they will be sutured open in prefecture-level cities.
In addition, this patient is...
It is extremely rare for patients with rupture of the long head of the biceps tendon that cannot be seen on MRI.
The preoperative conversation, preoperative diagnosis, and intraoperative diagnosis were all inconsistent. Would Su Min still dare to continue operating at this time?
Su Min didn't dare, because after all, this was the Third Hospital in Kyoto, not Ruijin where he was. His teachers, his team, and the people he could rely on were all not around.
Su Min was alone outside, even though she came here as a student, but Su Min still didn't dare to do such a arrogant operation that was beyond her ability.
Peng Peng smiled, then looked at the others with great satisfaction and asked: "Did any of you read the patient's conversation and signed the informed consent form for surgery before the surgery?"
"Has anyone carefully checked the specific information on the patient's plain X-ray and MRI?"
This is not part of their job, because they are here only to learn, not to be doctors. Moreover, after a class, they only have such a short time, so it is impossible to complete the process of talking and signing, and naturally it is impossible to get the medical record to look at it.
This kind of thing happened.
They have long been accustomed to managing patients independently of medical records, but what about reading films?
Who could have imagined that Peng Peng would deliberately dig a hole for them?
Zhen Xing and Zhou Muyun even took another look at the patient's preoperative MRI scan from a distance.
The result is still the same!
The long head of the biceps tendon seen on MRI is very smooth without any loss of continuity. It is almost impossible to diagnose such a patient through auxiliary examinations!
However, the gold standard for diagnosis in sports medicine is not an MRI scan, but an arthroscopy!
Look at the scene on the arthroscope display screen again: the biceps tendon is ruptured far away from its insertion point...
What the hell?
Who could have imagined such a routine?
Moreover, such a diagnosis is inconsistent with the diagnosis of other patients in this section, unless the MRI of the next patient is replaced by this patient, and then the MRI of this patient is transferred to the next patient.
But it doesn’t make sense. Should this group of patients only have simple rotator cuff injuries?
So where is this patient's MRI?
"You want to try?" Peng Peng tried his best not to underestimate the strength of the five little ones this time.
Zhen Xing, he had a rough idea of Yu Heng's abilities. Now that the operation had left Su Min in limbo, there were still Zhou Muyun and Zhou Cheng who could give him something to look forward to.
Zhou Muyun was in the same group as Zhen Xing, and Zhou Cheng, Su Min, and Yu Heng formed a group. Of course, priority was given to those in the group.
Zhou Chengcheng asked: "In this case, Teacher Peng, do you still think we can perform the surgery?"
This diagnosis and treatment procedure needs to be clarified. When Peng Peng spoke, it was Su Min who said that he was unable to do what he wanted and had given up the power of the main operator. The first priority was given to Peng Peng. So, if Zhou Cheng wants to take over, then
It must be confirmed that Peng Peng has made an assessment that they can perform the surgery.
Only in this way can it be called authorization.
What if there is a misunderstanding?
"If you feel confident, you can try it." Peng Peng said.
Both Su Min and Yu Heng looked at Zhou Cheng. Su Min looked a little expectant, but also a little scared. Yu Heng was quite suspicious. But amid the suspicion, there was also a trace of fear.
Yu Heng knew Yang Yifeng, so after learning that Zhou Cheng was from Xiang Province, he asked Yang Yifeng why he didn't arrive.
Who is Zhou Cheng? How could it be possible that Yang Yifeng from Hunan Province did not come, but Zhou Cheng came instead? And this has been unheard of before. This is very inappropriate!
After Zhou Cheng took over the position of chief surgeon, he didn't waste much time because Yu Heng and Su Min next to him were both knowledgeable people and their skills were not weak.
Therefore, showing that he knows arthroscopy skills in front of them will not seem out of place at all, but will only feel natural. In fact, it would be strange if Zhou Cheng didn't know anything.
