medical simulator

Chapter 286 Xiao Zhou, This Is Unscientific (Subscribe)
Zhou Cheng took the initiative to speak again, and worked with everyone on the detailed plan of the operation process for a while!

During the discussion, at first Director Zheng and others didn't pay much attention to it. It was Zhou Cheng who was singing a one-man show alone. Based on Professor Xue Xiude's trust in Zhou Cheng, the whole small incision open reduction and internal fixation itself was initiated by Zhou Cheng. Derived and integrated.

Therefore, neither Hu Xianhe nor Landscape Star, including Director Zheng and others, spoke a word.

But after Zhou Cheng talked about it for a while, it seemed that some of the processes that they thought were within the theory and outside of the operation were stripped out by Zhou Cheng in a very clever way.

Difficult surgical procedures are often not complicated in nature. If you think it is complicated, then you must not be able to step into the door.

Some operations can also be disassembled, even if it is a type IV operation, it can be gradually dismantled into a type III operation, or even a type II operation, but it is superimposed as a whole.

After Xue Xiude, Jing Jingxing is the second professor who can actively operate small incision open reduction and internal fixation. He has the most say and is also the most familiar with the difficulties in this operation.

He opened his mouth and asked, "Xiao Zhou, what do you mean, such a formula sleeve can be designed in the future? As long as the fracture line is aligned properly, this difficult operation is actually relatively simple?"

The formula, the sleeve, the simplest is the Kirschner wire as a guide, and then the screw is driven at a fixed point.

Then various other 'formulas' are derived.

Zhou Cheng nodded and said, "Yes, Professor Jing, the indications for the small incision open reduction and internal fixation that we are currently proposing actually have certain limitations. Such fractures with super long fracture lines are not among the indications." Inside."

"These all need to be perfected step by step."

Zhou Cheng's words instantly made Landscape Star and Hu Xianhe look at each other in dismay.

"Can the current surgery gradually expand the indications?" Hu Xianhe asked first.

"It should gradually mature with the increase in the number of operations performed." Zhou Cheng didn't say anything dead, thinking to himself.

The road has to be taken step by step. Yang Yifeng has made good things in several lifetimes, but he can release them all at once. He is not a fool.

Landscape star asked again: "Xiao Zhou, do you actually have a relatively comprehensive plan in mind? It's just that you didn't bring it up before?"

Zhou Cheng was silent and did not speak.

Closed reduction and plaster external fixation of fractures will have a relatively large impact on the equipment companies related to traditional plate screw and intramedullary nail internal fixation.

I am just an individual, not an official, so I definitely can't do anything forcibly in the form of national policy.

If all the small incisions for open reduction and internal fixation of all fractures are released at once, forcing others to have nowhere to go, that is to force the dog to jump over the wall.

Kill yourself.

Cutting off people's wealth, such as killing their parents, can affect other people's way of life to a certain extent. This is competition.

But if you crush others at once without the strength to support the monopoly, you will die.

"Professor Jing, you think too highly of me. These are relatively common diseases in clinical practice. Sometimes I just think about it in secret." Zhou Cheng is not arrogant, because he no longer needs to be arrogant.

Xue Xiude knew that Zhou Cheng didn't want to delve into this topic, so he interrupted: "Xiao Zhou, Professor Jing, let's put the core of the problem on today's surgery."

"Xiao Zhou, the formulas you just mentioned can simplify the operation, but there is no such formula for this operation at present, so how can we make this operation as good as possible without the formula? It’s a difficult point that we need to pay attention to.”

"Long fracture line..."

After almost another 5 minutes, everything was ready.

Zhou Cheng and others walked into the operating room. While washing hands with Professor Xue Xiude, Zhou Cheng asked, "Professor Xue, it's okay for me to perform this type III operation here, right?"

Every doctor, whether a professor or an associate professor, has a designated practice.

To practice in another place, it is necessary to report to the current practice point.

