Chapter 332 Key points and key points! (Please subscribe)
"Well, these two are also gods! But you can't blame them. If you don't have enough realm, you can't discover the power of others." Qin Ming thought to himself and didn't say much.
In normal times, before Zhou Cheng came, Lu Bin had reminded him more than once in the department not to look down upon Zhou Cheng because of his young age.
However, people in the department still complained a lot because Zhou Cheng was young and did not do the work of junior doctors.
Later, after seeing Zhou Cheng's surgery, such rhetoric slowly disappeared. However, we cannot blame Yang Tao and others. They are only resident doctors and have not yet been promoted to attending surgeons, and they have not yet performed the surgery alone.
You still don’t know how many difficulties you have to face and how many details you need to pay attention to when you are actually doing surgery. At this time, when you want to study again, how precious is the opportunity to learn. It was a waste of time before to follow your own graduate tutor.
Time to study is so hard-won.
But we are all colleagues, so there are some things we can only say so much. Maybe these two have mines at home, or their dream is not to go up in the career ladder, and they have a mentality of just hanging around and waiting to die. You can't say that others are wrong.
After all, being a doctor is really just a job to support your family.
Zhou Cheng continued the operation, while Qin Ming continued to watch. After a while, Director Lu Bin arrived late and said he was sorry while washing his hands and getting dressed before going on stage.
The words were spoken to Zhou Cheng, and his tone and expression showed that he had been threatened by Zhang Zhengquan just before. The apology to Zhou Cheng was mainly for the purpose of truly apologizing.
When he was undergoing surgery, Zhou Cheng watched and escorted him all the way. Now that Zhou Cheng has just started to carry out his own surgeries and perform surgeries on his own outpatients, he is late and absent, and he has to explain to Zhou Cheng.
Zhou Cheng's thoughts were not focused on Lu Bin at all, he just continued to deal with the joints.
This surgery can be easy or difficult. The easy part is that it only needs to straighten the deformity and make it grow back. It can achieve the purpose of the patient's hospitalization, restore the deformity to a normal structure, and then have some functions.
It is not difficult to do this. All it takes is osteotomy. After returning to normal shape, the function will naturally be restored to some extent. There is no need to reconstruct the base of the phalanges and the pulley at all.
However, Zhou Cheng didn't want to treat the operation so lightly and just dismissed it.
Trying his best to do his best, he hopes to be able to functionally recover the patients after surgery and do a better job.
Professional rehabilitation guidance is only one part. The reconstruction of the original anatomical structure is the basis for functional rehabilitation. If the foundation is not established well, no matter how good the rehabilitation guidance is, the upper limit is still too low.
The degree of reconstruction of basic anatomical structures is the way to improve the lower limit of surgical quality. Assisted by rehabilitation guidance, it is possible to raise the upper limit while raising the lower limit.
Deformity osteotomy and orthopedic surgery are not uncommon, and Lu Bin usually performs them. However, when Lu Bin arrived at the operating table, his eyes were completely attracted to the surgery.
Then he tilted his head slightly and saw that Qin Ming's eyes were serious, so he looked at it carefully again and tilted his head to look at the flat film display on the reader.
"Hiss!" Lu Bin took a deep breath.
To outsiders looking at the excitement, Yang Tao and Guo Xiaobing were still hanging around the threshold, but Lu Bin understood what was going on.
"Dr. Zhou, did you do a good job in reconstructing the phalangeal base and pulley? It's a pity that such a good joint structure does not have a joint capsule and corresponding aponeurosis structure." Lu Bin immediately expressed regret.
Previously, in the deformed state, the patient's aponeurotic structure and joint capsule structure were pathological. After returning to normal structures, they were naturally useless and had to be removed.
If you have feet of size 40, you must wear shoes of size 35. If you don’t throw away these shoes, your feet will become useless sooner or later.
When Lu Bin said this, Yang Tao and Guo Xiaobing stopped talking in private and carelessly, and looked over seriously. They could probably understand the meaning of Lu Bin's words, but to really understand it thoroughly, they still lacked basic skills.
Meeting someone who understood, Zhou Chengcheng continued: "Director Lu, this is what I think. Although the joint capsule and aponeurosis structures are difficult to reconstruct, we can try to create a similar structure by repositioning the tendons.