Under such circumstances, it was a good performance that week.
After Zhou Cheng took over Su Min's position as surgeon, he politely said to Su Min and Yu Heng, "Thank you for your hard work, you two."
Su Min and Yu Heng just opened their eyes and responded without saying a word, but their meaning was obvious. Why are you chatting when you go do something?
Zhou Cheng held the arthroscope and examined the anterior part of the inferior glenohumeral ligament and the middle glenohumeral ligament further downward.
Under normal circumstances, the anterior bundle of the inferior glenohumeral ligament is attached to the glenoid neck between two and four o'clock. The anterior joint capsule contains three independent ligaments with different attachment points. The attachment of these ligaments is normal, and only
A small amount of synovial membrane attachment.
Then Zhou Cheng controlled the arthroscope to enter the inferior recess and rotated the arthroscope toward the top of the glenoid to inspect the glenohumeral ligament and labrum. The integrity of the glenohumeral ligament and labrum was still acceptable.
However, even at this moment, Zhou Cheng did not rush to open the next hole, but gently rotated the upper limb externally. If the arthroscope can easily move forward in the joint, this phenomenon is called "Warren's Passing Sign".
There is widespread ligamentous laxity.
Fortunately, this situation does not exist. Peng Peng and others may not know what they are doing, but as the chief surgeon, Zhou Cheng also has to pay attention to all the details that should be paid attention to.
But even so, Zhou Cheng still frowned deeply!
Peng Peng walked out of the laboratory at this time without saying a word and not knowing what he wanted to do.
Zhou Cheng and others noticed Peng Peng leaving. Zhou Cheng frowned slightly. What did Peng Peng mean?
But in the end, Zhou Cheng continued to do it. With Peng Peng's authorization, he didn't stop. The current situation was not beyond my expectation. At least all the steps of shoulder arthroscopy were restored one by one according to the regular process.
.
I looked at the glenohumeral space before, now I need to look at the subacromial space.
Immediately afterwards, Zhou Cheng took the arthroscope out slightly from the glenohumeral joint, inserted the lever, and entered the subacromial space diagonally upward!
The arthroscope is entered through the arthroscopic sleeve again, and then the subacromial space is observed again!
The gap under the acromion has also become a mess!
There was a large amount of synovial hyperplasia inside, and the specific structure could not be seen clearly, and the arthroscope also punctured the synovium when it entered.
Bleeding profusely and red.
"Lumbar puncture needle!" Zhou Cheng shouted to the handwashing nurse.
Peng Peng washed his hands and came in. Seeing Zhou Cheng still continuing to operate, he raised his eyebrows, but he immediately understood what Zhou Cheng meant! He started to put on his own clothes.
Then an assistant, Su Min, immediately inserted the lumbar puncture needle from the front entrance into the subacromial space to drain the water. Zhou Cheng immediately put in the flushing fluid before flushing the blood cleanly and restored the arthroscopic field of vision.
Zhou Cheng took the lumbar puncture needle and moved it up and down.
The needle of the lumbar puncture needle was found in the field of view.
"sharp knife!"
After Zhou Cheng took the sharp knife, he made another incision along the waist with a needle. After opening it with straight pliers, he immediately started cauterizing it with a plasma electric knife.
After cleaning the joint cavity, only a small part of it was cleaned, and the shoulder joint capsule could be roughly seen clearly, Zhou Cheng called the hand-washing nurse to bring over the probe hook.
At this time, Peng Peng also finished washing his hands again and walked around the stage. He seemed a little uneasy.
Moreover, Zhen Xing and Zhou Muyun, who were watching from the side, also washed their hands, put on their clothes, and came to take a closer look.
Then Peng Peng noticed that Zhou Cheng suddenly ran into the gap under the acromion again. He frowned and asked, "Zhou Cheng, what are you doing?"
The tone was exactly the same as before, as if he was simply asking Zhou Cheng what he was doing.
