medical simulator

But the meaning of threat in the words is full.

Just now, Lu Bin just asked Qin Ming to go to the operating room with Zhou Cheng, obviously he had something to say to himself!He intentionally avoided what Zhou Cheng said, it must have something to do with Zhou Cheng, Zhang Zhengquan didn't want to care too much about it.

What he prefers is to control violence with violence and minimize all risks.

Before becoming the CEO of the company, he worked for Yan Hanhan in the Second Orthopedic Ward of the Eighth Hospital.Even Professor Ding Changle has been suppressed by others, let alone Lu Bin. If you are sensible, everyone will live in peace. If you have any pettiness, then sorry, I will send you abroad to become a doctor.

The side meaning is that I can make you unable to get along in the country now.

It's also very simple, just shake out your previous butt, and then spread it everywhere in the country, how can you mess around in the country?

Lu Bin became thoughtful, with a cold face, and didn't say a word.

Zhang Zhengquan thought it was almost time, so he rushed directly to the operating room.

In the operating room, the pre-operation preparations are already done.

"Quanzi, wash your hands and come to the stage to help. This one is an osteotomy correction for deformed thumbs. The speed is neither too fast nor too slow. You just want to learn. Anyway, you are fine." Zhou Cheng said to Zhang Zhengquan.

Naturally, it is necessary to explore Zhang Zhengquan's background in reality first.

"What can I learn, brother Zhou Cheng, are you kidding me? I can cook very well." Zhang Zhengquan joked very sincerely, "But I can show my strength on stage."

"Then stand aside and watch." Zhou Cheng identified Zhang Zhengquan as the teaching object, and naturally hoped that he could help him.

Qin Ming felt a little strange seeing Director Lu Bin not coming to the operating room, but as the director, Lu Bin has the right not to come, so he ordered: "Yang Tao, Guo Xiaobing, you two come to the stage and help."

Osteotomy orthopedic surgery for thumb deformity is not a particularly common therapeutic operation, but belongs to the category of repair function and cosmetic treatment.

But in fact, the deformity of the thumb can indeed affect the patient's quality of life and lifestyle.

The preparations for the operation were almost done, and the patient called out first: "Doctor, doctor, please slow down. The anesthesiologist said that my hand has not been anesthetized yet, but you put me on the stage."

"This can't be done, it will hurt me to death." He was terrified, and this was the first time he had encountered it until now, and he had never heard of it before.

The surgery was performed without anesthesia. When I was hospitalized, all the patients in the ward were in pain.

The doctor in charge of the bed first became nervous, and then quickly explained: "Brother, don't panic, it's not that you don't need anesthesia, it's local nerve block anesthesia, we think you don't need to use too much anesthesia for this operation, which is convenient for your postoperative recovery. , get it."

"We, Dr. Zhou, are operating on you. What are you worried about?"

Hearing this, the anesthetist was 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 use traditional serious anesthesia.

Zhang Zhengquan had never seen a patient before, so he glanced at Zhou Cheng curiously, and found that Zhou Cheng had a steady face, not worried at all, so he felt relieved.

Zhang Zhengquan didn't know about it, but he had heard from Luo Yun that Zhou Cheng was as stable as an old dog, so he wasn't 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 a gun). In addition to the bone deformity, there are also deformities of the skin and muscle tissue. The surgery we are going to do , the bone needs to be cut first to restore the bone to its normal structure.”

"After the osteotomy returns to its normal shape, after the osteotomy, the muscle tissue and tendon tissue must be restored to their normal structure, and then skin grafting will be performed."

"I plan to make a blade-thick skin or a medium-thick skin, which depends on the specific situation during the operation. However, his tendon contracture and ligament contracture must be very serious. We must pay attention to this."

This is 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 undertake some delicate work, so he plans to do osteotomy and correction when he is middle-aged. .

It is also convenient to marry a wife.

Hearing Zhou Cheng's voice, the patient was relieved, but he still said: "Of course I trust Dr. Zhou, but you don't want to do it without anesthesia. Although I am not afraid of pain, this kind of raw flesh cutting is still unacceptable."

