Chapter 331 The ignorant are fearless! (Please subscribe)
There are some operations that you can't appreciate the difficulty of if you don't do it yourself. And for some people, if you're not in that field, you can't feel the level of their level.
It is difficult to truly understand the height another person has reached by what he sees with his eyes and what he thinks in his mind.
If you know your brain well but your hands don't, this is something that can easily happen in routine operations.
After Lu Bin and Qin Ming experienced operating the first two machines themselves, they admired Zhou Cheng even more.
With such a great reputation, Lu Bin no longer had any surgeries of his own, and Lu Bin's mentality became much more relaxed. After leaving the operating room, he sighed to Zhou Cheng: "Dr. Zhou, I saw you perform surgery before, or should I say that you
After reduction, I will perform subsequent fixation operations with minimally invasive internal fixation devices."
"It doesn't feel too difficult, but when I have to do it all by myself, I still feel nervous and I can't always achieve the results I want. It's difficult." Lu Bin's expression was solemn, and he spoke slowly.
Drink a glass of water to relieve your inner emotions.
Qin Ming gave it to Zhou Cheng in a coy way, and Zhang Zhengquan and the other two also got a glass of water. Zhang Zhengquan stood up and took it, then thanked Qin Ming. Qin Ming didn't pay attention, but listened carefully to Zhou Cheng's explanation.
"Director Lu, the main reason is that I am relatively young, so I may be able to do things on my own, but when it comes to teaching, I actually have quite a few shortcomings. I really don't have any experience." Zhou Cheng also found his own shortcomings.
Is it difficult to be a teacher?
It’s not difficult to say, it’s just that you have to teach the knowledge well and express the knowledge and your own understanding, which is naturally not difficult. But it is not easy to teach people well and teach them until they understand.
Teaching in primary school and junior high school is not easy, let alone the current knowledge structure and system?
In fact, being a university teacher is both the best and the most difficult thing to do. It is best to be a teacher because you select high-quality students. The most difficult thing to be is that it is difficult for you to explain your understanding to others. It depends more on your personal talent.
.
This is difficult.
If it's just for individuals, Zhou Cheng has various methods. If it doesn't work, he can also use the simulator to simulate how to teach a person. However, what Zhou Cheng wants to do cannot be fully realized through the simulator.
In the process of teaching Lu Bin, Zhou Cheng did not take shortcuts, but planned to be a real teacher for once, which would also help Zhou Cheng improve his teaching theory in the future.
Before that, whether it was Chen Shengwu, Yang Yifeng, or Yu Heng, these people were not ordinary people. They had very high understanding. Even Qin Ming had quite good qualifications, and the people in front of him were quite good.
Lu Bin is the kind of person with mediocre talent.
How to teach such people well and in a broad-spectrum manner is very helpful for the regularization and systematization of medical teaching.
Now that we have decided to digitize and hierarchize the level of medical strength and skills, we have to consider all aspects and investigate in detail, which is not easy.
Not easy is a good thing. If everything can be achieved casually, then life will not have so much meaning. What's more, this matter is of great significance and has far-reaching impact.
If you do it well, you will be famous throughout the ages. If you do it poorly, please refer to the status of those medical students who compare China's training system with Western countries, but their treatment cannot keep up...
Lu Bin said: "No, Dr. Zhou, your teaching theory is solid and easy to understand, but my learning progress and speed are too slow to keep up with your pace. Perhaps, my learning speed is faster than Qin Ming's."
You have to be slow and just rely on your basic skills to hold on here."
In Lu Bin's view, Zhou Cheng is already an excellent teacher. His basic skills are extremely solid, his theory is thorough, and he can break down all knowledge structures, but it is difficult for him to absorb and apply it flexibly.
In the theoretical system of medicine, there are probably not many people who can achieve such a feat like Zhou Cheng.
There are too many people who are good at doing things but not good at teaching.
