Those years when I hung up and upgraded in the hospital

Chapter 69: Happy rather than complacent (please collect and read)

The arthroscopic instruments of the County Hospital of Traditional Chinese Medicine are slightly different from those of the People's Hospital. It should be due to different brands of arthroscopic tools. The slight difference is normal.

For example, the arthroscopy system of the Provincial People's Hospital is foot-operated for taking pictures, but the arthroscopy system of the Hospital of Traditional Chinese Medicine allows the surgeon to press the button to control the taking of pictures by hand to complete the shooting of key parts.

"Chen Liujun, did you see it? The broken meniscus fragments are loose in your knee joint."

"This is it. Don't you want to keep it in your body as a souvenir?" During Fang Yun's microscopic examination, he found not only that the patient's meniscus was ruptured, but also that the rupture was free in the joint cavity. After the normal saline filled the joint cavity, Float and rise.

Most knee arthroscopy surgeries require continuous anesthesia in the spinal canal, so the patient remains awake during the surgery and can see the arthroscope display when turning his or her head sideways during the surgery, which means the patient can see clearly into his or her joint cavity. What have changed.

If the patient can accept it, you can explain to the patient why the surgery is needed while communicating.

Chen Liujun is a younger brother of Du Yong. He grew up in the same village, so he has a good relationship and is not very old, so Fang Yun dared to joke with him.

Chen Liujun said hurriedly: "Doctor, don't make such a joke. Why do you keep this thing as a souvenir?"

"Ci'ao, why is it so big?" Chen Liujun's tone was uncertain.

Fang Yun then made some popular science: "It's not big, only three or four millimeters. It's just that under arthroscopy, the field of view is enlarged and the distance is close, so it's the same size as a pigeon egg."

"Actually, it's not that big." Fang Yun explained while keeping the palm of his left hand still. His right hand extended the forceps from the operating cavity into the joint, pinched out the loose body of the meniscus, and handed it to Du Yong.

"Brother Yong, show him the culprit of this joint jam. After seeing this bite forceps, get off the stage and deal with it."

Some instruments need to be absolutely sterile, but the arthroscopic operating system has more than one bite forceps, and there are various shapes of bite forceps, such as left curved forceps, right curved forceps, large curved forceps, etc.

Du Yong quickly took it: "Here, Xiao Chen, look, this thing is inside the joint, like a stone stuck in the sole of a shoe, getting stuck one by one. After taking it out, the pain caused by the jamming will disappear. "

"But there is still a break in the meniscus. I will give you a shape, partially remove it, and then suture it and fix it to prevent the meniscus from continuing to float and causing damage to the hip joints."

"Doctor Fang looks young, but you have seen how reliable his operation is, right?"

"Brother didn't lie to you, did he?"

Previously, Chen Liujun heard that Fang Yun was only 30 years old, younger than Du Yong. Du Yong said that Fang Yun would be invited to come for the surgery. Chen Liujun had complaints in the department, but according to Du Yong, if Fang Yun was not invited to come, he would not do it.

Director Chen who came to the town would not go to great lengths for such a small operation, and the director of the state hospital would certainly not go to the county for such a small operation. Chen Liujun could only go to Xiangzhou for the operation.

Only then did Chen Liujun agree.

"It's quite silky! But Brother Yong, please don't complain to me. It's not that I don't believe Dr. Fang, I just feel a little guilty."

"After all, Dr. Fang is too handsome to be an experienced doctor." Chen Liujun resolved his awkward situation with just one sentence.

Fang Yun smiled when he heard this and said thank you.

Then continue to polish the stump of his meniscus with concentration.

Unless the meniscus is badly ruptured and cannot be retained, the prognosis after shaping and suturing will be much better than directly removing it entirely.

This is supported by big data from literature. Fang Yun is not yet able to overcome such big data through his own understanding and experience. Therefore, he still plans to operate according to the techniques recommended by big data.

The meniscus is highly ruptured and irregular in shape. In such cases, arthroplasty is necessary.As the name suggests, plastic surgery is a surgery to repair an object according to its original shape. It is used in many fields of medicine.

The forming of the meniscus is actually O-shaped or C-shaped shaping and polishing.

Large gaps need to be removed with bite pliers, and small gaps need to be polished little by little with a planer.

After plastic surgery, the meniscus may become loose due to root damage, and occasionally roll up, causing further damage to the joints just like the insole rolling up and pressing on the sole of the foot. Therefore, in this case, the meniscus needs to be sutured and fixed locally.

The suturing here does not simply mean to sew the meniscus together, but to fix the meniscus and the soft tissue of the tibial platform of the knee joint to prevent it from drifting away and being compressed.

As for suturing, there are actually many methods, such as specialized suturing equipment.

However, such equipment was quite expensive, so Fang Yun planned to adopt a simpler suture method, sewing from the outside to the inside.

If there is a suturing device, the suturing operation will be relatively simple. However, without the suturing device, the suturing technique needs to be tested, and the operation is slightly complicated.

Therefore, at this time, Du Yong, Zhong Hanli and Qian Qiansheng all began to watch seriously.

Fang Yun knew that the three people were probably curious about how to perform suturing without a suture device, so he analyzed it while operating: "Director Zhong, when suturing from the outside to the inside, you usually need to use a puncture needle to position it first, and then The lateral skin and joint capsule pass through to the injured and displaced meniscal tissue.”

"Look, under direct vision under the arthroscope, you can see that the puncture needle has reached the front corner of the meniscus. This kind of suturing is only suitable for the front corner and body. This kind of suturing is not suitable for the posterior corner. It is too difficult. After all, the difficulty of operating the back corner will increase."

After the puncture needle is positioned, Fang Yun inserts the suture into the joint through the puncture needle. This is the first stitch.

Naturally, minimally invasive sutures require certain suture methods, which are not as smooth as traditional sutures. The sutures must be pulled out before they can be knotted.

"We put in a second puncture needle with a thread attached to it. This is the lead thread that leads the suture of the first needle out of the skin."

"In this way, the first suture is equivalent to a suture inside the meniscus. The entry of the needle hole is the first needle puncture channel, and the exit of the needle hole is the second needle puncture channel."

"After drawing out the sutures, we make a small incision to expose the joint capsule and fix the meniscus sutures to the joint capsule. This is the completion of the first stitch."

Fang Yun said while tying the knot steadily.

At this moment, when Fang Yun used the probe hook to pull the meniscus, the meniscus already seemed stable. Even if he used the probe hook to remove it, the meniscus did not tilt up. This shows that the fixation is very reliable.

However, such an operation needs to be particularly precise and the angle of the puncture should be mastered, especially the exit of the first needle puncture point and the exit of the second needle puncture point, so as to form the entry and exit needle points of the suture just right.

This is more difficult than direct suturing, and this is the basic medical skill and the flexible application of puncture in sports medicine.

After Deng Yong watched Fang Yun's operation, he praised without hesitation: "Who can think of such an operation is really a genius. The dexterity of a person who can perform such a difficult puncture technique is amazing."

Ordinary people have difficulty finding the needle opening when sewing clothes. It is difficult for ordinary people to imagine micro-manipulation of needle openings to achieve suturing purposes without direct vision.

Fang Yun was a little happy, but not complacent.

There are no useless basic skills, and my current skills have formed a certain degree of professional barriers even among professional people, so I am naturally happy.

But Fang Yun knew that he was just getting started in the field of sports medicine and there was no need to be particularly proud.

(End of this chapter)