Chapter 330: Know how to perform surgery and know how to operate! (Please subscribe)
"Dr. Zhou and Boss Zhang have known each other before?" Lu Bin saw that Zhou Cheng and Zhang Zhengquan were having a lively chat, so he inquired.
Before, the equipment dealer who came to the operating room was another person, but yesterday, he called and said that someone else was coming to the operating room and that he would also come on stage.
At that time, Lu Bin was still curious about who would come to the operating room and have to ask to go on stage. Because in Changshi Traditional Chinese Medicine Hospital, although there are not many people, the equipment dealer has not yet had to go on stage to help.
This kind of thing usually happens in a few prefecture-level city hospitals or county hospitals. The equipment dealer, as an assistant, comes on stage to help, or guide the surgeon to complete some new equipment instructions, or assist in completing certain operations during the operation.
Of course, the reason why Lu Bin asked this was because if Zhou Cheng could play with the equipment dealer, it would prove that Zhou Cheng was not the kind of pure scholar who only wanted to do research or work, rather than being distracted.
In this way, will I have a chance to complete the tasks assigned by Dean Yang Jun?
If Zhou Cheng is a pure person and Zhou Cheng has a great background and is impeccable, then Lu Bin can't do anything and will not have such thoughts to offend Zhou Cheng or make things difficult for Zhou Cheng. If Zhou Cheng has any desires, then he will
It's easy to handle.
Zhou Cheng didn't say anything, but Zhang Zhengquan took the initiative to take over: "Director Lu, I'm just kidding, you are my real God of Wealth. Brother Zhou Cheng and I have known each other before. I hope Director Lu can take more care of you in the future."
Lu Bin is the director of the department and has great authority. At least, he knows what kind of patients he has, what kind of equipment he can use, what kind of surgeries he can perform, and which surgical equipment he uses.
Although his company has gained a reputation for minimally invasive fracture devices, other companies have already begun to imitate them. In the future, they will definitely have to compete with each other for the market. However, his own company can get the first piece of the pie.
There is nothing we can do about it, we must give away some of the profits.
Lu Bin was washing his hands while thinking quickly: "Boss Zhang, you were familiar with Dr. Zhou before? We have a good relationship. Let's have a meal together when we are free."
Logically speaking, when Zhang Zhengquan first arrived, he should have invited people in the department to have a meal. After all, as a representative of equipment, Zhang Zhengquan would make more money the more equipment he sold.
Then while eating, I made a little statement that Zhang Zhengquan could not be regarded as this outstanding person.
If Zhou Cheng can be allowed to work at the grassroots level, no matter what method Zhang Zhengquan uses, it will ultimately come down to a game between Zhang Zhengquan and Zhou Cheng, and his own hospital will also benefit. This is a win-win situation with Zhang Zhengquan.
"Director Lu, if you don't tell me, I have to make arrangements for tonight. I'm new here. Director Lu and you doctors are working hard, so let's talk about our feelings and express our feelings." Zhang Zhengquan spoke very easy-going and was very polite.
Euphemistic.
Naturally, it is really not something that can be solved with simple meals.
Hearing this, Zhou Cheng didn't think too much, he just said: "Director Lu, let's start the operation. All the pre-operative preparations have been completed. This operation is relatively simple. You can try the repositioning technique first."
it is done."
Lu Bin came to operate alone, and Zhou Cheng had to watch from the side and then give instructions slowly.
The reset technique is simple but not simple, and it depends on the skill. Professor Xue Xiude from the Ninth Academy of the Magic City, and Professor Jingxing Xing from the Sixth Academy, they have their own skills and can draw parallels at will.
But Lu Bin is different. His previous understanding of method reset is definitely not up to their level. It just works well enough.
The purpose of all operations is ultimately to treat, not to show off skills. Better manual reduction techniques will of course provide better postoperative results, but the degree of effectiveness is actually limited.
If you pursue the highest degree of perfection in everything, it will be difficult to do things.
Lu Bin gradually calmed down and took a serious breath. Zhou Cheng was able to come to Changshi Traditional Chinese Medicine Hospital, which was their dream. Moreover, as the director of the Trauma Surgery Department of Changshi Traditional Chinese Medicine Hospital, Lu Bin actually faced a lot of pressure.
big.
The biggest competitor of the Trauma Surgery Department of Changshi Traditional Chinese Medicine Hospital is the Trauma Surgery Department of Changshi No. 1 Hospital. Director Zhang Jin has a doctorate degree. Moreover, they had Fang Yun there before. I heard that he was there before Zhou Cheng came here.
