medical simulator

I'm not stupid, can you understand?

Du Yanjun immediately looked overjoyed, and said, "I'll treat you to dinner at noon, Brother Zhou Cheng."

……

It wasn't until after the shift was over and the house inspection was over that Zhou Cheng realized how much preparation Du Yanjun had made in order to win the chance for him to be the chief surgeon.

Because Director Cai Dongfan didn't go to rest today, he had to go to the operating room himself.

And before going to the operating room, Cai Dongfan personally ordered Zhang Zhengquan, who had no surgery today, to be sent away.Ask Zhang Zhengquan to run a material for him...

There were two surgeries today, one performed by Du Yanjun, open reduction, plate and screw internal fixation for tibial fractures, and the other small one performed by Zhou Cheng, closed reduction and external fixation with Kirschner wires for fibula fractures.

Although it is said that Zhang Zhengquan is a social trainer and does not have his own surgical patients, there must be opportunities to study in the operating room, right?

After all, regular training belongs to cheap labor.

Besides, Cai Dongfan has the task of running materials, so it should be your turn to Du Yanjun, why did it fall on Zhang Zhengquan's head?

But Zhou Cheng could only see through without telling the truth, and silently followed everyone into the operating room.

Today's first surgery was performed on Du Yanjun's patient, who had a comminuted tibial plateau fracture and displacement. On the fifth day of admission, the swelling has subsided, and he is currently suitable for surgery.

This comminuted fracture operation is a routine operation in the department, and Luo Yun can also do it. Usually, Luo Yun is the chief surgeon. Director Cai Dongfan performs complicated fracture operations such as humerus, femur, and calcaneus, which Luo Yun cannot handle. many.

After entering the operating room, Cai Dongfan and Luo Yun, as senior physicians, naturally went to the lounge to lie down first.

After Du Yanjun and Zhou Cheng, two junior doctors, finished disinfecting and laying the towels, it was their right to come on stage again.

Moreover, Zhou Cheng is already in the third year of regular training, and Du Yanjun is also in the second year of graduate school. In the second year of regular training, he is already a mature skilled worker preparing for surgery, so they are not worried!

After Du Yanjun entered the operating room, he took the initiative and said: "Brother Zhou Cheng, I'm here to lift my leg today, you should wash your hands and disinfect first."

The heavy physical work was invited away.

The pre-operative disinfection in orthopedics is slightly different from other disciplines. In other surgeries, as long as the patient maintains a fixed posture, the surgeon can disinfect the operation area three times.

But the disinfection of orthopedics requires an assistant to lift the patient's affected limb out of the air after anesthesia, and another surgeon completes the 360-degree disinfection of the limb without dead ends to achieve strict sterility!

In surgery, it is rumored that all orthopedic surgeons are strong men, but it actually started from here.

The body shape of ordinary people is not bad, but if you encounter big fat legs weighing 280 or more than 300 kilograms, it really requires a lot of strength, and it is persistent strength.

Zhou Cheng didn't say much, it would be better if he could take it easy, anyway, the rest is doomed.

Take your time and you will always have your chance.

Zhou Cheng now has perfect fracture surgery skills, and he is naturally extremely proficient in disinfecting drape.

Moreover, when entering the operating room, Zhou Cheng subconsciously glanced at the patient's film, and immediately made more careful arrangements for the operation plan.

A series of actions such as disinfection and laying towels are done in one go.

In less than 4 minutes, Zhou Chengcheng and the hand-washing nurse completed the operation of spreading the towels, saving Du Yanjun the pain of labor!

Then Du Yanjun went out to call his mentors Cai Dongfan and Luo Yun, while Zhou Cheng put on the sterile surgical gown and finished the rest of the action of spreading the drape and wrapping the legs.

Just when the legs were wrapped and the surgical area was left perfectly, Luo Yun and Cai Dongfan walked in from the operating room just after washing their hands.

Then subconsciously swept over the operating table, Cai Dongfan immediately frowned.

Luo Yun also saw something was wrong, and immediately reprimanded: "Zhou Cheng, what are you doing? What the hell are you with your swollen legs? What we are going to do is open reduction of tibial plateau fractures. You should leave it alone." What is it?"

Zhou Cheng heard the words, thought about it seriously, and replied: "Mr. Luo, what does the LL approach to the tibial plateau look like?"

"What LL approach?"

The corner of Luo Yun's mouth twitched: "Hurry up and expose the inner side, and reapply the film."

