medical simulator

"Dr. Zhou and Boss Zhang have known each other before?" Lu Bin saw Zhou Cheng and Zhang Zhengquan had a lively chat, so he inquired.

Before, the instrument dealer who came to the operating room was another person, but yesterday, he called and said that someone else would come to the operating room, and he would be on stage.

Lu Bin was still curious about who would come to the operating room, and he had to ask to be on stage.Because in Changshi Hospital of Traditional Chinese Medicine, although there are not many people, there is no situation where equipment dealers have to come to the stage to help.

This kind of thing usually happens in a small number of prefecture-level city hospitals or county hospitals. The equipment dealer, as an assistant, comes to the stage to help, or guide the surgeon to complete some new equipment guidance, or assist in completing certain operations in the operation.

Of course, the reason why Lu Bin asked this is that if Zhou Cheng can play with the equipment dealer, it proves that Zhou Cheng is not the kind of pure scholar who only wants to do research or work, not the kind who has no other distractions.

In this way, do I have the opportunity to complete the task assigned by Dean Yang Jun?
If a pure person, Zhou Cheng has a great background and is impeccable, then Lu Bin has no choice but will not have such an idea to offend Zhou Cheng, or make it difficult for Zhou Cheng, but if Zhou Cheng has any desires, then Easy to handle.

Zhou Cheng didn't speak, but Zhang Zhengquan took the initiative to take the conversation: "Director Lu, I'm just kidding, you are my real God of Wealth. Brother Zhou Cheng and I have known each other before. I hope Director Lu can take care of you more in the future."

Lu Bin is the director of the department, and he has a lot of authority. At least, what kind of patients he has, what equipment he can use, what kind of surgery he performs, and which surgical equipment he uses.

Although his company has gained a reputation for minimally invasive fracture instruments, other companies have already begun to imitate them. In the future, they will definitely compete with each other in the market, but their own company can get the first share.

This is something that cannot be helped, and part of the profits must be given away.

While washing his hands, Lu Bin was active in his mind: "Boss Zhang, did you know Dr. Zhou before? That's a good relationship. Let's have a meal together when we are free."

Logically speaking, when Zhang Zhengquan first came here, he should have invited the people in the department to have a meal. After all, Zhang Zhengquan, as the equipment representative, sold more equipment, the more money he made.

Then during the meal, I would like to express myself a little bit, maybe Zhang Zhengquan can be regarded as this early bird.

If Zhou Cheng can be allowed to work at the grassroots level, no matter what method Zhang Zhengquan uses, it will ultimately be a game between Zhang Zhengquan and Zhou Cheng, and his own hospital will also benefit. This is a win-win situation with Zhang Zhengquan.

"Director Lu, if you don't tell me, I have to make arrangements for tonight. I'm new here. Director Lu and you doctors are all working hard, so let's talk about your feelings." Zhang Zhengquan spoke very easy-going, and he was very courteous. Euphemism.

Naturally, it is really impossible for a simple meal to be solved.

Hearing this, Zhou Cheng didn't think too much, just said: "Director Lu, let's start the operation. The preoperative preparations are already done. This operation is relatively simple. You can try it first and reset the technique first." it is done."…

Lu Binlai operated alone, Zhou Cheng had to watch from the side, and then give pointers slowly.

The method of reset is simple but not simple, and it depends on kung fu.Professor Xue Xiude from the Ninth Academy of Shanghai, and Professor Jingxing Xing from the Sixth Academy, they have their own skills, and they can draw inferences at will.

But Lu Bin is different. His previous understanding of the method of reset must not reach their level.It's enough.

The purpose of all operations is ultimately for healing, not for showing off skills.Better manual reduction surgery, of course, the postoperative effect will be better, but the degree of goodness is actually limited.

If everything is the pursuit of the highest degree of perfection, then it is difficult to do things.

Lu Bin gradually restrained his expression and took a serious breath.It was their dream that Zhou Cheng could come to Changshi Hospital of Traditional Chinese Medicine. Moreover, as the director of trauma surgery at Changshi Hospital of Traditional Chinese Medicine, Lu Bin was actually under a lot of pressure.

The biggest competitor of the Trauma Surgery Department of Changshi Hospital of Traditional Chinese Medicine is the Trauma Surgery Department of Changshi No. [-] Hospital.
The director, Zhang Jin, has a Ph.D degree. Moreover, there was Fang Yun there before. It is said that before Zhou Cheng came here, he had already started to perform minimally invasive fracture surgery alone.

