Just like the figure of Director Pin, which is different from that of most directors of medical departments, he is extremely thin and can be said to be as skinny as a stick, with bones wrapped in skin, and a gust of wind can blow him over.
But Mo Chengkong still showed great respect to the director.
"Mr. Gui said it was time to come out. I don't know the specific situation. It should be that Xiao Zhou's knitting technique is quite special, so Mr. Gui planned to come out early." Professor Pin replied.
Mo Chengkong immediately turned to look at Zhou Cheng, his mood became even more complicated.
He came to replace his student because of Zhou Cheng. He had been paying close attention to Zhou Cheng, but he still let Zhou Cheng slip away from his eyes.
It seems like he was born to do things. With just a slight turn, he can do things you didn't expect.
"Actually, this is fine." Mo Chengkong looked at the students in this college while feeling a little disappointed and said.
…
At the same time, when they saw a large group of people heading to the operating room, Zhen Xing and Zhou Muyun took a few steps back.
"Senior Brother Zhen, look, am I right? Our learning process is being monitored throughout the whole process." Zhou Muyun said as I expected.
Zhen Xing said: "Zhou Muyun, the previous quarrel with my senior brother has almost passed. You are older than me!"
This was naturally not Zhen Xing's focus, but he quickly discovered a particularly critical issue: "Zhou Muyun, have you noticed that there is not even a single person from the Third Hospital in Kyoto in this small training class?"
"When I first started, I felt something was wrong, and now I feel more and more that there is a pit in it!"
Gui Lao is the leader, the Third Affiliated Hospital of Kyoto University is the organizer, Gui Lao, Professor Pin, Professor Mo and other sports medicine departments serve as the venue and disease source provider, but there is not even a student from this hospital.
The only person who can be related is Zhen Xing, but Zhen Xing is from Jishuitan.
However, the superiors of the two hospitals, let alone fighting each other, at least would not be so generous, nor would they be as amiable as they appeared on the surface.
Zhou Muyun looked around and noticed the gazes of many peers and the complex charm in these people's gazes.
Some are convinced, some are not convinced, some are surprised, and even some are confused and at a loss.
…
The person under the greatest pressure is Su Min, who is now the main operator.
You know, when everyone was operating before, the largest number of onlookers were five people coming and going, but why suddenly when he came to perform the surgery, there was not only one more Mo Chengkong besides Peng Peng.
Are there such a large number of people?
Who are these?
Except for the old man at the head, Su Min didn't know anyone else at all.
When the large army came in, the operations of Su Min, Yu Heng and others naturally stopped, including Zhou Cheng who was weaving tendons. After putting down everything, he turned his attention to Gui Lao and others.
Although everyone knew that outsiders would not interfere with the surgical process, as the teacher, Mo Chengkong, was facing the door, everyone also knew that the person coming was not an ordinary person.
Mr. Gui was the first to bear the brunt. He glanced at Yu Heng and Su Min, who were a little nervous, and then said: "Don't be anxious, don't be nervous. You continue with yours, and we'll just watch ours. We won't disturb your surgical operation."
.”
After Mr. Gui opened his mouth to explain the situation, everyone stopped consciously. Within two meters of the sterile table of the operating table, no one went deep inside. Some people were just inside the crowd.
He stood on tiptoes, curiously watching the normal progress of the operation.
After Su Min and Yu Heng digested Mr. Gui's meaning and resumed the normal operation process, Mr. Gui said to Professor Pin again: "You and Cheng Kong go to see the tunnel for the operation. I'll go and see it."
The braided tendons of the sides.”
"Teacher Gui, shall we come with you?" Both Fatty Mo and Professor Pin knew very well that it was Zhou Cheng who could really attract Mr. Gui this time, so they were also curious about what Zhou Cheng was doing.
, how could he attract Mr. Gui so much.
"What's so cool about braided tendons? You go do your serious business." Mr. Gui rolled his eyes and was speechless with what Mo Chengkong and Professor Pin said.
Although I am still thinking, there is nothing interesting to see, why are you messing around like this? Is it boring?
But Mr. Gui is Mr. Gui. He has special privileges. If he doesn't let you watch it together, you can't watch it with him. So the two of them can only return their attention to the formal procedure of the operation in a depressed manner.
This process has been repeated by Mo Chengkong before, and both Professor Pin and Professor Mo were almost vomiting. They have done it at least thousands of times, if not ten thousand times. They do it every day, every day, and there is really nothing good to see.
of.
The only interesting thing is that Su Min's operation was within the baseline and very stable. It was a very calm operation.
Beyond Su Min's current age, even purely in terms of operation, Peng Peng may not be much better than Su Min.
