medical simulator

Chapter 233 Huh?What are you telling me to watch! (Please subscribe!)

Zhou Cheng's words, although everyone was very surprised, did not cause riots and shock.

Zhou Cheng's strength, in the past few days, has been obvious to all, from Mr. Gui as an academician, to graduate students and even interns.His clinical strength, without a doubt, can be said to be the strongest among all the young people present, and he can even break the age limit, even better than Peng Peng.

Peng Peng, as an introduced talent who is "privileged" to carry out pioneering operations alone, can carry out open reduction and internal fixation with small incisions that have never been seen before in the training course.

Zhou Cheng's strength is not weaker than Peng Peng's. Everyone has seen it. Naturally, no one thinks that there is something wrong with Zhou Cheng's suggestion that this patient is suitable for hip protection, or that there is something that should not be mentioned. .

However, it is definitely not enough to simply put forward this concept. Everyone is not a layman. You can say it, but you have to persuade and give your own reasons, not the kind of me that can say yes, or say, People in the past said it could be done.

Make it understandable, or at least logical!

Although there was no commotion, discussions with each other were inevitable. Many people started to turn on their mobile phones, or started to look up literature.

Because what Zhou Cheng said just now, although it is only a few simple words, has a lot of content, and it is very difficult to remember it clearly.

Maybe they feel that there is something missing.

Then, as the subject of Zhou Cheng's questioning, Lu Ganzhou took a deep breath, glanced at Zhou Cheng, and said, "You can choose to perform hip arthroscopy."

"Old Gui, I think that since Xiao Zhou thought of using arthroscopy for hip protection treatment, we should give him such a chance. After all, this training class is open."

"Xiao Zhou is capable and capable of expressing his own views and opinions, making his own innovations, and even creating a genre."

"What's your opinion?"

Although Lu Ganzhou was surprised by Zhou Cheng's words, he did not suppress Zhou Cheng at all because of Zhou Cheng's surprise, and, as Lu Ganzhou was at this level.

It is natural to know that the reason why all surgeries exist is because of non-surgical interventions that cannot be handled well.

The reason for the existence of grade IV surgery is that all surgeries under grade IV surgery cannot meet the requirements of surgery.

The fundamental purpose of all surgery is not how good-looking it is, but how beautiful it is performed.It's about healing.

However, whether Zhou Cheng is qualified to start the operation or not still depends on the organizer's opinion.

In fact, deep down in his heart, Lu Ganzhou didn't really hope that Zhou Cheng could use hip arthroscopy to perform the hip preservation surgery.

After all, although Zhou Cheng's surgery is currently the lowest in difficulty, if he can lower the level of surgery to achieve the therapeutic effect, then the corresponding difficulty will be completely different.

It's just that although there is currently a concept of hip protection.In fact, it is aimed at necrosis of the femoral head.

Osteonecrosis of the femoral head (ONFH), also known as avascular necrosis or aseptic necrosis, is one of the most common causes of hip joint disability in young adults.

There are three stages of femoral head necrosis, respectively 1. Ficat stage: also known as Ficat-Arlet stage, can be divided into I-IV stage.

2. Steinberg stage I-VI stage,
3. ARCO stage I-IV.

Each of these three stages has its corresponding scope of application of hip preservation surgery.

Hip preservation treatment, in terms of treatment methods, from the simplest, there are lifestyle changes, followed by drug treatment.

However, the indications for drug treatment and the drug treatment plan of the hip-preserving strategy involve a wide range of drugs, and no drug has been widely recognized at present.

At present, drug therapy is supported for hip preservation, which has a certain therapeutic effect on Ficat stage I/II or Steinberg stage I/II/III ONFH, and can also be used as a supplement to other hip preservation treatments.

Currently, several hip-preserving surgeries suitable for hip preservation are generally suitable for Ficat I/II or Steinberg I/II/III, IC and II of ARCO staging.

The case selected by Zhou Cheng belongs to a stage beyond the current stage for hip preservation surgery.

If you really want to stage them separately, it should be Ficat transition period, Steinberg IV A stage, and ARCO staging method III A.It meets the surgical indications for total hip arthroplasty, but does not meet the surgical indications for the eight commonly used hip-preserving surgeries.

Therefore, it was considered comprehensively and underwent total hip replacement surgery.

The symptoms are obvious and the pain is very severe.

After looking at Zhou Cheng, Elder Gui hesitated, but then looked at Pin Lu, Su Min, Yu Heng and others next to Zhou Cheng with their puzzled expressions and expectant eyes.

Then he even saw the eyes of the students in his own hospital looking forward to opening up and allowing Zhou Cheng to be given the freedom to perform the surgery. He still nodded and said, "Okay."

"I agree. But this kind of super-class operation is only one time!" Gui Lao added after finishing speaking.

