"Senior sister, did Brother Cao offend Teacher Li today?" Lu Chengdu couldn't stand it anymore and whispered.

"I don't know. It's possible that Teacher Li was stimulated by something and became a little strange." After Fang Nixin and the hand-washing nurse finished laying out the sheets, she began to wrap her hands and start traction.

The circulating nurse was helping in the audience, but the two bags of water hanging were still a bit heavy, so they were trembling.

When Li Dongshan saw this, he looked around and didn't seem to see Cao Xiaohe, so he went up to help himself and hung up the tow frame.

In this way, Lu Cheng could let go of his hand, and after the rope of the traction frame was wrapped with sterile dressing, he could officially start the operation.

However, Fang Nixin was not in a hurry to operate. What Li Dongshan said for the last time was to give this operation opportunity to Lu Cheng.

Moreover, Fang Nixin also wanted to see how good Lu Cheng was at arthroscopy, so she kept it.

Li Dongshan actually understood what Fang Nixin meant, but he didn't say much. Tomorrow, Xiao Lu was tricked by the orthopedics department. After he came to the emergency department, Li Dongshan didn't give him too many operating opportunities.

Now, in sports medicine surgery, Lu Cheng has obtained the authority to perform surgery without any patient training.

It would be unjustifiable if one of them refused to operate for Lu Cheng.

Li Dongshan wished Lu Cheng could continue to stay, and then sports medicine in the emergency department could be carried out normally.

But Lu Cheng is such a monster. Half of the four bone removal departments were robbed before. If he leaves tomorrow, I wonder if he will never come back.

This young man Lin Hui doesn’t respect his elders very much either!

It's really, really difficult.

Soon, Lu Chengcheng washed his hands, then walked in again, quickly put on his blue waterproof suit, and silently stood at the surgeon's position left for him by Fang Nixin.

Without saying anything else, he just got down to business.

"Hand-washing teacher, syringe!" Lu Cheng said and handed it over.

Then his left hand began to touch the acromion and greater tuberosity of the shoulder joint, and quickly located the soft spot.

After holding the needle in his right hand, he moved the fingers of his left hand slightly away and poked it in without hesitation.

After pumping two tubes in succession, nearly 60mL of liquid was injected, filling the joint cavity.

Cao Xiaohe looked at Lu Cheng from the opposite side, seeming a little confused.

Fang Nixin, on the other hand, looked at Lu Cheng's needle insertion point and was a little surprised. Lu Cheng had never been exposed to sports medicine surgery in the emergency department before, and she had never seen Lu Cheng undergo shoulder arthroscopy.

Being able to insert the needle so quickly and so decisively, how many patients has he stabbed?

Teacher Chen Bing was really willing to let Lu Cheng go and let him practice on patients. At that time, Lu Cheng was just a resident doctor. Should he be more conservative?

So brave.

But it was Chen Bing's courage that made Lu Cheng master this skill that impressed her.

After the joint cavity was filled, Lu Cheng quickly used a sharp knife to break open the skin to the subcutaneous level, and then bluntly penetrated the posterior approach with straight forceps. The arthroscopic sleeve was equipped with a core and a final stab was made!

It actually reached the inside of the glenohumeral space so quickly, and the process was very smooth.

Cao Xiaohe seemed to have been stabbed at him. He took a deep breath, then turned to look at Fang Nixin and hummed a few times.

When Fang Nixin heard this voice, she understood what Cao Xiaohe meant. He was laughing at me.

It's simply shameless. It's not like you are so smooth. Why are you so arrogant?

Cao Xiaohe felt so happy, especially since Lu Cheng came, senior sister Fang Nixin, who was usually a bit talkative, finally had less time to "wow wow wow", senior sister, she became much quieter.

If Professor Li Dongshan didn't go crazy from time to time, life would be better.

Lu Cheng was not disturbed. He pulled out the crowbar, then put the arthroscope into the arthroscope sleeve.

After the water is released, the structure inside becomes clear.

The glenohumeral space was very refreshing, and Lu Cheng quickly and clearly slid around the joint cavity.

After inserting the lens, first find the location of the biceps tendon and observe the upper part of the shoulder joint or the biceps tendon and the articular cartilage part of the shoulder glenoid. No problems can be seen with the biceps tendon and articular cartilage.

Then the camera moves forward to observe the humeral head and the cartilage part of the shoulder glenoid; no problem.

"Teacher, please take a picture." Seeing that the teacher in charge of arthroscopy was still a little indifferent, Lu Cheng reminded him.

The teacher in charge of arthroscopy immediately understood and clicked a few times.

These photos are meant to be kept for patients to see. Although only a small part is kept in the end, they are also excellent original materials for academic exchanges.

Lu Cheng's speed was too fast, and Fang Nixin couldn't keep up, so she said: "Junior brother, slow down a little and give me some explanation."

Fang Nixin put down her figure. Even though Lu Cheng was her junior brother, he was older than her, so she still had to admit defeat when it was time to admit defeat.

Lu Cheng said: "Senior sister, with the shoulder internally and externally rotated at this time, you can fully observe the humeral head and the cartilage part of the shoulder glenoid. Then we move the camera forward to observe the upper and lower surfaces of the biceps tendon, and the biceps tendon.

Are there any partial tears at the attachment point and superior labrum?"

"But this patient's tendons were intact and smooth."

At this time, Lu Cheng didn't remind him. The teacher over there also took a photo, and it flashed on the screen a few times, and Lu Cheng knew it.

Then Lu Cheng added: "At this time, we can use the antegrade surgical technique from outside to inside to open the opening and insert the anterior probe."

