Chapter 458 Wang Huan: I am not a Teletubbies (please subscribe)
Author: A lancet
Chapter 458 Wang Huan: I am not a Teletubbies (please subscribe)
"Master? Are these enough?" Zhou Cheng found some free time and brought his student Wang Huan from the orthopedics department to the emergency department.
I found a free emergency room, hung a patient's MRI on the reading panel, and started teaching.
Students need to bring it, and they need to bring it well.
Wang Huan was his first student, and he was considered the founding disciple.
Moreover, what Wang Huan most wants to engage in in the future is sports medicine, so MRI reading is an introduction that she must learn.
Zhou Cheng shook his head and said: "I took the MRI not just to read the images. It has another purpose. We will eventually return to the image reading system."
"It's just that these MRI aspects are selected by radiologists. We can find some shortcomings from them."
"Let's see what kind of misunderstanding they have fallen into and how we can avoid it."
"Then, we can also analyze which aspects they chose are better. If it were us, we would unpack those aspects and discuss the reasons!"
Zhou Cheng expressed his intentions without reservation.
Zhou Cheng, who has perfect skills, directly explained the big framework to Wang Huan.
Wang Huan quickly understood what Zhou Cheng meant, and was stunned for a moment, feeling a storm in her heart. She knew Zhou Cheng's purpose and ultimate position in teaching her.
However, Wang Huan couldn't keep up, so he wrote and drew quickly in his notebook.
The opportunity to learn is hard-won, and her current talent seems to be excellent!
But she is actually not outstanding. Many people can replace her, so she needs to work a little harder.
If a girl wants to go to surgery, she needs to put in more effort.
Therefore, she cherishes every learning opportunity.
Now that she has such a good teacher, Wang Huan will definitely not waste time.
She knows her qualifications are not good.
Time in a person's life is limited, and the learning process only lasts so long. Every step of effort in this process will eventually have a result.
There were only two MRIs brought by Zhou Cheng. He inspected them one by one and said, "Wang Huan, you see, these levels are all excellent. However, these eight levels are actually redundant.
There is no key content.”
"When we look at ankle ligament injuries, we must pay attention to the following directions..."
"Then you look again. Many aspects of this second MRI are actually repeated and do not have much meaning. Even for the comparison of T1 and T2, there is actually no need to compare so many aspects."
"Of course, this is what we need to see in the process of diagnosing this disease, and then there are some normal structures. You can see the medial ligaments and many ligaments in the foot, which can be visualized."
"Look here, there is also the posterior tibial artery, the dorsalis pedis artery arch, and here is the saphenous nerve. Do you see this one..." Zhou Cheng's teaching ability is definitely beyond doubt.
But if he wants to teach Wang Huan to understand, this requires certain methods and abilities.
Wang Huan listened carefully, his eyes were a little blurred, and he was also stressed. At the same time, he accepted it passively, taking notes, and followed hard.
After Zhou Cheng talked for a while, he turned to say: "Xiaohuan, please observe these aspects yourself first."
"The principle of magnetic resonance imaging is the same. The types of structures contained in the knee joint and ankle joint are the same, just a few types -"
"It's just that the name, location, anatomical shape and continuity of the anatomical structures are different. Last time we tried to read the full-thickness MRI of the knee joint, and just now we looked at the MRI of the ankle joint in relatively detail."
"You can compare and see how many things you can find and how many things you can count."
Many people may feel that the content learned in middle and high schools, including elementary school, is of little use.
Indeed, it may be useless and has little application in life, but this kind of learning idea!
But it is the most precious wealth.
During the learning process, there will be examples and exercises.
In fact, the training and practice of every professional skill is the process of learning and absorbing knowledge. There are example questions, and then we do the exercises ourselves.
Whenever you do exercises, you can improve your proficiency a little bit. Practice makes perfect, and your proficiency will be improved.
After your proficiency is improved, you will continue to improve and make leaps and bounds in this kind of thing.