"If there is a need for changes in the subsequent surgical arrangements, please explain in advance that we will reduce the number of operating tables and operations."

"We are responsible for the patients!" Mr. Gui said after careful consideration.

However, what Old Gui said immediately made Lu Ganzhou, who was also standing, startled for a while, and looked at Old Gui.

Got it all.

Gui Lao just said that this kind of super-class operation is only this time!
So it shows that yesterday's three small incision open reduction and internal fixation operations were all arranged in advance and signed with the patients and their families.

In other words, Peng Peng was arranged, but what about the other two patients?

Could it be that Zhou Cheng is also one of the potential challengers arranged by Gui Lao?
If so, then why did Old Gui not agree with Zhou Cheng on the operation method today?
That is to say, is Zhou Cheng and Old Gui okay?
When Zhou Cheng suddenly proposed this exceptional operation, one of the reasons why Lu Ganzhou supported Zhou Cheng so much was to test whether Zhou Cheng and Mr. Gui had reached an agreement.

Now that Mr. Gui has the bottom line, there is no need to make any special arrangements. Let's see if the hip arthroscopic surgery can achieve the effect of hip-preserving treatment.If it cannot be achieved, then the conversion to open surgery can be continued.

If it can be successful, someone will go out of the operating room during the operation to discuss and communicate with the patient's family members, telling them that the patient's current operation is not a major operation like hip replacement, but a minor operation .

This is very troublesome, and there will be more troubles in the future, but for Lu Ganzhou.

worth!

After Mrs. Gui nodded in agreement, no matter whether it was the joint surgeon in the operating room or Pin Lu and others, they all signaled to the itinerant nurse in the operating room to let her cooperate with Zhou Cheng's thoughts and requirements to get the instrument kit.

Different surgeries require different kits.

Because the pre-prepared operations are different, if you want to change the operation method, you need to change the instrument kit and get it temporarily.

It's a hassle, but the roving nurse is not offended.

Then, Pin Lu went to explain to the director of joint surgery: "Old Xin, I'm sorry, the accounting for this operation is still for your department."

It seems that it just changed the way of surgery, but in fact, the things involved are very troublesome.

In the third hospital, joint surgery and sports medicine are separated, and sports medicine does not have joint surgery patients.

If this kind of teaching is needed, then of course Mr. Gui will contact Director Xin of the Department of Joint Surgery. As an academician of sports medicine, Mr. Gui will need several operations to demonstrate, but it is not difficult.

However, if you want to take a joint surgery patient and change the operation method at will, it will not only increase the difficulty of the work of other departments, but also cause conflicts of interest. Originally, the surgery fee for the joint surgery is to be received by their department.

It's very realistic.

However, Professor Xin, who seemed to be quite rich, could only slap Pin Lu and said, "It doesn't matter if it keeps accounts or not! Professor Pin."

"I just think that since these people come here to do sports medicine, they should only study sports medicine. Why is joint surgery involved?"

Pin Lu quickly understood the meaning of Professor Xin's words. In this training, they didn't show their joint surgeons, and they didn't get a chance to learn.Moreover, the more important thing is that they came over and were used as a foil.

As for Peng Peng and Lu Ganzhou, the two freaks, it's just whoever goes up and who dies. How can there be anyone in the country to suppress them?
It is estimated that it will be difficult.

Pin Lu said: "Professor Xin, we don't have any students in our department. We will not show favoritism in this training class. All the master's and doctoral students in our hospital have large classes, and there is no private teaching."

"And, Professor Xin, if it's just a private lesson, then Lu Ganzhou wouldn't talk about the joint surgery course."

"It was a very purely academic exchange."

Professor Xin rolled his eyes, and didn't bother to pay attention to Pin Lu talking nonsense with him here.

It's purely academic exchanges, you just have to fight directly.Of course, Professor Xin can also understand that people like Lu Ganzhou are not easy to mess with.

Mr. Gui was right not to choose people from his own hospital as students.

More importantly, Lu Ganzhou used to be a student of Mr. Gui, but now he is a top prick in the country. It is really not easy to protect Lu Ganzhou and control him.

It is also a miracle that Mr. Gui can become an academician with such a particularly talented student.

"I know, let's watch the operation and attend the lecture..." Professor Xin quickly ended the topic.

There is no favoritism in sports medicine, Pin Lu came to plead for Zhou Cheng, not for Lu Ganzhou or others.Moreover, Professor Xin is also very curious now, what is going on with this young man surnamed Zhou.

If possible, he would be very interested in Zhou Cheng...

After all, if Zhou Cheng can win this operation, then this Lu Ganzhou can be regarded as Waterloo.

Lu Ganzhou said before that whoever defeats him will return to the country to surrender.

