medical simulator

Zhou Cheng will not commit the same misunderstanding and incident twice in a row.

Seeing that Zhou Cheng kept his mouth shut and stopped talking, Yang Yifeng sighed instantly, as if he saw something exciting in the novel, and the author actually broke the chapter, he couldn't get up and down, it was very uncomfortable.

Obviously wanting to know the following, but the next day I found out that the author is a eunuch!

Of course, Zhou Cheng is a free man, he has the right to choose what to say or not to say.

Yang Yifeng is not Zeng Yi either, Zeng Yi is the chief director of orthopedics, he can shut up Zhou Cheng with one word, but it is impossible for Yang Yifeng to make Zhou Cheng speak again with one word.

The same is true for Chen Tingye.

With the title of professor of Shonan University and vice-chairman of hand surgery, it is extremely useful when facing many directors. level one.

But it is not so easy to use, and Chen Tingye can't force Zhou Cheng to finish the rest, but he just feels quite regretful.

It's a pity that a rather intense academic collision and spark was about to happen just now, so it was cut off like this.

But the days to come are still long, if Zhou Cheng and Yang Yifeng are interested, they can organize another round.

Don't be in a hurry at this time.

Yang Yifeng's question is very exciting.

There is an old saying that what is difficult is asking questions, not the answers to them.Being able to ask subtle questions means that Yang Yifeng has a solid foundation.

However, after asking a good question, Zhou Cheng only had time to answer half of it, and this answer was interrupted by Zeng Yi.

The two continued to look at Zhou Cheng, and found that Zhou Cheng just continued to suture the perineurium silently!

Chen Tingye stopped being lazy, and continued to start his own work.

Zhou Cheng knows how to operate, and he also knows how to do it. He even feels that he can do it more delicately, so he doesn't have much thought to focus on Zhou Cheng's operation itself.

In his current state, what is more important is the collision of thinking and the improvement of cognition.Simple skills can be said to be close to the end, and are of little use.

Yang Yifeng watched Zhou Cheng and Chen Tingye's suturing for a while, and lost interest in watching it any longer, so he turned around and wondered why Zhou Cheng would say that he could start functional exercises five days after the operation.

You must know that modern medicine is reasonable. If you just say it so casually, it proves that you haven't figured it out yet.

The internal logic hidden under the deep layer is actually the most attractive.

The tip of the iceberg, what people see is the brilliant corner, but Yang Yifeng is more interested in exploring and understanding the iceberg itself. As for the corner, it is just a feast for the eyes.

Wang Yaoxiang ate melons the whole time, looked around Zhou Cheng and Chen Tingye were doing nerve suturing, turned to help Chen Tingye, and then exchanged Chen Tingye's assistant for Zhou Cheng's side.

Obviously, he is more willing to observe Chen Tingye's nerve suture operation, and constantly figure out the details of his operation.

……

On the other side, Zeng Yi saw that Yang Yifeng turned around and walked back after he finished speaking, while Chen Tingye immediately shut up, not even reading the following polite words.

Zeng Yi was prepared in his heart, Chen Tingye's problem is, it's just that everyone communicates casually, Director Zeng, you don't have to do anything.

He had prepared the answer, but Professor Chen Tingye didn't ask, so he was angry?

Zeng Yi's heart was flickering.

In the field of medicine, whether it is a professor or an expert, there is no superior-subordinate relationship between them. The reason why we hope to establish a good relationship with the higher-level hospital is to facilitate the turnover of patients, or when encountering medical disputes. Find the professor who came to solve the problem!

The second meaning is that if you have a good relationship with the professors in the higher-level hospital, when you go to study, you can make arrangements for you with just a greeting.

The third meaning is that when the higher-level hospital has a request for support to go to the countryside, it can think of you as soon as possible, and come to teach surgery for a period of time.

However, Zeng Yi reflected on his decision for a while, and it was still right.

If it was really misunderstood by Chen Tingye, and he and others did what Zhou Cheng said, and believed it to be true, then that would be a bigger trouble, why not cut it off from the source!

By cutting off like this, it is natural to understand the relationship between myself and Zhou Cheng, we play our own way.

There is actually no better way for Zeng Yi to make such a decision, and if Zhou Cheng doesn't take the initiative to play with him, then even if he praises Zhou Cheng, won't he be the one who hurts himself in the end?

……

The essence of nerve suture is the suture of epineurium and perineurium.

After suturing, it needs to be wrapped and put into the prepared vascular bed to restore the original anatomical position of the nerve.And if there is shortening, it needs to be treated separately. The nerve of this patient has not been cut too much, so no additional special treatment is needed.

In this way, three of the four major pieces of replantation of severed limbs have been completed.

Four major parts, bones, blood vessels, nerves, and tendons.Only bone fixation remains, not complete.

There are skin sutures that are not suitable for this patient.

Because there were too many skin defects, the subsequent skin flap transplantation could not escape.

Of course, if you don't pay attention to it, you can directly do this treatment on the tendon now. As long as the fingers can move after the operation, the operation will be considered complete.This is stepping down, and you can explain to the patients and their families.

