After all, Xu Xin has been working with Li Dongshan in the operating room for more than two months. She is a nurse specially dispatched from the operating room of the surgical building to the operating room of the emergency trauma center. She has seen intramedullary nail internal fixation.

There are not even a thousand skills, but at least five hundred or more.

It's just that she performed the intramedullary nail internal fixation step by step in the surgeries performed by Professor Li Dongshan, including the former director of the Department of Orthopedics, Professor Zhou and others.

First use a Kirschner wire to position, then taper the opening, and then send the guide wire in. Constant C-arm fluoroscopy ensures that the guide wire has entered the distal end of the fractured medullary cavity and the medullary cavity of the free bone before daring to use it again.

It can be reset by prying it with golden fingers.

Good guy, when this guy comes up, he doesn't even use his C-arm to penetrate the opening, and just pokes it in with the awl. How confident is he?

Xu Xin had only heard of Director Pang, the former director of the Department of Orthopedics. A few years before his retirement, he had the courage to do what Lu Cheng did. After opening, he directly used a cone drill to open the surgery without positioning.

I also heard old nurses in the operating room talk about such past events. Later professors were basically prudent and conservative and were unwilling to save such time.

But for a young doctor like Lu Cheng, she didn't know whether to say it's better to say that a skilled person is brave, or that a person who doesn't know is fearless.

Anyway, the result is that Lu Cheng has already sent in the golden finger and guide pin.

When Zhou Linli heard Lu Cheng's praise, he was in a very happy mood. He took a good look at the film and couldn't help but feel proud in his heart.

No matter how powerful Lu Cheng's guidance and explanations are, traction also depends on the strength and control of the operation. Basically all orthopedic doctors know the operation process, but knowing the principle means knowing the principle. Whether it can be restored is another matter.

thing.

Just like joint replacement, many orthopedic surgeons know what the steps are and what the results are, but whether the surgery is done well or not is another matter.

Being able to personally operate and participate in such a perfect surgical process, and having a strong sense of participation, gave Zhou Linli a completely different feeling. Although he could also go on stage in the departments where he had practiced in the past, most of them

They only do auxiliary tasks such as retracting hooks, and there are very few operations that they actually participate in.

There is basically not much sense of participation and accomplishment in such a trivial matter as sewing.

"Thank you, Teacher Lu." Zhou Linli knew that Lu Cheng's guidance was very crucial, and the details he told him were also an extremely important part of the reset process.

"Teacher Xu, please push out the C arm, and I will adjust the direction of the gold finger." Lu Cheng said.

Just because the golden finger and the guide pin have passed through the medullary cavity of the free bone segment does not mean that the operation is over. Further reduction is still needed so that the final intramedullary nail fixation plate can successfully achieve the purpose of fixation and reduction.

This is the key to surgery.

Lu Cheng didn't dare to call others for this step of operation, even Peng Shanquan looked a little eager to try it.

Lu Cheng said: "Now we have seen the patient's bone segment displacement direction during the operation from the C-arm machine. We have to try to adjust the prying direction of the golden finger, and strive to achieve anatomical reduction as much as possible, and then pull out the golden finger.

Come out and perform the entire marrow expansion with the guide needle as the center!"

"Dong Zhen, do you know our standards for functional reduction of orthopedic fractures? I don't want you to memorize them all. Just for this patient, what do you think is functional reduction?" Lu Cheng did not mean to ask for Dong Zhen's endorsement.

In clinical practice, there is never any process of endorsement or repetition of operations in textbooks. It is always adjusted at any time according to different patients and different conditions. Endorsement is necessary, but memorizing the book by heart is definitely not recommended.

However, the prerequisite for knowing and understanding is to memorize it and experience it carefully in clinical practice.

The text in the textbook is a summary of the essence. If you just memorize it without studying it carefully, it will be a waste of understanding the text that so many experts and professors have prepared carefully.

Professors Lin Hui and Min Hong had taught Lu Cheng how to read before, but that was their teaching method. Lu Cheng now wants to teach others in his own way and understanding. This will definitely not be repeated.

of.

Everyone has their own teaching philosophy. Lu Cheng’s own teaching philosophy will definitely not copy that of his teacher, because the students he encounters are definitely different from himself, and they need to teach students in accordance with their aptitude. This process is just a preliminary test for Lu Cheng. Maybe he

In the future, the current teaching method will be overturned, but now, the interns he is facing have good foundations.

However, compared with when I first came to the Second Xiangya Hospital, it was definitely a little worse. Naturally, I couldn't teach them completely theoretical and organized things.

After all, not everyone has it.

Dong Zhen, who was about to endorse, let out a sigh, then frowned and said, "Is it because the long bones are more than one-third aligned and the shortening is no more than 1cm? Teacher Lu?"

It would not be difficult for Dong Zhen to recite all of it, but Dong Zhen would not be so sure if he could only extract part of it.

The knowledge points in books are all systematic things. Sometimes, extracting the most appropriate part is the key to helping students understand all the knowledge points. Understanding why some parts are suitable and why some parts are not suitable is the key.

application.

Clinical practice comes from teaching materials and is higher than teaching materials, just like novels or TV series come from life but are higher than life.

The principles are interoperable!

Although novels or TV dramas that violate the rules of life may seem a bit jarring, they are not necessarily unwatchable.

It is definitely inappropriate to violate the clinical teaching materials, but sometimes it is reasonable.

Lu Cheng said: "You can see four knowledge points on functional reduction of fractures in the textbook."

"1. The rotational displacement and separation displacement of the fracture site must be completely corrected. 2. The shortening displacement should not exceed 1cm in adult lower limb fractures; the children should not exceed 2cm. 3. Regardless of the anterior and posterior angular displacement, the lateral displacement must be completely corrected.

