medical simulator

Well, these two are also gods! But they can't be blamed. If the realm is not enough, there is no way to discover the strength of others.Qin Ming thought to himself, but didn't say much.

In normal times, before Zhou Cheng came, Lu Bin had reminded him more than once in the department that Zhou Cheng should not be underestimated just because of his young age.

However, people in the department complained a lot because Zhou Cheng was young and did not work as a junior doctor.

Later, after seeing Zhou Cheng's operation, such rhetoric gradually disappeared.However, Yang Tao and others cannot be blamed, they are all just residents, they have not been promoted to attending, and they have not yet performed their own surgery.

I still don’t know how many difficulties you will face and how many details you need to pay attention to when you are actually doing the main surgery. At this time, when you want to study again, how precious is the opportunity to learn, and the time wasted before, followed by your graduate tutor How hard-won is the time to study.

But we are all colleagues, and some words can only be pointed out. Maybe these two have mines at home, or their dreams are not to go up, and they have a mentality of eating and waiting to die. You can’t say that others are wrong.

After all, being a doctor is really just a job to support your family.

Zhou Cheng continued with the operation, while Qin Ming continued to watch. After a while, Director Lu Bin came late, washed his hands and got dressed, and said he was sorry.

The words were addressed to Zhou Cheng, and the tone and expression did not reveal that he was threatened by Zhang Zhengquan just before.And the apology to Zhou Cheng is mainly for the real apology.

When he was undergoing surgery, Zhou Cheng watched and escorted him all the way. Now that Zhou Cheng started his own surgery, performing surgery on his outpatients, he was late and absent, and had to explain to Zhou Cheng.

Zhou Cheng didn't put his mind on Lu Bin at all, but continued to deal with the joints.

This operation can be easy or difficult. It is easy to correct the deformity and grow it back to achieve the purpose of the patient's hospitalization, restore the deformity to a normal structure, and then have some functions.

It is not difficult to do this, just need an osteotomy, and after the normal shape is restored, the function will naturally recover partly, and there is no need for reconstruction of the base of the phalanx and the pulley.

However, Zhou Cheng didn't want to treat this operation so easily, so he just let it go.

Doing his best, he hopes to be able to restore the patient's function after surgery and do a better job.

Professional rehabilitation guidance is part of it. The reconstruction of the original anatomical structure is the basis of functional rehabilitation. If the foundation is not well established, no matter how good the rehabilitation guidance is, the upper limit is too low after all.

The reconstruction of the basic anatomical structure is the way to improve the lower limit of surgical quality, with rehabilitation guidance as an aid, so that the lower limit can be raised and the upper limit can be raised at the same time.

Osteotomy and orthopedic surgery for deformity is not uncommon, and Lu Bin usually performs it. However, when Lu Bin came to the operating table, his eyes were all attracted by the operation.

Then he turned his head slightly and saw that Qin Ming's eyes were serious, so he looked carefully again, and looked at the plain film display on the film reader.

Hiss! Lu Bin took a deep breath.

Outsiders watching the fun, Yang Tao and Guo Xiaobing were still hanging around the threshold, but Lu Bin understood the work involved.

...

Dr. Zhou, did you do a good job in the reconstruction of the phalanx and pulley? Such a good joint structure, but unfortunately, there is no joint capsule and corresponding aponeurotic structure.Lu Bin immediately expressed regret.

Before, in the deformed state, the patient's aponeurotic structure and joint capsule structure were pathological. After returning to the normal structure, they were naturally useless and had to be removed.

If you have a size 35 foot, you must wear a size [-] shoe. If you don't throw away these shoes, your feet will be discarded sooner or later.

When Lu Bin said this, Yang Tao and Guo Xiaobing stopped their private conversation and casualness, and looked at it seriously. They could probably understand the meaning of Lu Bin's words, but they still lack basic skills to really see through.

Meeting someone who understood, Zhou Chengcheng continued to speak: Director Lu, I think so. Although the structure of the joint capsule and aponeurosis is difficult to rebuild, we can try to reposition the tendon.

Make a similar structure.Increases functional mobility of joints.

These words were not shared with Qin Ming and others before.

