medical simulator

Did you know the diagnosis of this patient long ago, or did you not know it long ago?I knew it a long time ago, why didn't I tell the correct diagnosis in advance, if I didn't know it in advance, what happened to the prepared kit?

Didn't you deliberately conceal your medical history in order to test us?

Oh my God?

You are a superior, you are a teacher, can we still trust you?

Peng Peng said: "You don't need to look at me. For this course study, all the patient's medical history, diagnosis, physical examination results, and film reading results, as well as the choice of surgery, are all up to you. I didn't say a word. I said it!"

"You didn't let me say too much."

"Since you have chosen to start from the beginning, you have to accept the end of this result."

The more Peng Peng said that, the more nervous Zhou Cheng and the others felt.

Especially Yu Heng and Zhen Xing, their backs felt cold, because before, they thought that Peng Peng was strong enough to be a teacher, so their previous operations were unscrupulous.

But now it seems that something is wrong with you, teacher?elder brother!

You know we are wrong, not saying a word, not making a sound, and still saying that now?Are you not afraid that we will make a mistake in the surgery?

……

The key operation of this operation is to re-fix the tendon.

You know, refixing the tendon is not as simple as suturing!

Under the strong pulling force and tension, if the place where the nail is inserted is not selected properly, and it breaks open from the middle with a bang, then this operation will develop towards an unknown and terrifying place.

Tendon is also very brittle, so in this case, it is best to have two nails driven in at the same time, which is the best choice.

These issues are difficult problems that must be considered before and during surgery.

However, this is not a problem for Zhou Cheng. Zhou Cheng's tendon reconstruction, tendon suture, and transposition are all at a perfect level. The only limitation is that Zhou Cheng has not done this himself under the operation of an arthroscope. surgery.

But he knew how to do this surgery, and he didn't need to learn it deliberately. He already had a corresponding plan engraved in his mind.

This is equivalent to after you have learned addition, subtraction, multiplication and division.

3*2+10÷2=?

You may not have done this calculation problem before, but you can still solve it with your own foundation.

Zhou Cheng chose to operate the supraspinatus tendon first.

The supraspinatus muscle originates from the supraspinatus fossa, passes outwards under the coracoid shoulder arch, and ends at the uppermost ossicle surface of the greater tuberosity of the humerus.It is tightly combined with the joint capsule to form the top of the rotator cuff and the bottom of the subacromial capsule. Such an anatomical position is destined to be the most vulnerable to damage under acromion impingement syndrome!

The supraspinatus muscle is originally located on the greater tuberosity of the humerus, and it will lose its original shape after being fixed.

At this time, Zhou Cheng immediately called the roving nurse to bring up the expander and rivets. He needed to suture the supraspinatus muscle first, and the suture method of the supraspinatus muscle is currently the most popular and most effective treatment method. The fixing method of the outer row of nails.

This requires placing the rivets 15-21 mm distal to the greater tuberosity and then using the suture bridge technique to create a double row of positioning holes.

"Puncher." Zhou Cheng shouted again.

This is a routine rotator cuff suture procedure, so the nurse who washed the hands had already prepared it and brought it over.Zhou Cheng actually knew some better sewing methods, but there was no need to show them!

His current status is a student, not a teacher, so he doesn't need to pretend, he just needs to hand in an answer sheet.

However, Peng Peng before gave Zhou Cheng the best example of how to submit the answer sheet!

It would be nice to be comparable to Peng Peng...

This hole punch is not electric, but manual, because the expander will not allow electric instruments to enter.

First implant two inner rows of rivets X Bio-Corkscrews FT (note: the following values ​​are directly replaced by rivets), the rivets have thread, and the suture needs to be passed through the rotator cuff tissue with a threader, and then knotted in the body .

This requires the use of a surgical instrument, the Scopion.

This instrument has a curved needle head, which is much lighter than the traditional method of suturing with ordinary straight needles.

This step is key.

If the thread of the rivet cannot pass through the rotator cuff, it is equivalent to the thread connecting the two nails, which fixes a loneliness.