"Doctor Zhou, don't joke with me, I'm afraid." Speaking of this middle-aged man, he is actually quite muscular. He seems to be able to endure hardships and is not afraid of pain, but at this moment, he is about to cry.

"It's all right, don't be nervous." Zhou Cheng explained to Qin Ming and others while talking: "The main purpose is that I don't want to have 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 this small and delicate operation and anesthesia can be carried out tentatively in our current hospital. A little topic."

"It's also in line with the rules."

While talking, Zhou Chengcheng started, "Is the local anesthesia prepared?"

"It's ready, Dr. Zhou, it's all in this syringe." The hand-washing nurse immediately handed over the anesthetic, and then surrounded her curiously, wanting to see what Zhou Cheng was going to do.

Zhou Cheng took it, and said: "Although the anatomical structure around our fingers is fine, the shape is very particular. Near the distal segment, there are a lot of local sensory nerve endings, so you can feel pain soon. "

"But in fact, on the side of the finger, although this is where the nerves go, the nerves at the end 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's okay."

While speaking, Zhou Cheng quickly inserted the tip of the needle into it. The strange thing is that according to ordinary people's understanding, the needle will be very painful, especially when the local anesthesia is administered, it will be even more painful.

However, Zhou Cheng pricked a little deeper, but the patient didn't feel anything yet.

Before he had time to scream for pain, Zhou Cheng had already completed the actions of back suction and pushing the medicine, and then said: "Look, after the quick needle insertion and the local anesthesia operation, the patient actually didn't have much pain. So emotional, I didn’t even have time to react.”

Zhou Cheng confirmed his statement, and then inserted the needle again on the radial side of the thumb, which is the inner side of our conventional understanding, and inserted the needle in the same way, and then pushed the medicine.

The patient still didn't cry out.

The anesthesiologist asked curiously, "Wang Limin, are you not in pain?"

Wang Limin was the patient's name. He heard the words of the anesthesiologist, "Ah".

"Have you started cutting? Why don't I feel it?" The nervousness caused his hand to flick a little, but the arc was very slight.

"Don't move!" Zhou Cheng stopped immediately, and then fixed his eyes on the anesthesiologist.

If you are curious, you are curious. When we talk about academics, it is academics. Why are you chatting with patients?Increase his mood, let him move during the operation?

Wang Limin's hands froze immediately.

"Don't move, Wang Limin, the operation will be very fast. Now, I am using a needle to poke your thumb. How does it feel?" Zhou Cheng asked.

"There is a little tactile sensation, 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 both surprised and happy.

"Don't worry, it's fine if it doesn't hurt, don't worry about anything, just treat it as you are resting, if you can't cooperate during the operation, I can only put you under general anesthesia!" Zhou Cheng confessed.

This operation is performed under local anesthesia followed by general anesthesia, and it can be transferred at any time, because Wang Limin is afraid of psychological burden, but at present, as long as no one makes trouble, Wang Limin will feel nothing.

Then, Zhou Cheng saw that Wang Limin didn't move anymore, and he saw that Zhou Cheng quickly completed the skin-cutting action. Zhou Cheng cut the skin on the side of Wang Limin's thumb interphalangeal joint. The blood seeped out, and then wiped with sterile gauze, the blood was gone.

Immediately afterwards, Zhou Cheng used vascular forceps to pick apart the skin and subcutaneous tissue, exposing the contracted tendon inside.

"The tendons of the thumb, there are eight in total, flexor pollicis longus, flexor pollicis brevis, extensor pollicis longus, extensor pollicis brevis, abductor pollicis longus, abductor pollicis brevis, adductor pollicis, and oppositus palmaris."

"But among these eight muscles, only the flexor hallucis longus and extensor hallucis longus pass through the first metacarpophalangeal joint and reach the distal knuckle."

"So, what we have to deal with is actually these two muscles."