Because during this period of time, no matter through the simulation in the simulator or through some teaching experience in reality, Zhou Cheng also knows that sometimes, it is not good to go too far.

Qin Ming and the others didn't respond at all, which meant that this was beyond their knowledge system.

Is surgery easy?
It's not simple at all. In every place, it's the best that comes from the natural parents. No matter how you repair it, it can't reach the level of the natural. This is an objective fact.

Even these structures in the thumb cannot be completely restored. It is already quite difficult to fully understand and apply them flexibly.

When Lu Bin heard this, he clicked his tongue a little, and asked: Doctor Zhou, what do you mean? To replace the lack of joint capsule and tendon sheath through transposition or transplantation of tendons? Is it difficult?
Zhou Cheng continued: "It's not easy. It's human-made. We have a thumb and a metacarpophalangeal joint. I'm going to explore the aponeurotic structure inside later. I'll see if I can wear another one." tendon past.

If you can't create something out of nothing, you can only make the best use of it.Zhou Cheng continued to observe the remaining structures while thinking about contingency strategies.

Lu Bin was thoughtful, and silently helped at the side, then took the tweezers from Qin Ming's hand, and carefully assisted Zhou Cheng, his tone filled with excitement: This is another extraordinary operation! , Qin Ming, Yang Tao, you should watch more and think more.

This must be a good thing again. In fact, the thumb deformity has no serious impact on the patient. However, if the patient's own functions can be restored to the greatest extent through surgery, this surgery will not be easy.

Seeing Lu Bin and Zhou Cheng cooperate with each other, Zhang Zhengquan didn't intend to sell him, and he was also relieved.

Lu Bin is sensible, which means that he should avoid explaining unnecessary things to Zhou Cheng. It's fine if Lu Bin says it. Zhang Zhengquan also has other considerations.

ten minutes later.

Lu Bin asked: Dr. Zhou, are you going to do tendon transplantation? Or do you plan to do transposition?
At this time, both methods can be chosen, and both can achieve the effect, but it is difficult to explain which one is better. it is good.

...

After the operation, the patient lost part of other functions, but it is great to be able to replace more directional functions and complete basic hand operations.

Our thumb has the highest range of motion. There is no way to do transposition on this finger. I thought about it, let’s do transplantation. The extra extensor hallucis longus tendon can still use.

If it doesn't work, let's see if we can get it from other parts.Zhou Cheng continued to lower his head, slowly resting the extensor hallucis longus and flexor hallucis longus tendons exposed in front of him, and then hesitated a little.

Zhou Chengcheng chose to cut off the proximal end of the flexor hallucis longus tendon, but left the distal insertion point.

Lu Bin quickly saw what Zhou Cheng meant, his scalp tightened, and he asked: Doctor Zhou, this flexor hallucis longus is very limited in length. After you cut off the proximal end, did you have two sutures afterward? The middle section, after surgery, is prone to the risk of fracture.

Lu Bin was puzzled.

Generally speaking, most of the tendon transplantation is done at the insertion point. At the insertion point, one end is fixed through the fixation of the tendon and bone, and then the entire shape is deformed. Only a single suture is required, so the risk will be reduced. a lot of.

When it comes to a surgery, no matter how delicate the pre-operative discussion is, the details during the surgery cannot be perfected. Instead, it is decided temporarily based on the actual situation and the level of the surgeon.

In line with the basic theory, but also adapt to the situation, this is the truth.Instead of admitting to the rules.

It's okay, as long as the tendon is sutured well, the risk of rupture is not high.Moreover, the natural muscle stop point will be more conducive to the degree of mobility, but it will be out of shape in the middle, just a leveraged structure.Zhou Cheng said
With inner considerations.

Lu Bin's words are naturally correct, the risk is high.

But Zhou Cheng's words are also true, the income is high.

And the risk, to a certain extent, can be compensated by suturing techniques and postoperative rehabilitation guidance!
Lu Bin stopped pushing, but turned his head to Qin Ming and said: Qin Ming, you have time to check the relevant literature. I think it might be good to write an ase for this patient.

Qin Ming nodded immediately: Director Lu, I think so too.