The reason why, currently in Chang City, the fracture is only seen at Chang City Hospital of Traditional Chinese Medicine. It is because the creator of this surgery is here, and the postoperative effect is very good, and the publicity is proper.

Moreover, this kind of publicity, even if Chang City No. [-] Hospital came up with such a technique, the effect may be very good, and it is impossible to pass Zhou Cheng's publicity.

Who can say that other people can do a better job than Zhou Cheng in minimally invasive fracture reduction?
Maybe in the future, but right now, it definitely doesn't exist.

Lu Bin was also very concerned about the situation in the No. [-] Hospital of the city. Fortunately, Fang Yun, who came from Long County for advanced studies, was called back by the director of Long County People's Hospital.

Today, it is Zhang Jin who performs minimally invasive fracture surgery in Changshi No. [-] Hospital. Zhang Jin's ability is not bad, but after all, his major is spine and joint surgery. Immersion Yin.

Lu Bin must also carry out such operations routinely in the department.

After all emotions subsided, Lu Bin shouted: "Qin Ming, help me fix the reset and reverse traction, Guo Xiaobing, cooperate with pushing the C-arm machine, my manual reset is definitely not as good as Dr. Zhou's."

"But we take our time, operate a few more times, repeat a few times, and adjust slowly."

Any operation is actually coordinated and completed by a team. Even if Lu Bin is the main operator, he will go through all the procedures first, but in order to speed up, it is still necessary to strengthen the team's collaboration ability.

In fact, Zhou Cheng is also like this. Even though his personal ability is very strong, he can lead the team to fly, but a well-fit and proficient team will only increase the speed and quality of surgery.

On the contrary, before, Zhou Cheng was dragged down in the operations he performed at Changshi Hospital of Traditional Chinese Medicine.

Zhou Cheng and Zhang Zhengquan stood aside, chatting in low voices, Zhang Zhengquan was talking, Zhou Cheng was listening.

Neither of them felt too much curiosity or pressure. This was not the first surgery Zhang Zhengquan had seen, nor was it the first time he had seen others learn such a technique. He also knew that Zhou Cheng would be able to tell the truth if he was here. …

He himself chose to become the boss of the company, so he was doomed not to stay in the hospital for long. The reason why he still came to the hospital was to find inspiration for the development of the company. The second was to enjoy life, a life without so many struggles .

Very leisure time.

While Zhang Zhengquan was talking, Lu Bin said, "Doctor Zhou, Boss Zhang, shall we explain it first?"

It seems to be a question, but it is actually asking the two to go to the isolation room and not to take radiation.

Zhou Cheng nodded, and Zhang Zhengquan shut his mouth.

The results of the fluoroscopy appear on the display screen. The reduction is basically possible, but there is still a reduction. It has reached the level of functional reduction, but has not yet reached the level of anatomical reduction. This level of fracture alignment will increase the follow-up. Difficulty of operation.

"Qin Ming, let's adjust it again, Guo Xiaobing, you come in..." Lu Bin led people back into the operating room with a calm tone.

Zhang Zhengquan and Zhou Cheng could chat, but Lu Bin himself had to concentrate. Zhou Cheng didn't need to care about some details, because he had reached his ability, but he had to experience it slowly.

Theory is theory and practice is reality.

Yang Tao and others also went into the operating room to watch Lu Bin's operation, while Zhou Cheng and Zhang Zhengquan continued to stay in the isolation room. The anesthesiologist, the roving nurse, and the handwashing nurse did not move.

At this moment, Zhou Cheng said to Zhang Zhengquan: "Speak less and show some respect to Director Lu, at least he is undergoing surgery."

Zhang Zhengquan nodded: "That's right, we'll talk about it later when the surgery is turned around."

Soon, Lu Bin and Qin Ming walked in again, and after looking through it again, everyone's faces were darkened.

Because, in Zhou Cheng's hands, the method of resetting the fracture seemed extremely easy, but it was very difficult to reach the level that Zhou Cheng did.

Seeing the results of the plain film, both Qin Ming and Lu Bin showed slight expressions.

Somewhat serious.

If it is not up to the standard, and this operation does not pursue speed, then naturally it can only be adjusted.

So back and forth, a full four or five times.

Both Lu Bin and Qin Ming seemed to be still dissatisfied, and they were about to enter the operating room to adjust.