Even Zhang Zhengquan said: "Brother Zhou Cheng, I think your teaching is very good. I can understand a lot even though I'm a poor person."
He does not mean that.
When Zhou Cheng heard what Zhang Zhengquan said, his eyes suddenly lit up.
Hey, yes, Zhang Zhengquan is now in Changshi.
If we want to say who has the lowest qualifications among the people he comes into contact with, then it is undoubtedly Zhang Zhengquan. His talent in medicine is not comparable to one-tenth or even one-hundredth of his weirdness...
If Zhang Zhengquan can be taught well, it will definitely be useful to most medical students.
In an instant, Zhou Cheng's eyes became hot.
Zhang Zhengquan Toolman can finally be launched online in the simulator...
Zhang Zhengquan saw that something was wrong with Zhou Cheng's eyes after he spoke, and his expression suddenly became stern. He tightened the collar of his sterile surgical gown, stretched his head over, and lowered his voice: "Brother Zhou Cheng, if you fall in love with me,
, just tell me and I will go to your house tonight."
"Get out!" Zhou Cheng cursed.
A joke broke the awkward atmosphere before.
"Boss Zhang and Dr. Zhou have a good relationship?" Lu Bin asked with a smile.
Zhou Chengcheng said: "Zhang Zhengquan and I were classmates in training together. We were in the same group. He was one year younger than me. But now he has withdrawn from training and has changed his profession instead of being a doctor."
Zhou Cheng himself completed the regular training program in April this year and also took the exam. It is estimated that he will be able to get the certificate soon, and in August, he will also take the exam for the attending physician.
go.
But Zhang Zhengquan no longer works as a doctor, and now he doesn't even bother to register himself. Although he has a medical qualification certificate and a practicing certificate, he has not completed the required training. He still cannot engage in related industries, at least he cannot practice alone.
Lu Bin's expression flashed: "So that's it. I really envy you young people."
There was something in Lu Bin's words, and his mind became active.
Isn't this a loophole given to him by Zhou Cheng? Zhou Cheng and Zhang Zhengquan used to be friends, but now one is an equipment dealer and the other is a clinician. If there is no interest at all, even a fool would not believe it.
Zhou Cheng did not hear the meaning of the words, but Zhang Zhengquan said with a stern look: "Director Lu, Brother Zhou Cheng and I are purely friends, and everything else is irrelevant. Director Lu, please don't have any misunderstandings, otherwise this misunderstanding will
It’s very difficult to untie.”
In fact, Zhang Zhengquan, as a device dealer, should please Lu Bin, but he is not afraid of Lu Bin. Now his role is to lead a company to purchase quantities. In a hospital, he can't eat much, and each piece
You can't make much money from steel plates.
You can only make money by following the quantity and following the quantity. Therefore, being a Lu Bin is not enough to scare him, and at worst, he will not do it. However, Zhang Zhengquan still wants to be harmonious and make money.
When Lu Bin heard this, his eyes froze, and he thought to himself, who is this kid, so fierce?
Zhou Cheng glanced at Zhang Zhengquan and explained: "Director Lu, I used to live in Magic City. My friends mostly work in Shashi. It just happened that we met in Changshi."
Zhou Cheng also helped.
Lu Bin immediately reacted, yes, Zhang Zhengquan was working in Hunan Province, but Zhou Cheng was in Shanghai, so there might not have been any interest before it was proved, but what about now? What about in the future?
…
After a while, Zhou Chengcheng took the initiative and said: "Director Lu, I'm going to take a look at the X-ray and pre-operative examination of the thumb deformity at the back, and go over the surgical plan again. I'll go to the operating room first."
"You and Director Qin, please come back later."
When Lu Bin heard this, it was a good opportunity at this time: "Qin Ming, you can go with Dr. Zhou and hurry up the operation turnaround. Those people below should stop being lazy and help get on stage."
"Boss Zhang and I have something to say."
