Those years when I hung up and upgraded in the hospital

Chapter 79 Appreciation (Please collect and read)

Meniscal rupture, if it is a simple and simple rupture that does not produce any symptoms, and the patient is older, surgical treatment may not be considered.

Generally speaking, as long as there is a rupture, whether it is full thickness or partial, it will definitely need to be repaired, either shaped or sutured, and excision is rarely considered.

Although magnetic resonance imaging can show the approximate shape of meniscal rupture, the gold standard for diagnosing meniscal rupture is still arthroscopic exploration to see the rupture under direct vision and determine the shape of the rupture.

Disinfection, draping, applying sterile coating, filling the joint cavity, making the entrance of the arthroscope sleeve, and exploration of the arthroscope, Fang Yun's operations are not only smooth but smooth, they are also smooth and smooth, with almost no pauses.

While investigating, I gave a little explanation, which was regarded as a report to Director Hu Jun.

"Director Hu, this patient's patellofemoral joint is fresh and clean, and there is no synovitis. There is a little synovial hyperplasia in the knee joint, which proves that the injury was not long enough and there has not been time to produce more inflammatory reactions."

"I just saw that the cruciate ligament and lateral meniscus are fixed in place and in full shape, no need for treatment."

"What needs to be dealt with now is the damage to the posterior corner of the medial meniscus."

"Brother Ye, help me change my posture." Fang Yun said, while asking Chai Junye, who was his assistant at the moment, for help.

Surgery is a team, and one person can never do it alone.

To observe the posture of the posterior corner of the medial meniscus, a relatively professional sports medicine doctor must be able to assume a relatively valgus position to fully expose the posterior corner area of ​​the medial meniscus of the knee joint.

Chai Junye is also very skilled. At the same time, the attending physician Wei Zhaoliang also helped to suppress the lateral femoral condyle. Under the angle formed by the two forces, the posterior corner of the medial meniscus was exposed again, at least allowing for arthroscopy. Damage to the posterior horn.

The middle layer of the back corner is torn through, which is like a layer cake. The upper and lower layers are superimposed and need to be sutured.

Otherwise, the upper layer of the meniscus will easily curl or come loose, causing more cartilage damage. Even now, the cartilage on the posterior edge of the medial femoral condyle has been damaged.

Hu Jun was quite satisfied with Fang Yun's current operational proficiency: "Dr. Chai, how is Dr. Fang's proficiency in arthroscopic exploration?"

Chai Junye nodded, and after posing, he used his abdomen to help fix it, released one hand, and gave a thumbs up.

"Pretty good. It must have been a result of hard work."

When Hu Jun heard this, he said, "Do you know how many sports medicine surgeries Dr. Fang has performed in total? His own surgeon and assistants do not exceed a hundred, maybe even less than fifty."

Chai Junye and Wei Zhaoliang were startled, and their upper bodies leaned back slightly.

Looking at Fang Yun, he was extremely surprised.Obviously he couldn't believe it.

"Director Hu, you are flattering. Teacher, please prescribe two sutures for me." Fang Yun gave the order to the operating room. After handing the mirror's hand to the resident doctor Guo Jinxi, Fang Yun planned to start suturing.

But Fang Yun's question confused the tour: "Why are you using sutures? Is one suture enough?"

"Sew the meniscus?" Fang Yun was also a little confused.

But soon, Fang Yun understood. His eyes flickered a few times and he said, "Director Hu, does our operating room have fastfix?"

The full name of fastfix is ​​FAST-FIX meniscal repair suture system. It is a suture tool specially used to suture meniscus. The price is very expensive, basically more than four figures.The stitching effect is naturally very good, and the stitching operation is relatively convenient, but Fang Yun has never operated this thing before.

Hu Jun now understood the meaning of Fang Yun's words: "Dr. Fang always performed sutures before, right? From the inside out or from the outside in?"

Of course, the simplest way to suture the meniscus is to use sutures. The fastfix meniscus repair suture system only appeared later. It was only when sports medicine was developed at Xiangzhou People's Hospital that this system was already very mature. .

It is a commonly used instrument in the operating room.The surgeon was not in use, so the assistant had to make rounds, and he had no idea that the meniscus could still be sutured.

"From the outside in, in the Longxian People's Hospital before, there may have been financial pressure on the patients, but our hospital did not introduce such a thing."

"Director Hu, I have never operated this fastfix before. Why don't I bother you or Brother Ye to do this surgery? Let me take a look first?" Fang Yun didn't dare to exaggerate.

Although I have seen the video, I have never touched it or tried it at all. If it breaks out, I will either have to bear the cost myself, or it will increase the financial burden on the patient. At least watch it once or twice before talking about it.

His current basic skills have reached a certain level. Hu Jun is a professional and must be confident.

It wouldn't matter if Hu Jun delegated his powers and let himself use sutures, which would be cheaper, as long as Hu Jun could tolerate the relatively poor quality of the meniscus suturing done by his team.

Wei Zhaoliang took the opportunity to correct him: "Doctor Fang, you should call Brother Chai, Brother Xiaojun."

"This is Brother Dajun."

Hu Jun and Chai Junye glanced at Wei Zhaoliang at the same time, but neither of them refuted.

Fang Yun quickly explained: "I didn't know that before, Brother Chai. I will pay attention to it in the future."

Sometimes a title contains a certain meaning.Brother Dajun is the director of the ward. There is no need to explain clearly what Brother Xiaojun means.

Fang Yun was not cowardly when he gave in. Hu Jun took over the position of surgeon. Fang Yun said: "Xiao Fang, in fact, the operation of fastfix is ​​much simpler than the operation of sutures. Look, the fastfix fixation system has two anchors. .”

"Each TFAST-FIX device contains two 2mm polymer anchors connected with a pre-tied sliding knot using US SP standard, O-size non-absorbable polyester braided wire. When the anchors are sequentially inserted into the meniscus, no need to tie Knot to secure tightly.”

"For repair of horizontal tears, puncture the lateral portion of the meniscus anteriorly until the puncture depth protector contacts the meniscus. The needle is withdrawn from the meniscus and the first implant is placed posterior to the meniscus."

"Push the golden button forward again to place the second implant into its intended position."

"Only when the golden button is pushed forward to the end, the implant can reach the predetermined position." Hu Jun was seen pushing the suturing device with clicks while explaining that one stitch of suture could be completed in half a minute. complete.

Fang Yun looked up at the display screen and said, "The speed and quality of sewing with a suture machine are faster and better than suturing. The tools are just different."

Perhaps the biggest difference between humans and animals is the use of words and tools. In fact, words are also a tool for cultural inheritance.

"Dr. Fang, at this time, just withdraw the puncture needle from the knee joint, leaving the free end of the suture. Pull the end of the suture, and the previous sliding knot will slide forward, gradually closing the meniscus tear. When You will feel a lot of resistance when the knot is pulled tight.”

"Like this."

"Slide the golden button forward now to cut the sutures."

Fang Yun nodded in surprise: "So the operation can be over now, right?"

Hu Jun nodded, and then said to the circulating nurse: "This time we can open the sutures, just sew the skin."

When he looked at Fang Yun, he could only admire him, without any dislike or feeling that Fang Yun was old-fashioned.

Just because you haven't seen it before doesn't mean you don't know how to use it. Fang Yun can use tools like arthroscopy. Meniscal sutures are more difficult to operate than fixation systems, and Fang Yun can operate them.

(End of this chapter)