medical simulator

Chapter 222 Pulling Hatred! (Please subscribe!)
Pin is one of the few surnames among the few surnames.

It's like the figure of the product director, which is different from most directors of medical departments. He is extremely thin, one can say that he is skinny, skin covered with bones, and it seems that a gust of wind can blow him down.

But Mo Chengkong still respected Director Pin.

"Mr. Gui said that it's time to come out. I don't know the specific situation. It should be that Xiao Zhou's weaving technique is quite special, so Mr. Gui planned to come out early." Professor Pin replied.

Mo Chengkong immediately turned his head to look at Zhou Cheng, his mood became more complicated.

He came to replace his student because of Zhou Cheng. He had been paying close attention to Zhou Cheng all the time, but he still let Zhou Cheng slip away from under his nose.

It seems that he was born to do things, just turn around a little, and he can do things that you didn't expect.

"Actually, that's fine." Mo Chengkong looked at the students in this academy while feeling a little disappointed, and said.

……

At the same time, Zhen Xing and Zhou Muyun took a few steps back when they saw a large army marching into the operating room.

"Senior Brother Zhen, look, am I right? We are being monitored throughout this learning process." Zhou Muyun said exactly as I expected.

Zhen Xingdao: "Zhou Muyun, the previous senior brother can almost pass by, you are older than me!"

Naturally, this was not the main point of Zhen Xing's attention, but soon discovered a particularly critical problem: "Zhou Muyun, did you find out that there is not a single person from the Third Kyoto Hospital in this small training class."

"At the beginning, I felt something was wrong, and now I feel more and more that there is a pit in it!"

Gui Lao was the leader, the Third Affiliated Hospital of Kyoto University was the sponsor, and Gui Lao, Professor Pin, Professor Mo and other sports medicine departments served as the venue and source of disease providers. There was not even a single student from the hospital.

The only one who can be related is Zhen Xing, but Zhen Xing belongs to Jishuitan.

But the superiors of the two hospitals, not to mention fighting together, at least not so generous, nor as amiable as they appear on the surface.

Zhou Muyun looked around, and also found the eyes of many people of the same age, and the complex charm in the eyes of these people.

Some were convinced, some were not convinced, some were surprised, and some were even puzzled and overwhelmed.

……

The person under the most pressure is Su Min, who is now the main trainer.

You know, when everyone was operating before, there were only five people coming and going with the largest crowd of onlookers, but why did it suddenly come when he came to be the chief surgeon, not only was there one more Mo Chengkong besides Peng Peng, it was fine.

There are such a large number of people?
Who are these?

Except for the old man who was the leader, Su Min didn't know anyone at all.

When the big troops came in, Su Min, Yu Heng and others naturally stopped their operations, including Zhou Cheng who was knitting tendons. After putting down all the things, they turned their attention to Gui Lao and others.

Although everyone knew that outsiders would not interfere with the operation process, but at this moment, Mo Chengkong, who was the teacher, was all heading towards the door, and everyone knew that the people who came were not ordinary people.

Gui Lao was the first to bear the brunt, and glanced at Yu Heng and Su Min who were a little nervous, and then said: "Don't worry, don't be nervous, you go ahead with yours, we'll just look at ours, we won't disturb your operation .”

After Mr. Gui explained the situation, everyone stopped consciously. Within two meters of the aseptic table top of the operating table, no one went deep inside. Standing on tiptoe, I also curiously watched the normal progress of the operation.

After Su Min and Yu Heng digested the meaning of Gui Lao and entered the operation process normally again, Gui Lao said to Professor Pin again: "You and Cheng Kong go to the tunnel of the operation, I will go to see that Braided tendons on the sides."

"Ms. Gui, shall we go with you?" Fatty Mo and Professor Pin both understood that it was Zhou Cheng who really attracted Mr. Gui this time, so they were also very curious about what Zhou Cheng was doing. , how could he be so attractive to Gui Lao.

"What's so good about braided tendons? You go about your serious business." Old Gui rolled his eyes, and then cut off what Mo Chengkong and Professor Pin had said.

Although I was still thinking in my heart, there is nothing to see, why are you meddling like this?Are you bored?
But Mr. Gui is Mr. Gui, he has privileges, if he says he won’t allow you to watch it together, you can’t watch it with him, so the two of them can only return their attention to the regular procedure of the operation in a rather depressed manner.

Mo Chengkong has repeated this process before, and both Professor Pin and Professor Mo are almost sick of watching it, not [-] times, at least thousands of times, doing it every day, every day, it’s really nothing to see of.