"Explore the biceps labral complex and assess the extent of the injury. Normally, the cord-like middle glenohumeral ligament crosses the subscapularis tendon and attaches to the scapular neck at the two o'clock position. In variations, this ligament inserts directly

The biceps tendon causes part of the area above the labrum to lose its labral coverage and become a bare area, called the Buford complex."

"Then we move the arthroscope further downward to examine the anterior part of the inferior glenohumeral ligament and the middle glenohumeral ligament. Normally, the anterior part of the inferior glenohumeral ligament is attached to the glenoid neck between two and four o'clock.

The anterior joint capsule contains 3 separate ligaments with different attachment points."

When Lu Cheng said this, Cao Xiaohe was stunned. His foundation was already a little poor, and considering that Fang Nixin was asking Lu Cheng to teach, what couldn't he do?

So Cao Xiaohe said again: "Junior brother, can you explain more slowly?"

"I told you to read a book but you didn't. You're wasting your time on the operating table this time." Fang Nixin complained with some contempt.

Cao Xiaohe immediately raised his head and said, "We have all wasted time. What's the point of taking fifty steps to laugh at a hundred steps? I used to be a professional in emergency medicine, right?"

"I have learned everything before, this is not the reason you are looking for." Fang Nixin criticized very harshly at this moment.

Cao Xiaohe wilted for a moment and muttered in a low voice: "What's the use of doing them all? It's not that none of them can stand up to the challenge. It's like he came from a special academic background."

Fang Nixin's eyes widened and she had no way to refute.

Li Dongshan's face turned a little green when he heard the two live treasures arguing with each other, and he reminded him loudly: "You have a senior sister and a senior brother, but you can't compare to a junior brother, so you still have the nerve to start a quarrel?"

"Don't you think it's embarrassing?"

Fang Nixin and Cao Xiaohe lowered their proud heads at the same time and fell silent.

At this time, Lu Cheng slowed down and said slowly: "At this time, we put the arthroscope into the inferior recess and rotate the arthroscope toward the top of the scapula to inspect the glenohumeral ligament and labrum."

"This is the glenohumeral ligament, and this is the labrum. If the labrum is damaged, instability of the shoulder joint will easily occur. But this patient did not."

"Then, we also need to check the attachment point of the joint capsule to the humeral head. Look, it's right here. Then we gently move the arthroscope back to check whether there is softening of the humeral head articular surface at the back of the glenohumeral articular surface, and the posterior glenoid of the shoulder joint.

Lip abrasion or partial tear."

"After moving the arthroscope back to the biceps tendon, we will begin to examine the tendon tissue."

"We only looked at the surface of the biceps tendon before, but if there is damage to the biceps tendon,"

"We can flex the elbow joint slightly to reduce the strain on the biceps brachii. Explore the biceps brachii tendon through the rotator cuff, including the upper and lower sides; use a probe to pull part of the biceps tendon into the joint through the anterior portal to determine whether there is slippage.

inflammation and incomplete tears in the more distal parts of the upper arm.”

"The arthroscope is rotated upward, aligned with the rotator cuff, and gently rotate the upper arm inward and outward to carefully check whether there is wear at the insertion point of the rotator cuff at the tuberosity, partial tears and calcifications in the rotator cuff. Move the arthroscope along the tendon.

Push medially to check for synovitis, abrasion or rupture."

"Gently withdraw the arthroscope and observe the back of the rotator cuff and the bare area of ​​the humeral head. There is no articular cartilage coverage here, and there are normal small blood vessels entering under the rotator cuff."

"We will open another anterior approach, which can be used as a subsequent operation access."

"Move the arthroscope to the anterior portal, and a probe can be placed at the posterior portal. Through the anterior portal, the posterior articular surface, posterior labrum, posterior recess and posterior joint capsule can be observed for hyperplasia, synovitis and shoulder joint instability.

Wear or inflammatory changes.”

"The arthroscope is moved to the front, and the rotator cuff can be observed upward, and the biceps labral complex can be seen when looking downward toward the glenoid."

"Moving the arthroscope further forward and pointing back toward the inferior recess, the humeral attachment point of the glenohumeral ligament and the glenoid attachment point below it can be seen."

“The arthroscope is then rotated downward to observe the attachment of the anteroinferior glenohumeral ligament and the labrum of the joint capsule, as well as the middle glenohumeral ligament, subscapularis tendon, and subscapular recess.”

"Next, we will explore the subacromial bursa, which can extend posteriorly from at least 2cm away from the front edge of the acromion to about the middle of the acromion. Place the posterior sleeve into the subacromial space."

Lu Cheng said as he finished the microscopic examination of the glenohumeral space.

After hearing these analyses, Li Dongshan beside him instantly became thoughtful.

A person's surgical level and treatment experience will jump up in a period of time, and the sign of this jump is the ability to teach. Before teaching, it is first and foremost to be very familiar with each operation step and familiar with various details.

And Lu Cheng has actually completed such a step at this moment, which proves that Lu Cheng has reached advanced or even top-level strength. Otherwise, there is absolutely no possibility of teaching.

Lu Cheng, you still have too many surprises for yourself.

Li Dongshan looked at the time again. Although Lu Cheng was explaining, he actually didn't spend much time. It only took about twenty minutes. However, he covered all the observation operations and anatomical positions in the entire glenohumeral space in detail.

I told Fang Nixin and Cao Xiaohe again.

Then he said: "Okay, that's enough, you just need to slowly digest this point first and bite off more than you can chew."
To be continued...