Increases functional mobility of joints.”
These words were never spoken to Qin Ming and others before.
Because during this period, whether it was through simulations in the simulator or through some teaching experiences in reality, Zhou Cheng also knew that sometimes it was not good to go beyond the limit.
Qin Ming and others did not respond at all, which meant that this was beyond their knowledge system.
Is surgery simple?
It is not simple at all. In every place, what parents give us is the best. No matter how we repair it, it will never reach the level it was born with. This is an objective fact.
Even these structures in the thumb cannot be fully restored. It is quite difficult to fully understand, understand and apply them flexibly.
Hearing this, Lu Bin clicked his tongue slightly and asked: "Dr. Zhou, what do you mean? To replace the missing joint capsule and tendon sheath through tendon transposition or transplantation? Isn't this difficult?"
Zhou Chengze continued: "It's not easy. It depends on the person. Our thumb also has a metacarpophalangeal joint. I plan to explore the aponeurosis structure inside it later and see if I can wear it more."
A tendon passes."
"You can't create something out of nothing, so you can only make the best use of it." Zhou Cheng continued to observe the remaining structures while thinking about contingency strategies.
Lu Bin thoughtfully helped silently, then took the forceps from Qin Ming's hand and carefully assisted Zhou Cheng, his tone full of excitement: "This is another extraordinary operation.
Ah, Qin Ming, Yang Tao, you should look more and think more."
This is definitely a good thing. Thumb deformity actually affects the patient no matter how serious it is. However, if the patient's original function can be restored to the greatest extent through surgery, this surgery will not be simple.
Zhang Zhengquan was relieved when he saw that Lu Bin and Zhou Cheng were cooperating with each other and had no intention of selling him out.
Lu Bin's ability to understand things meant that he would stop explaining unnecessary things to Zhou Cheng. Lu Bin would be fine if he did, but Zhang Zhengquan also had other considerations.
Ten minutes later.
Lu Bin asked: "Dr. Zhou, do you plan to do tendon transplantation? Or do you plan to do transposition?"
At this time, both methods can be chosen and both can achieve results, but which one is better cannot be specified. In fact, when the patient’s functional improvement requirements are not high, a transposition can be more effective.
good.
After surgery, the patient loses some other functions, but it is great to be able to replace functions in more directions and complete basic operations of the hand.
"Our thumb has the highest range of motion. Transposition on this finger is impossible. I thought about it and decided that we should do a transplant. The extra extensor pollicis longus tendon can still be used.
It works."
"If it doesn't work, let's see if we can get it from other parts." Zhou Cheng continued to lower his head, slowly resting the exposed extensor pollicis longus tendon and flexor pollicis longus tendon in front of him, and then hesitated for a moment.
Zhou Chengcheng chose to cut the proximal end of the flexor pollicis longus tendon, but left the distal insertion point intact.
Lu Bin quickly saw what Zhou Cheng meant. His scalp tightened and he asked: "Dr. Zhou, the length of this flexor pollicis longus muscle is very limited. If you cut off the proximal end, will there be two sutures or two?"
In the middle section, there is a high risk of breakage after surgery."
Lu Bin was confused.
Generally speaking, tendon transplantation is mostly done at the insertion point. At the insertion point, one end is fixed by fixing the tendon and bone, and then the whole deformation only needs to be sutured in a single place, so the risk will be reduced.
a lot of.
When getting used to an operation, no matter how elaborate the pre-operative discussion is, the details during the operation cannot be perfect, but are decided temporarily based on the actual situation and the surgeon's own skills.
It is right to comply with the basic theory and adapt to changes according to circumstances. Rather than accepting the rules to death.
"It's not bad. As long as the tendon is sutured properly, the risk of rupture is not high. Moreover, the natural muscle insertion point will be more conducive to mobility. On the contrary, it will deform in the middle and is just a borrowing structure." Zhou
Cheng said his inner thoughts.
What Lu Bin said is certainly true, the risk is high.
But Zhou Cheng is right, the income is high.
Moreover, the risk can be compensated to a certain extent through suturing technology and postoperative rehabilitation guidance!
Lu Bin stopped pressing, and instead turned his head and said to Qin Ming: "Qin Ming, when you have time, go check the corresponding literature. I think it might be good to write a case about this patient."
A case is a case report.