The only thing to watch is that Su Min's operation is within the baseline, very stable, and it is a very calm operation.

Beyond Su Min's current age, even in terms of operation, Peng Peng may not be much better than Su Min.

But what's so good about it?
Just mediocre...

On the tendon treatment table, Zhou Cheng was still braiding the tendon while looking at Elder Gui who was walking towards him from the corner of his eye.

My heart beats a little: won't it be seen?
No, my side is editing, can this be seen?
That's right, because, the tendon braiding technique that Zhou Cheng uses now is not more orthodox in the real world, but it's not the kind of "heterogenetic" either, it belongs to a transitional body.

What is excessive body? It is just the part of the tendon. For example, every three stitches, three stitches of regular knitting stitches are mixed with one stitch of special knitting stitches.

This is an exploratory clinical trial at the very beginning. This evil multi-strand multi-strand tendon braiding method has slowly developed and finally become the mainstream. It will take time to settle.

It suddenly becomes too different, of course it's not good.

"Student, what's your name?" Old Gui's voice was very soft, but the softness in his voice was different from the old Zeng's that Zhou Cheng had heard before, but Zhou Cheng couldn't tell the difference for a while. .

There is a certain distance between the woven table of the tendon and the operating bed in the operating room.

Although I don't know who this old man is, it is definitely not ordinary to be able to get so close under such circumstances.

"Hi teacher, I'm Zhou Cheng." Zhou Cheng glanced at him neither humble nor overbearing, then smiled, and immediately began to change the knitting technique in his hand.

The most important thing is not to affect the progress and operation of the operation because of other people's intervention.

"Why did you change it? I think you were good at knitting before?" Mr. Gui immediately noticed Zhou Cheng's changes in details.

Old Zhou Cheng's face blushed immediately. He thought that he would not be discovered by doing it silently, so he took the initiative to say frankly: "Teacher, just a few injections, it shouldn't have much impact, right?"

If this kind of thing is discovered, it is better to be honest. Otherwise, if the team's surgical concept is completely different from Zhou Cheng's understanding, even if such a weaving method is useless, it may be necessary to rework it all. Time to prepare.

However, obviously, Elder Gui didn't come to take the initiative to find fault, but continued: "What is your purpose for doing this?"

"Teacher, my intention is actually to make the tendon stronger." Zhou Cheng replied.

"Then how do you judge what kind of situation is more firm and what kind of situation is not firm enough? In addition, if firmness is a controllable factor, do you think the firmer the better? ?” This time, Old Gui asked a little more questions.

"If other factors are fixed, the firmer factor is the better. However, this argument is based on a series of preconditions that muscle contracture, bone impingement, muscle stiffness, and bone stiffness will not occur."

"The stronger our tendons are, the better." After Zhou Cheng first gave the answer based on this stable factor, he thought about it for a while, and then gave his own understanding and ideas.

"However, if all factors are considered, the original purpose of tendon reconstruction is to obtain joint mobility. If the extensibility is lost, then the meaning of tendon reconstruction will be lost."

"From this point of view, the stronger the tendon is, the better it is, but it is necessary to discuss the material from what it is made of."

Zhou Cheng's answer was slightly different from what Gui Lao expected.

The answer he wanted was that Zhou Cheng would answer his question by citing classics from various documents he had read, but Zhou Cheng, instead of taking such a conventional route, wanted to discuss basic mechanism issues with him.

This guy looks very brave.

Although it sounds very compelling to talk about what a certain document supports when you open your mouth, but when you shut your mouth, it means who did what experiment and what supported what, but if you really want to talk about basic things, these words are all fake.

Some conclusions of modern medicine are actually based on a hypothesis. If a similar hypothesis collapses, the entire system will collapse or be subverted!

Tendon and anatomy are such a very basic course.

"What if you don't consider the material? Is the material the same autologous tendon?" Old Gui naturally became interested, and asked while watching Zhou Cheng make it.

"If there is no need to consider the material, then there is no need to consider its ductility. The autogenous tendon has no immune rejection, and the autologous tendon, we only need to consider that its tensile capacity is sufficient."

"In the traditional sense, in the weaving process, the more strands we weave, such as double strands, four strands, six strands, eight strands... the more the number, the better the curative effect, and the subsequent functions The recovery is stronger."

"However, on the basis of increasing the number of shares, we actually increased the difficulty of double-strand splitting and splitting to a certain extent."

"In the measurement of our normal people, the anterior cruciate ligament is not a single bundle, but a collection of fiber bundles that fan out, and both ends are attached to the broad and flat bone surfaces of the femur and tibia."

