medical simulator

Chapter 206 The first show in the operating room! (seeking subscription)
Beside the operating table, the attending physician Lu Mo said in a low voice: "Professor Du, this patient has a PASTA injury, and it's not easy to treat. Isn't it a bit inappropriate to treat such an operation at all?"

PASTA injury is the abbreviation of Partial Articular Supraspinatus Tendon Avulsion, which means partial injury on the side of the supraspinatus tendon joint in Chinese.

It's just that joint surgeons are used to calling it PASTA verbally.

Not for the sake of being cool, but fewer syllables need to be pronounced.This kind of name is very professional, but the location is very precise, and the pronunciation is less, which is convenient for communication, but it is inconvenient when communicating with non-joint surgeons.

Associate Professor Du Kunning raised his eyelids slightly, glanced at Lu Mo, and said in a low and straight voice, "Xiao Lu, the times are different now! With the progress of the times, children nowadays are being developed more and more deeply. The same age status Come on, it was very difficult for us to compare before.”

"So don't watch such things with emotions. Ding Dian has already been exposed to Class III surgery. This kind of PASTA, she handles it, and it's not too rough."

"After all, Han Xiaoming's failure to learn does not mean that other students cannot learn."

"Those who are capable are superior. Would you like to try?"

Lu Mo looked up at the sky at that time, he couldn't talk today, and he was looking for trouble for nothing, so he hit the muzzle of the gun!

Han Xiaoming is not a real SB. PASTA injury is a very special injury among shoulder joint injuries. It is not even a simple injury of the supraspinatus tendon, or a surgery that can be concluded by casually doing a shoulder arthroscopy. .

This is a well-regulated category IV operation, and it is a difficult one among category IV operations.

Han Xiaoming is the chief hospitalist, and he has just graduated with a Ph.D. for a few years.The talent is very good, otherwise it would be impossible to stay, and he stayed in the Ninth Academy, which is becoming more and more complicated. He was an academic doctor before.

It has only been more than two years since I have been in clinical practice now, and I have been able to perform routine shoulder arthroscopic surgery. This kind of talent is really amazing, because even Lu Mo, a genuine doctor, now has to routinely carry out all Class III surgery. Surgery, I think it is quite difficult, and it will take time to polish it slowly.

However, although it is very difficult to perform type IV surgery, it is still no problem to ask him to do ordinary shoulder joint cleaning, acromion impingement, and frozen shoulder.

The operation volume of other operations is there, and rare operations still require operation volume for practice.

After Zhou Cheng and Ding Dian washed their hands and came in, they found that almost all the people in the audience were staring at them silently, with all kinds of expressions in their eyes!
Most of the eyes were stunned and awed, as well as surprised.

After Zhou Cheng got dressed, he didn't go directly to the operating table. Instead, he smiled at Ding Dian and went to the viewer to check the basic condition of the patient.

If the diagnosis is not clear, it is not nonsense to start the operation?
Even if he is not the chief surgeon, but he has not made a clear diagnosis, it is not easy to be an assistant, let alone understand the subsequent operation.

What's more, Lin Ziyuan has such a hot temper, don't go up and get scolded without knowing the process!

Yes, now Lin Ziyuan is still the first assistant, he is the second assistant.

Zhou Cheng took a quick look on the film reader and found something was wrong. This was not a complete tear of the rotator cuff, but a PASTA.

PASTA, which is more common in athletes, mainly occurs when the upper arm is violently stretched and twisted, and it is also prone to occur when the shoulder joint is repeatedly traumatized.These risk factors are basically written based on the training career of many athletes.

After Zhou Cheng basically figured out the basic situation, he came to the operating table.

Lin Ziyuan and Lu Mo just looked at him, without any explanation or instructions, just calling Ding Dian to play as they like.

This scene is like an exam.

The various tools of the arthroscope have been installed. The field of view of the arthroscope has been controlled by Professor Lin Ziyuan in the subacromial space. The humeral head is clearly visible and very white, but the roughness above the humeral head can be vaguely seen. It should be It is the point where the supraspinatus muscle is partially damaged.

When Ding Dian took over the operating part of the arthroscope, Lin Ziyuan suddenly looked at Ding Dian and Zhou Cheng, and asked, "Are you the first one to follow Ding Dian today?"

Zhou Cheng nodded hurriedly, and said honestly: "Yes, Teacher Lin, today is the first day I come to the department with Senior Sister Ding."

"Do you understand shoulder arthroscopy?" Lin Ziyuan asked again.

