medical simulator

Some operations, if you don't do it yourself, you can't appreciate the difficulty.And some people's level, I am not in that field, so I can't feel the level of their level.

What the eyes see and what the mind thinks, it is also difficult to truly understand the heights that another person has reached.

It is a kind of thing that is easy to happen in normal operations if the brain knows the hands.

Lu Bin and Qin Ming admired Zhou Cheng more and more after experiencing the first two units being operated by themselves.

Lu Bin’s mentality has also become much more relaxed. After leaving the operating room, he said to Zhou Cheng: Doctor Zhou, I watched your operation before, or you did it. After the reset, I will do the follow-up fixation operation of the minimally invasive internal fixation device.

It doesn't feel too difficult, but when I have to do it all by myself, I still feel nervous, and I can't always achieve the results I want.Difficult.Lu Bin's expression was dignified. While talking, he drank a glass of water slowly to ease his inner emotions.

Qin Ming pretended to get a glass of water for Zhou Cheng and Zhang Zhengquan. Zhang Zhengquan stood up and took it, and then thanked Qin Ming. Qin Ming didn't care, but listened carefully to Zhou Cheng's explanation.

Director Lu, the main reason is that I am relatively young, and I may be able to do things by myself, but when it comes to teaching, there are actually quite big flaws.There is really no experience.Zhou Cheng also found his own shortcomings.

Is it hard to be a teacher?
It is not difficult to say that it is not difficult, but it is not difficult to teach the knowledge well and express the knowledge and your own understanding.But it is not easy to teach people well, until people understand.

Teaching in primary and junior high schools is not easy, let alone the current knowledge structure and system?
In fact, being a university teacher is the best and the hardest thing to be. The best thing to do is to select high-quality students. The hardest thing to be a teacher is that it is difficult for you to explain your understanding to others. It depends more on your personal talent. .

This is difficult.

If it is only for individuals, Zhou Cheng has various methods. It is really not possible. He can also simulate how to teach a person through the simulator. However, what Zhou Cheng wants to do must not be fully realized through the simulator.

In the process of teaching Lu Bin, Zhou Chengcheng did not take shortcuts, but planned to be a real teacher for a while, which will also help Zhou Cheng improve his teaching theory in the future.

Before that, no matter whether it was Chen Shengwu, Yang Yifeng, or Yu Heng, these people were not normal people, they had a high level of comprehension.Even Qin Ming's aptitude is quite good, while Lu Bin in front of him belongs to the kind of person with mediocre talent.

How to teach such people well has a broad-spectrum nature, which is very helpful for the regularization and systematization of medical teaching.

Now that we have made up our minds to digitize the medical strength and skill levels and make them hierarchical, we have to think about all aspects and find out in detail, which is not easy.

Not easy is a good thing. If everything can be achieved casually, then life must not have so much meaning. What's more, this matter has great significance and far-reaching impact.

...

If it is done well, it will be famous for thousands of years. If it is not done well, please refer to the position in the hearts of medical students of the group of people who compare the training system of Huaguo to Western countries, but their treatment cannot keep up...

Lu Bin said: No, Dr. Zhou, your teaching theory is solid and easy to understand, but my learning progress and speed are too slow to keep up with your rhythm. Perhaps, my learning speed is faster than Qin Ming's. Be slow, just rely on your basic skills to stay here.

In Lu Bin's opinion, Zhou Cheng is already an excellent teacher.The basic skills are terribly solid, the theory is transparent, and all the knowledge structures can be divided into divisions, but it is difficult for oneself to absorb and apply flexibly.

In the theoretical system of medicine, it is estimated that there will not be too many people like Zhou Cheng.

There are too many people who are good at doing things but not good at teaching.

Even Zhang Zhengquan said: Brother Zhou Cheng, I think your teaching is very good.
a lot of.

He does not mean that.

Zhou Cheng's eyes lit up when he heard what Zhang Zhengquan said.

Hey, that's right, Zhang Zhengquan is here in Changshi now.

If you want to say, among the people he came into contact with, whoever has the lowest aptitude belongs to Zhang Zhengquan without a doubt. His talent in medicine is completely inferior to one-tenth, or even one-hundredth of his weirdness...

If Zhang Zhengquan can be taught well, it will definitely be useful to most medical students.

In an instant, Zhou Cheng's eyes became hot.

Zhang Zhengquan Toolman can finally go online in the simulator...

Zhang Zhengquan saw that there was something wrong with Zhou Cheng's eyes after he spoke, and his expression froze for a moment. He retracted the collar of his sterile surgical gown, stretched his head over, and lowered his voice: Brother Zhou Cheng, if you take a fancy to me, Just tell me, I'll go to your house tonight.