Perhaps because of an accidental intrusion yesterday, Zhou Cheng heard that during the penultimate operation, he almost beat Lu Ganzhou upside down, which frightened Lu Ganzhou at that time.

Today, Lu Ganzhou deliberately used a small trick to give Zhou Cheng a case that he would never show off.

If Zhou Cheng shows in reverse.

Don't you think this operation is not difficult? Then I will directly make it in the direction of doing it without total hip replacement. I will not play with you.

However, my direction and my realm are already one level higher than yours.

Soldiers who don't fight without fighting.

However, Professor Xin looked at Lu Ganzhou's still serious face, and he admired Lu Ganzhou a lot.

Obviously unwilling, obviously already a little guilty now, obviously very afraid that Zhou Cheng could show his face, but still stand up without changing his face, and let Mr. Gui give Zhou Cheng a chance, this is a werewolf.

And with the friendship between Gui Lao and Lu Ganzhou, he could actually let Gui Lao come forward to deny Zhou Cheng's suggestion.

However, Zhou Cheng is currently undergoing hip preservation surgery, what is the probability of success?
Professor Xin shook his head again.

The odds are nothing but miracles.

……

While waiting, Su Min, Yu Heng and others basically met the eyes of everyone on the scene.

Rao is very used to being admired by the stars, Su Min and Yu Heng, who are used to being the focus under the eyes of everyone, are also a little uncertain at the moment.It's not that they are not used to being surrounded by this kind of people.

Rather, they were not sure about the surgery that was going to be shown next.

Things that are not sure, if used for show, are death.

"Zhou Cheng, are you really going to do it?" Su Min's words were a little nervous. With his very fair skin, he couldn't see much blood at all, and he didn't know if he was a little scared at the moment.

Inverse surgery is suitable for surgery, which is not something that ordinary people can do.

Although small incision open reduction and internal fixation is an innovative operation, it is not a surgery with indications for reverse surgery, which needs to be clarified.

Innovation, and creation of inverse surgery indications are different concepts and different levels of difficulty.

Even Yu Heng, who has always been arrogant, has no idea: "Are you sure?"

"Almost. Don't worry, just cooperate with me when the time comes."

"It's too late for me to elaborate on the specific theories. However, as far as the current patient's situation is concerned, first, he is young. Second, his current osteoarthritis is a severe symptom with necrosis of the femoral head, but the acetabular There is not much to deal with.”

"This provides us with the possibility of hip-preserving surgery..."

Su Min and Yu Heng also nodded, and said, "Okay, you just have to be sure, we believe in you."

Now that there is no way to retreat, it is natural to rush forward, and it's not like I haven't rushed.

Moreover, if Peng Peng, who is in his 30s, and Lu Ganzhou, who is in his 40s, can be beaten up, it will be really comfortable.

This is something Su Min and Yu Heng wanted to do but couldn't.

Even though the protagonist this time is not the two of them, but Zhou Cheng.

but?
……

Soon, arthroscopy came along.

As an essential tool for sports medicine, the supporting facilities for arthroscopy are quite complete, and in addition to equipment nurses, there are also supporting equipment nurses for sports medicine specialists.

If the technique is changed, then all supporting facilities must be professional.

Zhou Cheng and the others are also very professional, and they are ready for the preoperative operation of the hip arthroscopy, which has not yet been carried out here.

Then after everything was in place, the hip arthroscopy started right away.

Zhou Cheng's operation is very smooth.

Because today's spectators are all relatively professional people, and the assistants are not ordinary people, so Zhou Cheng doesn't need to explain more——

Microscopic examination, very detailed——

"We can see the acetabulum, the labrum..."

"We can see the femoral head..."

"Next, let's proceed..."

Zhou Cheng, who has a perfect-redefining level of hip preservation surgery, has become very calm and composed at this moment. Every operation is not particularly bells and whistles. Compared with other operations, it is much less entertaining operation.

However, the more stable and accurate micro-operations make people feel more directly touched.

It makes people believe that with these steady hands, they will never mess around.

And then, very quickly, the surgery came to the crucial part.

Whether it is arthritis or the collapse caused by necrosis of the femoral head, its essence is local ischemia caused by various reasons, which then leads to local necrosis and cartilage defect, narrow joint space, and collapse of the articular surface.

The most commonly used operation is actually femoral head decompression, but the stage of aseptic necrosis of the femoral head in this patient cannot be resolved.

The so-called bone grafting also needs to be performed openly. It is impossible for you to operate the so-called bone grafting under the arthroscope because there is not enough space for the operation.

Therefore, everyone was very curious about what Zhou Cheng was going to do.

No bone grafting and no room for cardiac decompression.

If it wasn't Zhou Cheng who brought it up, Old Gui and the others wouldn't allow anyone to mess around here, let alone this as a student.