But what’s so good about it?
Just average...
On the tendon treatment table, Zhou Cheng was still braiding tendons while looking at Mr. Gui who was walking towards him with his peripheral vision.
I felt a little nervous in my heart: Isn't it going to be seen out?
That’s not right, I am using a pinch-knitting technique, can this be seen?
That's right, because the method of braiding tendons used by Zhou Cheng now is not relatively orthodox in the real world, but it is not completely 'evil tradition' either and is a transitional one.
What is a transitional body? It is just the part of the tendon. For example, insert one into three, and the three-needle regular knitting stitch is mixed with a special knitting stitch.
This is an exploratory clinical trial at the very beginning. This evil multi-stranded tendon braiding method has slowly developed and eventually become mainstream. It will take time to settle down.
It suddenly became too different, which of course is not good.
"Classmate, what's your name?" Gui Lao's voice was very soft, but the softness in his voice was different from the one Zhou Cheng had heard before from Zeng Lao. But what was different, Zhou Cheng couldn't tell for a while.
.
There is a certain distance between the tendon woven table and the operating table in the operating room.
Although I don't know who this old man is, it is definitely unusual for someone to be so close to him under such circumstances.
"Hello, teacher, I'm Zhou Cheng." Zhou Cheng looked at him a few times without being condescending, then smiled, and immediately began to change the knitting technique in his hands.
The most important thing is not to affect the process and operation of the surgery just because of other people's interruptions.
"Why the change? I thought you were already very good at knitting before?" Mr. Gui immediately noticed the changes in Zhou Cheng's details.
Zhou Cheng's old face immediately turned red. He thought that he would not be discovered if he was doing it silently, so he took the initiative and said frankly: "Teacher, just a few injections, it shouldn't have much impact, right?"
If such a thing is discovered, it is better to confess it honestly. Otherwise, if the team's surgical concept is completely different from what Zhou Cheng understands, and they feel that such a knitting method is useless, it would be necessary to rework everything.
Time to prepare.
However, it is obvious that Mr. Gui did not come to actively seek trouble, but continued: "What is your purpose for doing this?"
"Teacher, my original intention is actually to make the tendon stronger." Zhou Cheng replied.
"Then how do you determine under what circumstances it is stronger and under what circumstances it is not strong enough? In addition, do you think that if firmness is a controllable factor, then the firmer, the better?
?" This time, Mr. Gui threw a little more questions.
"If other factors are fixed, the firmer the factor, the better. However, this argument is based on a series of prerequisites such as muscle contracture, bone impact, muscle stiffness, bone ankylosis, etc. that will not occur."
"The stronger our tendons are, the better." After Zhou Chengxian gave the answer based on this stable factor, he thought about it for a while and then gave his own understanding and thoughts.
"But if all factors are taken into consideration, the original purpose of tendon reconstruction is to obtain joint mobility. If extensibility is lost, the significance of tendon reconstruction is lost."
"From this perspective, the stronger the tendon is not, the better, but we have to look at the material it is made of."
Zhou Cheng's answer was slightly different from what Gui Lao expected.
The answer he wanted was for Zhou Cheng to answer his question by quoting classics from various documents he had read. However, Zhou Cheng, instead of taking such a conventional route, wanted to discuss basic mechanical issues with him.
This young man looks very brave.
Although it sounds very cool to talk about what a certain document supports and what experiments to support by so and so, but when it comes to talking about basic things, these words are all
Fake.
Some conclusions of modern medicine are actually based on a hypothesis. If a similar hypothesis collapses, the entire system will collapse or be subverted!
Tendons and anatomy are such a very basic course.
"What if we don't consider the material? Is the material the same autologous tendon?" Gui Lao naturally became interested and asked while watching Zhou Cheng do it.
"If we don't have to consider the material, then we don't have to consider its ductility. Autologous tendons have no immune rejection. For our own tendons, we only need to consider that their tensile strength is sufficient."
"In the traditional sense, the more strands we weave during the weaving process, such as double strands, four strands, six strands, eight strands... the more the number, the better the curative effect, and the subsequent functions will be better.
The more you recover, the more powerful you become.”
"However, on the basis of increasing the number of strands, we have actually made it more difficult to separate the two strands into separate beams and directions."
"In the measurement of our normal people, the anterior cruciate ligament is not a single bundle, but a collection of fiber bundles that spread out in a fan-like shape, with both ends attached to the broad and flat bone surfaces of the femur and tibia."
"When the knee is flexed 90°, the angle between the long axis of the ligament and the long axis of the femur is 26±4°. Since the anterior cruciate ligament is in a sagittal position on the femoral attachment surface, while the tibial attachment surface is in a horizontal position, the ligament moves from the upper end to the lower end.