The fixation of the external fixation bracket allows Wang Yaoxiang to play, coupled with the VAC external fixation at the back, it is easy to find a resident doctor.

However, Chen Tingye is obviously not the one who underwent surgery to step down.

When he finished the nerve suturing, Zhou Cheng had already sat on the stool and waited for him for a few minutes, resting with his eyes closed.It looked a bit distracted, but Zhou Cheng was really closing his eyes and resting his mind.

Chen Tingye then asked: "Xiao Zhou, do you still have the strength to rebuild the muscle insertion in the back? Do you want to step down and take a rest?"

Muscle suturing, tendon reconstruction, only represents the existence of continuity.

Those who have learned the lever theorem will know that different fulcrums, different degrees of labor saving, and different arcs of motion.

And if multiple stop points and out-of-shape are involved, the fulcrum is different, and the trajectory of the movement will be very different!

Therefore, the reconstruction of muscle starting and ending points is particularly important in the replantation of amputated limbs, especially in the replantation of amputated limbs with mixed injuries.

There is no damage, there is no damage to the starting and ending points of the muscle, but the continuity is broken, so it will be fine if it is stitched.But with damage, the difficulty of replanting a severed limb has increased exponentially!

Zhou Cheng mentioned this before, so Chen Tingye knew that Zhou Cheng was a person who had a deep understanding of the replantation of severed limbs, and he would feel comfortable communicating with people who knew how to do it.

It's like, when people order takeaway, they like to order extra spicy egg tarts, that's their freedom.You stole other people's takeaway, and your own mouth has problems eating it, that is the consequence of your stealing.

That's the truth, but how bad is it when you meet someone who doesn't make sense?

When a scholar meets a soldier, there is a reason why he can't explain it clearly. This is the reason.

Zhou Cheng raised his eyelids a little, and said with a smile, "Professor Chen, no, I feel fine."

At the same time, he stood up, spread his arms around his chest, and returned to the operating table.

Then Chen Tingye looked at Wang Yaoxiang, rolled his eyes a few times, and said, "Doctor Wang, why don't you go to the opposite side to help Director Zeng and Director Li? It's enough for me and Xiao Zhou. "

Wang Yaoxiang immediately suffered [-] points of real damage from the critical strike!

Holy crap, even if there is a difference in the titles between Xiao Zhou and Dr. Wang, you still want to drive me away?

But the head nodded honestly: "Okay, Professor Chen."

Then he left silently with the resident doctor next to him. Chen Tingye is a professor, and he is a professor of an outer hospital. He has the absolute right to choose who to play with and who not to play with. If you disagree, he will stop taking everyone.

After Chen Tingye cleared away other obstacles, he and Zhou Cheng put on the 'miner' glasses respectively, and began to carefully arrange the muscles after debridement.

Muscle damage exists, and the necrotic tissue that should be cut has been cut.

Some of the broken ones were only stitched together, but the shape was very disordered, and some muscles were torn off and not connected.

Therefore, the fixation of the starting and ending points of the muscles is very particular, and if it is slightly wrong, it will be fatal to the recovery of postoperative function.

There are several major thresholds for the evaluation of severed finger replantation.

Whether he can live, not to mention the replantation of severed limbs.

Whether it has function or not, don't mention that you are a hand surgeon, and you are doing replantation of severed fingers.

There is functional restoration, counted in the door.How much has been recovered, goodbye Zhenzhang.

Chen Tingye took a deep breath immediately, and said confidently to Zhou Cheng: "Xiao Zhou, the first thing we recovered was the insertion point of the brachioradialis..."

The suture of amputated limb replantation can be done by doctors in many prefecture-level cities nowadays, and it can be done. The only difference is whether the suture is good or not, but it is not an advanced technology. How to retain more functions needs to be paid attention to. There are actually many details.

The reason why Chen Tingye dared to take charge of replantation of amputated limbs in a province was because he knew many tricks, and now is the time for him to perform.

The anatomy of the muscles is divided into the starting point and the ending point, and the shape is in the middle.

The anatomy of the muscles determines the range of activity and the trajectory of the contraction, so Zhou Cheng and Zhou Cheng only need to talk about where to do it.

Hearing this, Zhou Cheng nodded and found the brachioradialis muscle.

And because the position of the injury is at the transition between the elbow and the forearm, there is no starting point of the brachioradialis, only the insertion point needs to be dealt with.

Zhou Cheng carefully used the vascular forceps to carefully observe the remaining brachioradialis muscle, and then looked at Chen Tingye holding the Kirschner wire with a slightly depressed look.

Zhou Cheng whispered, "Professor Chen, we don't have rivets here."

The best tool for rebuilding the starting and ending points of muscles is to fix them with rivets. However, that thing is the main weapon of sports medicine. In the Eighth Hospital, a place where sports medicine has not yet opened, this thing cannot be found.

Chen Tingye asked the itinerant nurse, and after confirming whether there was one, his expression became tangled, and he sighed: "Then use the traditional method."