Professor Xue Xiude smiled when he heard the words: "These are the most basic issues of principle. Director Zheng must have considered them before, so don't worry. Process issues are not issues that you and I need to consider."

"A consultation will look like a consultation, and there will be no pitfalls, unless everyone in this unit will never want to contact any other colleagues."

Please consult with the surgery, if you don't complete the process yourself, you will cheat others.

This time, I resisted stubbornly. If you don't say anything, who will dare to work with you in the future?What are you kidding?
Everything is ready.

When everyone arrived in the operating room, Zhou Cheng once again confirmed his position as the chief surgeon: "Professor Xue, Professor Jing, Professor Hu, and Director Zheng, there is no formula for this operation, so I will try it first?"

"Xiao Zhou, we are also very curious about how you operate without a formula. We are not sure, so naturally you are the only one." Landscape Star replied.

When Zhou Cheng came to the stage, he saw that the previous approach had been completed, and it should be a remnant of the operation that was not completed last time.

Zhou Cheng did not give up, but looked at the two approaches. Immediately afterwards, Zhou Cheng asked Xue Xiude, who was the first assistant, to get a Kirschner wire first.

After carefully looking at it, he used the Kirschner wire to locate the approximate upper edge of the fracture line. After this, Zhou Cheng did not operate again, but continued to use the internal fixation device for small incisions, using the original opening, placed.

After the two ends of the mushroom-shaped instrument were placed into the bone marrow cavity, the fixation of the union did not start directly.

But let it go again.

After that, Zhou Cheng said: "To be on the safe side, let's re-perspective now to see the fracture line and displacement."

Zhou Cheng's words caught the others by surprise.

However, before the formal operation, it is a routine operation to perform fluoroscopy again.

Everyone withdrew and went to the isolation room.

Soon, the X-ray results came out, and the alignment of the fracture line was quite good. It should be Xue Xiude or Professor Jingxing Xing’s method of reset. It was done very well, and the degree of cracking of the fracture line before the operation seemed to fit much better. .

After this, everyone re-entered the operating room, and Xue Xiude asked: "Xiao Zhou, you just had this perspective. What are you going to do?"

"Professor Xue, it's mainly for positioning and orientation."

"The position where I just placed the Kirschner wire happened to be at the upper edge of the flat fracture line. I was thinking about whether the Kirschner wire should be inserted at the upper edge of the flat fracture line or at the lower edge."

"The main basis for evaluating this is that I need to look at the oblique angle of the fracture line and the upper and lower lengths of the small incision internal fixation devices we want to use."

"This is why I don't fix the internal fixation device in advance. And I have to evaluate the shaft diameter, because the best fixation method is to drive the Kirschner wire below the fracture line, and the internal fixation device can just cross the Kirschner needle position."

"Only in this way can we achieve the best fixation effect." Zhou Cheng said while starting to operate again.

Professor Xue Xiude and others are still digesting what Zhou Cheng just said.

All I saw was that Zhou Cheng was already manipulating the internal fixation instruments at both ends, fitting them together perfectly.

However, at this moment, Zhou Cheng did not complete the operation of stretching the internal fixation device to grasp the bone in the bone, but was gesturing.

Seeing this situation, Xue Xiude suddenly came to his senses and asked: "Xiao Zhou, you don't mean to think about inserting the Kirschner wire into the hole of the internal fixation device through blind guidance?"

Xue Xiude is the professor who has seen the most internal fixation devices, so he is most familiar with its structure. Among them, there is a hole left in the pedicle of the mushroom structure. He has never figured out what it is for.

However, thinking about it now, it seems that Zhou Cheng left this hole in advance.

In fact, when Zhou Cheng designed this internal fixation device, he had already thought of a small incision internal fixation device for fractures with long fracture lines.

