medical simulator

Chapter 11 Du Yanjun's inner activities!

Medicine is not a child's play, it is an extremely rigorous science.

The treatment of fractures requires the support of systematic knowledge.

First of all, we must start with the principles of fracture treatment. The treatment of fractures should pay attention to three principles.

Reset, strict immobilization, rehabilitation.

The first thing to pay attention to is reduction, and the purpose of surgery is also to serve for fixation and reduction.

just.

Whether to have surgery after a fracture is not certain.

Any kind of surgery has its strict indications and contraindications.

Patients with relative contraindications can choose whether to undergo surgical treatment depending on the situation.And if there are absolute contraindications, then surgery must not be done.

Only patients who meet the surgical indications need surgical treatment, because some fractures can be treated conservatively with plaster external fixation after manual reduction.

This can also achieve the purpose of reset and fixation.

If the indications and contraindications are just to determine whether the patient can have surgery and whether surgery is needed.

Then, in terms of the choice of surgical method, it is also necessary to choose a more suitable surgical method according to the classification of the fracture.

This patient suffered a fracture of the tibial plateau. The classification of the tibial plateau is mostly based on the Schatzker classification, which is divided into type VI.

Basically, all tibial plateau fractures require surgical treatment. The basic principle of this will not change, unless the physical condition is very poor, unable to tolerate surgery, stepping down to the operating table, and patients with a risk of death, all tibial fractures All plateau fractures require surgery.

This point will be strictly determined before the operation.

Once the operation is determined, the surgical plan must be determined, and the surgical plan is determined according to the classification.

Type V of the Schatzker classification: bicondylar fracture involving medial and lateral plateau splitting, combined with vascular and nerve injury, this type accounts for 12.0% of tibial plateau fractures!

Then, the operation method for type V fractures is that open reduction and internal fixation are required at the fractures of internal and surgical splits to firmly fix the fractures.

After the operation, the patient's treatment returns to the principle of fracture treatment.

Reset, immobilize, recover...

In addition, after determining the surgical method to be internal and external fixation, how to choose the surgical approach, how to expose the broken end of the fracture and then suture it out is also very particular. Different surgical approaches have an impact on the overall quality of the operation. ,Can not be ignored.

The traditional approach for tibial plateau fractures is naturally the medial and lateral approach, but there are better approaches to choose.

Of course, all of this is naturally what Zhou Cheng thinks in his heart, and he dare not and cannot say it directly.After all, he is just a resident doctor with a junior professional title, and he definitely cannot take over Class IV surgery such as open reduction and internal fixation of tibial plateau fractures.

Zhou Cheng silently modified the exposed parts.

Cai Dongfan remained silent, and Luo Yun didn't say much.

Zhou Cheng has not been in the group for a short time, and this year is already the third year of regular training. He is actually a very experienced and reliable junior doctor. hate.

A little mention will suffice.

Also watching Zhou Cheng modifying the exposure space was Du Yanjun. Although his expression didn't seem to fluctuate, he still smiled secretly.

Since Zhou Cheng came to the department so early this morning to read the medical records, Du Yanjun knew that Zhou Cheng must also have the intention to compete for the place in the hospital.

Du Yanjun didn't think it was ridiculous for Zhou Cheng to compete for a place in the hospital.

The number of places in the hospital is quite precious, and everyone wants it, which is human nature.

It's just that relatively speaking, Zhou Cheng really doesn't have much advantage in this competition, so the possibility is extremely slim.

In terms of connections, Zhou Cheng is just an ordinary social trainer, not as good as Du Yanjun and Min Chaoshuo who have mentors as strong connections in the department.Not to mention getting in touch with a relative like Xu Yanlin who is the deputy director of the hospital.

Compared with academic qualifications, Zhou Cheng has no advantage. There are four graduate students in the department, two academic types, and SCI papers in hand.

And he was planning to publish the second article. Du Yanjun felt that if he wanted to compete with them, he had to publish SCI. Zhou Cheng wanted to publish an article, but the chances were too small.

than chance?
Needless to say, social training does not have a mentor as a strong backing, who will rest assured that Zhou Cheng can get started?Therefore, if Zhou Cheng wants to compete, he must first gain the trust of the superior doctor.

In other words, it is to try to show yourself better and attract attention first.

However, it was obvious that Zhou Cheng acted too hastily this time, pretending to be a bully on the cow's belly, and then the bull sat down.

The consequences will naturally be dire...

But Du Yanjun will not laugh at Zhou Cheng, because Zhou Cheng is indeed not easy, there is nothing ridiculous, and he himself does not have a 100% competitive advantage.

If Zhou Cheng knew Du Yanjun's thoughts at the moment, he would definitely feel very wronged, and Du Yanjun's brain power is too strong.

……

After Zhou Cheng sorted out the surgical field, the preparations for the operation began, and Cai Dongfan came to the chief surgeon.

Luo Yun subconsciously wanted to stand opposite Cai Dongfan as a help.

But Cai Dongfan said: "Luo Yun, you change positions with Yan Jun, and you come to my side."

Luo Yun was taken aback for a moment, then nodded, and said, "Okay, Director Cai."

Then immediately turned back to back with Zhou Cheng, bypassed the operating table and went to Cai Dongfan's starting position.

The position during the operation is also quite particular, the chief surgeon stands on the direct operation side of the affected limb.

Easy to operate, good vision, all assistants should serve as the main knife.

Opposite the chief surgeon is the position of an assistant, who can assist in the operation and has the second best surgical field of vision.

Then there is the underhand side of the main surgeon, which is the position of the second assistant. The field of vision is relatively poor, but auxiliary operations are also required.The secondary assistant standing opposite the second assistant can be the third or fourth assistant, but they are complete tools.

That is to say, Zhou Cheng's current position, he basically can't see the surgical field of vision, as long as he pulls the hook under the guidance of the chief surgeon.

After the position is adjusted, the operation begins step by step.

Cai Dongfan picked up the round knife, first cut the skin, and then used the electric knife to cut the subcutaneous tissue, and soon exposed the broken end of the tibial plateau fracture.

However, after the outer severed end was exposed, Cai Dongfan frowned.

Obviously, the fracture this time was not that simple. Even if he came to reset the fracture, it would still be difficult.

Three principles of fracture, reduction and fixation.

What the operation completes is the operation of reduction and fixation.

It is clearly stated in the principle, it must be reset first.

The displacement of the fracture is very obvious, and it is pulled into a somewhat deformed displacement by the muscles starting at the femur...

"Bone peeling." Cai Dongfan shouted to the hand washing nurse, who was also called the equipment nurse.

PS: Please collect, recommend, and follow up.In addition, thank you humble gentleman and humble self-shepherd for your reward, ninety-degree bow.

(End of this chapter)