Qin Ming immediately nodded: "Director Lu, I think so too."
Zhou Cheng glanced at Lu Bin and Qin Ming, smiled and said nothing. In this regard, Lu Bin's scientific research acumen was higher than Cai Dongfan's.
When Zhou Cheng was with Cai Dongfan in the past, Cai Dongfan never thought about writing articles, but Lu Bin was able to capture this point keenly, and he still had the mindset to think and share.
This is also a type of scientific research thinking. Although it is simple thinking, it is also a kind of consciousness.
The reason why Lu Bin attaches great importance to cases is that no one mentioned this matter when he was in the Ninth Courtyard of the Magic City. It is because in the Ninth Courtyard of the Magic City, several cases were completely boring. They were too lazy to publish such articles.
I'm too lazy to write, there's no need.
The key is to work directly on the topic and publish RCT papers.
A case is a personal surgery show, and a randomized controlled trial is a sublimation and promotion of a theory. The starting point of the two will be different. Teaching hospitals like Modou Ninth Hospital are no longer willing to show off their individual
The surgical technique of the case.
In this way, more than forty minutes passed.
Two new tendons reappeared in public view, and with the assistance of Kirschner wires, the patient's thumb changed from a passive flexion of fifty degrees to a straight state.
Lu Bin finished reading and sighed with emotion: "Wang Limin, you are really lucky to have met Dr. Zhou. From the current point of view, your thumb is worth looking forward to after the operation. The quality of this operation is definitely not good."
As good as any professor you'll find in the country."
"You can achieve this level of success with us, you've made a lot of money."
What Lu Bin said was a bit exaggerated, but Qin Ming also agreed: "This surgery is indeed exquisite. The anatomical structure can be reconstructed to such a level. The postoperative function will definitely not be too bad."
“And there are no blood vessel or nerve problems, so it’s worth looking forward to.”
"Wang Limin, you must cooperate with the exercises after the surgery. Otherwise, it will be a pity that Dr. Zhou has put so much effort into preparing you for so many basic conditions."
Wang Limin didn't understand that much, but these words sounded comfortable to him and he said solemnly: "Hey, thank you Dr. Zhou, thank you Director Lu, Director Qin, you are all good people."
"Don't worry, I will definitely cooperate and live up to your efforts and hard work. If you recover well after the operation, it will be a good thing for me."
"Thank you all doctors." Wang Limin did not forget to thank the others at the end.
The atmosphere in the operating room instantly became much warmer, and everyone felt relaxed.
"The main thing you want to thank Dr. Zhou is that we can't produce this kind of technology." Lu Bin explained, not wanting to steal the limelight from Zhou Cheng.
Hearing this, Zhou Cheng felt quite happy in his heart, and he thought to himself: Director Lu, if you can find ten people all over the world who can do this, consider me the loser.
?
This is Zhou Chengzai's conservative smugness. Of course, it's not easy to say this, just do it.
Zhou Cheng is still carefully suturing the tendons with microscopic instruments. Zhou Cheng still uses the modified Kessler suture method, which is reinforced stitch by stitch to avoid postoperative tendon rupture or suture rupture.
"Brother Zhou Cheng, you are really amazing. Director Lu said so, so it's definitely not bad." Zhang Zhengquan also gave Zhou Cheng a thumbs up, and was still thinking about whether there could be any patents for this new technique, or whether
It could be some special equipment.
Zhou Cheng turned his head and glanced at Zhang Zhengquan and said: "Quanzi, you have to strengthen your professional skills. If you don't learn, you can't even flatter the key points. Tell me, what's good about this surgery?"
Where is it?"
"How are you going to flatter other people in the future?" Zhou Cheng said to Zhang Zhengquan.
Zhang Zhengquan looked at the operating table carefully for a long time, but he couldn't hold back a word. However, in the end, Zhang Zhengquan still said: "The products produced by Zhou Cheng must be high-quality products. I can't be wrong about this, right?"
"Go away! You are feeding Shi in disguise, you are flattering me." Zhou Cheng cursed.
He must activate Zhang Zhengquan's interest in learning, provide him with good teaching theory, and make a contribution.
After the tendons, joint bases and joint pulleys are reconstructed, the surgery is still not the end. Skin problems still need to be dealt with.