Then, in this umbrella structure, there are some rather strange and invisible shapes, do they have other uses?
Zhou Cheng smiled: "Yes, Professor Xue, in fact, this concept is borrowed from the formula of external instruments used in the process of intramedullary nail fixation, which can blindly drive screws into the screw holes of the intramedullary nail from outside the body. among."

"It's just that it hasn't been designed yet." Zhou Cheng replied.

He didn't say much, but first pierced the outer skin through the tip of the Kirschner wire, and then passed through the muscle layer until it reached the outside of the bone.

"For small incision open reduction and internal fixation, we choose to place internal fixation instruments, at least 2cm above the fracture line, and the length of the middle part is generally not less than 5cm!"

"The hole in the middle of our internal fixation device is usually placed in the middle. Therefore, we at least choose the place where the Kirschner wire is inserted, which is 3cm below the fracture line. The longer the length of the middle part, the greater the distance."

"The better the bone preservation is on both sides of the fracture."

While Zhou Cheng was talking, he directly used the electric drill and drove the Kirschner wire directly towards the femur. Along the way, apart from the blockage brought by the femur, there was no other sense of blockage at all.

Soon, the Kirschner wire came to the inner wall of the bone on the other side of the marrow cavity.

What does this mean? It means that Zhou Cheng either crossed the umbrella handle fixed in the mushroom, or passed through the hole.

It's too accurate to be able to pass through that part with such precision?

Incredible, right?
Zhou Cheng didn't immediately see through the inserted Kirschner wire, but used the same method to insert the second Kirschner wire.

Another perspective view.

Through the C-arm X-ray viewer, it can be seen that the Kirschner wire just passed through the hole of the internal fixation without bias.

This is absolute control over the entire surgical process!

During the operation, some experienced operators can blindly penetrate certain structures, such as directly hitting the greater trochanter of the femur. This is experience.

But if you want to drill a fixed point into a hole, and the hole is still random, this is beyond experience.

This kind of operation is like the magic skill of an oil seller.

In the isolation room, there was a sound of gasping for air.

But Zhou Cheng did not fluctuate because of these voices, but continued: "Because the fracture line was very flat during the first X-ray, therefore, if we fix the internal fixation device first in this process."

"It may cause oblique fractures to be shortened and shifted obliquely, and eventually lead to operation failure. This is also the step of internal fixation with small incision open reduction and internal fixation, which is more restrictive."

"When oblique fractures, be quite aware of this."

"But if we fix it horizontally first, we can avoid this from happening."

There is sliding in oblique row, and the tendency of sliding is great.

Zhou Cheng continued: "For oblique fractures, simple parallel fixation with Kirschner wires cannot achieve the fixation effect, so we'd better add internal fixation. The internal fixation device is square fixation. Together."

"At this moment, opening the internal fixation mushroom fixation device will no longer lead to the deviation of the fracture, and the preoperative manual reduction is excellent, so this belongs to compression fixation."

"This is borrowed from the principle of the compression screw."

As Zhou Cheng said, he opened the umbrella frame of the mushroom internal fixation device and pierced into the bone marrow cavity!
"This is the second fixation device, which prevents front-back, left-right, and left-right misalignment to a certain extent, because it is multi-axial fixation, and it can just fill the bone marrow cavity in a fully stretched state."

"But that's not enough. We also need to fix it with the steel wire of the coat to prevent lateral displacement. This is the idea of ​​using the steel wire of the patella fracture."

After speaking, in order to verify his theory, Zhou Chengcheng took another perspective.

After the fluoroscopy this time, Landscape Star heaved a long sigh: "Practice what you have learned and bring forth the new. Xiao Zhou did a good job in this surgery."

Blue out of blue is better than blue, and blue out of blue.

When everyone can understand and can find reference objects, and then use them together, this is to bring forth the new through the old.

With the internal fixation method that everyone is familiar with in the past as a reference analysis, everything is natural.

Are you familiar with compression screws, open reduction and Kirschner wires for patella fractures, and internal fixation with steel wires?It couldn't be more familiar, this is a classic technique, which has been verified many times in history.