Zhou Cheng glanced at Lu Bin and Qin Ming, smiled and said nothing, just for this, Lu Bin's scientific research sensitivity is higher than that of Cai Dongfan.

When Zhou Cheng was with Cai Dongfan before, Cai Dongfan never thought about writing articles, but Lu Bin was able to capture this point keenly, and he was quite thinking and sharing.

This is also a kind of scientific research thinking. Although it is a simple thinking, it is also a kind of consciousness.

And the reason why Lu Bin revisited the matter was that no one mentioned it when he was in the Ninth Hospital of the Shanghai Metropolis before, because in the Ninth Hospital of the Shanghai Metropolis, a few ases were completely meaningless, and they were too lazy to post such articles, and they were too lazy to post them. To write, there is no need.

Doing the project directly and publishing RCT articles is the key.

In this way, another full 40 minutes passed.

Two brand new tendons reappeared in everyone's field of vision, and with the help of Kirschner wires, the patient's thumb also changed from a [-]-degree passive flexion to a straight state.

After reading it, Lu Bin was full of emotion: Wang Limin, your luck is really good, you met Dr. Zhou.Your thumb, from the current point of view, is still very worth looking forward to after the operation.The quality of surgery in this unit is absolutely no less than that of any professor you can find across the country.

...

You can achieve this level with us, you have made a lot of money.

What Lu Bin said was a bit exaggerated, but Qin Ming also echoed, saying: This operation is indeed exquisite, and the anatomical structure can be reconstructed to such a level, and the postoperative function will definitely not be too bad.

And there are no blood vessel and nerve problems, which is worth looking forward to.

Wang Limin, you must cooperate with the exercise after the operation, otherwise, it would be a pity that Dr. Zhou took so much effort to prepare you for so many basic conditions.

Wang Limin didn't understand so much, but he sounded comfortable with these words, and said solemnly: Hey, thank you Doctor Zhou, thank you Director Lu and Director Qin, you are all good people.

Don't worry, I will definitely cooperate and will definitely live up to your hard work and hard work.If the recovery is good after the operation, it is also a good thing for me.

Thank you doctors.Wang Limin finally did not forget to thank the others.

The atmosphere in the operating room instantly became much warmer, and everyone felt relaxed.

You mainly want to thank Dr. Zhou. We can't do this kind of technology.Lu Bin explained that he didn't want to steal Zhou Cheng's limelight.

Hearing this, Zhou Cheng was actually very happy in his heart, and he also thought a little badly in his heart: Director Lu, if you can find ten people all over the world, and you can do this, then count me as the loser ?
This is still Zhou Cheng's conservative smugness. Of course, it's hard to say this, just do it.

Zhou Cheng is still carefully suturing the tendon with microscopic instruments. Zhou Cheng is still using the modified Kessler suture method, which is reinforced one stitch at a time, to avoid tendon rupture or suture rupture after surgery.

Brother Zhou Cheng, you are really good. Director Lu has said so, so it must be the same.Zhang Zhengquan also gave Zhou Cheng a thumbs up, still thinking about whether there is any patent for this new technique, or some special equipment.

Zhou Cheng turned his head to look at Zhang Zhengquan, and said, "Quan Zi, you have to strengthen your professional skills. If you don't study, you won't even be able to capture the key points. Tell me, what is so good about this operation?" What?
How can you flatter other people in the future? Zhou Cheng is just an output to Zhang Zhengquan.

Zhang

Zhengquan carefully looked at the operating table for a long time, but he couldn't hold back a word, but in the end, Zhang Zhengquan still said: Zhou Cheng's product must be a high-quality product, so there must be no mistake in this statement?
Get out! Hey shi in disguise, you are killing me.Zhou Cheng cursed.

He must activate Zhang Zhengquan's interest in learning, do a good job of teaching theory for him, and make a contribution.

After the reconstruction of the tendon, the joint base of the joint, and the joint trochlea, the operation is not the end, and skin problems still need to be dealt with.

However, this is not a difficult operation for Zhou Cheng. He even has the means to remove scar tissue, let alone such a simple skin transplant.

Lu Bin said: Xun Xun, you go and get a blade-thick leather remover.The skin grafting is about to begin.