However, this is not a difficult operation for Zhou Cheng. He can even remove scar tissue, let alone such a simple skin transplant.
Lu Bin said: "It's time to go get a thick-edged skin remover. We're going to start skin grafting."
Originally, everyone planned to do medium-thickness skin, but Zhou Cheng's reconstruction was so good that there was no need for medium-thickness skin to be used as a fig leaf. It could be treated as a skin defect.
However, Zhou Cheng stopped: "Director Lu, please slow down. Don't remove the thick skin first. Let's deal with the structure under the skin."
Lu Bin groaned and looked at the surgical field with a troubled look: "How should we deal with this subcutaneous structure?"
Zhou Cheng didn't show off too much, and then continued to expand some of the incisions, which were just under the skin of the surgical incision, and cut out a large amount of fat tissue from somewhere.
Moreover, after taking out the fat tissue, Lu Bin saw that Zhou Cheng did not know where he had taken out a very thin blood vessel, almost less than 1mm in size.
For such blood vessels, let alone finding their severed ends, even if they are seen on a regular basis, electrocoagulation is used to stop the bleeding.
After seeing two blood vessels, Zhou Cheng's eyes started to light up.
Then he shouted: "Jiujiu, open the thinnest vascular suture for me."
At this moment, Lu Bin really understood what Zhou Cheng meant, and his expression was full of astonishment: "Dr. Zhou, you don't want to anastomose the nutritional blood vessels of this fat, do you?"
"Well, that's what I think." Zhou Cheng nodded.
"Because in fact, the best skin graft is to cover the wound with only skin defect with a thin layer of skin. Moreover, we all know that adipose tissue is the source of all evils that cause us to gain weight."
"However, its buffering effect and covering and protecting soft tissue are stronger than any other structure. It can also support the skin." Zhou Chengcheng carefully repeated this basic knowledge to Lu Bin and others.
Lu Bin became numb on the spot.
This is the truth, but on weekdays, who of us would pay attention to this point?
No, Lu Bin's head was running for a while, and then he repeated the operation Zhou Cheng did today. Damn it, I don't know if this is a simple deformity osteotomy and correction.
What did Zhou Chengdu do?
Osteotomy, reconstruction of bony structures, incision and suturing of diseased tendons, tendon transplantation, post-fracture internal fixation, and then skin grafting. Before this, Zhou Cheng also performed a reconstruction of subcutaneous tissue.
Then according to Zhou Cheng's idea, a subcutaneous tissue trimming operation was performed.
A seemingly simple operation was played so clearly by Zhou Cheng that he almost pulled out some tricks.
"Doctor Zhou, you are amazing!" Lu Bin now sincerely admired Zhou Cheng.
He has met many people with superb skills and excellent performance in major surgeries. He has been to meetings, including national orthopedic annual meetings and provincial orthopedic annual meetings. There are live broadcasts of surgeries, and there are many exquisite techniques that are rare.
However, Lu Bin had never seen someone like Zhou Cheng perform an extremely simple operation so perfectly and pay such attention to details.
A glimpse of one spot reveals the whole leopard, and one can see even the smallest detail!
Zhou Cheng's surgical skills have definitely reached the level of proficiency, because without reaching this level, it is absolutely impossible to derive so much content from such a simple and basic surgical technique.
Step by step, the principle is simple, but the operation is still superb, and there is a feeling of turning decay into magic.
This is not Lu Bin's own big talk, but after watching Zhou Cheng's step-by-step operation, this is a true reflection in his heart.
Some people's surgeries are so mysterious that you can't even understand them, but Zhou Cheng's surgeries are easy to understand. The principles are also very simple. They are just the combination and dismantling of some extremely simple surgeries, and then every step is explained.
Do a good job, even if it is a small operation, Zhou Cheng will complete it very meticulously.
Therefore, it is not that Zhou Cheng only knows minimally invasive open reduction and internal fixation of fractures, but because Zhou Cheng simplifies this surgery, one cannot see his surgical skills and only think that his operations are magical.
The miraculous skills he has shown before are actually just the manipulation of bone fractures to achieve perfection. There is only so much he can show, but in fact, the basic skills and kung fu that Zhou Cheng knows are far more than that.
.
It was everyone, or rather, Zhou Cheng himself, who created a very influential surgical technique, which led to other people's image of Zhou Cheng being too rigid, thinking that Zhou Cheng was a new technique.