Minimally invasive fracture surgery has already begun to be performed independently.
The reason why, currently, people with broken bones in Chang City only go to the Chang City Traditional Chinese Medicine Hospital is because the founder of this surgery is here, and the postoperative results are very good, and the treatment is well publicized.
Moreover, for such publicity, even if Changshi No. 1 Hospital had developed such a procedure, the effect might be very good, and it would not be possible to go beyond Zhou Cheng to publicize it.
Who can say that others can do a better job than Zhou Cheng in minimally invasive fracture reduction?
There may be one in the future, but right now, it definitely doesn't exist.
Lu Bin was also very concerned about the situation in Changshi No. 1 Hospital. Fortunately, Fang Yun, who came from Long County for further study, was called back by the director of Long County People's Hospital.
Nowadays, it is Zhang Jin who performs minimally invasive fracture surgery at Chang City First Hospital. Zhang Jin’s ability is not bad, but after all, his major is spine and joint surgery. His learning ability may be very strong, but after all, he does not have that long time.
soaked.
Lu Bin must also perform this kind of surgery regularly in the department.
After all the emotions calmed down, Lu Bin shouted: "Qin Ming, help me with the fixation and reverse traction of the reduction. Guo Xiaobing, if you cooperate with the C-arm machine, my reduction technique will definitely not be as good as Dr. Zhou's."
"But we take our time, do it a few times, repeat it a few times, and adjust slowly."
Any operation is actually coordinated and completed by a team. Even if Lu Bin, as the main operator, goes through all the procedures first, in order to speed up the operation, the team's collaboration ability must be strengthened.
Zhou Cheng is actually like this, even if his personal ability is very strong and he can lead the team, a very fit and proficient team will only increase the speed and quality of the surgery.
On the contrary, Zhou Cheng's previous surgeries at Changshi Traditional Chinese Medicine Hospital were all delayed.
Zhou Cheng and Zhang Zhengquan were standing aside, chatting in low voices, Zhang Zhengquan was talking, and Zhou Cheng was listening.
Neither of them had much curiosity or pressure. This was not the first surgery Zhang Zhengquan had ever seen, nor was it the first time he had watched others learn such a technique. They also knew that Zhou Cheng would definitely be able to tell the truth here.
He chose to become the boss of the company, so he was destined not to stay in the hospital for long. The reason why he still came to the hospital was to find inspiration for the development of the company. The second reason was to enjoy life, a life without so many fights.
.
Very relaxing time.
As Zhang Zhengquan was talking, Lu Bin said: "Dr. Zhou, Boss Zhang, let's go through it first, shall we?"
It seemed like a question, but it was actually asking the two of them to go to the isolation room and not take radiation.
Zhou Cheng nodded, and Zhang Zhengquan shut his mouth.
The results of the fluoroscopy appear on the display screen. The reduction is basically OK, but there is still reduction. Functional reduction has been achieved, but it has not yet reached the level of anatomical reduction. This level of fracture alignment will increase the subsequent complications.
Operational difficulty.
"Qin Ming, let's make some adjustments. Guo Xiaobing, come in..." Lu Bin led people back into the operating room with a calm tone.
Zhang Zhengquan and Zhou Cheng can chat, but Lu Bin himself must concentrate. Zhou Cheng does not need to care about some details, because he has the ability, but he must slowly experience it.
Theory is theory, practice is practice.
Yang Tao and others also walked into the operating room to watch Lu Bin's operation. Zhou Cheng and Zhang Zhengquan continued to stay in the isolation room. The anesthesiologist, circulating nurse and hand-washing nurse did not move.
At this moment, Zhou Cheng said to Zhang Zhengquan: "Speak less and be more respectful to Director Lu. After all, he is undergoing surgery."
Zhang Zhengquan nodded: "That's right, we'll talk about it later when the surgery is over."
Soon, Lu Bin and Qin Ming walked in again. After looking through the scene again, everyone's faces turned dark.
Because, in Zhou Cheng's hands, the fracture reduction technique that seemed particularly easy was actually very difficult to achieve the level that Zhou Cheng did.
Seeing the results of the plain film, both Qin Ming and Lu Bin looked slightly serious.
If it fails to meet the standard, this operation does not pursue speed, so naturally it can only be adjusted again.
Repeat this for four or five times.
Neither Lu Bin nor Qin Ming seemed satisfied yet, so they were about to go into the operating room again for adjustments.