Zhou Cheng said while operating: "I suspect that this patient also has a rotator cuff injury. Under normal circumstances, when the type 3 acromion wears out the biceps tendon, the supraspinatus muscle closest to the acromion will definitely not be special.
good."
"However, this patient's situation is a bit special."
"He doesn't have type III acromion." Zhou Cheng calmly told Peng Peng what he saw, and moved the arthroscope to a position where he could just see the acromion.
Zhou Cheng then looked at Su Min: "Does this patient have a history of trauma?"
"I remember that he had a history of trauma." During the previous ward rounds, Su Min asked about his medical history. Although everyone heard it, it was definitely Su Min who remembered it the most.
"Yes! It was the fifth day after the trauma when I was admitted to the hospital. I came to the outpatient clinic because of unbearable pain, and then was admitted to the hospital. The patient is currently 52 years old. An MRI was taken in the outpatient clinic, which showed acromion impingement syndrome. His age is also
If it suits me, I'll take it in." Su Min quickly nodded and replied.
During the previous diagnosis process, it was only thought that the patient had acromial impingement syndrome and suspected rotator cuff injury.
However, after opening it, the first thing you see is the rupture of the biceps tendon!
This made Su Min a little doubtful about life.
"However, I just saw that the injury to this patient's biceps tendon is fresh, not old. And during the physical examination, no muscle atrophy was seen!"
"And the patient's MRI showed no edema in the tendon. Therefore, the patient is most likely to have an MRI problem."
Peng Peng reached out and took the patient's shoulder joint capsule. After just briefly exploring the shape of the supraspinatus muscle, he suddenly saw the contracted supraspinatus muscle.
Then he continued: "You continue. Now you are the chief surgeon, and we are your assistants."
Peng Peng was very relaxed and didn't say anything professional-related to disturb Zhou Cheng's thoughts.
Zhou Chenggong said: "I just looked at the patient's supraspinatus. It's a huge rotator cuff, and the retraction must be more than 5cm. This patient may eventually need biceps tendon transfer surgery!"
"Yes, you are right, you continue. We have prepared the corresponding instruments. Tour, open the instrument package!" Peng Peng immediately said to the circulating nurse in the operating room.
"????" Zhou Cheng raised his head and looked at Peng Peng.
Did you already know this patient’s diagnosis, or did you not know it earlier? You already knew it, so why didn’t you tell him the correct diagnosis in advance? If you didn’t know it in advance, what happened to the prepared instrument kit?
Could it be that you deliberately concealed your medical history in order to test us?
Oh My God?
You are a superior and a teacher. Can we still trust you?
Peng Peng said: "You don't need to look at me. In this course, all the patient's medical history, diagnosis, physical examination results and film reading results, as well as the choice of surgical method, are all up to you. I didn't say a word."
Said it!"
"You didn't ask me to say too many words."
"Since you have chosen to start from the beginning, you must accept the end of this result."
The more Peng Peng said this, the more Zhou Cheng and others became frightened.
Especially Yu Heng and Zhen Xing, both of them felt chills on their backs, because before, they thought Peng Peng was strong enough to be the teacher, so their previous operations were unscrupulous.
But now it seems that there is something wrong with you, the teacher, isn’t it? Brother!
You know we were wrong, but you didn't even say a word or make a sound, and yet you still say that now? Aren't you afraid that we might get the operation wrong?
…
The key operation of this surgery is to re-fix the tendon.
You know, re-fixing tendons is not as simple as sewing them together!
Under the strong pulling force and tension, if the location of the nail is not selected correctly and the nail is broken from the middle, then the operation will move towards an unknown and terrifying place.
Tendons are also very brittle, so in this case, it is best to drive two nails in at the same time, which is the best choice.
These questions are all difficult issues that must be considered before and during surgery.