"We all know that the fingers have no musculature, and the muscles from the forearm and palm to the fingers have become tendons. According to their functions, they are mainly divided into two groups: flexor tendons on the palm side, and extensor tendons on the dorsal side."

"After the extensor tendon crosses the metacarpal joint, it expands on the dorsal side of the proximal phalanx to form a strong dorsal aponeurosis."

"The dorsal aponeurosis of the fingers is divided into 3 parts: the central tendon inserts at the base of the middle phalanx. After receiving the lumbrical muscle and part of the interosseous muscles, the tendons on both sides merge on the back of the middle phalanx and then insert at the base of the distal phalanx . Each bundle is reinforced by tendons."

"When the finger extensor tendons are ruptured, the finger joints are in a flexed state, the proximal interphalangeal joint cannot be straightened when the middle bundle is ruptured, and the distal interphalangeal joint cannot be straightened when the two lateral bundles are ruptured."

"This is a state of trauma. This patient's interphalangeal joints were deformed and fused due to early trauma. Therefore, his tendon development was also abnormal. During this process, his thumb grew The extensor tendon must be too long, and the flexor hallucis longus must be too short."

"So, I plan to see if he can combine the two tendons through anatomical positioning. If it is not possible, we can only take the secondary functional tendons from other places to complete the tendon transplantation."

Zhou Cheng slowly popularized the knowledge of anatomy, but he actually said it to Zhang Zhengquan. Among them, Zhang Zhengquan's foundation may be the worst.

Zhou Cheng explained in such detail, and there are references, so Zhang Zhengquan can also understand.

"Because we don't need to deal with the blood vessels and nerves, they are now in a flexed state, so the blood vessels and nerves are actually too long, so there is no need to consider them after surgery. So in this case, our operation can be roughly divided into two steps .”

"The first step is to cut the bone and reshape the articular surface."

"The second step is the treatment of the tendon, autograft, or rearrangement!"

"The third step is skin treatment, such as skin grafting."

"The fourth step is to fix."

"It's not difficult, is it?" Zhou Cheng asked.

Then looking at Zhang Zhengquan, Zhang Zhengquan nodded.

It's really not difficult.

Zhou Cheng continued to popularize science: "The interphalangeal joint is composed of the pulley of the upper phalanx and the bottom of the next phalanx. Now that they are fused, we have to rebuild a pulley structure, and then polish it into the bottom of the bone."

"Let's find a suitable place and cut the skin. Before, we cut the side. At this time, we have to cut the skin from the proximal phalanx."

"Then, let's expose..." Step by step, Zhou Cheng's movements were neat and clear, and everyone could understand.

However, after Zhou Cheng exposed the fused bones and cut off the surface of the fused bones, Zhou Cheng directly used the bone contusion, and in a very short time, he polished out a pulley structure.

Yes, Zhou Cheng polished a pulley structure by himself, and then asked in a flat tone: "Look, is this similar to a normal pulley structure? The pulley of the proximal phalanx of our thumb is almost in the shape of a conical barrel." , about the diameter of…”

"And the bottom of the phalanx is shaped like a basin, and its diameter is about..." Zhou Cheng said while doing this.

Then looking at Zhang Zhengquan, Zhang Zhengquan shook his head and narrowed his eyes.Meaning, this one I really don't know.

Qin Ming did the same, swallowed his saliva, and replied seriously: "Doctor Zhou, you usually don't care about the data you mentioned, and you don't remember it."

"And it's useless to remember, this kind of reconstruction of the base of the phalanx and the pulley of the phalanx?"

Qin Ming only said half of what he said. If I can do this, am I still just a deputy chief physician?

Brother, you are rebuilding the bottom of the phalanx and the pulley of the phalanx. This is almost impossible in the world at present. In theory, it has not yet been done yet?

Qin Ming's tone was sour, his expression and eyes were strange.

And Qin Ming's weirdness, Zhang Zhengquan and others couldn't understand it, because they didn't know how difficult it was, they just felt shocked.

Yang Tao was still saying: "Hey, look, it looks like a normal pulley..."

Guo Xiaobing nodded: "Well, almost exactly the same."