"That's right, these techniques and theories are actually what we see every day. Xiao Zhou really has a thorough understanding of these things, so that he can quote from side to side."

"Xiao Zhou's mastery of the knowledge system has reached a certain level." Hu Xianhe also said the same.

Then, he said: "It is still the same for the upcoming project of our research group."

Speaking of this, Hu Xianhe stared at Zhou Cheng.

That stupid student of mine had no problem with his IQ, but Zhou Cheng was controlling him to death, which made him feel uncomfortable.

Zhou Cheng knew that he was suspected of taking advantage of Yu Heng, but he also had no regrets. It was Yu Heng's own suggestion, and he just gave a certain amount of help.

But after all, he still took advantage of it and did not act obediently: "Thank you, Mr. Hu, and thank you, Professor Jing, for your compliment."

"After this step in the operation, the surgery can actually be over. However, to be on the safe side, we still need to add an extra step, wire binding!"

Zhou Cheng then changed the subject: "What if the patient can rest after the operation? But if it is still necessary to get out of bed early, then it is necessary to fix it as much as possible."

After the operation, if you want to get up early for activities, you must be absolutely fixed, otherwise, the operation is no joke, how can you go to participate in any activities so quickly?
Upon hearing this, Director Zheng said, "Thank you, Doctor Zhou, if it wasn't for you, I really don't know what to do today."

"Each step, although it looks simple, is actually thrilling, and I'm afraid it can't be repeated."

Xue Xiude shook his head: "Director Zheng, it's better not to repeat this kind of operation."

Medicine does not allow showing off skills, whether it is Xue Xiude, Jingxing, or even Zhou Cheng, seeing this case for the first time, the preferred treatment plan is still a very safe traditional treatment method.

The pursuit of beauty is more important than the pursuit of quality, and the quality of medical treatment is undoubtedly more important.

If it wasn't for Director Zheng's secret assistance and the patient's own special requirements, this small incision open reduction and internal fixation should not be officially carried out.

Thinking of so many ways, don't you think it's a brain-consuming thing?

Director Zheng is also an old fritter, so he naturally understood Xue Xiude's meaning: "Professor Xue, this kind of thing will never happen again next time."

Although the idea of ​​this operation is borrowed from many previous operations, the operation is very difficult, and if you are not careful, it may fall short. Even if it is successful, the patient will have to bear various risks.

Although Director Zheng took the risk by himself, if something really happened to the old man, it would be a big obstacle to the promotion of small incision open reduction and internal fixation in the end.

In the current situation, I don’t know how many people hope to find out the limitations and defects of small incision open reduction and internal fixation, and then put them into the prison, so that they will never be reborn forever.

It's just that now, there are still curative effects, backing, and funds.

Zhou Cheng remained unmoved, and still cautiously added a third layer of steel wire binding.

I saw that Zhou Cheng tied the steel wire into a certain shape in advance, similar to a spring, and then sent the distal end into the opening.

Outside the periosteum, it is close to the muscles. What Zhou Cheng needs to do is to let the steel wire wrap around the bone. The difficulty of this step is also unimaginable.

Even in the cut state, the placement of the steel wire still requires the aid of formulas!

But I saw that Zhou Cheng fed the steel wire in as easily as turning a screw, and then took out the wire head very simply from the incision below.

Seeing this, including Professor Xue Xiude, the scalp was numb, and the muscles in the hands were extremely stiff.

This is the most difficult step in this operation, even more difficult than blind drilling into the hole of the internal fixation device. They thought that Zhou Cheng would spend a lot of time!

but?
It seems that this is not the case.

Several people were stunned for a moment, their tone was not calm, Landscape Star even grabbed Zhou Cheng's hand, looked carefully for a while, and said in a trembling tone: "Xiao Zhou?"

"This unscientific!"

(End of this chapter)