Get out! Zhou Cheng cursed.

A joke broke the previous embarrassing atmosphere.

Boss Zhang and Dr. Zhou have a good relationship? Lu Bin asked with a smile.

Zhou Chengcheng said: Zhang Zhengquan and I used to be fellow trainees in the same group. He was one year younger than me, but now he has withdrawn from the training and has changed his career from being a doctor.

Zhou Cheng himself, in April of this year, has already completed the training plan, and has also taken the exam. It is estimated that he will be able to get the certificate in a short time, and in August, he will also participate in the exam for the attending physician go.

But Zhang Zhengquan no longer engages in the profession of a doctor, and now he doesn't even bother to get a name. Although he has a doctor's qualification certificate, the training has not yet been completed.It is still not possible to engage in related industries, at least not to practice alone.

Lu Bin's expression flashed: So that's the case.I really envy you young people.

There was something in Lu Bin's words, and his mind became active.

Isn't this a loophole that Zhou Cheng gave him? Zhou Cheng and Zhang Zhengquan were friends before, but now one is a device dealer and the other is a clinician. If there is no interest relationship in it, no fool will believe it.

Zhou Cheng didn't understand the meaning of the words, but Zhang Zhengquan said with a serious expression: Director Lu, Brother Zhou Cheng and I are purely friends, and everything else is irrelevant.Director Lu, don't have any misunderstandings, otherwise it will be difficult to solve the misunderstanding.

...

In fact, as an equipment dealer, Zhang Zhengquan should please Lu Bin, but he is not afraid of Lu Bin.Now the role he is taking on is a company with quantity procurement targets. In a hospital, he can't eat much quantity, and he can't make much money per steel plate.

It is purely based on quantity, and only by taking quantity can you make money. Therefore, a Lu Bin is not enough to make him afraid, and it is a big deal not to do it, but Zhang Zhengquan still wants to make money with peace.

When Lu Bin heard this, his eyes froze, and he thought to himself, who is this kid, so fierce?
Zhou Cheng took a look at Zhang Zhengquan and explained: Director Lu, I used to be in Shanghai, and my friends worked in Shashi more often, and it happened that I met them in Changshi.

Zhou Cheng also chimed in.

Lu Bin immediately realized, that's right, Zhang Zhengquan was in Hunan Province, but Zhou Cheng was in Shanghai, so there may be no interest relationship before the proof, so now? What about later?
……

After a while, Zhou Chengcheng took the initiative to propose: Director Lu, I will go to see the plain film and preoperative examination of the thumb deformity at the back, and go through the operation plan again. I will go to the operating room first.

You and Director Qin, come back later.

Lu Bin heard that this is a very good opportunity: Qin Ming, you can go with Dr. Zhou and hurry up the operation turnaround. Those people below should not be lazy and help out on stage.

Boss Zhang and I have something to say.

Qin Ming thought that Zhang Zhengquan, as a new equipment dealer, was still young, and his previous words were a bit aggressive, so Director Lu Bin planned to hit him, and the content of the conversation was inconvenient to listen to, so he immediately followed him out.

He is now the deputy chief physician, for the inner door
The way is still clear.

After Zhou Cheng and Qin Ming left, Qin Ming consciously closed the door.

However, Lu Bin saw that the timing was right, and Zhang Zhengquan said before he could speak: Director Lu, let me tell you, I am Zhang Zhengquan, and Zhongzheng Company is mine.

I don't dare to say anything else, but if I don't want to provide Changshi Hospital of Traditional Chinese Medicine with this permission, I still have it.

Zhou Cheng is my friend, I hope Director Lu, you will not embarrass him, and don't think about embarrassing him.

This is how I am. I like to say anything on the bright side.Zhang Zhengquan changed his face first, his face was dark, he couldn't see any joy or anger, but he directly gained the upper hand while speaking.

Just kidding, Zhang Zhengquan had been in contact with the directors and professors of major hospitals before. Although he was at a disadvantage at that time, he learned a lot over time.

Lu Bin, the director of a prefecture-level city hospital, he can really look down on.When he was able to overwhelm others with his strength, Zhang Zhengquan didn't want to push him too much.

When Lu Bin heard this, he immediately swallowed his own words back, and looked at Zhang Zhengquan in astonishment, with an inexplicable expression on his face.

Zhang Zhengquan continued to say: Director Lu, in our business, the most important thing is to make money in peace.But our company does not want to touch some principled things. The main purpose of my starting this company is not to make money.