However, this is not a problem for Zhou Cheng. Zhou Cheng's tendon reconstruction, tendon suturing, and transposition surgery are all at a perfect level. The only limitation is that Zhou Cheng has not done this himself under arthroscopic surgery.
surgery.
But I know how to perform this surgery, and I don’t need to deliberately learn it. I already have the corresponding plan engraved in my mind.
This is equivalent to after you learn addition, subtraction, multiplication and division.
3*2+10÷2=?
You may not have done this calculation problem before, but you can still solve it with your own foundation.
Zhou Cheng chose to operate the supraspinatus tendon first.
The supraspinatus muscle originates from the supraspinatus fossa and travels outward under the coracoacromial arch to the small bone surface of the uppermost part of the greater tuberosity of the humerus. It is closely combined with the joint capsule to form the top of the rotator cuff and the bottom of the subacromial bursa.
The anatomical location determines that it is most susceptible to injury under acromial impingement syndrome!
The supraspinatus muscle is originally located on the greater tubercle of the humerus, and after fixation it will return to its original shape.
At this time, Zhou Cheng immediately called the circulating nurse to bring over the expander and rivets. He needed to suture the supraspinatus muscle first. The suture method of the supraspinatus muscle is currently the most popular and the most effective treatment method is double-sided suturing.
How to fix the outer row of nails.
This requires placing the rivet 15-21mm distal to the greater tuberosity, and then using suture bridge technology to create a double row of positioning holes.
"Hole punch." Zhou Cheng shouted again.
This is a routine rotator cuff suturing procedure, so the hand-washing nurse has already prepared it and brought it over. Zhou Cheng actually knows some better suturing methods, but there is no need to bring them out!
He is now a student, not a teacher, so he doesn't need to show off, he just needs to submit an answer sheet.
However, Peng Peng had already given Zhou Cheng the best example on how to hand in the answer sheet!
It would be nice to be on par with Peng Peng...
This punch is not electric, but manual, because the expander will not allow electric instruments to enter.
First, implant two inner rows of rivets
.
This requires the use of a surgical instrument, Scopion.
This kind of instrument has a curved needle head, which is much lighter than traditional sutures with ordinary straight needles.
This step is key.
If the thread of the rivet cannot pass through the rotator cuff, it is equivalent to the thread connecting the two nails, fixing a lonely place.
This operation requires very high sensitivity and high concentration.
After the two threads were taken out from the shoulder joint entrance through the green thread, they were inserted into the Scopion needle hole. Then Peng Peng passed through the suture exit position and inserted the Scopion needle (note: below, a suture needle is used)
instead) is delivered to the shoulder joint.
Peng Peng already knew what Zhou Cheng meant, and immediately pulled the supraspinatus tendon closer to the greater tubercle without any instructions, and exposed the most suitable position for inserting the needle.
At the same time, Zhou Cheng also placed the camera at the farthest but most comfortable viewing position, so that it would not block the second assistant Su Min's pliers or Zhou Cheng's stitches.
The suture needle quickly penetrated into the tendon of the rotator cuff with sufficient operating space and vision.
After threading a needle, Zhou Cheng immediately used the grasping pliers with his other hand to catch the thread that was delivered.
This operation takes less than three seconds.
Peng Peng was stunned at that time. He thought he had seen it wrong. He blinked, but he saw that Zhou Cheng's hands on the other side had indeed pulled the thread very firmly.
This technique? This speed, Peng Peng had a lot of questions in his mind.
During this process, what a normal sports medicine physician should not do is to first expose the grasping forceps to the field of vision, then move it to the point past the tendon line, and then compare it left, right, front and back.
Open the pliers again, bite it, and then pull it to test. If both sutures can be pulled out, it proves that they have been pulled out. Will he then withdraw the needle?
how?
What if you don't play according to the routine?
The surgery continues.
Pull the remaining thread in and out again. Then use the same method to fix the other two strands of the other rivet to the tendon.
The entire operation process was very refreshing and took less than eight minutes.