Zhou Cheng glanced at the plain film on the display screen and said, "Director Lu, it's okay. The reset can be done to this level. During the operation, the remaining offset can be adjusted with internal fixation instruments. There is no need to completely reach it."
Levels of anatomical reduction.”
When Lu Bin heard this, he looked back at Zhou Cheng, and the self-confidence in his heart collapsed slightly——
"Is it really possible? Dr. Zhou?" Lu Bin didn't dare to say it was possible now, because he felt that before taking the stage, he had made all the preparations, but how could he do it, but he acted like this?
.
"Okay. This degree of reduction is enough. During open reduction and internal fixation of small incision fractures, we have to classify the fractures according to the fracture line. If there is displacement in the axial direction perpendicular to the fracture line, it must be corrected.
"
"But if there is only displacement along the axial direction of the fracture line, internal fixation equipment can be used for fine-tuning and correction. The postoperative recovery effect is also excellent." Zhou Cheng explained.
He probably saw that at present, Lu Bin was at most a proficient level in manual reduction. To achieve complete anatomical reduction, such manual reduction would have to be repeated many times.
This will increase the wear and tear on the broken end of the fracture. If the fracture does not heal or the healing slows down after surgery, it will really be worth the loss.
Regarding delayed fracture healing, one of the theories written in textbooks is that multiple manual reductions have failed...
"That's okay, Dr. Zhou, you are an expert in this field. If you say it's okay, then that's okay." Lu Bin sighed, feeling helpless.
Lu Bin had done the next operation before with Zhou Cheng's manual reduction. He just had to put the instruments in. This was not difficult, but this time, when placing the minimally invasive internal fixation instruments.
The difficulty of placement and docking was because the previous reset method was not particularly good, so it was repeated many times before the docking was completed.
The treatment, reduction and fixation of fractures are all very critical, and the difficulty of the operation is actually the reduction, not the fixation.
However, the effect after fixation is still excellent.
Because it was intramedullary fixation, the final fracture line was only vaguely visible, but it was not nearly completely hidden like it was after Zhou Cheng's reduction.
Although the gap is small, it is still a difference between kung fu and realm. It needs to be improved. In fact, there is still a long way to go.
So, after a full hour and twenty minutes, the operation finally came to an end.
Lu Bin looked at the postoperative C-arm fluoroscopy results for a long time before asking Zhou Cheng: "Dr. Zhou, there should be no problems with such postoperative results, right?"
Zhou Chengcheng said directly: "Congratulations, Director Lu, you have been able to complete minimally invasive open reduction and internal fixation of fractures alone. If such postoperative plain films are released, the patient's postoperative healing will definitely be excellent."
.”
Hearing what Lu Bin said, Lu Bin slowly breathed a sigh of relief and said: "Dr. Zhou, when I saw you doing it before, it was quite easy. But when you actually do it yourself, you realize how difficult it is."
"Ashamed of myself, I probably understand what it means." Lu Bin shook his head, did not pursue the matter further, and planned to step down.
The subsequent suturing and surgical turnaround work was naturally left to Yang Tao and the resident doctors.
Qin Ming also started to help Zhou Cheng take off the tie of the sterile surgical gown, and then said with a smile: "Director Lu, this operation is already very fast. If we want to switch to traditional open reduction and internal fixation, what will happen?"
How long will it take?"
"It only took a little over an hour. Of course it can't be compared with Dr. Zhou, but it's much faster than most people, and the plain X-rays after the operation are also good."
"The fixation of the fracture is stable, the fracture line is well aligned, the surgical wound is small, and the postoperative recovery effect is also worth looking forward to."
Although Qin Ming is also aware of the gap between the quality of Lu Bin's surgery and Zhou Cheng's, he also understands that if different people perform traditional open reduction and internal fixation of the same fracture, the results may be completely different.
But there's nothing I can do about it. Who is Zhou Cheng?
Who are you and others? If you really want to pursue the same state as Zhou Cheng, then you can only extend the operation time indefinitely. He is the pioneer of this operation, so this cannot be compared.
When you start competing with the ceiling, you have to be strong. There is nothing wrong with being strong when you have the ability.
But if you are not capable enough, then don’t pursue perfection.
Zhang Zhengquan also came off the stage, and then everyone arrived in the lounge.
Lu Bin continued to ask for advice: "Dr. Zhou, you said, it is the same manual reduction, the same theory, how come there is such a big difference when it is applied?"
