The genius doctor starts from the game

Chapter 150 Be a person
At the same time, he began to help Associate Professor Zhou Ren start tendon harvesting.

After the rupture of the anterior cruciate ligament and posterior cruciate ligament, autologous tendon needs to be taken for reconstruction.
Generally, the gracilis and semitendinosus tendons are used as replacements. If the two tendons are not enough, it may be necessary to use the peroneus longus tendon or allogeneic tendon to make up for it.

The allogeneic tendon is rarely used, except when the ligament is ruptured again after ACL reconstruction and the tendon is no longer desirable.

This operation is very smooth,
The tendon point is generally at the position of the goose foot, which is the insertion point of the three tendons of the sartorius, semitendinosus, and gracilis muscles. It is an aponeurosis-like tissue on the inner side of the knee joint. Named goose feet.

Generally speaking, the semitendinosus is preferred for tendons.

But at this point, Zhou Ren suddenly asked again: "Xiao Lu, how do you distinguish between the tendons of semitendinosus and gracilis?"

Oh shit, Lu Cheng thought to himself, this is testing me.

Lu Cheng thought for a while, and immediately replied: "Professor Zhou, first, the tendon of the gracilis is much smaller than that of the semitendinosus. Second, the tendon with bifurcations is mostly the gracilis. There are two points, You can basically tell the difference."

Although both tendons can be taken during reconstruction, it is better if they can be distinguished, rather than randomly taken randomly.

Associate Professor Zhou Ren smiled, and picked it with a blunt straight hook, and a white and fat semitendinosus tendon jumped out.

The visual diameter is estimated to be more than five millimeters, and this is the lowest position with the smallest diameter.

I feel comfortable just looking at it,
Associate Professor Zhou Ren then said to the patient: "You exercise regularly, right? The tendon is so thick, it is estimated that you can take this tendon enough."

The patient replied: "I don't exercise often, I usually work at home, and I don't have time to exercise. I basically have to carry a few thousand catties every day, and then I get tired."

"Doctor, do I need to play more after the operation?"

Zhou Ren: "..."

Others in the operating room also felt speechless for a while.

I'm afraid this big brother has some misunderstandings about exercise. With his stamina, he can basically beat 90.00% of fitness trainers, okay?
"No, you should have a good rest after you go back. Don't work any more. Otherwise, if you break again, you will need another operation, which is a waste of money." Zhou Ren kindly reminded.

If this elder brother can move after returning home, and pick another few thousand catties, I'm afraid his operation will be in vain.

"Oh! Rest for at least three months, right? I remember." He seemed to hear the doctor's explanation very clearly.

"Well. You have to rest for at least three months. Don't go to work in the three domains." Associate Professor Zhou Ren answered very conservatively this time. If it is someone else, it is okay to go to work within three months, but this brother, absolutely not Let him go to work again, even the previous day.

The patient sighed helplessly, and said, "Okay, doctor, I'll listen to you. Then for the next three months, I'll just watch those people do it, and I won't play in person."

Zhou Ren suddenly asked with a flash of expression: "What are you doing?"

"I'm a contract worker, and I usually like to have trouble with my brothers, so I can do more and earn a little more." The elder brother sighed. "Doctor, can I drink now? When will I be able to drink in the future?"

"It's okay to walk and not work, right?"

"I have contracted a total of eight buildings and two roads."

After Zhou Ren heard it, he was in a bad mood. Why did he feel so bad today?

I was worried that this was a migrant worker, and if he worked hard, he would break his tendon and waste money.

Now that he heard it this way, his one day's income might be enough for him to make two tendons.

Although this equivalence is not quite right, it is the fact.

But Zhou Ren still replied: "The road can be walked, drink less alcohol. It is best not to drink."

"Then I won't drink it, I'll follow the doctor's orders."

His speaking again directly extinguished the cheerful atmosphere in the operating room.

Obviously everyone moves bricks, but there is a gap between brick movers and brick movers.

Some people moved stone bricks, while others moved gold bricks.

After Zhou Ren took the tendon, he immediately started braiding the tendon, while Lu Cheng sent the arthroscope to the joint cavity again, and said to Zhu Zilan, "Bend the forceps left."

The patient seemed to be honest. He didn't hear Zhou Ren and the others speak any more, and he didn't dare to disturb the doctor who was performing the operation on him, for fear that they might spoil the operation if they were distracted.He shut his mouth obediently.

A hundred more patients who cooperated like this would not be too many, but if he kept speaking so frankly, Zhou Ren would probably want to change his career to move bricks to make money.

After about 15 minute,
Lu Cheng finished meniscus formation + synovial membrane removal, then looked at Zhou Ren who was weaving the tendon, and asked, "Associate Professor Zhou Ren, do you want to open the femoral tunnel and I will weave the tendon?"

Zhou Ren was still a little unbalanced in his heart at the moment, and he didn't know where to think, so he said, "It's just a passage, open it yourself. I made it up well."

