Guo Xiaoyong is naturally not stupid, and he is also a bit clever. Apart from occasionally being clever, he is also hardworking enough. Otherwise, it is impossible for him to say that he is valued by Chen Bing and become the only one who was transferred from the third bone department to the fourth bone department. People who come from science.

The reason why his mentality changed before was that he had made an appointment with Lu Cheng yesterday, but Chen Bing, the old director, occupied his position and refused to let him go. Wouldn't he have no chance to get started?

But in fact, as long as you think about it more deeply, you can also know that Chen Bing has never been a fool. There must be something wrong with him watching Lu Cheng perform surgery so seriously. At least it means that Lu Cheng has one thing better than Chen Bing. Well done.

Chen Bing rarely went to see Liu Deqian for surgery, so this issue became clear.

But even though he figured it out, Guo Xiaoyong still couldn't understand what Lu Cheng did better than Chen Bing, and what Chen Bing should learn from.

Guo Xiaoyong's current level is only to roughly understand some parts of the arthroscope. After changing the position, for example, he only saw the attachment point of the joint capsule to the humeral head.

The biceps tendon is a relatively obvious tissue.

However, Lu Cheng examined the insertion point of the rotator cuff at the trochanter, the posterior part of the rotator cuff and the bare area of ​​the humeral head, the posterior articular surface, the posterior labrum, the posterior recess and posterior joint capsule, the biceps labral complex, Guo Xiaoyong was confused when he discovered the subscapularis tendon and subscapular recess, which were relatively unusual places.

Because Chen Bing rarely goes to these places when he performs shoulder arthroscopy. For ordinary rotator cuff injuries, after checking that there is no damage in the shoulder joint, he will go directly to the subacromial space, so there is no risk at all. You have to look at these things.

As for the standard shoulder joint release surgery for frozen shoulder, it is necessary to find the inflammatory and proliferative tissues in various locations and treat them one by one.

This requires an extremely comprehensive shoulder arthroscopy. If you don’t have enough experience, just dream about understanding these things.

So, after Guo Xiaoyong paid attention for a while, he became a little bored and distracted his attention.

It’s really hard to be attracted by reading it even if you don’t understand it.

Chen Bing may have noticed Guo Xiaoyong's current state, and after sighing slightly in his heart, he asked: "Xiao Lu, when you are operating, can you slow down a little and explain a little bit, otherwise, I'll see if you The surgery was a bit difficult.”

When these words were spoken, the handwashing nurse's pupils shrank slightly.

Oh haha!

Is this what Chen Bing should say as the chief director of orthopedics?

It turns out that I had made a mistake before. This was not Director Chen leading a junior doctor to perform an operation at all?

After taking another careful look at Chen Bing's serious and sincere eyes, she once again confirmed this fact, and immediately moved her eyes to Lu Cheng, secretly taking a deep breath.

This man looks so young. Where did Director Chen find the professor?

No, Director Chen, when you asked someone to come down to perform the surgery, didn’t you even give us a greeting in advance?

Suddenly, the handwashing nurse became more focused. Although she was not a specialist nurse in the orthopedics department, since she was here to set up the stage, she naturally couldn't embarrass Chen Bing.

At the same time, the anesthesiologist and circulating nurse secretly put down their mobile phones, and then carefully looked at the operations on the display screen, pricking up their ears, as if they could really understand what surgery was being performed.

After Lu Cheng heard this, he turned his head and looked at Chen Bing. He absolutely did not believe that Chen Bing did not understand his operation.

What he is doing now is the most basic shoulder arthroscopy. Of course, it is not easy to do the most basic shoulder arthroscopy well. Every operation that looks extremely beautiful is actually a pitfall at every step.

, go step by step, and after taking each step well, then combine some tips to shorten the operation time.

However, on the basis of shortening the time, it is absolutely undesirable if the quality of the surgery is reduced.

Since Chen Bing can perform shoulder arthroscopy surgery alone, there will definitely be no problem with these basic procedures. Otherwise, he would not dare to operate on patients alone and cannot handle unexpected situations. So what will he do after he steps down?

Probably just to let myself tell Guo Xiaoyong.

Lu Cheng said casually: "Director Chen, let me just say something casually. Maybe it's not very good..."

(Note: The teaching steps for shoulder arthroscopy have been written before, so I won’t waste time by repeating them.)

As Lu Cheng's explanation joined in, Guo Xiaoyong suddenly became refreshed, because he knew the anatomy, but he didn't quite understand what the anatomy looked like on the arthroscope display screen.

Moreover, Lu Cheng's operations are very standardized, so during Lu Cheng's explanation.

Well, the circulating nurse, hand-washing nurse and anesthetist all felt like they could keep up with Lu Cheng's pace. At least they knew which parts Lu Cheng was cleaning now, and Lu Cheng would also talk a little while he was operating.

Let’s take a look at what might happen if we don’t loosen it here.

Although I only mentioned it in passing, it is a reflection of solid basic skills.

Whether one can perform surgery and whether one can teach surgery are two different realms; whether one can teach surgery clearly is another matter entirely.

Therefore, the circulating nurses and hand-washing nurses became more convinced that Lu Cheng was the young professor invited by Chen Bing. Although Chen Bing still shouted "Little Lu", he must be a private teacher. A person who can explain the surgery well.

How can someone with such a clear mind be so powerful?

Therefore, when Lu Cheng asked for something, the handwashing nurse would reply very enthusiastically: "Okay, Professor Lu."

"Okay, Professor Lu..."

Chen Bing would look at her strangely at first, but after looking at her, he missed the steps of Lu Cheng's operation, and he stopped looking at it later.

