Those years when I hung up and upgraded in the hospital

Chapter 151 Solid foundation of skills (please subscribe)

What is a slap injury?
Slap is the Superior labrum anterior and posterior, which is the entire thickness of the upper labrum of the shoulder joint from front to back. It is an anatomical structure, equivalent to the entire upper labrum, and has no special meaning.

Slap injury means that there is damage throughout the entire process, not just one point of damage.

However, at this time, Fang Yun finally understood that it was possible that the doctors in the imaging department had cut off the most critical page that could see the SLAP injury, so that he, and Director Hu Jun, could not see the key. part.

And if the difficulty of rotator cuff injury is originally 10, then the difficulty of treating slap injury is at least 30 or even 40!

Oh shit.

However, at this time, don't panic.

What Fang Yun detected through the arthroscope was not only seen by Director Hu Jun, but also by other professors and directors of the assessment team.

Looking in the direction of Hu Jun, he seemed to be smiling but not smiling.

Because standing in their field of vision, they didn't know whether it was an accident or whether it was a deliberate arrangement by Hu Jun. He specifically found such a difficult injury just to let Fang Yun show off his skills.

These people were all professional and sophisticated people, so after seeing the content on the display screen, they moved to the MRI film on the reader and looked at it carefully.

There was even Director Zhang from No. 1 Civil Hospital in Chang City who was familiar with Director Hu Jun. He bumped Hu Jun’s side with his butt, as if to say, Okay, little brother, you dare to take out such a disease. Used as material for surgical authorization assessment.

Once the pretense is successful, it will definitely be a big show.

At this moment, Hu Jun really wanted to go out and wash his hands and go on stage!
However, he couldn't do this, he just secretly drummed and complained in his heart.

Fang Yun has doubted it so many times, why didn't he think of taking another set of MRI for the patient?

However, Fang Yun was just on the operating table, and after a stalemate for half a minute, he took out the arthroscope directly.

sharp knife!

Slap injury is also a special type of rotator cuff injury. Fang Yun had only seen it in the literature before. Even Hu Jun did not dare to easily bring such an injury into the department for diagnosis and treatment because the operation was extremely complicated.

However, just because it’s complicated doesn’t mean you can’t give it a try.

Fang Yun's current proficiency in rotator cuff suturing has reached level 3, 75%, which is not completely insurmountable.

However, the conventional surgical approach for slap injuries is not the previous approaches. Instead, a posterior approach must be directly opened.It cooperates with the anterosuperior approach and the anterior approach, and also has an additional Wilmington approach.

The last approach is added for the repair of posterior slap damage. If there is damage to the posterior inferior labrum and reduction is required, the posterior approach needs to be lower.

Fang Yun had just checked and found that there was no damage to the posterior inferior labrum.

Not so many surprises!
But an accident was enough to make Fang Yun a little bit unable to accept it.

"Sharp knife!~Pry the core!" Fang Yun's tone became more serious.

Fang Yun's tone, coupled with the strange actions of a group of people in the assessment team, also made the traveling nurse and Wei Zhaoliang smell something unexpected. At this moment, Chai Junye had already begun to take the stage.

When Professor Zhu and others from the assessment team arrived at the operating table again, Fang Yun had already opened the standard posterior approach without marking the body surface.

Then he started to explore and dictated: "There is no obvious synovial hyperplasia in the glenohumeral joint, there is edema in the labrum, slap damage to the upper labrum, and no damage to the joint capsule."

Fang Yun did not elaborate or explore the content any more. After sliding skillfully in the joint cavity, he pulled out the mirror, inserted the crowbar again, and transferred the sleeve's field of view to the subacromial space.After the arthroscope was inserted again, Fang Yun said: "The appearance of the rotator cuff is clear, with no obvious damage or synovial hyperplasia, and the shape of the acromion is normal. There is no obvious acromion impingement syndrome."

"Treat the slap injury, keep giving me the sharp knife!" Fang Yun turned his field of view again and entered the glenohumeral space.

The field of view within the glenohumeral joint is dry, the injury has not been long-lasting, and there is no excessive synovial hyperplasia. No special cleaning is required, and surgery can be performed directly.

Perform the anterior approach under the guidance of lumbar puncture needle!In fact, it is best to use a long needle specially designed for arthroscopy, but conditions are limited, and a lumbar puncture needle is also sufficient.

Under direct vision, after seeing that the lumbar puncture needle had entered the shoulder joint space, Fang Yun directly opened the joint capsule with a sharp knife, then used a vascular forceps to slightly expand the pre-working access just established, and inserted a plastic cannula. As a working channel.

After the working channel was established, Fang Yun did not start the treatment operation, but once again carefully inspected the anterior labrum, inferior humeral ligament, posterior labrum and joint capsule.

This time, probing hooks were used to assist to avoid any accidents. This operation could not withstand any accidents. The current difficulty of the operation was already very difficult for Fang Yun.

The damage was determined by sliding the probe hook from front to back in the direction of the slap.

Fang Yun took the planer from Chai Junye's hand and reached in through the sneak path.

It is necessary to clean up the wear and debris at the attachment point of the biceps tendon and the labrum, freshen the injured labrum and scapula, and perform peeling and grinding.

This step is relatively simple, it is a variation of joint cavity debridement and arthroplasty.

Fang Yun operated this step very steadily, trying to keep his field of view in the best position at every angle.

Fang Yun was not showing off his skills, but seeking stability with a somewhat guilty conscience.

At this time, Fang Yun performed the surgery even more like a novice than usual, pursuing the most favorable perspective in everything.

No matter how difficult the operation is, I just need to follow the steps step by step, be honest, everything can be seen and touched, and don't show off to metaphysics!
However, the completion of debridement is only the first and simplest step of the entire operation. The subsequent suturing is the most troublesome.

Even though it’s difficult, we have to continue.

"Locator!" Fang Yun went into detail.

Because Fang Yun knows that the current surgical process has entered the blind spot of many people, such as instrument nurses, such as Chai Junye and Wei Zhaoliang. The person on stage who can master and understand everything should be himself.

Slap injury is an advanced version of rotator cuff injury. People who have not mastered the simplest rotator cuff suture generally do not understand this aspect. No wonder Chai Junye and Wei Zhaoliang.

As for traveling nurses, dealing with difficult diseases is not their specialty——

Fang Yun used a locator to drive a guide pin into the scapula and slowly pulled out the guide pin to ensure that the locator did not move.

Use a suture anchor to be implanted into the hole of the guide pin opening along the positioner, enter from the anterior approach with a 30° pointed thread holder, and pass out between the damaged labrum and joint!

This is the first time to wear it!
But at this time, it is necessary to clamp one of the anchor wires and lead it out along the anterior approach.

This is the second elicitation.Just such an operation has already completed the most difficult operation of simple rotator cuff suturing, and this may be less than one-third of the workload in slap injuries.

Why is it difficult to suture the rotator cuff? The difficulty lies in the suturing.

(End of this chapter)