Rotates outward about 90° on its own central axis.”
"It is the narrowest in the middle, with a width of about 11mm and a thickness of about 4mm. When the knee is straightened, it is in the shape of a flat belt, and when the knee is bent, it twists. When the knee joint is flexed at 90°, the length of the anteromedial side of the ligament is 30-40mm.
The length of the posterior and lateral sides is about 20mm."
"Let's talk about its anatomy: It originates from the front and medial side of the intercondylar eminence of the tibia, merges with the anterior corner of the lateral meniscus, obliquely posterior, upper and lateral, and the fibers are attached to the medial side of the lateral femoral condyle in a fan shape."
"The average length is 31-38mm, the average width of the middle part is 10-12mm, the cross-section is approximately oval, and the average area for women and men is 36mm and 44mm respectively. The ligament gradually spreads out 10-12mm away from the tibial insertion point..."
"The ACL femoral insertion point is located at the back of the medial surface of the lateral femoral condyle. It is an oval concave surface with an average length of 18mm and a width of 11mm, and an area of 113 to 170mm..."
When Gui Lao heard this, he kept nodding his head and his muscles gradually became stiff.
Because of some of what Zhou Cheng was talking about, some parts gradually fell out of his understanding.
One thing is very clear. Although academicians are engaged in research, neither academicians nor professors are databases or encyclopedias. They can know everything, including what the so-called area is.
What.
"The ACL forms a "foot"-like structure at the insertion point of the tibia, which increases the attachment area and avoids collision between the ACL and the intercondylar notch when the knee is extended."
"The transplanted ACL does not have a "foot"-like structure. Choosing the tibial insertion point closer to the front can cause the graft to collide with the intercondylar notch when the knee is extended, which is one of the reasons for limited extension after surgery. However, there are actually corresponding solutions and
As for the method of handling this, teacher, we will discuss it again when we have another chance!"
Zhou Cheng immediately passed over a very important topic and continued the current topic: "The anterior medial bundle (AMB) is distributed in the posterior and upper part of the femoral insertion and the anteromedial part of the tibial insertion; the posterior medial bundle (PLB) is distributed
On the antero-inferior part of the insertion point of the femur and the posterior and outer part of the insertion point of the tibia.”
“…In view of this, people began to use double-bundle reconstruction that is closer to normal functional anatomy to restore the normal function of the ACL.”
After Zhou Cheng explained the underlying reasons why there are double bundles and multiple strands, he really started to explain, saying: "Teacher, according to the theory we mentioned before, we can find that between PLB and AMB
Among the structural differences, we can actually handle different situations through weaving techniques."
"When the knee joint is straightened, the PLB is tight, wide and flat; when the knee is flexed to 90°, the AMB is tight and the ligament is torsion, and the PLB is relaxed approximately horizontally. Looking at the overall ligament, the AMB is roughly located in front of the PLB, which causes the PLB to be tight and flexed when the knee joint is straightened.
When the AMB is tense, single-bundle reconstruction cannot restore the stress change characteristics of different fibers, which will inevitably lead to abnormal stress in some fibers, which can lead to reconstruction failure."
"..."
"Teacher, but one thing is that most of the current research on ACL biomechanics is based on animals or human corpse specimens. Little is known about the stress on the ACL under normal human physiological conditions. Understand the stress on the ACL under physiological conditions.
It is of great significance to guide rehabilitation exercises and promote functional recovery after surgery."
Mr. Gui: "..."
The current research is not based on animal and human corpse specimens, so do we need to obtain data directly from humans?
"The maximum stress of the ACL in daily activities is less than the ultimate stress, which is generally 0.0% to 44% of the ultimate stress. Under normal circumstances, the contraction of the quadriceps is the main force. When the flexion is small (such as the isometric contraction of the quadriceps,
Squat up, actively extend your knees, etc.) The ACL is subject to greater stress!"
"So I think in situations like this, we treat the autologous tendons we take differently, like..."
Then Zhou Cheng talked and entered the so-called state.
While Zhou Cheng was talking, he was conducting practical demonstrations seriously. However, Gui Lao himself was not here to correct Zhou Cheng's mistakes, so he just watched silently, becoming the most "culprit".
audience.
When Zhou Cheng discovered that what he had just said to Mr. Gui was just a hypothesis, he also discovered that it seemed that he had become a little more excited during the lecture. He was not only analyzing the principles.
I did it once and also tried the weaving technique.
It's easy to knit, but it's impossible to take it off again.
"Teacher, what about these two bundles of tendons? Do they need to be re-braided?" Zhou Chengcai asked Mr. Gui what he meant. If he wanted to re- braid them, he would have to remove all the current threads and re-braid them.