When Ding Dian heard this, his pupils shrank slightly, and he immediately opened his mouth to excuse Zhou Cheng: "Xiao Zhou has always been there before."

But Lin Ziyuan reached out his hand to interrupt Ding Dian, and looked at Zhou Cheng instead.

Zhou Cheng thought about it seriously, and replied, "Know a little bit."

"Then you do an investigation. I will do it later."

"You just do the scouting, explaining while scouting." Lin Ziyuan shook his head at Zhou Cheng, and then signaled Ding Dian to get out of the way.

He didn't move at all, and he was still thinking about how to explain it.

Lin Ziyuan said: "Ding Dian, this patient is a practitioner of sports medicine. It is precisely because he is a practitioner that he agreed to practice for you, but the requirement is that the operation should not exceed three hours."

"It's a really good teaching material."

"Ding, don't waste time."

"Do you want to try it?" Lin Ziyuan asked as if he knew Zhou Cheng's background.

After thinking about it for a while, Zhou Cheng accepted the lens of the arthroscopic lens, and followed his own train of thought to make a detailed investigation——

Arthroscopes have water inlet and outlet pipes. After the water is released, the structure inside becomes clear.

In the glenohumeral space, Zhou Cheng quickly and clearly slid a circle in the joint cavity.

After inserting the lens, first locate the location of the biceps tendon and observe the upper part of the shoulder joint or the biceps tendon and the articular cartilage portion of the glenoid.No problem with the biceps tendon and articular cartilage.

Then the camera zooms forward, looking at the humeral head and the cartilaginous part of the glenoid; no problem.

"Teacher, please take a picture." Zhou Cheng reminded the teacher who was in charge of the arthroscopist indifferently.

Professor Lin Ziyuan saw that Zhou Cheng's movements were a little nimble, as if he was very proficient, but he was not quite used to the arthroscopic instruments in their hospital, so he took the initiative to explain: "This is not the kind of arthroscopic instrument with assisted operation, you can directly operate it yourself. The handle is here to complete the shooting action."

These photos are to be kept for the patients to see. Although only a small part is kept in the end, they are also excellent original materials for academic exchanges.

What Zhou Cheng said about asking the teacher to take pictures is another kind of arthroscopic device, which is relatively old-fashioned. Just because Zhou Cheng understands the old-fashioned arthroscopic operating system, Zhou Cheng can't be considered stupid.

Zhou Cheng nodded, and automatically took a photo under Lin Ziyuan's explanation.

"Let's give some explanation, I think your operation is quite smooth." Lin Ziyuan immediately increased the difficulty for Zhou Cheng.

Sometimes, some people know what to do, but they don't know why. The difficulty of demonstration operation and demonstration explanation has increased by at least three to four times.

Zhou Cheng said to Ding Dian, who was standing on the assistant's position at this moment: "Senior sister, please help me rotate my shoulder internally and externally at this time, so that I can fully observe the humeral head and the cartilage part of the glenoid."

"Then we moved the camera forward and looked at the upper and lower surfaces of the biceps tendon, the biceps tendon insertion, and the superior labrum for partial tears."

"But in this patient the tendons were all intact and smooth."

At this time, Zhou Cheng himself automatically pressed the camera button on the operating handle, the display screen flashed a few times, and the negatives were left, and these photos were used for a clear diagnosis.

The gold standard for diagnosing rotator cuff injuries is not MRI, but arthroscopic exploration!
Then Zhou Cheng said: "At this time, we can use the antegrade surgical technique from the outside to the inside to open the opening and insert the probe in front."

"Probe the labral complex of the biceps and assess the extent of the injury. Normally, the cord-shaped middle glenohumeral ligament crosses the subscapularis tendon and attaches to the neck of the scapula at the two o'clock position. In variants, this ligament inserts directly The biceps tendon, which removes part of the labrum above the labrum, becomes a bare area called the Buford complex."

“Then we move the arthroscope further down to examine the anterior portion of the IGL and the middle glenohumeral ligament. Normally, the anterior portion of the IGL attaches to the glenoid neck between two and four o’clock. The anterior capsule contains 3 separate ligaments with different attachment points."

When Zhou Cheng said this, Ding Dian, who was standing beside her, was a little dazed, because this area was an area she had never been to on weekdays, and it belonged to the wild area!

For shoulder arthroscopic exploration, there is a common area and a wild area.

Zhou Cheng's move immediately made the eyes of Du Kunning and Lin Ziyuan brighten. Zhou Cheng's operation just now was obviously a surprise.

