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.
To be continued...