Zhu Zilan was startled, and looked at Zhou Ren seriously, Zhou Ren seemed to be still weaving tendons seriously,
Seeing that Lu Cheng didn't seem guilty, he directly asked her for something: "Sister Lan, the electric drill has a 2.0 Kirschner wire."

"This brother, help me bend my legs to the extreme, thank you!"

Zhu Zilan didn't dare to give it directly, and said in a low voice: "Can you really come? How about waiting for Associate Professor Zhou Ren?"

Lu Chengcheng said, "Don't worry, Sister Lan. I'll make sure before inserting the needle."

Anterior cruciate ligament reconstruction requires first establishing a channel from the lateral condyle of the femoral intercondylar fossa to the outside of the femur to reshape the shape of the anterior cruciate ligament. This is a particularly critical step.

After the Kirschner wire femoral tunnel is established, the Kirschner wire does not need to be pulled out directly. The Kirschner wire can directly pass through the skin to the outside, and then expand the femoral tunnel.

"3.5cm, how much is the loop plate?" After establishing the channel, Lu Cheng measured the insertion length of the Kirschner wire on the medial femoral condyle.

Reconstruction of the anterior cruciate ligament requires multiple calculations.

Zhou Ren glanced at the arthroscopic mirror, and suddenly asked, "Xiao Lu, which do you think is better, the anatomical reconstruction of the cruciate ligament or the isotonic reconstruction?"

After anterior cruciate ligament rupture, there are two reconstruction methods, one is anatomical reconstruction and the other is isotonic reconstruction.

Anatomical reconstruction means selecting the stump of the anterior cruciate ligament as the needle insertion point and establishing a channel to the lateral epicondyle of the femur. Isotonic reconstruction does not select an anatomical point, but selects the position of 3-5 o’clock on the medial condyle to insert the needle.

At present, it is still controversial in theory as to which of the two reconstruction methods is better and the effect is better.

"Let's reconstruct the anatomy. This will be more consistent with the patient's anatomical structure before the injury. Moreover, the current case analysis does not clearly distinguish the efficacy of the two."

"I personally feel that anatomical reconstruction has certain advantages in terms of statistics." After Lu Cheng calculated the length of the loop steel plate, he performed a second expansion of the bone channel.

This time the bone tunnel was prepared for the reconstructed ligament,
It is precisely because of the establishment of concentric bone medullary canals of different sizes that the loop plate with wire can pass through, and the traction and fixation of the femoral side are given, and then the tibial side of the anterior cruciate ligament is fixed with absorbable screws to give the pulling force of the tibial side. The ligament can be rebuilt with tension, and the original anterior cruciate ligament is preserved to protect the stability of the knee joint from prolapse.

Zhou Ren smiled and said: "Then do you think this direction, the current accumulation of literature, is enough to write a meta?"

Zhou Ren's question was originally a temporary idea, but it is a good idea direction for writing meta analysis.

Lu Chengdao: "Associate Professor Zhou Ren, I don't have any statistics on the number of specific literature. I think there should be no problem. Sports medicine is still very popular recently. It is estimated that after another half a year, there may be two to three more articles published. The data It's enough."

"By the way, Associate Professor Zhou Ren, the femoral tunnel here has been built. Shall we start to build the tibial tunnel now?"

Zhou Ren stretched his tendons over there, and said, "It's still you who build it!"

For men, the anterior cruciate ligament should be at least 7mm, preferably 8mm, and it can be in between, and it can be divided into tightness and tightness.

If the tendon can pass through tight seven and loose eight, it is the best state.
Represents 7mm+, 8mm-;

It can also be tight eight loose nine, girls can be tight seven.

Lu Cheng didn't delay either. He naturally knew that Zhou Ren was willing to take the risk to give him the opportunity to have an operation, and he was willing to wipe his ass. With such an opportunity, and Lu Cheng also felt that he could take it, he just There will be no polite words and words to shirk responsibility.

Otherwise, for the four types of surgery on the anterior cruciate ligament, only senior attending physicians can apply for the corresponding surgical qualifications in the hospital, and even some associate professors can perform the surgery alone.

Compared with the femoral canal, the tibial canal is simpler. Take the tibial locator, one end is positioned on the tibial stump of the anterior cruciate ligament, and the other end is positioned on the medial side of the tibial tuberosity. Take 37°, which is exactly in line with the medial tibial joint line. Drilling the tibial tunnel between 60-65° can restore the function of the knee joint and achieve the best.

Each of these data is slowly explored by countless predecessors after countless improvements and experiments, and after a long evaluation of the curative effect of the operation.

Clinical medicine is a very complicated subject, and its progress must be slow, but it must also be very detailed.

In many cases, it is the final summary of countless very fine statistics, which forms the textbook.

Until you are not satisfied with textbooks and guides.

Lu Cheng put in the needle quickly, and got out the needle quickly.

After the cavity was expanded, Lu Chengcheng took the initiative to give up his position and said, "Associate Professor Zhou Ren, the cavity expansion is completed, you go to the tendon."