But in fact, this is one of the most time-consuming and difficult points in the rotator cuff suturing process.
What, just solved it like this?
Zhou Cheng did it happily and said: "Next, we will separate the two bundles of sutures and knot them, and then insert the knotless anchors into the bone ends of the outer row. An open 'zone' shape will be formed inside."
"Before we do this, we need to tie a knot." Zhou Cheng was explaining his intention. Otherwise, all situations must be based on understanding to avoid mistakes.
At this time, a special arthroscopic knotter was needed to tie the knot, and Zhou Cheng quickly used it. With just a little force, the upper edge of the supraspinatus returned to the position of the upper edge of the rivet.
Then pull the lower edge over again.
Drill the outer row of nails again.
Differentiate the four sutures of the upper and lower inner rows of rivets. Take one suture from the upper and lower rows and pass it into the knotless anchor, and then drive it into the outer row of rivets in the upper row.
Tighten the suture. Immediately start tapping the knotless anchor until the laser-marked line is submerged in the cortical bone. Turn counterclockwise for 6-7 weeks to cut the line.
After Zhou Cheng finished operating one, he thought that this was Su Min's assessment, and then looked at the time on the surgical timing panel. Although he had gained the authority to be the surgeon due to an accident, during the process of Su Min's assistance, Zhou Cheng
Cheng felt that his method was not bad.
He said, "Su Min, can you operate this knotless anchor?"
Knotless anchors are threaded and will be embedded in them after being knocked in. They are very stable. However, if the nail path is too loose due to excessive force, it will become unstable.
Su Min was stunned for a moment, glanced at Zhou Cheng with complex eyes, and then said helplessly "Okay!"
Although what Zhou Cheng said now seems to be a reward opportunity, Zhou Cheng seized the opportunity that he gave up before, and he was able to complete the operation so well.
This is his ability and strength. He also told Peng Peng that it was beyond his ability!
This is a Class IV surgery, which can even be said to be one of the most difficult surgeries in sports medicine!
While Su Min was thinking in her mind, she quickly took another knotless anchor and quickly threaded the remaining two inner row nails' own threads through the folded silk thread into the pinhole of the knotless anchor.
go.
Then penetrate the sleeve through the outer row of nail channels.
tension!
After the tension is equal to that of the upper outer row of nails.
He winked at Zhou Cheng.
Zhou Cheng also completed the thread-cutting operation immediately. In this way, Zhou Cheng naturally gave up the main position to Su Min. After Su Min completed this critical operation and was about to come out, Zhou Cheng said
: "Su Min, please continue."
Su Min felt that Zhou Cheng's tone was so familiar. It was the tone she used to speak to her senior brothers when she was in the department. It was to take care of their feelings and not to embarrass their face.
Kind words to speak to them.
He himself felt at the time that he had absolutely no intention of being arrogant.
But when you change from the person who speaks to the person who listens, the mood is still different.
But fortunately, this operation started with him and ended with him. It had a beginning and an end. This was the respect Zhou Cheng gave him and had no other meaning!
Although Zhou Cheng retreated to the second line, people including Peng Peng glanced at Zhou Cheng inadvertently.
That look seems to be saying, although everyone is very powerful and they know that you are a bit powerful, is it a bit too much for you to be so ruthless in your first attack?
Peng Peng slowly took off his surgical clothes.
Under the stage, Zhen Xing and Zhou Muyun were whispering.
"Junior Brother Zhou, can you complete this operation alone?"
Zhou Muyun's expression suddenly became very solemn: "It's a bit difficult, but if you spend some time and have familiar assistants, you can complete it!"
"But, it's not like this?"
"He is controlling time." Zhou Muyun is very tall, and his eyes are very sharp. He is tall and fat, but the gaze he projects condescendingly is a bit blurry, as if he is looking up to someone.