Wang Huan was shocked and a little flustered: "Ah? Master, I can only read the report now. What if I read the film?"
"Maybe I can't even get started."
Just now, Zhou Cheng listed several levels of film reading for him.
To get started, first learn to read the MRI report. This is a directional diagnostic report given by the imaging doctor after reading the MRI.
If you understand this first, you are just getting started.
Don't think that being able to understand a report is a very simple matter and requires a relatively in-depth knowledge reserve and foundation.
Even the MRI report on the knee joint, which is not in the professional field of sports medicine, is just hanging outside the door.
For example, among Wang Huan's MRI reports, there was an MRI reading report that stated that the lateral ligament of the ankle joint was sprained (II degree).
Currently, ligament injury is defined as a sprain based on the American Medical Association's "Standard Nomenclature of Sports Injuries" of the American Medical Association's Committee on Sports Medicine.
Injury to muscles or tendons is defined as a strain. The grading standard for sprains is.
First-degree injury (minor injury): refers to a strain or contusion of the ligament, with its continuity intact and only changes in congestion and swelling.
Second-degree injury (moderate injury): refers to a partial tear of the fibrous connective tissue of the ligament, accompanied by mild to moderate joint instability.
Third-degree injury (severe injury): refers to the complete rupture of the ligament or the avulsion of the starting and ending points of the ligament at both ends, resulting in a greater impact on the stability of the joint.
After ligament injury, depending on the severity, it is recommended that patients adopt plaster, brace external fixation, and surgical suture repair. In some cases, ligament reconstruction may also be considered.
Looking at this definition, Liu Yihong's suggestion is correct. Second-degree injuries to the ankle ligaments do require external fixation or plaster fixation.
This is what you can see when reading the report. It is also what sports medicine doctors need to master at the entry level of MRI reading.
Zhou Cheng ignored it and slowly gave Wang Huan instructions: "Read the report first, and then find the relevant lesions on the MRI level."
"The lesion is something to locate. First of all, you have to see that the lesion and the damaged part are indeed the ligaments of the ankle joint.
“Then we will redefine the degree of injury based on the degree of ligament damage, rather than simply making diagnosis and treatment based on the radiologist’s report and recommendations…
"After the lesion, we need to look at the complete anatomy to see if there is a complete break. If there is no break, and through physical examination, we cannot see that the patient's ankle joint is unstable.
"Under such circumstances, performing plaster external fixation is actually over-treatment!"
"It's not necessarily excessive treatment for money and making money, but just accurate diagnosis and erroneous classification of appropriate treatment!"
Based on Wang Huan's performance, Zhou Cheng determined that the upper limit of what Wang Huan could see was to be able to understand anatomical structures.
This is one of the more difficult things about becoming a doctor. It requires far more knowledge than you think.
If you go deeper and have level 5 MRI reading skills, you can roughly predict the patient's injury mechanism, whether it is medial and lateral injury, or the starting and ending point of the final stress of the injury, whether there is a tear of the ligament root, etc...
"Okay, Master." Wang Huan replied weakly.
I thought to myself that maybe my teacher is better and has more stringent requirements and standards for students.
It's so hard for me.
When reading pictures, you need to concentrate, especially in the beginner stage!
Now, Zhou Cheng wants to teach Wang Huan, so he needs to show him the way one by one, understand where Wang Huan is, what level he is at, and then how to reach a higher level in the next step.
Wang Huan reads the report first, then the anatomy!
Only after watching the anatomy can we look at the layers!
This is Zhou Cheng's understanding, because if you want to see a temple that is deeper than anatomy, you need to be more careful, because each section may have a lot more things than the last section.
For example, at which level should the anterior tibial artery appear, at which level should the dorsalis pedis artery appear, at which level should the posterior tibial artery appear, and at that level the peroneal artery should appear.
Then use the arteries to find accompanying veins, nerves and other anatomical structures.