That's about all I have to say.In addition, we can be friends, we should eat, drink, talk about what we should talk about, and we don't talk about what we shouldn't talk about.

...

After Zhang Zhengquan finished speaking, he remained silent, and then waited for Lu Bin to speak.

Lu Bin digested it for a long time, and finally came to his senses: So, Boss Zhang, you came to Changshi just for Dr. Zhou?
Among other things, the general managers of some major equipment companies are no longer at the grassroots level. As the CEO of a company, Zhang Zhengquan directly came to the prefecture-level hospitals, which is not normal in the first place.

If he was able to come here in person, the relationship between him and Zhou Cheng would have to be reassessed.

There are some things that Zhou Cheng, as a doctor, is not easy to do or say, he can say.

It almost means that I am the younger brother who hangs out with Brother Zhou Cheng.Director Lu, thank you for taking care of Brother Zhou Cheng during this time, and I hope Director Lu will take care of him more in the future.

If necessary, our company can provide Director Lu with a lot of convenience, including opportunities for advanced studies. I can not only send Director Lu to study abroad.They can even send you, Director Lu, to become a doctor abroad.Zhang Zhengquan smiled, showing his teeth, but they were covered by the mask.

But the meaning of threat in the words is full.

Just now, Lu Bin just asked Qin Ming to go to the operating room with Zhou Cheng, obviously he had something to say to himself! He deliberately avoided what Zhou Cheng said, it must have something to do with Zhou Cheng, Zhang Zhengquan didn't want to care too much about it.

What he prefers is to control violence with violence and minimize all risks.

Before becoming the CEO of the company, he worked for Yan Hanhan in the Second Orthopedic Ward of the Eighth Hospital.Even Professor Ding Changle has been suppressed by others, let alone Lu Bin. If you are sensible, everyone will live in peace. If you have any pettiness, then sorry, I will send you abroad to become a doctor.

The side meaning is that I can make you unable to get along in the country now.

It's also very simple, just shake out your previous butt, and then spread it everywhere in the country, how can you mess around in the country?
Lu Bin became thoughtful, with a cold face, and didn't say a word.

Zhang Zhengquan thought it was almost time, so he rushed directly to the operating room.

In the operating room, the pre-operation preparations are already done.

Quanzi, wash your hands and come to the stage to help. This one is an osteotomy orthopedic for thumb deformity.Zhou Cheng said to Zhang Zhengquan.

Naturally, it is necessary to explore Zhang Zhengquan's background in reality first.

What can I learn, Brother Zhou Cheng, are you kidding me? I can cook very well.Zhang Zhengquan
Just kidding, honestly, but I can do my best on stage.

Then stand aside and watch.Zhou Cheng identified Zhang Zhengquan as the teaching object, so he naturally hoped that he could help him.

Qin Ming felt a little strange seeing Director Lu Bin not coming to the operating room, but as the director, Lu Bin could have the right not to come, so he ordered: Yang Tao, Guo Xiaobing, you two come to the stage and help.

Osteotomy orthopedic surgery for thumb deformity is not a particularly common therapeutic operation, but belongs to the category of repair function and cosmetic treatment.

But in fact, the deformity of the thumb can indeed affect the patient's quality of life and lifestyle.

The preparations for the operation were almost done, and the patient called out first: Doctor, doctor, please slow down, the anesthesiologist said that my hand has not been anesthetized yet, but you put me on the stage.

...

This can't be done, it will kill me when the time comes.He was terrified, and this was the first time he had encountered it so far, and he had never heard of it before.

The surgery was performed without anesthesia. When I was hospitalized, all the patients in the ward were in pain.

The doctor in charge of the bed first became nervous, and then quickly explained: Brother, don’t panic, it’s not that you don’t need anesthesia, it’s local nerve block anesthesia. We think that for your operation, the range of anesthesia does not need to be too wide, which is convenient for your postoperative recovery. I know.

Our doctor Zhou performed the operation on you, what are you worried about?
Hearing this, the anesthetist was quite happy, and stood there curiously, ready to see what Zhou Cheng was going to do. This operation was obviously a serious operation, but it did not use traditional serious anesthesia.

Zhang Zhengquan had never seen a patient before, so he glanced at Zhou Cheng curiously, and found that Zhou Cheng had a steady face, not worried at all, so he felt relieved.

Zhang Zhengquan didn't know about it, but he had heard from Luo Yun that Zhou Cheng was as stable as an old dog, so he wasn't worried about Zhou Cheng's decision.

Zhou Chengcheng said: Actually, the deformity of his thumb is very similar to the trigger finger (refer to the action of firing a gun).In addition to bone deformities, there are also deformities of skin and muscle tissue. The surgery we have to do requires an osteotomy first to restore the bone to its normal structure.