Qin Ming thought that as Zhang Zhengquan was a new equipment merchant, he was still young, and what he said before was a bit rude, so Director Lu Bin wanted to hammer it down, and it was not convenient to listen to the conversation, so he immediately followed him out.
He is now the deputy chief physician, and he is quite familiar with the inner workings.
After Zhou Cheng and Qin Ming left, Qin Ming consciously closed the door.
However, Lu Bin saw that the time was right, and before he could speak, Zhang Zhengquan spoke: "Director Lu, let me explain to you, I am Zhang Zhengquan, and Zhongzheng Company belongs to me."
"I dare not say anything else, but if I don't want to provide Changshi Traditional Chinese Medicine Hospital with the authority to provide any equipment, I still have it."
"Zhou Cheng is my friend. I hope Director Lu will not embarrass him or think about embarrassing him."
"That's how I am. I always like to say things clearly." Zhang Zhengquan changed his face first. His face was dark, and he couldn't tell whether he was happy or angry. However, when he spoke, he immediately gained the upper hand.
.
Just kidding, Zhang Zhengquan’s previous contacts were all directors and professors of major hospitals. Although he was at a disadvantage at that time, he learned a lot over time.
He could really look down on Lu Bin, the director of a prefecture-level city hospital. When he could use his strength to overwhelm others, Zhang Zhengquan didn't want to push him too hard.
When Lu Bin heard this, he immediately swallowed his words and looked at Zhang Zhengquan in astonishment, with an inexplicable look on his face.
Zhang Zhengquan continued: "Director Lu, the most important thing for us in business is to be friendly and make money. But there are some principled things that our company does not want to touch. The main purpose of opening this company is not to make money."
"That's pretty much what I want to say. Apart from that, we can be friends. We can eat and drink when we should, talk about what we should, and we won't talk about what we shouldn't."
After Zhang Zhengquan finished speaking, he remained silent and waited for Lu Bin to speak.
Lu Bin digested it for a long time, and finally came to his senses: "So, Boss Zhang, you came to Changshi just for Dr. Zhou?"
Among other things, the general managers of some major equipment companies no longer work at the grassroots level. As the CEO of a company, Zhang Zhengquan went directly to a municipal-level hospital. This is not normal.
He was able to come here in person, so the relationship between him and Zhou Cheng had to be re-evaluated.
There are some things that Zhou Cheng, as a doctor, cannot do or say, but he can say them.
"That's pretty much it. I'm the younger brother who follows Brother Zhou Cheng. Director Lu, thank you for taking care of Brother Zhou Cheng during this period. I also hope that Director Lu will take more care of him in the future."
"If necessary, our company can provide Director Lu with many conveniences, including opportunities for further study. Not only can I send Director Lu to study abroad, but I can even send you, Director Lu, to go abroad to become a doctor." Zhang Zhengquan smiled and showed his face.
Teeth, but covered by the mask.
But the words were full of threats.
Just now, Lu Bin just asked Qin Ming to go to the operating room with Zhou Cheng. He obviously had something to say to him! He deliberately avoided what Zhou Cheng said, which must be related to Zhou Cheng. Zhang Zhengquan didn't want to worry too much about it.
What he prefers is to fight violence with violence and minimize all risks.
Before becoming the CEO of the company, Yan Haihan from the Second Ward of the Orthopedics Department of the Eighth Hospital had done something to him. Even Professor Ding Changle, he had someone suppress him, let alone Lu Bin. If you are sensible, everyone will be in peace.
If you have any trouble with me, I'm sorry, I'll send you abroad to become a doctor.
The side meaning is that now I can make it impossible for you to survive in the country.
It's also very simple. Just shake your ass out and spread it everywhere in the country. How can you still get along in the country?
Lu Bin became thoughtful, with a cold face, and said no more words.
Zhang Zhengquan, thinking that time was almost up, rushed directly to the operating room.
In the operating room, preparations for the operation have already been made.