However, Zhou Cheng glanced at the flat film on the display screen, and said, "Director Lu, it's ok, reset to this level, and the remaining part of the offset can be adjusted by internal fixation devices during the operation. layers of anatomical reduction."

Hearing this, Lu Bin glanced back at Zhou Cheng, his inner self-confidence disintegrated a little——

"Is it really possible? Dr. Zhou?" Lu Bin dare not say it is possible now, because he feels that before he came to the stage, he had already made all the preparations, but how to do it, but it is such a ghostly look .

"It's ok. This degree of reduction is ok. In open reduction and internal fixation of small incision fractures, we need to classify fractures according to the fracture line. If there is a displacement in the direction perpendicular to the axis where the fracture line is located, it must be corrected. "

"However, if there is only a displacement along the axial direction of the fracture line, it can be fine-tuned and corrected with internal fixation devices. The postoperative recovery effect is also excellent." Zhou Cheng explained.

He probably noticed that at present, Lu Bin has at most reached the level of proficiency in the manual reset. If this manual reset is to achieve a complete anatomical reset, he does not know how many times he will have to repeat it. …

This will increase the wear and tear of the broken end of the fracture. In case of postoperative nonunion or slow healing of the fracture, it is really not worth the candle.

Among the delayed healing of fractures, one of the theories written in textbooks is that repeated manual reduction failures...

"That's fine, Doctor Zhou, you are an expert in this field, if you say it's fine, then it's fine." Lu Bin sighed, feeling very helpless.

The next operation, Lu Bin had done before with Zhou Cheng's method of reset, just put the instruments in, which is not difficult, but this time when placing the minimally invasive internal fixation instruments.

The difficulty of placement and docking, because the previous method of reset was not done particularly well, so it was repeated many times before the docking.

The treatment of fractures, reduction and fixation, are quite critical, and the difficulty of the operation is actually reduction, not fixation.

However, the fixed effect is still excellent.

Because it was fixed through the intramedullary, the final fracture line was only faintly visible, but it was not nearly completely concealed like that after Zhou Cheng's reset.

Although the gap is small, it is also a difference between kung fu and realm, which needs to be improved. In fact, there is still a long way to go.

So, after a full hour and 10 minutes, the operation was finally coming to an end.

Lu Bin looked at the results of the postoperative C-arm fluoroscopy for a long time before asking Zhou Cheng: "Doctor Zhou, there shouldn't be any problems with such postoperative effects, right?"

Zhou Chengcheng said directly: "Congratulations, Director Lu, you have been able to complete the minimally invasive fracture open reduction and internal fixation alone. If such postoperative plain films are released, the postoperative healing of the patient must be excellent. .”

Hearing what Lu Bin said, Lu Bin breathed a sigh of relief slowly, and said: "Doctor Zhou, when I watched you do it before, it was quite easy, but I realized how difficult it is when I actually operate it myself."

"I'm ashamed, I probably understand what it means." Lu Bin shook his head, didn't pursue further, and planned to step down.

The subsequent suture and surgical turnaround work was naturally handed over to Yang Tao and the resident physician.

Qin Ming also began to help Zhou Cheng take off the tie of the sterile surgical gown, and then said with a smile: "Director Lu, this operation is already very fast. How long will it be?"

"It's only a little over an hour. Of course it can't be compared with Dr. Zhou, but compared with most people, it's much faster, and the postoperative plain film."

"The fixation of the fracture is stable, the alignment of the fracture line is good, the surgical wound is small, and the postoperative recovery effect is also worth looking forward to."

Although Qin Ming is also aware of the gap between Lu Bin's surgery quality and Zhou Cheng's surgery quality, he can also understand that the results of traditional open reduction and internal fixation for the same fracture may be completely different if performed by different people.

But there is no way, who is Zhou Cheng?
Who are I and others? If I really want to pursue the same realm as Zhou Cheng, then I can only extend the operation time infinitely. He is the pioneer of this operation, so this cannot be compared.

If you directly compare yourself to the ceiling from the beginning, you must be stronger. If you have the ability, there is nothing wrong with being stronger. …

But if the ability is not enough, then don't pursue such perfection.

Zhang Zhengquan also stepped off the stage, and then all the people went to the lounge.

Lu Bin continued to ask for advice: "Doctor Zhou, you said, the same method is reset, the same theory, how can there be such a big gap in application?"

Hearing this, Zhang Zhengquan also pricked up his ears.

