medical simulator

Page 477

This is a desperate thing, Zhou Cheng was actually a little touched in his heart.

At the age of more than 80, there is no need to put on a show anymore, this is purely the pursuit of life.

In his 80s, he can still gain people's trust. This old man must have been quite popular when he was young.

"These risks are beyond our consideration. Everyone has their own choices and things to do."

"Doctor Xiao Zhou, if you are sure, I personally beg you to come forward."

"The old man is kind to me personally and to my family. The reason why I invited so many professors this time is actually my private request, because the old man convinced me."

"Well, today's operation was carried out, to a certain extent, it was mixed with my personal grievances, and I won't be on stage later."

Hearing this, Zhou Cheng was sincere when he saw Director Zheng.

Everything can be explained, why Xue Xiude still called him.

In such a place, with such troublesome patients and such unreasonable demands, as Director Zheng inside the hospital, he still has to continue the operation.

"Then? Professor Xue, let's go over the surgical plan first. I have a suggestion for a surgical approach. Teachers, please help me to review the feasibility."

Someone took the responsibility away, and he was just a doctor. To a certain extent, the patient's condition and personal request were personal choices, and he was strongly willing to bear the corresponding risks. At the end of the operation, Zhou Chengcheng completed the treatment itself.

What will happen next, Zhou Cheng can only give him sincere blessings.

"Professor Xue, may I ask where your incision is now?"

"1cm below the greater trochanter, about 18cm below." Xue Xiude accurately reported the location.

Zhou Cheng's thoughts turned quickly, and he nodded: "Okay, then we will continue to take these two positions, but our operation method needs to be slightly changed."

"The current difficulty in fixation of patients is that the fracture line is too long and the fixation is unstable. We need to add some binding and fixing props and auxiliary binding equipment."

"For example, we use Kirschner wires to cross the position 1cm and 18cm below the trochanter of the femur, and then we use steel wires to bind them in a figure-eight shape to complete the first fixation."

"Then, we use the extended internal fixation device to fix the upper and lower Kirschner wires a second time, and then extend the device for the third fixation."

"In this way..."

"After the fixation is completed, I will provide a special wheelchair with one pedal, which is very suitable for patients with fractures to get out of bed after surgery..."

"Teachers, what's your opinion?" Zhou Cheng finished speaking and looked around.

Jing Jingxing, Hu Xianhe, and Xue Xiude were just stunned, but the others, including Director Zheng, all opened their mouths wide and stared round their eyes.

Zhou Cheng can understand what he said.

Zhou Cheng's idea of ​​fixation is nothing more than the combination of traditional intramedullary nail fixation and steel wire binding internal fixation. However, the combination is a combination, and it is carried out in an open state.

When it is closed, you have to complete the bundling operation of the steel wire, or bundling in a figure-eight shape.

Brother, why don't you go to heaven?

Within the theory, outside of the operation, have high eyes but low hands?

However, Professor Xue Xiude has seen Zhou Cheng's operation before, so Xue Xiude nodded: "Triple fixation has reached the pinnacle of the internal fixation method. If there is still an accident, then there is really no other way." Good idea."

"I agree with Xiao Zhou's opinion."

"I agree too." Landscape Star and Hu Xianhe said one after another.

The three top bosses all spoke, and the others didn't dare to speak any more. They could only nod and walked out of the temporary conference room.

It is not difficult to complete this operation, but it is difficult to complete it to the point where it can go to the ground early without complications.

It's just that this little Zhou, although it sounds nice, can he really do this?

The ignorant are fearless!

Chapter 284 Xiao Zhou, This Is Unscientific

Zhou Cheng took the initiative to speak again, and worked with everyone on the detailed plan of the operation process for a while!

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

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

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

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

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

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

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

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

Then various other 'formulas' are derived.

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

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

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

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

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

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

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

Zhou Cheng was silent and did not speak.

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

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

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

Kill yourself.

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

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

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

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

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

"Long fracture line..."

After almost another 5 minutes, everything was ready.

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

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

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

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

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

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

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

Everything is ready.

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

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

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

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

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

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

But let it go again.

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

Zhou Cheng's words caught the others by surprise.

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

Everyone withdrew and went to the isolation room.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Then, in this umbrella structure, there are some rather strange and invisible shapes, do they have other uses?

Zhou Cheng smiled: "Yes, Professor Xue, in fact, this concept is borrowed from the formula of external instruments used in the process of intramedullary nail fixation, which can blindly drive screws into the screw holes of the intramedullary nail from outside the body. among."

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

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

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

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

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

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

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

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

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

Incredible, right?

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

Another perspective view.

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

This is absolute control over the entire surgical process!

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

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

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

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

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