"When the knee is bent at 90°, the angle between the long axis of the ligament and the long axis of the femur is 26±4°. Since the anterior cruciate ligament is in the sagittal position on the femoral attachment surface, and the tibial attachment surface is horizontal, the ligament is from the upper end to the lower end. Rotate about 90° outward on its own central axis."

"The middle part is the narrowest, with a width of about 11mm and a thickness of about 4mm. When the knee is straightened, it is in the shape of a flat belt, and when the knee is flexed, it is twisted. When the knee joint is flexed at 90°, the length of the anteromedial ligament is 30-40mm, The posterolateral length is about 20mm."

"Let's talk about its anatomy again: it starts from the anterior medial side of the intercondylar eminence of the tibia, joins with the anterior horn of the lateral meniscus, obliquely to the posterosuperior lateral side, and the fibers attach to the medial side of the lateral femoral condyle in a fan shape."

“平均长度31～38mm，中间部分平均宽度为10～12mm，横截面近似卵圆形，平均面积女性和男性分别为36mm和44mm。韧带在距胫骨止点10～12mm处逐渐散开……”

"The femoral insertion point of ACL is located on the medial surface of the lateral femoral condyle. It is an oval concave surface, with an average length of 18mm and a width of 11mm, and an area of ​​113-170mm..."

When Gui Lao heard the middle, he kept nodding, and his muscles gradually became stiff.

Because of some of the content Zhou Cheng was talking about, some parts gradually deviated from his cognition.

One thing is very clear, although academicians are engaged in research, whether academicians or professors, they are not databases or encyclopedias. They can know everything, including the so-called area, etc. what.

"The ACL forms a "foot"-like structure at the tibial insertion point, which increases the attachment area, and at the same time avoids the impact of the ACL on the intercondylar fossa during knee extension."

"The transplanted ACL does not have a "foot"-like structure, and choosing an anterior insertion point of the tibia may cause the graft to collide with the intercondylar notch when the knee is extended, which is one of the reasons for the limitation of postoperative extension. However, there are corresponding solutions and solutions As for the solution, this teacher, let’s discuss it again when we have a chance!”

Zhou Cheng skimmed over a very important topic at once, and continued the current topic: "The distribution of the anterior internal bundle (AMB) is in the upper part of the femoral insertion point and the anterior medial part of the tibial insertion point; the distribution of the posterior internal bundle (PLB) In the anteroinferior part of the femoral insertion and the posterior lateral part of the tibial insertion."

“…In light of this, double-bundle reconstructions that more closely approximate normal functional anatomy have been used to restore normal ACL function.”

Zhou Cheng blah blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah. Among the structural differences, we can actually deal with different situations through weaving techniques."

"When the knee joint is straightened, the PLB is tense and flat; when the knee is flexed to 90°, the AMB is tense with ligament torsion, and the PLB is relaxed approximately horizontally. From the perspective of the ligament as a whole, the AMB is roughly located in front of the PLB, which causes the PLB to be tense and flexed when the knee is straightened. When the AMB is tense. Single-bundle reconstruction cannot restore the stress variation characteristics of different fibers, and it will inevitably lead to abnormal stress of some fibers, which can lead to reconstruction failure."

"..."

"Teacher, but there is one point. At present, most of the research on ACL biomechanics is based on animals or human cadaver specimens. There is little understanding of ACL stress under normal human physiological conditions. Understanding ACL stress under physiological conditions It is of great significance to guide postoperative rehabilitation exercises and promote functional recovery."

Old Gui: "..."

The current research is not based on animal and human cadaver specimens. Should data be taken directly from humans?

"In daily activities, the maximum stress of the ACL is less than the ultimate stress, generally 0.0% to 44% of the ultimate stress. Under normal circumstances, the contraction of the quadriceps is the main force, and the degree of flexion is small (such as isometric contraction of the quadriceps, squatting, active knee extension, etc.) the ACL is stressed!"

"So I think that in a situation like this, we treat the autologous tendon that we take differently, like..."

Then Zhou Cheng went into the so-called state barabara as he talked.

While Zhou Cheng was talking, he was earnestly demonstrating the operation, and Mr. Gui himself didn't rush to correct Zhou Cheng's mistakes, so he just watched silently and became the most "culprit" audience.

When Zhou Cheng found out that what he just said to Mr. Gui was just a hypothesis, he also found out that it seemed that he was a little bit excited when he was speaking just now, not only to analyze the principle After reading it again, I also tried the weaving technique.

It is easy to weave, but it is impossible to remove it again.