Make bricks without straw.

What's the use.

Zhou Chengcheng took the initiative to open the insertion point of the brachioradialis at an angle to the original outer side.

Seeing this, Chen Tingye was slightly taken aback, and then lowered his voice and said, "The insertion point of the brachioradialis muscle can be slightly drawn inward. Although it inserts on the outer side of the radial styloid process, it doesn't need to be so outward."

The brachioradialis originates from the proximal 1/3 of the upper border of the lateral epicondyle of the humerus, at the lateral muscle septum.Inserts laterally on the base of the radial styloid process.This is its anatomy.

Chen Tingye thought that Zhou Cheng didn't quite understand.

Zhou Cheng slightly turned the proximal end of the elbow joint, where the radial canal was located, and said in a low voice, "Professor Chen, there is a radial nerve in the radial canal."

"The inner wall of the radial canal is the brachialis muscle, and the outer wall is the brachioradialis muscle."

"The muscle fiber bridge of the brachioradialis obliquely spans the surface of the brachialis and the brachioradialis, which can strengthen the action of the brachialis and the brachioradialis in elbow flexion. It can limit the lateral sliding of the brachioradialis when flexing the elbow, and it can also cooperate with the brachioradialis. elbow flexion and tensions the deep fascia of the forearm, similar to the action of the biceps aponeurosis."

Zhou Cheng stopped short. He believed that Chen Tingye must have understood what he meant.

Chen Tingye was slightly taken aback——

Zhou Cheng's reminder reminded him of a detailed problem.

The radial canal is the channel of the radial nerve. When the elbow joint is swollen or the supracondylar fracture occurs, the normal position of the radial canal changes. The brachioradialis muscle fiber bridge can limit the displacement of the brachioradialis and brachialis muscles, and at the same time limit the lower end of the radial canal. Dilation, leading to increased pressure in the radial canal, if this change cannot be prevented, flexed canal syndrome will appear.

Therefore, in the treatment of swelling of the elbow joint and supracondylar fracture of the humerus, methods such as dehydration and braking should be performed to reduce the pressure in the radial canal.When performing radial nerve release in the radial canal, the fiber bridge should be incised first to expose the radial nerve and its branches.

7% of the radial nerve and the brachioradialis muscle fiber bridge are not directly affixed, and 3% are directly affixed, which shows that the possibility of the brachioradialis muscle fiber bridge compressing the radial nerve is an anatomical factor, which is one of the causes of radial tunnel syndrome, but in most cases It will not directly compress, and it is the potential or direct cause of radial tunnel syndrome under pathological conditions such as swelling and fracture.

Although this detail seems to be purely about the formation of radial canal syndrome, in fact, if you look at it the other way around, if the brachioradialis is displaced, it will also lead to an increase in the pressure in the radial canal.

Therefore, Zhou Cheng now moves the insertion point of the brachioradialis more outward, is it to avoid similar symptoms?

Chen Tingye's scalp suddenly became numb.

The layman looks at the excitement and the insider looks at the doorway.

The more you know, the more rewarding you will feel when you chat with people who know what you know.Zhou Cheng's knowledge and understanding has gradually gone beyond the scope of anatomy, but has taken the whole into consideration.

And these ideas are obviously problems that no one would have noticed in the field of replantation of severed limbs before.

How did Zhou Cheng think of it?

Sudden idea, or already know?

Can he expect this patient to be injured, and he just knows that the muscle insertion point of the brachioradialis is damaged?So do your homework in advance?

Absolutely impossible!

Chen Tingye is a firm believer in materialism. He absolutely does not believe in this kind of fantasy thinking, so it can only be a solution that Zhou Cheng came up with on the spot.

Chen Tingye's eyes and forehead lines were wrinkled for a while, and stretched for a while, which was very wonderful.

Zhou Chengcheng thought that Chen Tingye didn't believe it, so he stepped back and said, "Professor Chen, after we can temporarily fix it later, let's do a contraction test of the brachioradialis muscle."

"The distal end of the radial nerve has already been sutured, so the proximal end should not be compressed!"

"And we're going to sever the fiber bridges of the brachioradialis!"

Chen Tingye was startled when he heard the words, and after a strange color flashed in his pupils, his tone became normal, and he said, "Okay, it makes sense, I'll reset and fix it!"

Chen Tingye quickly figured it out, and stopped pushing him on the spot.

It's just that he feels that there must be a lot to chat with Zhou Cheng in the future. There are too many questions and exchanges, and if they spread out, they won't be able to finish talking in a few days and nights, so he can only talk about it another day.

Just do things today.

Therefore, in the eyes of outsiders, Zhou Cheng and Chen Tingye simply discussed simple anatomical knowledge, so they didn't pay much attention to it. Even Yang Yifeng, because he didn't look here with his own eyes, couldn't react. .

Zhou Cheng and Chen Tingye's matchup this time will actually cause an academic shock, or an academic feast!

Although it is a damaged injury, in fact, there are not many muscles that need to rebuild the insertion point!