"Quanzi, wash your hands and come to the stage to help. This one is for osteotomy and orthopedic surgery for thumb deformity. The speed is neither fast nor slow. You should learn from it. Anyway, you will be fine." Zhou Cheng said to Zhang Zhengquan.
Naturally, we must first explore Zhang Zhengquan’s background in reality.
"What can I learn? Brother Zhou Cheng, are you kidding me? I'm very good at it." Zhang Zhengquan joked sincerely, "But I can go on stage and show my strength."
"Then just stand aside and watch." Zhou Cheng identified Zhang Zhengquan as his teaching subject and naturally hoped that he could help him.
Qin Ming felt a little strange when he saw that Director Lu Bin did not come to the operating room. However, as the director, Lu Bin had the right not to come, so he ordered: "Yang Tao, Guo Xiaobing, you two come on stage and help."
Osteotomy and orthopedic surgery for thumb deformity is actually not a particularly common therapeutic surgery, but a functional repair and cosmetic treatment.
But in fact, thumb deformity can indeed affect the patient's quality of life and lifestyle.
The preparations for the operation were almost complete, and the patient woke up first: "Doctor, doctor, please slow down. The anesthesiologist said that my hand has not been anesthetized yet, but you just put me on the stage."
"This can't be done. It will hurt me to death." He was frightened. This was the first time he had encountered it so far and was unheard of before.
There was no anesthesia during the operation. When I was hospitalized, the patients in the ward were in great pain even though they were under anesthesia.
The doctor in charge of the bedside became nervous at first, and then quickly explained: "Brother, don't panic, it's not that there is no anesthesia, it is local nerve block anesthesia. We think that for your surgery, the scope of anesthesia does not need to be too wide to facilitate your postoperative recovery.
, you know."
"We, Dr. Zhou, are performing surgery on you. What are you worried about?"
Hearing this, the anesthesiologist felt quite happy and stood there curiously, ready to see what Zhou Cheng was going to do. This operation was obviously a serious operation, but it did not require traditional serious anesthesia.
Zhang Zhengquan had never seen the patient, so he glanced at Zhou Cheng curiously and found that Zhou Cheng had a calm face and was not worried at all, so he felt relieved.
Zhang Zhengquan didn't know about others, but he heard from Luo Yun that Zhou Cheng was as stable as an old dog, so he was not worried about Zhou Cheng's decision.
Zhou Chengcheng said: "Actually, the deformity of his thumb is very similar to the trigger finger (refer to the action of shooting). In addition to bone deformities, there are also skin and muscle tissue deformities. The surgery we need to do
, we need to cut the bone first to restore the bone to its normal structure.”
"After the osteotomy returns to normal shape, after the osteotomy, the muscle tissue and tendon tissue must be restored to their normal structure, and then skin grafting must be performed."
"I plan to do a blade-thickness skin or a medium-thickness skin, depending on the specific conditions during the operation. However, his tendon contracture and ligament contracture must be serious. We must pay attention to this."
He has a deformity of his thumb. The current angle is about 45 degrees, which is very inconvenient for daily operations. He is not very old now, but he has to take on some delicate work, so he plans to have a section in his middle age.
Orthopedics.
It is also convenient to get a wife.
Hearing Zhou Cheng's voice, the patient felt relieved, but still said: "Of course I trust Dr. Zhou, but don't do it without anesthesia. Although I'm not afraid of pain, I still can't do this kind of raw flesh cutting."
"Dr. Zhou, don't joke with me, I'm scared." This middle-aged man is actually quite strong. He seems to be able to endure hardships and is not afraid of pain. But at this time, he was almost crying.
"It's okay, don't be nervous." Zhou Cheng said, while explaining to Qin Ming and others: "The main purpose is that I don't want to use too much anesthesia during the operation. We all know that,
The innervation of the thumb is actually very limited."
"And our surgical field is actually only up to the thenar, so we don't need to do a large range of anesthesia. I think our current hospital can try to carry out such small and delicate operations and anesthesia.