Hearing this, Zhang Zhengquan also pricked up his ears.
Qin Ming's eyes lit up, and he took the initiative to pass a glass of water to Zhou Cheng, and another to Lu Bin. He didn't drink water himself, so Zhang Zhengquan didn't have a share.
If you want to drink water, you can only help yourself.
Zhou Cheng thought for a while and then said: "Director Lu, actually, after understanding the most basic principles of the technique, you still need to understand some things."
"The very first step is to use force to resist and stretch to achieve the effect of reset. The further you go, you will feel that the operation is very skilled and you can easily and quickly achieve the effect of reset."
"But this is a simple fracture reduction. When it comes to complex parts or special parts, simple brute force may not be suitable. At this time, skillful strength must be used."
"The use of Qiao Jin is to think and explore by yourself through the shape and anatomical position of the muscles. By increasing the number of reset techniques, you can feel the inner connection between the different muscle shapes in our human body, and then use the power of four or two to move a thousand catties.
, to achieve the effect of reset.”
"I think Director Lu, you can go in this direction and have a good understanding of it." Zhou Cheng said slowly.
This set of rhetoric was compiled by Zhou Cheng himself. With the help of some realm divisions and corresponding points that Fang Yun had taught him before, Zhou Cheng screwed up the method reset and divided different periods, or different proficiency levels.
A relatively objective division was made between them.
Hearing this, Lu Bin was thoughtful, but felt that it was extremely mysterious: "That's right, I'll just say that when I saw Dr. Zhou, your reset was quick and effortless."
Qin Ming has a relatively strong learning ability and understanding ability, so he asked again: "Doctor Zhou, according to you, Qiao Jin also requires a lot of strength. I see that when you usually reset, you don't use much strength. Are you?
How to achieve the reset effect?”
Qin Ming was very curious about what kind of power Zhou Cheng borrowed for his reset.
Lu Bin also turned around.
Zhou Cheng thought for a while, and found that these were things he had not specifically noted in his manual reduction theory before, but now, Zhou Cheng himself summarized them as an objective object.
"After Qiao Jin, there should be a transformation power. After a fracture occurs, if the patient is not anesthetized, the muscles will naturally contract due to pain stimulation, and this contraction force is actually very strong.
Strong."
"If we can make good use of these forces when resetting, the surgeons and operators themselves will not need to use a lot of force, and they will already have enough power to achieve the resetting state."
"What we surgeons may need to do is to block the traction force of the passive contraction of some muscles, so that the various forces that originally exist in balance will reach an unbalanced state."
"It's almost the highest level that manual reset can reach, that's it." Zhou Cheng explained slowly.
But hearing these words, Lu Bin and others were stunned.
TM Could this still be possible?
What kind of state is it to use the contraction force of the patient's own muscles to complete the manual reduction of fracture displacement? This is a huge difference.
Hearing this, Zhang Zhengquan looked confused, rolled his eyes, and said with a smile: "It sounds awesome, but it's also very difficult. Fortunately, I got out early, otherwise it would be difficult for me to get started with my hands."
Lu Bin and Qin Ming ignored Zhang Zhengquan's complaints and congratulations, but frowned and thought about Zhou Cheng's words.
After crying and thinking for a long time, although he did not fully understand and understand it, he still sighed and said, "Dr. Zhou, if my teacher could teach like this when I was studying, it would be great."
"What if the anesthesia has been completed?" Qin Ming asked his question again.
When Zhou Cheng heard Qin Ming's words, he said with emotion, Brother, do you think everyone knows these things? How much effort did it take for me to summarize these points? Now, they are not perfect yet.
Although it is simple and easy to understand, I understood it thoroughly, tore it into pieces, and then fed it to you. Of course it is easy to understand. If it is difficult to understand, then all the efforts I have made before will be in vain.
The complaint was just in my heart, and I replied: "Under anesthesia, even if muscle relaxants are added, the muscles will still feel the stimulation through proprioception and produce a micro-contraction state. At this time, we may have to apply
It’s not an antagonistic force, but an active stress force.”
"This is not easy to understand, but to put it simply, we can actively stimulate the muscles we think we need to use to produce a state of contraction to help us achieve the purpose of reset."
Lu Bin opened his mouth, blocked by the mask, but his eyes were narrowed.
It's so damn simple. Can you make it simpler?
Qin Ming simply didn't bother to ask anymore. It was too shocking. He also knew that some things could only be understood but not expressed in words.
"Oh, so that's it." Qin Ming could only pretend that he understood.