Qin Ming's eyes lit up even more, and he took the initiative to hand Zhou Cheng a glass of water, and then Lu Bin. He didn't drink water himself, so Zhang Zhengquan certainly didn't have it.

To drink water, you can only help yourself.

Zhou Cheng thought for a while, and then said: "Director Lu, actually, after understanding the most basic principles, you need to experience some things after resetting the technique."

"The initial introduction is to antagonize and stretch through strength to achieve the effect of reset. If you go further, you will feel that the operation is very proficient, and you can easily and quickly achieve the effect of reset."

"But this is a simple fracture reduction. When it comes to complex parts or special parts, simple brute force may not be suitable. At this time, we must use ingenuity."

"The use of ingenuity is to think and explore by yourself through the shape of the muscles and the position of the anatomy, and to feel the inner connection between the shape of different muscles in our human body by increasing the number of manual resets, and then through four or two dials. , to achieve the reset effect.”

"I think Director Lu, you can go in this direction and have a good understanding." Zhou Cheng said slowly.

This set of rhetoric was compiled by Zhou Cheng himself. With the help of some realm divisions and corresponding points that Fang Yun had given him before, Zhou Cheng reset the technique, and used different periods, or different proficiency levels. Between, made a more objective division.

When Lu Bin heard this, he was thoughtful, but felt extremely mysterious: "That's right, let me say, seeing Dr. Zhou, when you reset, it's quick and effortless.

Qin Ming has a relatively strong ability to learn and understand, so he asked again: "Doctor Zhou, according to what you said, cleverness also requires a lot of strength. I see that you usually don't use much strength when you reset. Are you How to achieve the reset effect?"

Qin Ming was very curious about what kind of power Zhou Cheng borrowed for his reset.

Lu Bin also turned around.

Zhou Cheng thought for a while, these are the things he didn't specifically mark in his theory of technique reset before, but now, Zhou Cheng has summed up an objective object by himself.

"After ingenuity, there should be a transformation force. After the fracture occurs, if the patient is not anesthetized, the muscles will naturally contract due to the stimulation of pain, and this contraction force is actually very strong. Strong."

"If we can make good use of these powers when resetting, the operator and the operator themselves don't need to use a lot of power, and they already have enough power to reach the resetting state."

"What we surgeons may need to do is to block the traction force of passive contraction of some muscles, so that the various forces that originally existed in balance will reach an unbalanced state."

"Almost, the highest level that can be achieved by manual reset, that's it." Zhou Cheng explained slowly. …

But hearing these words, Lu Bin and the others were dumbfounded.

TM can still be like this?
Using the contraction force of the patient's own muscles to complete the manual reset of the fracture displacement, what kind of state is this, this is a four-two-two thousand catty.

Hearing this, Zhang Zhengquan was stunned and turned

Rolling his eyes, he said with a smile, "It sounds awesome, but it's also difficult. Fortunately, I got out early. Otherwise, with my hands, I'm afraid it will be difficult to get started in my life."

Lu Bin and Qin Ming ignored Zhang Zhengquan's complaints and rejoicing, but frowned, thinking about Zhou Cheng's words.

After crying and thinking for a long time, although he didn't understand and understand thoroughly, he still sighed. Qin Ming said, "Doctor Zhou, if my teacher could teach like this when I was studying, that would be great."

"What if the anesthesia has already been completed?" Qin Ming asked his own question again.

Hearing Qin Ming's words, Zhou Cheng said with emotion, "Brother, do you think that everyone knows these things? How much effort did it take me to summarize these points? Now, it is not perfect yet.

Although it is simple and easy to understand, I realized it thoroughly, tore it to pieces, and then fed it to you. Of course, it is easy to understand. If it is difficult to understand, then all the hard work I did before was in vain.

The complaint was just in my heart, and I replied: "Under anesthesia, even if muscle relaxants are added, the muscles will still feel stimulation through proprioception and produce a state of micro-contraction. At this time, we may have to apply Not antagonism, but active stress.”

"It's not easy to understand, that is, to put it simply, we can actively stimulate the few muscles we think we need to use, produce a contraction state, and help us achieve the purpose of reset."

Lu Bin opened his mouth and was blocked by the mask, but his eyes narrowed.

It's so fucking simple, can you make it simpler?
Qin Ming simply didn't bother to ask anymore, it was too shocking, but he also knew that there were some things that could only be understood but not expressed in words.

"Oh, so that's how it is." Qin Ming could only pretend that he understood.