As for the attending physician, Lu Mo, his eyelids flickered, as if the upper and lower eyelids were trembling slightly.A little hairy.

Then the other graduate students and professional doctorates, who were still surrounded by them, all took half a step back.His eyes were full of doubts, but amidst the doubts, there was also a trace of respect!

The reason why the wild area is called the wild area is because it is rarely reached, and it is difficult to reach!

After Lin Ziyuan was quite surprised, he said, "Xiao Zhou, slow down a little."

At this time, Zhou Cheng slowed down all the speed, and said slowly: "At this time, we will put the arthroscope into the inferior recess, and rotate the joint lens to face the upper glenoid to inspect the glenohumeral ligament and labrum."

"This is the glenohumeral ligament, and here is the glenoid labrum. If the glenoid labrum is damaged, it is easy to cause instability of the shoulder joint. But this patient did not."

"Then, we also examine the attachment point of the joint capsule to the humeral head, look, this is here. Then the arthroscope is moved back slightly to check for softening of the glenohumeral articular surface at the back of the glenohumeral joint, and the posterior glenoid of the shoulder joint. Lip frayed or partially torn.”

"After moving the arthroscope back up to the biceps tendon, we're starting to examine the tendon tissue."

"We've only looked at the surface of the biceps, but if there's an injury to the biceps,"

"We can flex the elbow slightly to reduce the biceps pull. Probe the biceps tendon through the rotator cuff, both upper and lower; use a probe to draw part of the biceps tendon into the joint through the anterior portal to determine if there is slippage." Meningitis and an incomplete tear in the more distal part of the upper arm."

"Arthroscopic surface rotation, alignment of the rotator cuff, gently inward and outward rotation of the upper arm to carefully examine the insertion of the rotator cuff at the tuberosity for wear, partial tearing of the rotator cuff, and calcification. Move the arthroscope along the tendon Advance medially to check for synovitis, wear, or rupture."

"Gently withdraw from the arthroscope and observe the rear of the rotator cuff and the bare area of ​​the humeral head. There is no articular cartilage covering here, and there are normal small blood vessels entering under the rotator cuff."

"We will open another anterior approach, which can be used as a later operation approach."

"Move the arthroscope to the anterior entrance, and the probe can be placed at the posterior entrance. Through the anterior entrance, the posterior articular surface, posterior labrum, posterior recess and posterior joint capsule can be observed for hyperplasia, synovitis and shoulder joint instability. Abrasion or inflammatory changes."

"The arthroscope is moved forward to look up to the rotator cuff and down to the glenoid to see the biceps labrum complex."

"Moving the arthroscope further forward and pointing back toward the inferior recess, the humeral attachment of the glenohumeral ligament and its inferior glenoid attachment can be seen."

"The arthroscope is then rotated downward to observe the attachment of the anterior inferior glenohumeral ligament and the labrum of the joint capsule, as well as the middle glenohumeral ligament, the subscapularis tendon, and the subscapular recess."

"Then we will explore the subacromial bursa, which can extend posteriorly from at least 2cm from the anterior edge of the acromion to about the middle of the acromion. Place the posterior sleeve into the subacromial space..."

While talking, Zhou Cheng concluded the microscopic examination of the glenohumeral space.

After hearing these explanations, Lin Ziyuan and Du Kunning looked at each other in dismay. One of them was a professor and the other was an associate professor.

A person's surgical realm and treatment experience will leap in a period of time, and the sign of this leap is the ability to teach.Before teaching, it is very important to be very familiar with each operation step and various details.

As for Zhou Cheng, he has completed such a step at this moment, which proves that Zhou Cheng has reached a certain level and has a certain strength, otherwise, there is absolutely no possibility of teaching.

This is Zhou Cheng showing Lin Ziyuan and Lu Mo his basic skills!

Doing a comprehensive and detailed arthroscopic examination is an entry-level skill and basic skill that every sports medicine doctor must learn. According to common sense, it should be done in place for every step of exploration and microscopic examination, because only you can do the arthroscopic examination. After the inspection is in place, you can expose the vision of the place you want, and then carry out the next step of surgery.

Zhou Chengcheng did this, and planned to re-examine all the structures in the joint capsule.

All the up and down, left and right, inside and outside, inside the joint capsule, and the subacromial space were all taken by Zhou Cheng to look at it, and it didn't take too long!

With just this basic skill, both Lin Ziyuan and Lu Mo were amazed. Even Lu Mo could faintly smell a hint of danger.

I thought to myself, no way, no way?This is such a pervert?
Do it yourself, can you do better than Zhou Cheng?
(End of this chapter)