, synonymous with innovation.
But in fact, there are so many so-called innovations, they are just reinterpretations and perfect embodiments of basic techniques.
Zhou Cheng continued to operate slowly and carefully, step by step!
Finally, after about ten minutes, the previous gap was sealed, and the outer fat surface was polished to what it should have been.
After reaching this point, Zhou Cheng still sighed: "It's a pity. The current medical level in our world may sound very advanced, but in fact, during the skin grafting operation, even the folds and horizontal lines of the skin are removed.
Not coming out."
"Alas!~" Zhou Chengzai sighed.
Lu Bin trembled all over and shouted in his heart, Damn it, you still want to reconstruct the horizontal lines and folds?
Horizontal lines only exist on the wrists, palms and inter-finger joints of human limbs. These are lines caused by skin relaxation caused by our frequent activities.
Who can find specialized striated tissue during skin grafting?
You are trying too hard to improve.
"Dr. Zhou, these horizontal stripes are not very useful. There is no need to pursue such perfect beauty." Lu Bin felt that his and Zhou Cheng's thinking concepts were not at the same level at all.
If he performs this operation, he cuts off the bone, polishes it casually, and then cuts the tendon and makes a tendon transplant. After the operation, the patient's thumb can be straightened, and then he can leave.
How can someone like Zhou Cheng waste time doing so many details? If you have this time, wouldn't it be better to do another surgery?
"That's true."
Then Zhou Chengcheng gave the patient another nerve block anesthesia near his elbow, and then used a thick-edged skin remover near his wrist to take out a thin layer of skin and stick it to the surface of the wound.
After simple suturing, subsequent operations such as covering with oil gauze were no longer among the small operations that Zhou Cheng needed to continue.
The operation lasted for an hour and a half before it was announced to be over.
It was time for lunch. Zhou Cheng, Qin Ming, Lu Bin and others left the stage to eat. Even Zhang Zhengquan did not step down at this time, because as an equipment dealer, he certainly could not leave the operating room in advance.
Went to eat.
Although Zhang Zhengquan is the boss, since he has taken up his current position, he must do his own supporting work. You are here, it is not like the rules and it is not appropriate...
Then, at this time, Lu Bin took a serious look at Zhou Cheng and said, "Dr. Zhou, do you feel too busy recently? If you feel too busy, you must communicate with me at any time."
Lu Bin didn't ask about Zhou Cheng's participation in the emergency surgery. It was not just because of Zhou Cheng's surgical skills, nor because of Zhang Zhengquan's warning, but because Lu Bin felt that, like Zhou Cheng now,
You shouldn't go for that kind of emergency surgery.
This is a teacher. The most basic respect for a teacher is not to let him seek benefits for his department, but to give him more rest time.
"Director Lu, you are the ones who have the hardest time. I just sit in the outpatient clinic and occasionally do surgeries. It's not tiring." Zhou Cheng shook his head and told the truth.
He was actually tired, but this tiredness was not caused by Lu Bin, so naturally he would not complain to Lu Bin. It was just his own wishful thinking that he wanted to produce more things, and it was a hard choice for him.
You can't talk about it with Lu Bin.
"That's good, Doctor Zhou."
"Before, I still felt that our vision was too narrow. To put it bluntly, Dr. Zhou, don't be angry. We all felt that you came to our hospital just to teach us minimally invasive fracture internal fixation.
style."
"After all, you are the pioneer of this surgery and you need to promote this surgery. However, I now realize that I was really wrong." Lu Bin told the truth.
If you want to learn more, you must put yourself in the right position with the other person, and have the right attitude. This is appropriate.
Zhou Cheng smiled, a little surprised. To be honest, not only did Lu Bin have a stereotype about him, he was also very wary of Lu Bin in his heart.
When I first came to the department, I found that the nurses in the department were all very good-looking, and with the wine on the wine table, and the little classmate in purple in the outpatient clinic, he was also a stunner.
Zhou Cheng has never let down his guard, which is actually not conducive to his work, but Zhou Cheng can only try to find ways to deal with them.
Now that Lu Bin was able to say these words, Zhou Cheng's attitude towards Lu Bin also changed a lot: "Director Lu, in fact, many times, not only you think so, but other people also think so."