After the osteotomy restores its normal shape, after the osteotomy, the muscle tissue and tendon tissue must be restored to their normal structure, and then skin grafting is required.

I plan to make a blade-thick skin or a medium-thick skin, which depends on the specific situation in the operation.However, his tendon contracture and ligament contracture must be very serious.We must pay attention to this.

This is a deformity of his thumb. The current angle is about 45 degrees, which is very inconvenient for daily operations. He is not very old now, but he has to undertake some delicate work, so he plans to do osteotomy and correction when he is middle-aged. .

It is also convenient to marry a wife.

Hearing Zhou Cheng's voice, the patient was relieved, but he still said: "Of course I trust Dr. Zhou, but you don't want to do it without anesthesia. Although I am not afraid of pain, this kind of raw flesh cutting is still unacceptable."

Doctor Zhou, don't joke with me, I'm afraid.As far as this middle-aged man is concerned, he is actually quite muscular. He seems to be able to endure hardships and is not afraid of pain, but at this moment, he is about to cry.

It's all right, don't be nervous.While talking, Zhou Cheng explained to Qin Ming and others: The main purpose is that I don't want to have too much anesthesia during the operation. We all know that the innervation of the thumb is actually very limited.

Moreover, our surgical field is actually only up to the thenar, so we don't need to do a large range of anesthesia. I think such a small and delicate operation and anesthesia can be carried out tentatively in our current hospital. A small subject.

Also in line with the rules.

While talking, Zhou Chengcheng started, is the local anesthesia prepared?
It's ready, Dr. Zhou, it's all in this syringe.The hand-washing nurse immediately handed over the pouch, and then surrounded him curiously, wanting to see what Zhou Cheng was going to do.

Zhou Cheng took it, and said: The anatomical knots near our fingers
...

Although the structure is fine, the shape is very particular. Near the distal segment, there are a lot of local sensory nerve endings, so you can feel pain soon.

But in fact, on the side of the finger, although this is where the nerves go, the nerves at the end are less distributed.Therefore, we can use this method of anesthesia to achieve the anesthesia effect of one finger, and there may be one more operation during the operation, but it doesn't matter.

While speaking, Zhou Cheng quickly inserted the tip of the needle into it. The strange thing is that according to ordinary people's understanding, the needle will be very painful, especially when the local anesthesia is administered, it will be even more painful.

However, Zhou Cheng pricked a little deeper, but the patient didn't feel anything yet.

Before he had time to cry out for pain, Zhou Cheng had already completed the actions of back suction and pushing the medicine, and then said: You see, after the quick needle insertion and the local anesthesia operation, the patient actually didn’t feel much pain. Yes, I didn't even have time to react.

Zhou Cheng confirmed his statement, and then inserted the needle again on the radial side of the thumb, which is the inner side of our conventional understanding, and inserted the needle in the same way, and then pushed the medicine.

The patient still didn't cry out.

The anesthetist was very curious and asked: Wang Limin, are you not in pain?
Wang Limin was the patient's name. He heard what the anesthesiologist said, and ahed.

Have you started cutting yet? Why didn’t I feel it? The nervousness caused him to flick his hand a little, but the arc was very slight.

Don't move! Zhou Cheng stopped drinking immediately, and then stared at the anesthesiologist with both eyes.

You are curious, we are talking about academics, why are you chatting with the patient? To increase his emotions and let him move during the operation?
Wang Limin's hands froze immediately.

Don't move, Wang Limin, the operation is very fast. Now, I am using a needle to poke your thumb. How does it feel? Zhou Cheng asked.

There is a little tactile sensation, but no pain, really no pain at all.Did you poke it with the tip of a needle? Not your finger? Wang Limin's voice was both surprised and happy.

Don't worry, it's fine if it doesn't hurt, don't worry about anything, just treat it as if you are resting, if you can't cooperate during the operation, I can only transfer you to general anesthesia! Hand in hand.

This operation is performed under local anesthesia followed by general anesthesia, and it can be transferred at any time, because Wang Limin is afraid of psychological burden, but at present, as long as no one makes trouble, Wang Limin will feel nothing.

Then, Zhou Cheng saw that Wang Limin didn't move anymore, and he saw that Zhou Cheng quickly completed the skin-cutting action. Zhou Cheng cut the skin on the side of the joint between Wang Limin's thumbs. The blood oozes out, and with a wipe of sterile gauze, the blood is gone.

Immediately afterwards, Zhou Cheng used vascular forceps to pick apart the skin and subcutaneous tissue, exposing the contracted tendon inside.