Frozen shoulder release surgery is actually a very basic surgery that tests basic skills. People who can really perform frozen shoulder release surgery very well are basically in the field of shoulder arthroscopic surgery, and other surgeries are

It won't be a bad job either.

Lu Cheng took the explanation, so the speed of the operation was a little slower. It took a full hour and twenty minutes to finally complete the shoulder joint capsule release + synovial debridement + acromioplasty.

After the operation, Lu Chengcai asked: "Director Chen, should I step down first or should I also do the suturing and injection of the cocktail?"

There is a large amount of synovial hyperplasia before frozen shoulder surgery, and inflammation in multiple locations can cause severe pain. Although release is performed during the surgery, the postoperative pain will make the patient very reluctant to cooperate with functional exercises.

If you don't move, you will become stiff. If the postoperative rehabilitation exercises are not good, then no matter how thorough the intraoperative release is, it will not help.

The recovery speed of normal people's soft tissues is extremely fast. If two fingers are kept together for a long time without being separated, at least there is a small opening on one finger, and the two fingers can grow together.

After the release operation, the released parts are similar to this kind of opening and come together, so.

In the treatment process of frozen shoulder, the final curative effect of surgery may only be 40%, 10 to 20% is analgesia, and the remaining 40% to 50% is due to pain relief.

Rely on the patient’s own functional exercises!

Chen Bing said: "It's okay. I'll leave the cocktail making to Guo Xiaoyong."

"You have to talk about how this patient will recover at that time. You are the chief surgeon now, and you have to complete the entire process."

Chen Bing is a person who really understands sports medicine, so he naturally knows that Lu Cheng must have his own model of rehabilitation exercise, so he hopes that Lu Cheng can bring something different to the department.

After all, Chen Bing has been away from sports medicine for at least five years. If he has not touched this thing for a long time, he cannot keep up with the pace of the times.

Although he picked it up recently, there are too many new things popping up, and he is busy with chores and does not have much time to study how to catch up with the latest rehabilitation training model.

Lu Cheng actually had his own ideas, but he didn't dare to mess around, so he said: "Director Chen, just follow the usual rehabilitation training in the department. It just needs to be coordinated with the postoperative analgesia."

Already."

Chen Bingxu kicked him: "You are just bullshit. Just say what I tell you."

"Damn, it's only been less than half a year since I went out, and you've already become a bitch, right? For those who didn't know, I thought you went to Thailand."

Lu Cheng dodged, jogged a few steps, and said with a smile: "Director Chen, that's not what I meant. The main reason is that my inner thoughts and reality are not consistent. I think patients can recover and exercise casually after surgery, but this

It actually doesn’t meet the guidelines.”

Lu Cheng has studied rehabilitation training after shoulder arthroscopy. He had studied this before when Lin Hui asked him to pay attention to it.

Immobilization after surgery is because movement will cause a devastating blow to the surgery. However, in fact, as long as the rotator cuff is not damaged, casual activities will not cause accidental injuries. However, in the past and current opinions, it is believed that after surgery,

Excessive activity can lead to secondary injuries, so rehabilitation exercises will be partially inhibited.

But Lu Cheng feels that as long as the rotator cuff and meniscus are not damaged, he can quickly exercise.

But Lu Cheng feels that reality is reality. If you follow the latest and your own ideas, the patient will be fine and everything will be fine, but it will be no good for you. If anything happens, you just don't follow the guidelines.

If it was at the Second Xiangya Hospital, that would be no problem. Lu Cheng and the others had almost passed the approval of the Ethics Society and could conduct clinical trials.

But the test site is at the Second Xiangya Hospital, not the Changshi First People's Hospital. Therefore, even if Lu Cheng said it, Chen Bing would probably not dare to follow it unless he was very brave.

As expected, Chen Bing frowned slightly: "You mean, if you just move around, the forearm sling and triangle scarf can be dispensed with?"

Forearm slings and triangular scarves are actually simplified versions of shoulder joint braces. Shoulder joint braces are the most formal when combined with rehabilitation exercises.

"Director Chen, the brace, the forearm sling, etc., all play the role of partial braking. When you can move at will, partial braking is meaningless. This is our understanding." Lu Cheng said.

Chen Bing nodded, sighed, and said with a wry smile: "That can only be you. Xiaoyong, when the time comes, will you still have to put a forearm sling on the patient? As for rehabilitation training, we should follow our usual routine."

"Lift first, practice abduction a week later!"

"Okay, Director Chen." Guo Xiaoyong frowned, feeling confused.

If you still ask if you can’t do it, isn’t asking in vain?

Chen Bing patted Lu Cheng on the shoulder and said seriously: "Xiao Lu, you don't need to be so conservative. Whether you can do it is one thing, but knowing how to do it is another thing."

"I know that if I don't use the latest ideas, and I don't have to use them, these are two different things."

"I hope you can bring more different things to me, to Xiaoyong. Even if we can't use these things now, we can strive to use them to provide patients with the most advanced and highest quality of service. Only then can we

It’s fundamental.”

Before Lu Cheng could reply, Chen Bing led him outside the operating room.

Guo Xiaoyong was on the stage, crying listlessly. The shoulder arthroscope had been removed. Although he could reinstall it, he didn't dare to do it alone without Chen Bing and Lu Cheng.

Chen Bing is the deputy chief physician and the director of the Department of Orthopedics. He has the authority to operate at the third level and above. Lu Cheng was invited. He belongs to the kind of off-site practice registered at the Second Xiangya Hospital, but he, Guo Xiaoyong, does not.

This happened.

But, Guo Xiaoyong thought for a while, and his eyes suddenly lit up again.

Yes, Director Chen just said, whether it can be used is one thing, but whether it can be used is another matter.

Brother Xiaocheng, just wait for me, I have to empty you out!
To be continued...