Like chatting, eating and drinking...

3 Thirty chapters focus and focus!

"Well, these two are also gods! But they can't be blamed. If you don't have enough realm, you won't be able to discover the strength 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 that Zhou Cheng should not be underestimated just because of his young age.

However, people in the department complained a lot because Zhou Cheng was young and did not work as a junior doctor.

Later, after seeing Zhou Cheng's operation, such rhetoric gradually disappeared.However, Yang Tao and others cannot be blamed, they are all just residents, they have not been promoted to attending, and they have not yet performed their own surgery.

I still don’t know how many difficulties you will face and how many details you need to pay attention to when you are actually doing the main surgery. At this time, when you want to study again, how precious is the opportunity to learn, and the time wasted before, followed by your graduate tutor How hard-won is the time to study.

But we are all colleagues, and some words can only be pointed out. Maybe these two have mines at home, or their dreams are not to go up, and they have a mentality of eating 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 with the operation, while Qin Ming continued to watch. After a while, Director Lu Bin came late, washed his hands and got dressed, and said he was sorry.

The words were addressed to Zhou Cheng, and the tone and expression did not reveal that he was threatened by Zhang Zhengquan just before.And the apology to Zhou Cheng is mainly for the real apology.

When he was undergoing surgery, Zhou Cheng watched and escorted him all the way. Now that Zhou Cheng started his own surgery, performing surgery on his outpatients, he was late and absent, and had to explain to Zhou Cheng.

Zhou Cheng didn't put his mind on Lu Bin at all, but continued to deal with the joints.

This operation can be easy or difficult. It is easy to correct the deformity and grow it back to 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, just need an osteotomy, and after the normal shape is restored, the function will naturally recover partly, and there is no need for reconstruction of the base of the phalanx and the pulley.

However, Zhou Cheng didn't want to treat this operation so easily, so he just let it go.

Doing his best, he hopes to be able to restore the patient's function after surgery and do a better job.

Professional rehabilitation guidance is part of it. The reconstruction of the original anatomical structure is the basis of functional rehabilitation. If the foundation is not well established, no matter how good the rehabilitation guidance is, the upper limit is too low after all.

The reconstruction of the basic anatomical structure is the way to improve the lower limit of surgical quality, with rehabilitation guidance as an aid, so that the lower limit can be raised and the upper limit can be raised at the same time.

Osteotomy and orthopedic surgery for deformity is not uncommon, and Lu Bin usually performs it. However, when Lu Bin came to the operating table, his eyes were all attracted by the operation.

Then he turned his head slightly and saw that Qin Ming's eyes were serious, so he looked carefully again, and looked at the plain film display on the film reader.

"Hiss!" Lu Bin sucked in a sharp breath.

Outsiders watching the fun, Yang Tao and Guo Xiaobing were still hanging around the threshold, but Lu Bin understood the work involved.

"Doctor Zhou, did you do a good job in the reconstruction of the phalanx and pulley? Such a good joint structure, it's a pity that there is no joint capsule and corresponding aponeurotic structure." Lu Bin immediately expressed regret.

Before, in the deformed state, the patient's aponeurotic structure and joint capsule structure were pathological. After returning to the normal structure, they were naturally useless and had to be removed.

If you have a size 35 foot, you must wear a size [-] shoe. If you don't throw away these shoes, your feet will be discarded sooner or later.

When Lu Bin said this, Yang Tao and Guo Xiaobing stopped their private conversation and casualness, and looked at it seriously. They could probably understand the meaning of Lu Bin's words, but they still lack basic skills to really see through.

Meeting someone who understood, Zhou Chengcheng continued: "Director Lu, this is what I think. Although the structure of the joint capsule and aponeurosis is difficult to reconstruct, we can try to make a similar structure by repositioning the tendon. Increases functional mobility of joints."

These words were not shared with Qin Ming and others before.

Because during this period of time, no matter through the simulation in the simulator or through some teaching experience in reality, Zhou Cheng also knows that sometimes, it is not good to go too far.