Zhou Cheng suddenly realized.

I thought in my heart, I’m dead bird, I made a fucking mistake about one thing, that is, the best choice for tibial plateau schatzker V-type fracture surgery——LL approach, few people are aware of it now, maybe Cai Dongfan and Luo Yun listened I have never heard of it, and they are more accustomed to the joint approach of the anteromedial and anterolateral.

Zhou Cheng held perfect skills and didn't realize it at all. This is not his surgery, but Director Cai Dongfan's. So all surgical habits must follow Cai Dongfan's.

Moreover, which surgical approach is the best is not clear in a sentence or two.

Zhou Chengcheng quickly admitted his mistake: "Okay, Teacher Luo, Teacher Cai. I'm sorry, I'll change it right away."

Chapter 11 Du Yanjun's inner activities!

Medicine is not a child's play, it is an extremely rigorous science.

The treatment of fractures requires the support of systematic knowledge.

First of all, we must start with the principles of fracture treatment. The treatment of fractures should pay attention to three principles.

Reset, strict immobilization, rehabilitation.

The first thing to pay attention to is reduction, and the purpose of surgery is also to serve for fixation and reduction.

just.

Whether to have surgery after a fracture is not certain.

Any kind of surgery has its strict indications and contraindications.

Patients with relative contraindications can choose whether to undergo surgical treatment depending on the situation.And if there are absolute contraindications, then surgery must not be done.

Only patients who meet the surgical indications need surgical treatment, because some fractures can be treated conservatively with plaster external fixation after manual reduction.

This can also achieve the purpose of reset and fixation.

If the indications and contraindications are just to determine whether the patient can have surgery and whether surgery is needed.

Then, in terms of the choice of surgical method, it is also necessary to choose a more suitable surgical method according to the classification of the fracture.

This patient suffered a fracture of the tibial plateau, and the classification of the tibial plateau is mostly based on the Schatzker classification, which is divided into type VI.

Basically, all tibial plateau fractures require surgical treatment. The basic principle of this will not change, unless the physical condition is very poor, unable to tolerate surgery, stepping down to the operating table, and patients with a risk of death, all tibial fractures All plateau fractures require surgery.

This point will be strictly determined before the operation.

Once the operation is determined, the surgical plan must be determined, and the surgical plan is determined according to the classification.

Type V of Schatzker classification: bicondylar fracture involving medial and lateral plateau splitting, combined with vascular and nerve injury, this type accounts for 12.0% of tibial plateau fractures!

Then, the operation method for type V fractures is that open reduction and internal fixation are required at the fractures of internal and surgical splits to firmly fix the fractures.

After the operation, the patient's treatment returns to the principle of fracture treatment.

Reset, immobilize, recover...

In addition, after determining the surgical method to be internal and external fixation, how to choose the surgical approach, how to expose the broken end of the fracture and then suture it out is also very particular. Different surgical approaches have an impact on the overall quality of the operation. ,Can not be ignored.

The traditional approach for tibial plateau fractures is naturally the medial and lateral approach, but there are better approaches to choose.

Of course, all of this is naturally what Zhou Cheng thinks in his heart, and he dare not and cannot say it directly.After all, he is just a resident doctor with a junior professional title, and he definitely cannot take over Class IV surgery such as open reduction and internal fixation of tibial plateau fractures.

Zhou Cheng silently modified the exposed parts.

Cai Dongfan remained silent, and Luo Yun didn't say much.

Zhou Cheng has not been in the group for a short time, and this year is already the third year of regular training. He is actually a very experienced and reliable junior doctor. hate.

A little mention will suffice.

Also watching Zhou Cheng modifying the exposure space was Du Yanjun. Although his expression didn't seem to fluctuate, he still smiled secretly.

Since Zhou Cheng came to the department so early this morning to read the medical records, Du Yanjun knew that Zhou Cheng must also have the intention to compete for the place in the hospital.

Du Yanjun didn't think it was ridiculous for Zhou Cheng to compete for a place in the hospital.

The number of places in the hospital is quite precious, and everyone wants it, which is human nature.

It's just that relatively speaking, Zhou Cheng really doesn't have much advantage in this competition, so the possibility is extremely slim.

In terms of connections, Zhou Cheng is just an ordinary social trainer, not as good as Du Yanjun and Min Chaoshuo who have mentors as strong connections in the department.Not to mention getting in touch with a relative like Xu Yanlin who is the deputy director of the hospital.