"Teacher Peng's previous operation time was 22 minutes. Yu Heng's previous operation time was 24 minutes. Senior brother, the time you completed the first hand speed Hu was 28 minutes."
"The current time is only 22 minutes. The second half and the first half were all done by Su Min."
"So, this Zhou Cheng, he is not playing with us, he is playing with Teacher Peng Peng!" Zhou Muyun looked like he was facing an enemy, and he was no longer as calm as before.
Tall and fat, he has lost all the honesty and honesty he once had.
Because Zhou Cheng didn't take them to play, it was quite abominable, but it was a pity that Zhou Muyun was going to play in the next one. He didn't know if he could do what Zhou Cheng did, but he was sure of one thing.
That is, Zhou Cheng has already played with Peng Peng.
…
Zhou Muyun could see that, as a teacher, how could Peng Peng know nothing?
Even after Zhou Cheng completed the key operation and returned the operating position to Su Min, Peng Peng's heart skipped a beat.
Isn't it?
This Zhou Cheng, wouldn't he want to return the operating position to delay time?
Is this just to give me face? Or is it stepping on me?
Interesting, interesting!
Peng Peng was happy because he had not been able to find a friend who could compete with him for a long time.
Anyone who can beat him now cannot be beaten by him!
"Let's start the third operation. You will perform the surgery." Peng Peng pointed at Zhou Muyun.
…
Then, in the third case of the second lecture, it was Zhou Muyun’s turn to perform the surgery.
This case was due to the sudden situation of the patient Su Min met before, so this time, Zhou Muyun carefully read all the patient's information again.
After finding no accident, his mood was a little complicated.
Because, if they are all such routine cases, even if his data in all aspects exceeds Zhou Cheng's, it will not help, right?
They are not all questions of the same difficulty. Does it make sense to have high scores and low scores?
Of course, this did not prevent Zhou Muyun from working hard to express himself. In the end, he completed the operation and shortened it to twenty minutes.
Simply terrible.
For a rotator cuff suturing, the total time from the beginning to the end of the operation is twenty minutes.
In an ordinary place, it would basically take an hour to walk up!
You also need to know that this Zhou Muyun is just a student, his age and grade are unknown!
After Zhou Muyun finished his operation, today's class finally came to the afternoon lunch break.
The time is already half past twelve.
Because they are responsible for their own food and accommodation, and have lunch breaks, they have to go out to find food separately. In fact, they are looking for food at or across from the hospital.
This time, five people gathered together, and even Yu Heng didn't have such a special aura of arrogance.
There are different tastes in different places, so I just choose to eat noodles. In the end, I add my own seasonings.
Zhou Cheng almost reserved all the chili peppers, but he added two tablespoons of them, which didn’t taste right.
Zhou Muyun and Zhen Xing persuaded Zhou Cheng to add some garlic to make it delicious, but Zhou Cheng couldn't appreciate it. They also imitated Zhou Cheng and added some chili oil, and each of them became so spicy that they became pugs. They were laughing and crying.
Out.
Looks a bit like an actor.
However, after finishing eating, Zhou Muyun and others did not leave. Instead, they each ordered a bottle of water and asked, "Do you think this training class is weird?"
"From the time we came to the present, there has been only one teacher. Then all the patients were prepared in advance, and there were no crowds of people watching. It was as if we didn't exist at all."
"In the operating room where we are the surgeons, no one accidentally walks in the wrong direction."
"So I think we may have been tricked by Kyoto Third Hospital!"
"My guess is this. It is possible that our courses and the entire operation were live broadcast, and there were other people elsewhere monitoring our every move during the learning process."
Zhou Muyun's words made Zhou Cheng and others think deeply, but they all felt that they were not particularly credible.
When Zhou Muyun saw no one responded, he said, "Really, you have to believe me, because this is what our association did before..."
"???" Several people scratched their heads and looked at Zhou Muyun with a questioning look in their eyes.
Zhou Muyun was the first person to reveal his identity!