A small topic.”
"It's also in line with the rules."
As he spoke, Zhou Chengcheng began, "Has the local anesthesia been prepared?"
"It's ready, Doctor Zhou. It's all in this syringe." The handwashing nurse immediately handed over the anesthetic drugs, and then gathered around curiously, wanting to see what Zhou Cheng was going to do.
Zhou Cheng took it and said: "Although the anatomical structure near our fingers is fine, its shape is very particular. Near the distal segment, there are many local sensory nerve endings, so you can feel pain quickly.
"
"But actually, on the side of the finger, although this is where the nerves run, the nerve endings are less distributed. So we can use this anesthesia method to achieve the anesthesia effect of a single finger, and there may be an additional one during the operation.
But it doesn’t matter.”
While talking, Zhou Cheng quickly inserted the needle tip. The strange thing is that according to ordinary people's understanding, acupuncture will be very painful, especially when local anesthesia is given, it will be even more painful.
However, Zhou Cheng suddenly inserted it a little deeper, but the patient still felt nothing.
Before he could complain of pain, Zhou Cheng had already completed the action of reverse suction and pushing the medicine, and then said: "Look, after quickly inserting the needle and completing the local anesthesia operation, the patient actually didn't feel much pain.
It was so touching that I didn’t even have time to react.”
Zhou Chengcheng confirmed his statement, and then inserted the needle again on the radial side of the thumb, which is what we conventionally understand as the inner side. Using the same technique, he inserted the needle in and pushed the medicine in.
The patient still didn't call.
The anesthesiologist asked curiously: "Wang Limin, don't you feel any pain?"
Wang Limin was the patient's name. When he heard the anesthetist's words, he said "ah".
"Have you started cutting? Why don't I feel it?" The nervousness made his hand flick a little, but the arc was very slight.
"Don't move!" Zhou Cheng immediately stopped and stared at the anesthesiologist.
If you are curious, we are talking about academics. Why are you chatting with the patient? To increase his mood and make him move during the operation?
Wang Limin's hands immediately stiffened.
"Don't move, Wang Limin. The operation is very fast. Now, I'm using the needle to prick your thumb. Do you feel anything?" Zhou Cheng asked.
"It's a little tactile, but it doesn't hurt. It really doesn't hurt at all. Did you poke it with the tip of a needle? Not your finger?" Wang Limin's voice was filled with surprise and joy.
"Don't worry, as long as it doesn't hurt, don't worry about anything. Just treat it as if you are resting. If you can't cooperate during the operation, we will have to transfer you to general anesthesia!" Zhou Cheng said.
This operation is performed under local anesthesia and general anesthesia, and can be transferred at any time. I am afraid that Wang Limin will have a psychological burden, but at present, as long as no one makes trouble, Wang Limin will feel nothing.
Then, when Zhou Cheng saw that Wang Limin was no longer moving, he saw that Zhou Cheng quickly completed the action of cutting the skin. Zhou Cheng cut open the skin on the side of the interphalangeal joint of Wang Limin's thumb. With two cuts, only a slight
The blood oozed out, and then the sterile gauze was wiped, and the blood was gone.
Immediately afterwards, Zhou Cheng used vascular forceps to open the skin and subcutaneous tissue, exposing the contracture tendon inside.
"There are eight tendons in the thumb: flexor pollicis longus, flexor pollicis brevis, extensor pollicis longus, extensor pollicis brevis, abductor pollicis longus, abductor pollicis brevis, adductor pollicis and opponent pollicis."
"But among these eight muscles, only the flexor pollicis longus and extensor pollicis longus pass past the first metacarpophalangeal joint and reach the distal phalanx."
"So, what we have to deal with is actually these two muscles."
"We all know that fingers have no muscle tissue. The muscles from the forearm and palm to the fingers have become tendons. They are mainly divided into two groups according to their functions: the flexor tendons on the palm side and the extensor tendons on the dorsal side."