Reduction. 4. For transverse long bone shaft fractures, the fracture ends should be aligned at least about 1/3, and metaphyseal fractures should be at least about 3/4."

"So, which type of fracture does this fracture belong to? A transverse fracture? Or a comminuted fracture?"

"Are we in agreement or not?"

"Is there any lateral displacement?"

Lu Chengcheng wants to dismantle the surgical process into knowledge points that Zhou Linli, Dong Zhen and others can understand and access, and then let them think about it. This process is very necessary.

This is also what Lu Cheng will do when he is learning surgery.

Why is clinical surgical operation difficult? Because every step of the operation must have its own knowledge structure and system, which frame the standards for the operation and the standards after the operation. If you can't learn to think in leaps and bounds, you can't learn to dismantle.

If you don't understand it, it will be difficult to learn it.

Because you don’t know what the superior doctor is doing at this step, what to do next, and why it is like this.

But if you learn and know how to apply only the framework, and decompose and disassemble the entire surgical process, you will definitely find that in fact, the entire surgical process is a random combination of all the basic orthopedic knowledge structures that you can access.

That’s all!

Senior doctors sometimes don't have time to teach you too much. They will only tell you which step to do and how to do it. As for why, you need to experience it yourself.

There is a way to experience it!

Lu Cheng did not give an answer because he believed that Zhou Linli and others should understand what he meant.

In fact, not only Zhou Linli and others, but also Xie Jian also understood. Although he came to the postgraduate entrance examination, it does not mean that he is poor. His knowledge base is very weak. Anyone who can enter the Second Xiangya Hospital after the postgraduate entrance examination is...

He has killed at least dozens of people who have passed the preliminary examination, and they are all good!

So Xie Jian immediately asked: "Brother Lu, if this patient does not have the above abnormal standards after surgery, can he get out of bed and move around the next day with sufficient stress support from the intramedullary nail?"

Xie Jian comes from sports medicine. He spent a month in the sports medicine department, that is, Chang Weilong and Zhu Lihong. Although there are no joint replacements in the fourth department of orthopedics now, he also knows the joint replacement patients, and even the next day

I was able to get out of bed and move around that afternoon.

Why? Because the joint prosthesis can provide the patient with a good stress structure, allowing him to ignore the amputated femoral head!

In the same way, it can be inferred that after fracture patients have intramedullary nails, they can also have a good stress structure and can get out of bed quickly. Functional exercises can be carried out early.

When Xie Jian said this, Zhou Linli, Peng Shanquan and Dong Zhen all looked at Xie Jian with a little curiosity in their eyes.

This is the knowledge blind spot belonging to their interns.

The specific methods of orthopedic rehabilitation movements and rehabilitation training are not accessible to interns. Only graduate students can understand them, and they are not written in textbooks.

Specialist rehabilitation is something that even the rehabilitation department cannot participate in and cannot evaluate! Only the surgeon and the person who has been exposed to the operation can evaluate and set the corresponding rehabilitation method according to the patient's own conditions!

This is the beauty of professional rehabilitation.

However, the Second Xiangya Hospital does not currently have professional rehabilitation specialists, and several large hospitals in Shanghai are equipped with them!

After hearing this, Lu Cheng smiled and said while operating, "Xie Jian, are you asking me a difficult question, or do you really think so yourself? Should patients with fractures get out of bed the next day?"

Of course Lu Cheng knew that patients with fractures had to have steel plates and had to get out of bed at least a week later, but intramedullary nailing could be done on the same day or the next day. Moreover, patients with intramedullary nailing did not need traditional surgery. According to the so-called drainage tube, the trauma was small.

, recover quickly and get out of bed early, this is the unique charm of this technique!

"I think it should be possible." Xie Jian made his attitude clear, because Chang Weilong told him a truth, that is, don't be afraid of making mistakes, and dare to say it. As long as it is not a particularly stupid or stupid question, you can ask it.

If you don’t ask, everyone will just think you know. If you ask, you will have the opportunity to correct your mistakes. This is also one of the qualities necessary for graduate students!

"The result you said is correct, but the reason is wrong. But I don't want to tell you at this time. You are our postgraduate student specializing in orthopedics. You have the ability and must have the ability to find this answer yourself. Go home and read a book and check it out.

You can read the literature or ask your teacher."

"I just hope that you don't take this as an order from your superiors, but that you really know why. I am not responsible for supervising whether you have done the process of seeking answers. This matter itself is what you should do at this stage.

Made.”

"Including me now, if I encounter a problem, I have nowhere to ask." Lu Cheng said jokingly.

But in fact, Lu Cheng also told the truth in his heart, and he really had no place to ask. Now, even Lin Hui and Min Hong may not be able to give him a more appropriate answer to the questions in his heart.

Moreover, Lin Hui left the Second Xiangya Hospital, Min Hong went to the General Orthopedics Department, and Lu Cheng is now the boss of the trauma center. Where is there anyone ready to answer his questions at any time? He can only rely on himself.

Now, something has happened to him, and he can only bear full responsibility. He is no longer the student who is protected by his superiors and can ask questions casually.

This is a step that Lu Cheng must take. He must also instill this idea in his students, the students he has taught. They must learn to find answers on their own. They can make appropriate pointers, but they will not tell them all.

Because every student will eventually get to where he is now. He has nowhere to ask, so he can only ask himself and the vast palace of medicine.

For the next operation, Lu Chengcheng didn't waste any more time.

It can be said that a key part of intramedullary nailing is the step of passing the guide pin through the fracture end, and then other operations, such as reaming, measuring, and intramedullary nailing after fixation.
To be continued...