Originally, everyone planned to make medium-thick skin, but Zhou Cheng rebuilt it so well that he didn't use medium-thick skin as a fig leaf at all, and it could be treated as a skin defect.

However, Zhou Cheng called a stop: Director Lu, slow down first.Let's not take the blade-thick skin first, let's deal with the structure under the skin.

...

Lu Bin let out a groan, and looked at the surgical field with embarrassing eyes: How should we deal with the subcutaneous structure?
Zhou Cheng didn't show off too much, and then continued to expand some incisions, just crossing the subcutaneous part of the surgical incision, and from nowhere, a large lump of fat tissue was cut out.

Moreover, after taking out this mass of fatty tissue, Lu Bin saw again, Zhou Cheng didn't know where, and pulled out a very thin blood vessel, almost a blood vessel.

Such blood vessels, not to mention finding their broken ends, even if they are usually seen, are called electrocoagulation to stop the bleeding.

After seeing the two blood vessels, Zhou Chengcheng's eyes began to shine.

Then yelled: Tour, give me the thinnest vascular suture.

At this moment, Lu Bin really understood what Zhou Cheng meant, and his expression was full of astonishment: Doctor Zhou, you don't mean to connect the nourishing blood vessels of this fat, do you?
Well, that's what I thought.Zhou Cheng nodded.

Because in fact, the best skin grafting is to cover the wound with only skin defect, and then cover it with a thin layer of skin. Moreover, we all know that adipose tissue is the source of all evils for us to gain weight.

However, its cushioning effect and the covering and protecting effect on soft tissue are stronger than any other structure.It can also support the skin.Zhou Chengcheng carefully repeated this basic knowledge to Lu Bin and others.

Lu Bin became numb on the spot.

The truth is this, but on weekdays, who would go to this point?
No, Lu Bin's brain was running again for a while, and then he repeated the operation that Zhou Cheng did today. Damn, I don't know if I don't sort it out. It's a simple osteotomy for deformity.

What did Zhou Cheng do?
Osteotomy, reconstruction of bony structure, incision and suture of sick tendon, tendon transplantation, internal fixation after fracture, and skin grafting. Prior to this, Zhou Cheng also performed a reconstruction of subcutaneous tissue. Then according to Zhou Cheng's idea, a pruning of the subcutaneous tissue was also performed.

A very simple operation was played by Zhou Cheng so clearly that he almost got out of tricks.

Dr. Zhou is amazing! At this moment, Lu Bin sincerely admires Zhou Cheng.

He has seen many people with superb skills and good major surgery. He has been to the national orthopedic annual meeting and the provincial orthopedic annual meeting. There is a live broadcast of the operation.

However, like Zhou Cheng, Lu Bin has never seen such a simple surgery done so perfectly and with such attention to detail.

You can see the whole leopard with a glimpse, and you can see the micro!

Zhou Cheng's surgical technique has definitely reached the level of proficiency, because without this level, it is absolutely impossible to derive so much content from such a simple and basic surgical procedure.

Step by step, the principle is simple, but the operation can still be superb
There is a feeling of turning decay into magic.

This is not Lu Bin's own big talk, but after watching Zhou Cheng's step-by-step operation, this is the true reflection of his heart.

Some people's surgery is so unpredictable that you can't even understand it, but Zhou Cheng's surgery, you can understand it, and the principle is also very simple. It is the combination and disassembly of some extremely simple operations, and then every step Done well, even if it's a small operation, Zhou Cheng completes it very delicately.

...

Therefore, it is not that Zhou Cheng only knows how to perform minimally invasive open reduction and internal fixation of fractures, but because Zhou Cheng simplifies this operation, so it is impossible to see his surgical skills, and he only thinks his operation is miraculous.

And the miraculousness he has shown before is actually the restoration of fractures, which has reached perfection. There is only so much he can perform, but in fact, Zhou Cheng's basic skills and kung fu are far more than that. .

It's everyone, or rather, Zhou Cheng himself, because after he created a highly influential surgical technique, other people have a too rigid image of Zhou Cheng, thinking that Zhou Cheng is a new surgical technique , synonymous with innovation.