This manipulation requires very high sensitivity and intense concentration.

After the two threads were taken out from the entrance of the shoulder joint through the green thread, they were inserted into the needle hole of Scopion, and then Peng Peng passed the position of the exit of the suture, and put the Scopion needle (note: the needle used below) instead) into the shoulder joint.

Peng Peng had known what Zhou Cheng meant a long time ago, and immediately pulled the supraspinatus tendon closer to the greater tubercle without ordering, and exposed the position of the needle to the most suitable place.

At the same time, Zhou Cheng also placed the camera in the farthest but most comfortable viewing position, so as not to block the second assistant Su Min's pincers, nor Zhou Cheng's stitches.

The suture needle quickly penetrated into the tendon of the rotator cuff with sufficient operating space and vision.

After threading a stitch, Zhou Cheng immediately held the pliers with the other hand to catch the thread sent over.

This operation takes less than three seconds.

Peng Peng was taken aback at the time, thinking that he had read it wrong, and blinked, but saw that Zhou Cheng's hands had indeed pulled the thread firmly.

This method?At this speed, many children with question marks came out of Peng Peng's heart.

During this process, what normal sports medicine physicians should not do is to first expose the grasping forceps to the field of vision, then move to the point where the tendon line has passed, and then compare it left, right, left, right, back and forth.

Open the pliers again and bite, then pull and test it, if both sutures can be pulled out, it proves that it has been pulled, and then he will withdraw the stitches?

how?

What if you don't follow the routine?

Surgery continues.

Pulled the remaining thread back in and then pulled it out again.Then the other two strands of the other rivet were fixed to the tendon in the same way.

The entire operation process was very refreshing and only took less than 8 minutes.

But in fact, this is one of the most time-consuming and difficult points in the rotator cuff suturing process.

What, is that the solution?

Zhou Cheng did it happily, and said: "Next, we will separate the two bundles of sutures and tie them into knots, and then insert the knotless anchors into the bone ends of the outer row. The inside will form an open 'zone' shape."

"Before that, we need to tie a knot." Zhou Cheng was explaining his intentions, otherwise, all the situations would only depend on his understanding, so as not to make mistakes.

At this time, a special arthroscopic knotter was needed to tie the knot. Zhou Cheng quickly used it. With just a little force, the upper edge of the supraspinatus returned to the position of the upper edge of the rivet.

Then pull the lower edge over.

Play the nail track of the outer row of nails again.

The four sutures of the upper and lower inner rows of rivets are distinguished, and one of the upper and lower sutures is passed into the knotless anchor, and then driven into the upper row of the outer row of nails.

Pull the suture taut.Immediately begin tapping the knotless anchor until the laser-marked line is submerged in the cortical bone.Turn counterclockwise for 6-7 weeks to cut the thread.

After Zhou Cheng finished operating one, he thought that this was Su Min's assessment, and then looked at the time on the operation timing panel. Cheng felt that his technique was okay.

He said, "Su Min, will you handle this knotless anchor?"

Knotless anchors are threaded, and they will be embedded inside after being knocked in, which is very stable, but if the nail channel is too loose due to excessive force, it will be unstable.

Su Min was stunned for a moment, looked at Zhou Cheng with complicated eyes, and said hello helplessly!

Although what Zhou Cheng said now is suspected of rewarding opportunities, but what Zhou Cheng seized before was the opportunities he gave up, and he was able to complete the operation so well.

This is his ability and strength, he also told Peng Peng himself, it is beyond his ability!

This is a grade IV operation, and it can even be said to be one of the most difficult operations in sports medicine!

While Su Min's heart was stirring, he quickly took another knotless anchor, quickly folded the silk thread, and passed the self-contained threads of the remaining two inner row nails into the pinhole of the knotless anchor. go.

Then it penetrates through the sleeve to the position of the nail track in the outer row.

tension!

After the tension is equal to that of the upper and outer rows of nails.

He winked at Zhou Cheng.