I have paid enough attention to you, can you achieve——

When everyone was still thinking about how to deal with Zhou Cheng, Zhou Cheng's change came. After Zhou Cheng sent a channel similar to the heart decompression technique, Zhou Cheng actually asked the itinerant nurse to ask for it. An operating instrument for vascular surgery...

Zhou Cheng did not perform the bone flap transplantation of pedicled blood vessels, but he wanted to reconstruct the blood vessels under arthroscopy, which is an alternative pedicled bone flap transplantation.

Restore the blood supply and re-graft the bone.

It was only then that everyone discovered that the channel that Zhou Cheng made before turned out to be a lumen that horribly just entered a nourishing blood vessel in the medullary cavity of the femoral head...

As soon as this discovery exploded, the scene immediately exploded.

Old Gui and Pin Lu couldn't help standing up, Lu Ganzhou also blinked and stroked his hair.

Face to face with Gui Lao and the others.

How is this going?

You know, at this time, Zhou Cheng is looking for a problem with the nourishing artery. How thin is this artery?

What is Zhou Cheng going to do this week?
As soon as this doubt arose, Pin Lu panicked, and immediately thought of a solution, and asked Old Gui and Lu Ganzhou, "Old Gui, Xiao Lu, can you two understand what Zhou Cheng is doing now?"

"Should we find someone from vascular surgery to come over and explain a little bit."

"Yes!" Lu Ganzhou admitted now!

He had never heard of this operation.

There is interventional surgery for femoral head vascular thrombolysis in the treatment of stage I and II avascular necrosis of the femoral head.

But Zhou Cheng's current operating mode?

What the hell?
"Then why don't you call?" Old Gui urged.

There is a specialization in the art industry, and there is a time to attain the Tao.

Orthopedics and vascular surgery have certain interdisciplinary subjects. It is impossible for Mr. Gui to be completely ignorant of vascular surgery, but he knows that the knowledge he has mastered is not superficial in vascular surgery.

But in fact, in ordinary prefecture-level city hospitals, it is still more than enough to be a deputy director and director.

……

The operation is still going on, but no one who understands has come yet.

Moreover, even if Pin Lu called, the other party had his own business, and the professor who was the fastest to step down came to the operating room after more than 20 minutes.

And when he arrived in the operating room, some fresh blood had already appeared on the operating mirror.

Seeing these bloodstains, Zhou Chengcheng let out a long sigh of relief, and then began to clean up some necrotic cysts on the femoral head...

The professor who came over was quite old, 62, a top professor of vascular surgery. After greeting Mr. Gui, he watched it carefully for a minute.

Then he turned his head and asked, "Old Gui, Professor Pin, what are you asking me to come over to see?"

"Is this your sports medicine surgery?"

"Does the patient have a blood clot?"

When talking, Qin Xuansheng felt so innocent. He is already a 60-year-old man, and he originally said that he would call him to have a look.But after I arrived, I watched the operation for a while and didn't understand it.

Gui Lao was also a little embarrassed, and hurriedly said: "Professor Qin, no, in fact, the thing is like this, before, Zhou Cheng..."

Although Gui Yuanping is an academician of orthopedics, he is of the same generation as Qin Xuansheng, so when facing Qin Xuansheng, he still treats him politely.

However, after Gui Yuanping finished speaking, Qin Xuansheng was completely confused.

He opened the mouth and said: "Then this access is made from the common access of your orthopedics department? It should be your orthopedics department to determine which bone flap is the nutrition or nourishing blood vessel?"

"It shouldn't belong to our vascular surgery problem? And I didn't see his operation process."

"Let me see, is this?"

"Equipment for thrombectomy..."

"I didn't understand it either." Qin Xuansheng admitted his cowardice first, and said it very bluntly, he didn't understand it, and he didn't understand it either.

Qin Xuansheng has already said that, but now, the problem is embarrassing.

Qin Xuansheng didn't come when he was doing vascular surgery. They didn't understand and didn't know how the surgery was going.

Now that the person came, Zhou Cheng started to only do orthopedic surgery again, but he still didn't understand.

These two groups of fools got together.

And Qin Xuansheng still feels that he is very innocent, why did he drag him here?

A few minutes later, Qin Xuansheng suddenly had a bad premonition, and quickly got up and said, "Old Gui, why don't I go back first, we still have some things to do in the operating room."

But how could Gui Yuanping let Qin Xuansheng go, he held Qin Xuansheng enthusiastically, and said: "Professor Qin, you are so old, you should let it go. Don't do everything yourself, pay attention to your body."

"Please sit down, please sit down, we still have a lot of questions to ask..."

Qin Xuansheng can't leave, otherwise the scene will be even more embarrassing later.

(End of this chapter)