But in fact, where there are so many so-called innovations, they are nothing more than the reinterpretation and perfect embodiment of the basic techniques.

Zhou Cheng continued to operate slowly and carefully, step by step!
Finally, after about 10 minutes, the previous gap was closed, and the outer fat surface was polished into what it should have been.

After reaching such a point, Zhou Cheng still sighed: It's a pity, considering the current medical level in our world, it sounds very advanced, but in fact, during skin grafting surgery, even the folds and horizontal lines of the skin cannot be done. come out.

well! ~ Zhou Cheng is sighing.

Lu Bin trembled all over, and shouted in his heart, what the hell, do you still want to rebuild the horizontal lines and folds?
Horizontal lines only exist on the wrists, palms and interphalangeal joints of human limbs. These are the lines caused by the loose skin caused by our frequent activities.

Who can find specialized striated tissue during TM skin grafting?
You are also too refined.

Doctor Zhou, these horizontal stripes are not very useful, there is no need to pursue such a perfect beauty.Lu Bin felt that he and Zhou Cheng's thinking concepts were not at the same level at all.

If it is he who performs this operation, the bone is cut off, casually polished, and then the tendon is cut open and a tendon graft is performed. After the operation, the patient's thumb can be straightened, then he can leave you.

Where would it be like Zhou Cheng who wastes time doing so many details? If you have this time, go and do another operation, isn’t it good?
That's right.

Then Zhou Chengcheng administered a nerve block anesthesia to the patient's elbow again, and then used a blade-thick skin picker to take a thinner layer of skin near the wrist, and stuck it on the surface of the wound.

Then, after simple suturing, subsequent operations such as covering with oil gauze were not included in the small operations that Zhou Cheng needed to continue.

The operation was only declared over after an hour and a half.

It was also time for lunch at noon, Zhou Cheng, Qin Ming, Lu Bin and others stepped down to eat, and even Zhang Zhengquan did not step down at this time, because as an equipment dealer, he must not be able to leave the operating room in advance to eat.

Although Zhang Zhengquan is the boss, since he is in the current position, he has to do a good job of supporting himself. You are here, it is not quite the rules, and it is not suitable...

Then, at this moment, Lu Bin took a serious look at Zhou Cheng and said, "Doctor Zhou, do you feel too busy recently?"If you feel too busy, you must communicate with me at any time.

...

Lu Bin didn't ask about Zhou Cheng's participation in the emergency surgery, not only because of Zhou Cheng's surgery skills, but also because of Zhang Zhengquan's warning, but Lu Bin felt that, like Zhou Cheng now, No need for emergency surgery like that.

This is a teacher, the most basic respect for a teacher is not to let him work for the welfare of his department, but to give him more rest time.

Director Lu, you are the ones who have worked harder. I just sit in the outpatient clinic and do surgery occasionally, which is not tiring.Zhou Cheng shook his head, telling the truth.

He was actually tired too, but this tiredness was not caused by Lu Bin, so naturally he would not complain to Lu Bin.It's just that he wanted to make more things out of his own wishful thinking, and he chose hard.

It can't be said with Lu Bin.

That's good, Dr. Zhou.

Before, I still felt that our field of vision was too narrow. To put it in a bad way, Dr. Zhou, don't be angry.We all feel that you came to our hospital just to teach us minimally invasive internal fixation of fractures.

After all, you are the pioneer of this operation and need to promote this operation.However, I now find that I was really wrong.Lu Bin told the truth.

If you want to learn more things, you have to put yourself and the other side in the right position, and put the attitude in the right way. This is the right way.
Zhou Cheng smiled, a little surprised, to be honest, not only was Lu Bin stereotyped him, but he was also very wary of Lu Bin in his heart.

From the first time I came to the department, I found that the nurses in the department are very good-looking, and with the wine on the wine table, and the little student in purple in the outpatient clinic, she is also a stunner.

Zhou Cheng has never let down his vigilance, which is actually not conducive to the work, but Zhou Cheng can only see tricks.

Now, Lu Bin was able to say these words, which greatly changed Zhou Cheng's attitude towards Lu Bin: Director Lu, in fact, many times, not only you think so, but other people think so too.