But in fact, what Zhou Cheng was talking about, he was also a little confused.

Zhou Cheng didn't continue to struggle, and then everyone moved the topic to other places, mainly asking, does boss Zhang Zhengquan have a girlfriend, what does the family do, and then talk about whether Qin Ming's son has studied this year. No nutritious words.

Soon, the operation proceeded to the opening of the second stage.

The fracture in this table is a fracture of the humerus. Although it is a fracture of the middle part of the humerus, it is a bit difficult to reset the fracture of the middle part of the humerus.

At the beginning, Zhou Cheng and Zhang Zhengquan were still on the sidelines, and then Lu Bin, Qin Ming and others began to reset the technique.

However, three times in a row, the fracture was still broken, and the reset did not reset at all. Lu Bin's face was so dark that it was ugly.

Seeing this, Zhou Cheng did not wait for Lu Bin to take the initiative to speak, and said first: "Director Lu, the fracture of this unit is indeed a little difficult to reset. Let me do the reset. You and Director Qin will complete the subsequent fixation operation. .”

While speaking, Zhou Cheng, Lu Bin, and Qin Ming walked into the operating room. …

Zhou Cheng said at the same time: "Director Lu, Director Qin, the reason why the fracture of the humerus is difficult to reset lies in the stretching of the muscles. Under such circumstances, we need..."

Zhou Cheng tried his best to use a theory slightly higher than that of Lu Bin to guide him, and then to carry out printing and comparison through realistic operations.

"At this time, the original friction between the fractures can just resist the pulling force of the muscles. After the fracture is reset, it will no longer be displaced." Zhou Cheng said while leading people out of the operating room. Came to the isolation room.

After pressing the button to take a photo, sure enough, on the display screen, there was an unremarkable display of a fracture reduction state that was even more perfect than the manipulative reduction of the tibial fracture done by Lu Bin before, just waiting for Lu Bin to complete the fixation operation up.

Because of Lu Bin's previous comparison, everyone in the isolation room could immediately feel the gap between Zhou Cheng and Lu Bin, and looked at Zhou Cheng with even more awe.

Without comparison, there will be no harm. When you get used to better things, it is difficult to change from extravagance to frugality!
This is Zhou Cheng, minimally invasive fractures, although everyone can do it, but the final effect must still be different.
Sex, too, is completely different.

This can be said to be another level of art.

Lu Bin nodded even more, and said with emotion: "Doctor Zhou, I take it."

"It seems that our department is still a long way from actually carrying out minimally invasive fractures." Lu Bin completely abandoned his previous thoughts.

Some things are not as simple as they seem on the surface. Some operations, you can understand, and you really can, that is a completely different concept...

What I understand is that I can operate, but I can start the operation completely, complete it completely, and then increase the speed and quality of the operation.

However, the real skill in surgery is to disassemble and disassemble the surgery, just like an art performance, and slowly express them, one is just a simple operation, and the other is a work of art up.

Minimally invasive internal fixation of fractures is not difficult, simple, and even more difficult.

Zhou Cheng's teaching made Lu Bin feel more deeply about Zhou Cheng's knowledge reserve, as well as his ability and depth of understanding of surgery.

Zhou Cheng pursed his lips and said, "Director Lu, it's actually okay, the most important thing is still reset."

"Small incision open reduction and internal fixation, the treatment concept is derived from the treatment principle of fractures, and it is not difficult to go beyond this principle. It is the first time for Director Lu to operate alone today, so he will find it difficult to progress. .”

"But once there are more sets, you will gradually become proficient."

Director Lu, you must not be so anxious. What level have you reached? At most, you just got started, and you just want to reach my perfect level. It must take time to accumulate.

When I first studied, I relied on my own groping, now you just need to follow my current path...

Of course, Zhou Cheng didn't dare to say this, otherwise, he would feel a little guilty. The surgery he learned by himself was based on cheating, and Lu Bin and others learned it in real terms.

It can't be compared like this.

The next operation was still going smoothly.

Surgery sounds grand, but there are key points and difficulties. Some basic operations are known to most surgeons.Zhou Cheng's treatment concept is actually independent of manual reset, and its root is naturally manual reset.

Minimally invasive internal fixation is just the finishing touch, in order to increase the reinforcement and fixation of fractures after manual reduction.

To have a thorough understanding of a surgery is to strip out the essence and start with principles, so that you can better understand a surgery...
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