During the time he was in the Magic City, wasn't Zhou Cheng just a tool? No one invited him to do other spells. He still had to fight for opportunities by himself, slowly accumulating and polishing his resume.
Only when you can do the main surgery yourself can you be exposed to more diseases.
This visit to Changshi is a good opportunity to reserve in advance.
"Dr. Zhou, this is what I think. In the future, our department will naturally focus on minimally invasive surgery, but the types of diseases it treats will be more diversified. I don't know if this will make Dr. Zhou more diversified.
Is it difficult to do your job?”
"After all, before you came, I was also worried that treating too many other diseases would make it difficult for you, Dr. Zhou." Lu Bin expressed his concerns.
Nowadays, there are not a few people who can make a fortune by relying on one trick. Therefore, everyone likes to do what they like, and the same is true for Lu Bin. He is also afraid that he, a patient who deliberately seeks difficulty, will be beaten by Zhou.
It became a misunderstanding.
"Director Lu, generally speaking, normalized treatment of diseases is what the department should do. No matter what difficulties there are, only by overcoming them together can we make progress together."
"It is a good thing to have breakthroughs in key areas, but it is also quite inappropriate to ignore the treatment of other diseases just because of breakthroughs in key points."
"We can discuss more together and treat clinical cases as learning opportunities again and again."
"This is also one of the reasons why I came to Changshi."
Enriching real clinical diseases and developing appropriate surgical techniques based on the patients he encounters is what Zhou Cheng has always wanted to do.
"Dr. Zhou, come to think of it, I was envious of your surgical skills before, but now I'm jealous."
"Tell me, how old are you? With such good skills, you simply don't let us old guys live." Lu Bin then joked again.
Zhou Cheng also laughed, not being too modest or anything. Now that Lu Bin saw some things and was modest about them, it was because he was too proud.
It's not necessary. Moreover, Zhou Cheng also learned a lot from Lu Bin. When appropriate, he knows how to retreat and seek to advance. This is the embodiment of Lu Bin's life experience. When solving some problems, don't be too arrogant.
Too tough.
For example, when you are experiencing some sophistication in Chang City, you can be a little more tactful, and there is no need to adhere to the principles and rules completely.
Rules are dead, people are alive, and this is the human world.
Soon, in the next surgery, Zhou Cheng once again performed at his best, a very subtle nerve reconstruction and nerve transposition surgery, which left Lu Bin, Qin Ming and others confused.
Until the end of the operation, Lu Bin was still in shock and astonishment.
"Doctor Zhou, is this the end of the operation?" Lu Bin looked at Zhou Cheng who had already begun to suture. As he imagined, Zhou Cheng did not perform any of the operations of muscle incision, muscle transplantation, and tendon processing.
"Hmm. Didn't I do an electromyogram before? It showed abnormal nerve activity. Although it was apraxia of atrophy, the root problem was actually the nerves. After we transposed the nerves, the nutrition of the nerves was restored.
, after the range of motion is restored a lot, this problem can be easily solved."
"Since there is no problem with the structure of the muscles, let's not add any unnecessary extravagance. Just focus on the most important points and handle them well." Zhou Cheng completed the suturing while explaining to Lu Bin and others that this machine
The core of surgery.
Surgical operation is a key point, but surgery is for treatment. Surgery is a means of treatment, not treatment is the embodiment of surgery. This must be understood.
In clinical practice, whether it is scientific research, surgery, or examination, everything serves the purpose of treatment. After pursuing superb surgical techniques, it must be reflected in
In terms of therapeutic effect and thinking, rather than pursuing how great you are!
Lu Bin was thoughtful, gave Zhou Cheng a thumbs up, and said with a smile: "Teacher Zhou, I have learned a lesson. I think I will have to change my words in the future."
"Teacher Zhou, please don't be polite. If we put it in ancient times, our clinical practice would be a big river and lake. Everyone has his or her own specialty. Those who are masters are teachers."
Zhou Cheng was not polite and said, "Then I'll call you Teacher Lu, and we can talk about our own affairs."
The atmosphere suddenly became very good.
Zhang Zhengquan interrupted and said: "Director Lu, Doctor Zhou, I'm going to step down first and find a more elegant and quiet place. Let's make an appointment in the evening..."