There are eight tendons in the thumb, flexor pollicis longus, flexor pollicis brevis, extensor pollicis longus, extensor pollicis brevis, abductor pollicis longus, abductor pollicis brevis, adductor pollicis, and oppositus palmaris.

But among these eight muscles, only the flexor hallucis longus and extensor hallucis longus pass through the first metacarpophalangeal joint and reach the distal knuckle.

So, what we have to deal with is actually these two muscles.

We all know that the fingers have no musculature, and the muscles from the forearm and palm to the fingers have become tendons.According to its function, it is mainly divided into two groups: the flexor tendon on the palm side, and the extensor tendon on the dorsal side.

...

After the extensor tendon crosses the metacarpal joint, it expands on the dorsal side of the proximal phalanx to form a strong dorsal aponeurosis.

The dorsal aponeurosis of the fingers is divided into 3 parts: the central tendon inserts at the base of the middle phalanx.After receiving the lumbrical muscle and part of the interosseous muscle, the tendons on both sides merge at the back of the middle phalanx, and then insert at the base of the distal phalanx.Each bundle is reinforced by tendons.

When the finger extensor tendons are ruptured, the finger joints are in a flexed state, the proximal interphalangeal joint cannot be straightened when the middle bundle is ruptured, and the distal interphalangeal joint cannot be straightened when the two lateral bundles are ruptured.

This is in a state of trauma. This patient's interphalangeal joints were deformed and fused due to early trauma. Therefore, his tendon development was also abnormal.

During the process, his extensor hallux longus tendon must have been too long, and his flexor hallucis longus tendon must have been too short.

Therefore, I plan to see if he can combine the two tendons through anatomical positioning. If it is not possible, we can only take the secondary functional tendons from other places to complete the tendon transplantation.

Zhou Cheng slowly popularized the knowledge of anatomy, but he actually said it to Zhang Zhengquan. Among them, Zhang Zhengquan's foundation may be the worst.

Zhou Cheng explained in such detail, and there are references, so Zhang Zhengquan can also understand.

Because we don't need to deal with the blood vessels and nerves, they are in a buckled state now, so the blood vessels and nerves are actually too long, so there is no need to consider them after surgery.So under such circumstances, our operation can roughly be divided into two steps.

The first step is osteotomy to reshape the articular surface.

The second step is the treatment of the tendon, autograft, or rearrangement!
The third step is skin treatment, such as skin grafting.

The fourth step is to fix.

Isn't it difficult? Zhou Cheng asked.

Then looking at Zhang Zhengquan, Zhang Zhengquan nodded.

It's really not difficult.

Zhou Cheng continued popular science: the interphalangeal joint is composed of the pulley of the upper phalanx and the bottom of the next phalanx.Now it's merged, so we have to recreate a slider structure, and then polish it into a bone base.

Let's find a suitable place first and cut the skin.Before, we cut the side. At this time, we have to cut off the skin from the proximal phalanx.

Then, we exposed... step by step, Zhou Cheng's movements are clean and neat, and everyone can understand.

However, after Zhou Cheng exposed the fused bones and cut off the surface of the fused bones, Zhou Cheng directly used the bone contusion, and in a very short time, he polished out a pulley structure.

Yes, Zhou Cheng polished a pulley structure by himself, and then asked in a flat tone: Look, is this similar to a normal pulley structure? The pulley of the proximal phalanx of our thumb is almost in the shape of a conical barrel. The diameter is about...

Then the bottom of the phalanx is shaped like a basin, and its diameter is about... Zhou Cheng said while doing this.

Then looking at Zhang Zhengquan, Zhang Zhengquan shook his head and narrowed his eyes.Meaning, this one I really don't know.

The same is true for Qin Ming, who swallowed a mouthful of saliva, and replied seriously: Doctor Zhou, the data you mentioned are generally ignored or remembered.

And it’s useless to remember, this kind of reconstruction of the base of the phalanx and the pulley of the phalanx?
Qin Ming only said half of what he said. If I could do this, would I still be a deputy chief physician now?
Brother, you are rebuilding the bottom of the phalanx and the pulley of the phalanx. This is almost impossible in the world at present. In theory, it has not yet been done yet?
Qin Ming's tone was sour, his expression and eyes were strange.

And Qin Ming's weirdness, Zhang Zhengquan and others couldn't understand it, because they didn't know how difficult it was, they just felt shocked.

Yang Tao is still saying: Hey, look, it looks like a normal pulley...

Guo Xiaobing nodded: Well, almost exactly the same.

Like chatting, eating and drinking...
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