"Teacher, what about these two bundles of tendons? Do you need to weave them again?" Zhou Chengcai asked Elder Gui what he meant. If he wanted to weave them again, he would have to tear off all the threads now and then weave them again.

Gui Lao shook his head: "The double-bundle reconstruction and recovery you mentioned is a concept, not a specific method. What you are doing now is also double-bundle reconstruction and recovery. Compared with single-bundle reconstruction, it is relative. There is no such thing as an advantage option.”

"As for your current treatment of the tendon braiding process, there is no special definition or standardization at home and abroad."

"With non-standardized things, where is there any absolute right or wrong?"

"What makes me even more curious is that your hands are really a pair of enviable hands?" Old Gui suddenly said meaningfully, and then asked Professor Pin next to him for his opinion.

Professor Pin also nodded, and said, "These hands are something you can meet but never ask for. People who can reach the peak simply by relying on their skills have very skillful hands."

"Handy!"

"I'm knowledgeable, I have a solid foundation, but I'm not ashamed. Much better than some students in our hospital, isn't it, old Gui?"

Zhou Cheng hurriedly put down the braided tendons!
Looking at the old man, he already had guesses in his heart, but he still clasped his fists in a respectful salute: "I've seen Teacher Gui!"

Old Gui took a deep breath and said, "Yes, it's really good. Pin Lu, you came a little late, so you missed some more exciting things. It's a pity that such a scene may not have a chance to be repeated."

It was only through Old Gui's words that Zhou Cheng knew Professor Pin's name, and then said, "I've met Professor Pin."

Apart from looking at Zhou Cheng and Elder Gui, Pin Lu was also paying attention to Su Min and the others. When Zhou Cheng was chatting with Elder Gui, Su Min and Yu Heng had already completed other preparations for the cruciate ligament reconstruction surgery. .

Now I am waiting for Zhou Cheng to send the braided tendon.It was only because Mr. Gui was still discussing the matter with Zhou Cheng that there was a slight delay.

Pin Lu hurriedly said: "Old Gui, after this operation is over, there will be a return to the scene according to the arrangement. Let's discuss this operation together at that time. For now, let's let the operation continue with the normal process?"

In Pin Lu's eyes, the standard and routine surgical procedure is just a procedure.

"Okay! Let's finish the operation first."

"Xiao Zhou, you also go to help, end the operation early, and then we will review today's operation together. At that time, I hope that Xiao Zhou can take the initiative to share your thoughts."

When Zhou Cheng wanted to say more, Elder Gui nodded and said, "That's the decision, you can say what you think, and I'm the one who makes a mistake."

These words made Zhou Cheng quite excited.

Now that Mr. Gui said so, Zhou Chengcheng began to think carefully about the lecture later.

However, something that Zhou Cheng never expected happened just when the operation was about to end!
Old Gui said directly: "Mo Chengkong, Peng Peng, do you know how the missions of the two of you failed?"

"That's right, both of you were defeated by Zhou Cheng."

"Don't think that Zhou Cheng is young, and don't think that other people's qualifications are young, so you can belittle..."

"And our students, we should pay attention to each other. What age are you now, what are you doing now, and what are others doing?"

"Kyoto University. What happened to the students of Kyoto University?"

"Insufficient strength and insufficient hard work. When you enter the workplace, you are also watching other people's performances. Don't think that you are the pride of heaven. Your previous victory is only because you have a better learning environment and learning environment. resource."

"It doesn't mean you have everything, don't set your sights on the item."

"Why can't any of our own students get qualifications and places in the training courses held by our own department?"

"Why? Aren't you usually proud?"

"Think about why?"

"When you think that you are already very powerful compared to your peers, you have long since disappeared in the eyes of others. People who will always focus on their eyes, just live on one acre and three points of land. When I didn't say anything."

"However, if you really feel that you are not willing to admit defeat, then."

"In the next few days, Su Min, Yu Heng, Zhou Cheng and others in the training class will be your targets."

"It doesn't matter, it doesn't matter if you lost before."

"It doesn't matter how many times you lose in the past few days!"

"It doesn't matter if you lose for a few years, I'm afraid you will continue to lose in the future. At that time, you will only be unconvinced, and you can't say anything else."

When Mr. Gui said this, Zhou Cheng felt that he was about to believe his words, and almost thought that he was really a bit of a cow.

However, the more so, Zhou Chengcheng felt that this old Gui's teaching mode was too scary!

It is absolutely impossible for these students who are watching now to be mediocre.

Everything today may be a part of his design, just to motivate them in disguise.

If this group of people has been taught like this all the time, then they must be wolves, and they are the kind of wolves who endure and plan.

(End of this chapter)