But actually, he was a little confused by what Zhou Cheng was talking about.
Zhou Cheng did not hesitate anymore, and then everyone moved the topic to other places. They mainly asked whether boss Zhang Zhengquan had a girlfriend and what he did at home. Then, Qin Ming's son studied this year and did not have these things.
If it is not nutritious.
Soon, the operation progressed to the second stage.
The fracture in this unit is a humeral fracture. Although it is a mid-shaft humeral fracture, it is a bit difficult to reduce a mid-shaft humeral fracture.
At first, Zhou Cheng and Zhang Zhengquan were still watching, and then Lu Bin, Qin Ming and others began to reset the technique.
However, three times in a row, the fracture was still a fracture, but the reduction failed at all. Lu Bin's face was so dark that it was ugly. After the third reduction, it still bounced off, so he simply gave up.
Seeing this, Zhou Cheng said before Lu Bin took the initiative: "Director Lu, the fracture on this unit is indeed a bit difficult to reset. I will perform the reset while you and Director Qin complete the subsequent fixation operations."
.”
While talking, Zhou Cheng, Lu Bin, and Qin Ming walked into the operating room.
Zhou Cheng said: "Director Lu, Director Qin, the reason why it is difficult to reduce the fracture of the humerus is because of the stretching of the muscles. In this case, we need to..."
Zhou Cheng tried his best to use theories that were slightly higher than Lu Bin's level to guide him, and then carried out printing and comparison through practical operations.
"At this time, the friction that originally existed between the fractures can just resist the pulling force of the muscles, and the fractures after reduction will no longer shift." Zhou Cheng said as he led people out of the operating room.
Came to the isolation room.
After pressing the button to take a photo, sure enough, I saw on the display screen that it showed a normal fracture reduction state that was even more perfect than the manual reduction of tibial fracture done by Lu Bin before. I was waiting for Lu Bin to complete the fixation operation.
.
Because of Lu Bin's previous comparison, everyone in the isolation room could immediately feel the gap between Zhou Cheng and Lu Bin, and looked at Zhou Cheng with even more awe.
Without comparison, there is no harm. When you get used to better things, it is difficult to change from luxury to frugality!
This is Zhou Cheng. Although everyone can do minimally invasive fractures, the final results are definitely different, and the appreciation of the surgery is also completely different.
This can be said to be a work of art of another level.
Lu Bin even nodded and said with emotion: "Dr. Zhou, I accept it."
"It seems that our department is still a long way from truly carrying out minimally invasive fractures." Lu Bin completely abandoned his previous ideas.
Some things are not as simple as they appear on the surface. For some surgeries, whether you can understand them or actually do them is a completely different concept...
I understand that being able to perform surgery means being able to start and complete the operation completely, and then increase the speed and quality of the operation.
However, those who are truly skilled in surgery will be able to dismantle and dismantle the operations, just like an art performance, and slowly express them. One kind is just a simple operation, while the other kind is a work of art.
.
Minimally invasive fracture internal fixation is not difficult, it is simple, but it is not simple either.
Zhou Cheng's teaching gave Lu Bin a deeper understanding of Zhou Cheng's knowledge reserve and ability and depth of understanding of surgery.
Zhou Cheng pursed his lips and said, "Director Lu, it's actually not bad. The most important thing is that it's still being reset."
"Small incision open reduction and internal fixation, the treatment concept is based on the treatment principles of fractures, but slightly exceeds these principles, so it is not difficult. Today is the first time that Director Lu performs it alone, so he will naturally find it difficult to make progress.
.”
"But once you do it more times, you will gradually become more proficient."
Director Lu, you must not be so anxious. What state have you reached? You are just getting started. If you want to reach my perfect state, it will definitely take time to accumulate.
When I first learned, I had to explore all by myself. Now you just need to follow my current path...
Of course, Zhou Cheng did not dare to say this, otherwise, he would feel a little guilty. The surgery he learned was based on plug-ins, while Lu Bin and others were learning in earnest.
It can't be compared like this.
The next surgery was still smooth sailing.
Surgery sounds lofty, but it has key points and difficulties. Most surgeons know some basic operations. Zhou Cheng's treatment concept is actually independent from manual reduction. Its root is naturally
Manual reset.
Minimally invasive internal fixation is just the finishing touch, just to strengthen the fixation of the fracture after manual reduction.
To understand an operation thoroughly, you need to strip out its essence and start from the principles, so that you can better understand an operation...