Zhou Cheng also immediately completed the thread-cutting operation, so Zhou Cheng naturally gave up the main operation position to Su Min.Su Min finished this critical operation, and when he was about to come out, Zhou Chengcheng said, "Su Min, go ahead."

Su Min felt that Zhou Cheng's tone was very familiar. It was the tone she used to speak to her seniors when she was in the department. It was to take care of their feelings and not embarrass them. Kind words to them.

He himself felt at the time that he absolutely did not mean to be arrogant.

But when he changed from a speaker to an obedient person, his mood was still different.

But fortunately, this operation started from him and ended from him, from the beginning to the end, this is the respect Zhou Cheng gave him, and there is no other meaning!

Although Zhou Cheng retreated to the second line, everyone, including Peng Peng, glanced at Zhou Cheng inadvertently.

That look seemed to say, although everyone is very powerful and knows that you are a bit powerful, but you are so ruthless for the first time, isn't it a bit too much?

Peng Peng slowly took off his surgical gown.

In the audience, Zhen Xing and Zhou Muyun were whispering.

"Junior Brother Zhou, can you complete this operation alone?"

Zhou Muyun's expression suddenly became very serious: "It's a bit difficult, but with some time and familiar assistants, it should be possible!"

"But, isn't it like this?"

"He is controlling time." Zhou Muyun is tall, his eyes are very sharp, tall and fat, his condescending gaze is a bit blurred, as if he is looking up at someone.

"Teacher Peng completed the operation in 22 minutes. Before that, Yu Heng completed the operation in 24 minutes. Brother, you completed the first hand speed Hu in 28 minutes."

"The current time is only 22 minutes. The second half and the first half are still done by Su Min."

"So, this Zhou Cheng, he's not playing with us, he's playing with Teacher Peng Peng!" Zhou Muyun looked like he was facing an enemy, and he was no longer as calm as before.

Tall and fat, he is not as simple and honest as before.

Because Zhou Cheng didn't bring them to play, it was quite abominable, but it was a pity that Zhou Muyun was going to play the next one. He didn't know if he could do what Zhou Cheng did, but he was sure of one thing.

That is, Zhou Cheng has already played with Peng Peng.

……

Zhou Muyun could see that, as a teacher, how could Peng Peng know nothing?

Even, just when Zhou Cheng returned the operating position to Su Min after finishing the crucial operation, Peng Peng's heart skipped a few beats.

isn't it?

This Zhou Cheng, he wouldn't want to return the operating position to delay time, would he?

Is this just to save face?Are you still stepping on me?

Interesting, interesting!

Peng Peng was delighted, because he hadn't been able to find a friend with whom he could fight equally for a long time.

Those who can beat him now are all he can't beat!

"Let's start the third operation. You, come to be the chief surgeon." Peng Peng pointed to Zhou Muyun.

……

Then, for the third case in the second lecture, it was Zhou Muyun's turn to perform the surgery.

This case was due to the unexpected situation of the patient that Su Min encountered before, so this time, Zhou Muyun carefully read all the patient's information again.

After finding out that there was no accident, his mood was a little complicated.

Because, if they are all such routine cases, even if his data in all aspects surpasses Zhou Cheng, it will not help?

They are not questions of the same level of difficulty, so is it meaningful to have high and low scores?

Of course, this did not prevent Zhou Muyun from going all out in order to express himself. In the end, the time he completed the operation was shortened to 10 minutes.

Just horrible.

For a rotator cuff suture, the total time from the beginning of the operation to the end of the operation is 10 minutes.

In general places, it is basically an hour to go up!

You also need to know that this Zhou Muyun is just a student, his age is unknown, and his grade is unknown!

After Zhou Muyun finished his operation, today's class finally came to the lunch break in the afternoon.

It's already 12:30.

Because they are taking care of their own food and lodging, and there is a lunch break, they have to go out to find food. In fact, they are looking for food opposite the hospital or opposite the hospital.

This time, the five of them got together, and even Yu Heng didn't have such a special arrogance anymore.

There are different tastes in different places, so just choose to eat noodles, and finally add seasoning by yourself.