Mr. Gui shook his head: "The double-beam reconstruction and recovery you talked about is a concept, not a specific method. What you are doing now is also double-beam reconstruction and recovery. Compared with single-beam reconstruction, it is inherently relative.
There is nothing wrong with the advantageous options.”
"As for your current treatment of the tendon weaving process, there is currently no special definition or standardization at home or abroad."
"How can there be any absolute right or wrong in non-standardized things?"
"What makes me even more curious is that your hands are really enviable hands, aren't they?" Mr. Gui suddenly said meaningfully, and then asked Professor Pin next to him for his opinion.
Professor Pin also nodded and said: "These hands are something that can only be found but not sought. People who can reach the peak simply by relying on their skills have very skillful hands."
"Dexterous!"
"You are also knowledgeable and have a strong foundation, but your face is a bit thin. Much better than some students in our hospital, right, Mr. Gui?"
Zhou Cheng hurriedly put down the braided tendons!
Looking at the old man, he already had a guess in his mind, but he still respectfully clasped his fists in a salute: "I've seen Teacher Gui!"
Mr. Gui took a deep breath and said: "Yes, it is indeed good. Pinlu, you came a little late, so you missed some more exciting things. Unfortunately, such a scene may not have the opportunity to be repeated."
It was only through Gui Lao's words that Zhou Cheng learned Professor Pin's name, and then said, "I have met Professor Pin."
In addition to looking at Zhou Cheng and Mr. Gui, Pinlu was also paying attention to Su Min and others. When Zhou Cheng and Mr. Gui were chatting, Su Min and Yu Heng had already completed other preparations for the cruciate ligament reconstruction surgery.
.
At this moment, he was waiting for Zhou Cheng to send the braided tendons. It was only because Gui Lao was still discussing the problem with Zhou Cheng that there was a slight delay.
Pinlu hurriedly said: "Mr. Gui, after this operation is over, there will be a return surgery as scheduled. Let's discuss this operation together at that time. For now, let's let the operation continue as normal."
Standard and conventional surgical procedures are actually just procedures in Pinlu's eyes.
"Okay! Let's finish the operation first."
"Xiao Zhou, please go over and help, finish the operation as soon as possible, and then we will all review today's operation together. At that time, I hope you can take the initiative to share your thoughts, Xiao Zhou."
When Zhou Cheng wanted to say something more, Mr. Gui nodded and said, "That's it. You can say whatever you think. If you say something wrong, I will be the one to blame."
This sentence made Zhou Cheng quite excited.
Now that Mr. Gui had said this, Zhou Chengcheng began to carefully plan the lectures he would give later.
However, something Zhou Cheng didn't expect happened just when the operation was about to end!
Mr. Gui said directly: "Mo Chengkong, Peng Peng, do you know how you two failed in your missions?"
"Yes, you two were defeated by Zhou Cheng."
"Don't think that Zhou Cheng is young and don't think that others' qualifications are young because they can be looked down upon..."
"And our students, we should also pay attention to each other. How old are you now, what are you doing now, and what are you doing?"
"Kyoto University. What happened to the students of Kyoto University?"
"Insufficient strength and insufficient effort. When you enter the workplace, you also do it to watch other people's performances. Don't think that you are the proud ones. Your previous victory was just because you had a better learning environment and study experience."
resource."
"It doesn't mean that you have everything. Don't put your eyes above your own."
"Why can't any of our own students get qualifications or places in the training courses held by our own department?"
"Why? Aren't you usually arrogant?"
"Think about why?"
"When you think you are already very powerful compared to your peers, you are no longer in the eyes of others. People who will always only focus on what is in front of them can just live a life of one-third of an acre.
Pretend I didn’t say anything.”
"But, if you really feel that you are unwilling to admit defeat, then..."
"In the next few days, Su Min, Yu Heng, Zhou Cheng and others in the training class will be your targets."
"It doesn't matter. It doesn't matter if you lost before."
"It doesn't matter how many times you lose these days!"
"It doesn't matter if you lose for a few years, I'm afraid you will keep losing in the future. By then, all you will have left is dissatisfaction, and you won't be able to say anything else."
When Mr. Gui spoke like this, Zhou Chengdu felt that he was about to believe what he said, and almost thought that he was really a bit awesome.
However, the more this happened, Zhou Chengcheng felt that this Gui Lao's teaching model was too terrible!
There is absolutely no way that these students who are watching now are all mediocre people.
Everything today may be part of his design, just to motivate them in disguise.
If this group of people have always been taught this way, then they must be wolves, and they are the kind of wolves that endure before planning.