After you become more proficient, you can know at a glance what level you are at, what ligaments, blood vessels, and fascia you can find...
How top experts and professors manage to see so many outpatients in one day is how they learn and accumulate.
Wang Huan can also understand Zhou Cheng's intentions and intentions!
This is also a manifestation of Zhou Cheng's own skill. If a layman who doesn't understand it can't even tell what level Wang Huan is at, then why not teach him?
Teaching does not always have to be unilateral feeding to show the power of the teaching teacher, but at the appropriate time, the most appropriate "feeding method" and the most appropriate learning measures are recommended. This is teaching
.
Zhou Cheng has already taken Wang Huan to look at the ankle injury that Wang Huan found from the department!
Wang Huan participated in the operation, knew the diagnosis, had a certain impression and understanding of the general anatomy, and knew that the patient's injuries were the anterior tibiofibular ligament and the anterior calcaneofibular ligament.
The anterior tibiofibular ligament connects the tibia and fibula, while the anterior calcaneofibular ligament connects the calcaneus and fibula.
Wang Huan had to find them first, and to find them using nuclear magnetic resonance, she had to find these corresponding skeletons.
"Master, here, you see, there are two levels here, both showing the anterior calcaneofibular ligament, and three levels showing the anterior tibiofibular ligament."
"The anterior calcaneofibular ligament is ruptured here, and the anterior tibiofibular ligament is also discontinuous here."
"Is this because the ligaments have become loose or contracted after being damaged?" Wang Huan asked after reading it.
Zhou Cheng heard this and scanned it again: "This patient's ligaments should have shrunk! If he is older, the ligaments will not be so tough and they will float out."
"At the nuclear magnetic level, it is floc-like or tail-like, free in the middle of the bone, and it needs to be seen from the coronal or axial position."
The level of nuclear magnetism is divided into many directions, similar to the different directions of the cube we saw during our high school studies.
Simply and easily understood, it means front view, side view, top view...
Wang Huan instantly felt a sense of enlightenment. This may be because she has accumulated enough in the past, so she can understand what Zhou Cheng said, or it may be because Zhou Cheng can easily identify what needs to be seen at each level.
When teaching, be able to lift things lightly.
From reports, lesions, anatomy, theory, etc., I can get in and out with ease.
Can answer any question raised by Wang Huan.
This is a treasure house. Wang Huan can just dig it without worrying about hollowing out Zhou Cheng.
Wang Huan nodded and took notes quickly while reading. This was her study habit and she was someone who firmly believed that a good memory is worse than a bad writing.
Zhou Cheng saw that Wang Huan still had a little bit of understanding and was much better than he was before the adventure, so he decided to take her to see more things.
"This MRI also shows another typical injury. You can look for it."
"This is what we have learned in the basic theory of orthopedics. It is called stress fracture. This is at the level of microfracture. Only MRI can show it. See if you can find it." Zhou Cheng said.
I want to teach Wang Huan a broader field of knowledge.
"Ah?" Wang Huan paused and looked at Zhou Cheng.
But Zhou Cheng is now a strict teacher, and there is no doubt about it.
However, when Zhou Cheng said this, Wang Huan immediately nodded: "I know, Master, stress fractures, although in undergraduate textbooks, it is written as marching fractures, which mostly occur in the metatarsal bones."
"But in fact, stress fractures exist in various fields of orthopedics, but there is no such classic conclusion."
"Knee osteoarthritis is the result of reshaping of the fractures after multiple stress fractures, leading to deformity."
"Even during the fracture rehabilitation period, stress fracture displacement and healing can occur during functional exercises."
"Here! Here. The middle-lower and lateral edema signal of the tibia is different from the ordinary bone marrow edema signal. The upper edge of the talus is also not an ordinary edema signal."
"It's just a microfracture like this and doesn't need to be treated." Wang Huan replied while showing it to Zhou Cheng. He had also read the book.
I can still do basic skills like looking at edema and identifying bones on MRI.