"After the extensor digital tendon crosses the metacarpal joint, it expands to both sides on the dorsal side of the proximal phalanx, forming a strong dorsal digital aponeurosis."
"The dorsal finger aponeurosis is divided into three parts: the central tendon strip inserts at the base of the middle phalanx. After the two tendinous strips bear the lumbrical muscles and part of the interosseous muscles, they merge on the back of the middle phalanx, and then terminate at the base of the distal phalanx.
.Each bundle is strengthened by tendons.”
“When the extensor digital tendon is ruptured, each finger joint is in a flexed state, the proximal interphalangeal joint cannot be straightened if the middle bundle is ruptured, and the distal interphalangeal joint cannot be straightened if the two lateral bundles are ruptured.”
"This is a state of trauma. This patient's interphalangeal joints suffered deformed fusion due to trauma in his early years. Therefore, his tendon development was also abnormal. In the process, his thumb lengthened.
The extensor tendon is definitely too long, and the flexor pollicis longus tendon is definitely too short.”
"So, I plan to see if he can combine the two tendons through anatomical positioning. If it doesn't work, we can only take secondary functional tendons from other places to complete the tendon transplantation."
Zhou Cheng slowly popularized anatomy knowledge, and he actually told it to Zhang Zhengquan. Among them, Zhang Zhengquan probably had the worst foundation.
Zhou Cheng explained in such detail and had references, so Zhang Zhengquan could understand it.
"Because we don't need to deal with blood vessels and nerves. They are in a flexed state now, so the blood vessels and nerves are actually too long, so they don't need to be considered after surgery. In this case, our operation can be roughly divided into two steps.
.”
"The first step is to cut the bone and reshape the joint surface."
"The second step is tendon treatment, autografting, or rearrangement!"
"The third step is skin treatment, such as skin grafting."
"The fourth step is to fix it."
"Isn't this difficult?" Zhou Cheng asked.
Then he looked at Zhang Zhengquan, who nodded.
This is indeed not difficult.
Zhou Cheng continued to popularize science: "The interphalangeal joint is composed of the pulley of the upper phalanx and the base of the next phalanx. Now that they are fused, we need to create another pulley structure and then polish it into a bone base."
"We first find a suitable place and cut the skin. Previously we cut the side, now we have to cut off the skin from the proximal phalanx."
"Then, we are exposed..." Zhou Cheng's movements were clean and neat step by step, and everyone could understand them.
However, when Zhou Cheng exposed the fused bone and cut off the fused bone surface, Zhou Cheng directly used a bone file and polished a pulley structure in a very short time.
Yes, Zhou Cheng polished a pulley structure by himself, and then asked in a calm tone: "Look, is this almost the same as the normal pulley structure? The pulley of the proximal phalanx of our thumb is almost in the shape of a cone barrel.
, the diameter is almost..."
"Then the base of the finger bone is in the shape of a basin, and its diameter is about..." Zhou Cheng said as he reached this point.
Then he looked at Zhang Zhengquan. Zhang Zhengquan shook his head and narrowed his eyes. It means, I really don’t know this.
Qin Ming did the same. He swallowed his saliva and replied seriously: "Dr. Zhou, I generally don't pay attention to the data you mentioned, nor do I remember it."
"And it's useless to remember it. This kind of reconstruction of the phalangeal base and phalangeal pulley?"
Qin Ming only spoke half of what he said. If I could achieve this level, would I still be just a deputy chief physician now?
Brother, you are reconstructing the base of the phalanx and the pulley of the phalanx. This is almost impossible to accomplish in the world at present. In theory, this is not available yet?
Qin Ming's tone was sour, and his expression and eyes were strange.
Qin Ming's weirdness is something that Zhang Zhengquan and others cannot understand, because they don't even know how difficult it is, they just feel shocked.
Yang Tao is still saying: "Well, look, it looks like a normal pulley..."
Guo Xiaobing nodded: "Well, almost exactly the same."