During the time Zhou Cheng was in Shanghai, wasn’t he just a tool man? No one invited him to do other spells, and he still had to fight for opportunities by himself, slowly accumulating and polishing his resume.

Only when I can do the main surgery can I get in touch with more diseases.

Coming to Changshi this time is a good opportunity to reserve in the early stage.

Dr. Zhou, I think so. In our department, minimally invasive surgery will naturally still be the focus in the future, but the types of diseases we receive will be more diversified. I don’t know if this will make Dr. Zhou feel uncomfortable. Difficult to carry out work?

After all, before you came, I was also worried that putting too many other diseases would make Dr. Zhou feel embarrassed.Lu Bin expressed his concerns.

Now, relying on one trick, there are not a few people who eat all over the world. Therefore, it is what everyone likes to do, and Lu Bin is the same. He is afraid that he is a patient who is deliberately looking for difficulties. It was a misunderstanding.

Director Lu, generally speaking, normalized treatment of diseases is what the department should do. No matter what difficulties there are, we can overcome them together so that we can make progress together.

It is a good thing to have key breakthroughs, but it is quite inappropriate to neglect the treatment of other diseases because of breakthroughs.

...

We can discuss more together and treat clinical cases as learning opportunities again and again.

This is also one of the purposes of my coming to Changshi.

Enriching the real clinical diseases and developing suitable surgical methods according to the patients encountered is what Zhou Cheng has always wanted to do.

Doctor Zhou, speaking of it, I used to be envious of your surgical skills, but now I'm jealous.

Tell me, how old are you, and your skills are so good, you simply won't let us old guys live.Lu Bin then joked again.

Zhou Cheng also laughed, not being too modest.Some things, since Lu Bin has seen it, if he tries to be modest, it means that he is too proud.

It's not necessary. Moreover, Zhou Cheng also learned a lot from Lu Bin. When the time is right, he knows how to retreat and make progress. This is the embodiment of Lu Bin's life experience. Too rigid.

For example, when experiencing some sophistication in Changshi, you can be a little more tactful, and there is no need to stick to principles and rules.

Rules are dead, people are alive, humane, this is the world.

quickly,

In the next surgery, Zhou Cheng performed at his peak again, a very delicate nerve reconstruction and nerve transposition surgery, which made Lu Bin, Qin Ming and others puzzled.

Until the end of the operation, Lu Bin was still in shock and amazement.

Doctor Zhou, is this the end of this operation? Lu Bin saw that Zhou Cheng had already started suturing. Zhou Cheng did not perform such operations as imagined, such as muscle incision, muscle transplantation, and tendon treatment.

Um.Didn’t I have an electromyogram before, and it showed abnormal nerve activity. Although it is atrophy due to disuse, it is actually a nerve problem. After we transposed the nerve, the nutrition of the nerve recovered, and the activity level was restored. After recovering a lot, such problems can be easily solved.

Since there is no problem with the structure of the muscles, then we don't need to add to the superfluous, just grasp the most important points and deal with them well.While completing the suture, Zhou Cheng explained to Lu Bin and others the core of this operation.

Surgical operation is a key point, but surgery is for treatment. Surgery is a means of treatment, not treatment is the embodiment of surgery. This point must be understood.

In clinical practice, or whether it is scientific research, surgery, or examination, everything is for the purpose of treatment, and after the pursuit of superb surgical techniques, it must be reflected in the In terms of therapeutic effect and thinking, instead of pursuing how powerful you are!
Lu Bin gave Zhou Cheng a thumbs up thoughtfully, and said with a smile: Teacher Zhou, I have been taught, I think I have to change my words in the future.

Teacher Zhou, you are welcome.In our clinical practice, if we put it in ancient times, it would be a big river and lake, with different opinions.Those who have achieved are teachers.

Zhou Cheng was not polite, so he said: "Then I will call you Mr. Lu, and we will discuss our own things."

The atmosphere suddenly became very good.

Zhang Zhengquan interjected and said: Director Lu, Dr. Zhou, I will step down first and find a more elegant and quiet place. Let's make an appointment at night...

……
-
to view