Compared with academic qualifications, Zhou Cheng has no advantage. There are four graduate students in the department, two academic types, and SCI papers in hand.

And he was planning to publish the second article. Du Yanjun felt that if he wanted to compete with them, he had to publish SCI. Zhou Cheng wanted to publish an article, but the chances were too small.

than chance?

Needless to say, social training does not have a mentor as a strong backing, who will rest assured that Zhou Cheng can get started?Therefore, if Zhou Cheng wants to compete, he must first gain the trust of the superior doctor.

In other words, it is to try to show yourself better and attract attention first.

However, it was obvious that Zhou Cheng acted too hastily this time, pretending to be a bully on the cow's belly, and then the bull sat down.

The consequences will naturally be dire...

But Du Yanjun will not laugh at Zhou Cheng, because Zhou Cheng is indeed not easy, there is nothing ridiculous, and he himself does not have a 100% competitive advantage.

If Zhou Cheng knew Du Yanjun's thoughts at the moment, he would definitely feel very wronged, and Du Yanjun's brain power is too strong.

……

After Zhou Cheng sorted out the surgical field, the preparations for the operation began, and Cai Dongfan came to the chief surgeon.

Luo Yun subconsciously wanted to stand opposite Cai Dongfan as a help.

But Cai Dongfan said: "Luo Yun, you change positions with Yan Jun, and you come to my side."

Luo Yun was taken aback for a moment, then nodded, and said, "Okay, Director Cai."

Then immediately turned back to back with Zhou Cheng, bypassed the operating table and went to Cai Dongfan's starting position.

The position during the operation is also quite particular, the chief surgeon stands on the direct operation side of the affected limb.

Easy to operate, good vision, all assistants should serve as the main knife.

Opposite the chief surgeon is the position of an assistant, who can assist in the operation and has the second best surgical field of vision.

Then there is the underhand side of the main surgeon, which is the position of the second assistant. The field of vision is relatively poor, but auxiliary operations are also required.The secondary assistant standing opposite the second assistant can be the third or fourth assistant, but they are complete tools.

That is to say, Zhou Cheng's current position, he basically can't see the surgical field of vision, as long as he pulls the hook under the guidance of the chief surgeon.

After the position is adjusted, the operation begins step by step.

Cai Dongfan picked up the round knife, first cut the skin, and then used the electric knife to cut the subcutaneous tissue, and soon exposed the broken end of the tibial plateau fracture.

However, after the outer severed end was exposed, Cai Dongfan frowned.

Obviously, the fracture this time was not that simple. Even if he came to reset the fracture, it would still be difficult.

Three principles of fracture, reduction and fixation.

What the operation completes is the operation of reduction and fixation.

It is clearly stated in the principle, it must be reset first.

The displacement of the fracture is very obvious, and it is pulled into a somewhat deformed displacement by the muscles starting at the femur...

"Bone peeling." Cai Dongfan shouted to the hand washing nurse, who was also called the equipment nurse.

What about fixed in Chapter 12? !

A fracture is not what we habitually imagine, it is simply a broken bone.It has its own definition in medicine!

-

Disruption of bone integrity and continuity.

Therefore, it can be boldly inferred that as long as the continuity and integrity of the bone are interrupted, it can be identified as a fracture.

This is different from what we imagined as the name suggests, the two things are separated very cleanly and rigorously.

The broken ends of the fracture are irregular, and there are a lot of residual blood and broken bone debris.This bone debris, if not removed, can form entrapped tissue between the broken ends.

Unable to achieve a perfect anatomical reduction, it is a bit like if there is mud on the soles of your shoes, you will have a feeling of unevenness when you walk on the road.

This is definitely not possible.

To clean up these bone debris, you need to use tools in the operating room, bone peeling, also called bone stripper, as the name suggests, it can separate the bones so that the debris in the middle can be cleaned.

It is similar to how we clean up the mud sticking to the soles and restore the normal walking feeling.

Moreover, bone stripping can not only remove bone debris, but also assist in the reduction of broken bones!

However, after the equipment nurse took the bone stripper to the operating table, although some debris from the fracture was cleaned away, troubles appeared during the reset process.

First, there is the medial tibial insertion point. The medial muscle group consisting of the semitendinosus, semimembranosus and tibial endometrial muscle from the ischial tuberosity pulls the stump of the medial tibial platform and tilts it up.