In fact, this last step doesn't have much skill at all, but Lu Cheng still left this position to Zhou Ren. After all, this is the most critical step, and it is also the embodiment of the final curative effect and result of the operation.

Zhou Ren gave himself too many opportunities to practice his mobile phone. There is no need to pursue the operation from beginning to end in order to complete the operation.

In the real ACL reconstruction, Lu Cheng has already done the most critical and special operation very well.

Zhou Ren didn't say much, and showed that the wires connected to the femoral ring plate were sent into the femoral tunnel with wires.

Then he ordered: "Bend the knee joint to ninety degrees, I am ready to enter the tendon."

"Pull! Pay attention to confrontation!"

Of course, Lu Cheng and another doctor in charge of the bed cooperated very well, but the doctor in charge of the bed was only exerting force, while Lu Cheng was commanding while exerting force, "You only need to be responsible for bending."

"Associate Professor Zhou Ren, pull it!"

"Pass!" Zhou Ren used his hands hard, and easily found that the loop plate passed the small tunnel of the femoral concentric tunnel, and had turned over.

Moreover, he clearly felt that the end of the ligament was just being resisted by large and small concentric circles through the feel of his hand, which was very powerful.

Zhou Ren immediately said: "If my first ligament reconstruction could have such a good channel, I wouldn't have to cut open the lateral femoral condyle to sort out the shape of the loop plate."

"I'm ready to close the line, pay attention to confrontation."

Take-up is the secondary arrangement of the loop plate, and it must be confirmed that the two lines between the loop plate and the cruciate ligament must reach full tension, otherwise the ligament will be loose in the end, and there will be too many cruciate ligaments in the tibial tunnel , resulting in waste of tendons and failure of surgery.

Pull it tight, cut the suture with a sharp knife, and the broken end is perfectly inserted into the skin!
The reconstruction of the femoral end is completed.

Then, thread the other end of the tendon to the end of the tibia, still in the state of knee flexion; after tension,

Zhou Ren repeatedly bent the knee joint for about twenty times, and found that the tension was sufficient, and there was no collision or friction between the reconstructed cruciate ligament and the inner and outer condyles, so he said to Xiaolan who washed her hands: "How about it, little brother Is the hole okay?"

After hearing this, Xiaolan poked Zhou Ren with a planer: "Do the surgery well, there is no highway here!"

Lu Cheng didn't speak, Zhou Ren said again: "Where did you want to go? Didn't I explain to you our Lu Cheng's ability. You must know that when a man is suspected by a girl of his incompetence, he is very special." No face."

Zhou Ren simply stopped holding it in front of Lu Cheng. Anyway, the parking space at the nurse's place in the operating room had already been prepared for him, and sooner or later he would have to reveal his secrets.

Learning is everywhere in society.

It doesn't matter.

Xiaolan ignored Zhou Ren directly, but said to Lu Cheng: "Don't learn from your Associate Professor Zhou Ren in the future. He was honest when he first came, and I thought he was an honest man."

After speaking, he gave Zhou Ren a glance, but he didn't blush like a little girl.

While installing the tibial absorbable screw to lock the anterior cruciate ligament, Zhou Ren said, "Xiao Lan, don't talk nonsense. If others hear about this, I don't know how many people will come to marry me."

Xiaolan snorted, then laughed, scolded for being rude, and then began to prepare for washing and suturing.

Zhou Ren checked the mobility of the anterior cruciate ligament through the arthroscope again, then handed it over to Lu Cheng for suturing and bandaging, and stepped off the stage.

He went straight to Associate Professor Qin Qiguo's operating room to observe the rotator cuff suture operation.

After entering the door, he found that Zheng Liu was helping Qin Qiguo to pull the thread, so he said directly: "Brother Liu is not bad, one set of debridement and suture plus one set of joint dislocation and reset, it will be done in less than half an hour."

Hearing this, Associate Professor Qin Qiguo looked at Zheng Liu in surprise.

Everyone came from the general hospital. If Zheng Liu can really be so good, then he will really be admired.

He has changed.

Zheng Liu looked weird and didn't speak.

"Associate Professor Zhou Ren, I was wrong."

Originally, Lu Cheng was able to complete the debridement and suture and VAC coverage so quickly, so he was quite depressed. He thought that he could take Lu Cheng with him, but at that point, he was about to complete the dislocation and reset it. Give Lu Cheng a good lesson on debridement.

They had stepped down early to help me, and I was strangled to death even as soon as I thought about it.

And Zhou Ren would be annoyed by this.

How could Zheng Liu be happy?

He felt that Zhou Ren did it on purpose, or that Lu Chengcheng did it on purpose,
Zhou Ren let out an 'ah':
"Eh!~ What did you say?"

"I was wrong." Zheng Liu repeated a little aggrieved, but thinking of his situation in the department, he still didn't dare to say that Zhou Ren was acting weird here.

But I kept saying in my heart, Associate Professor Zhou Ren, just be yourself!

(End of this chapter)