Chapter 206 Debut in the operating room! (Please subscribe)

Beside the operating table, the attending physician Lu Mo whispered: "Professor Du, this patient has a PASTA injury, and it is not easy to handle. Isn't it a little inappropriate to handle such an operation?"

PASTA injury is the abbreviation of Partial r Supraspinatus Tendon Avulsion, which in Chinese means partial injury on the articular surface side of the supraspinatus tendon.

It’s just that joint surgeons are accustomed to calling it PASTA verbally.

It’s not to be cool, but to pronounce fewer syllables. This kind of name is very professional, but the position is very precise, and there are few pronunciations, which is convenient for communication, but it is inconvenient when communicating with non-joint surgeons.

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Associate Professor Du Kunning raised his eyelids slightly, glanced at Lu Mo, and said in a low and straight voice: "Xiao Lu, times are different now! With the progress of the times, today's children are being developed more and more deeply. At the same age,

Come on, it was difficult for us to compare before."

"So don't watch this kind of thing with emotions. Ding Dian has already been exposed to Category III surgeries. When she handles this kind of PASTA, it's not too inappropriate."

"After all, just because Han Xiaoming can't learn it doesn't mean that other students can't learn it."

"The one with the best will win. Why don't you give it a try?"

Lu Mo looked up at the sky. He couldn't talk that day. He was just looking for trouble and hit the muzzle of the gun!

Han Xiaoming is not a real SB. PASTA injury is a very special injury among shoulder joint injuries. It is not even a simple injury of the supraspinatus tendon, or a surgery that can be completed with a casual shoulder arthroscopy.

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This is a pretty standard Category IV surgery, and it is a rather difficult type of Category IV surgery.

Han Xiaoming is the chief resident, and he just graduated with a doctorate a few years ago. He is very talented, otherwise he would not be able to stay, and he is staying in the Ninth Hospital, which is getting more and more complicated. He was an academic doctor before.

Now, after just over two years of clinical experience, he is already able to perform shoulder arthroscopic surgeries on a regular basis. Such a talent is really staggering, because even Lu Mo, a genuine surgeon, now has to routinely perform all Class III surgeries.

Surgery is quite difficult, and it takes time to polish it off.

However, although it is very difficult to perform Class IV surgery, it is still no problem to ask him to do an ordinary shoulder joint cleaning, acromion impingement, and frozen shoulder.

The surgical volume of other surgeries is there. Rare surgeries still require surgical volume for practice.

After Zhou Cheng and Ding Dian washed their hands and came in, they found that almost everyone in the audience was staring at them silently, with various expressions in their eyes!

Most of them had looks of astonishment, awe, and surprise.

After Zhou Cheng got dressed, he did not go directly to the operating table. Instead, he smiled at Ding Dian and then went to the image reader to check the patient's basic condition.

Wouldn't it be nonsense if we start surgery without even getting a clear diagnosis?

Even if he is not the surgeon, he does not understand the diagnosis, is not a good assistant, and cannot understand the subsequent operations.

What's more, Lin Ziyuan has such a hot temper, don't go up and get scolded without understanding the process!

Yes, Lin Ziyuan is still the first assistant now, and he is the second assistant.

Zhou Cheng took a quick look at the radiograph reader and discovered something was wrong. This was not a complete tear of the rotator cuff, but a PASTA.

PASTA is more common in athletes. It mainly occurs when the upper arm is violently stretched and twisted, and it is also prone to occur when the shoulder joint is repeatedly traumatized. These risk factors are basically written based on the training careers of many athletes.

After Zhou Cheng basically understood these basic conditions, he came to the operating table.

Lin Ziyuan and Lu Mo just looked at him, without any explanation or instructions, and just told Ding Dian to do whatever he wanted.

This scene is like an exam.

Various tools of the arthroscope have been installed. The field of view of the arthroscope has been controlled by Professor Lin Ziyuan to the subacromial space. The humeral head is clearly visible and very white, but the roughness above the humeral head can be vaguely seen. It should be

This is where the supraspinatus muscle is partially injured.

When Ding Dian took over the operating part of the arthroscope, Lin Ziyuan suddenly looked at Ding Dian and Zhou Cheng, and then asked: "Are you the first to follow Ding Dian today?"

Zhou Cheng nodded hurriedly and said honestly: "Yes, Teacher Lin, today is my first day in the department with Senior Sister Ding."

"Do you know about shoulder arthroscopy?" Lin Ziyuan asked again.

When Ding Dian heard this, his pupils shrank slightly and he immediately opened his mouth to excuse Zhou Cheng: "Xiao Zhou has always been there before."

However, Lin Ziyuan reached out to interrupt Ding Dian and looked at Zhou Cheng instead.

Zhou Cheng thought about it seriously and replied: "I know a little bit."

"Then you do a little investigation. We'll do it later."

"You just do the investigation, and explain at the same time." Lin Ziyuan shook his head at Zhou Cheng, and then motioned for Ding Dian to get out of the way.

He didn't move at all, still wondering how to explain it.

Lin Ziyuan said: "Ding Dian, this patient's identity is a practitioner of sports medicine. It is precisely because he is a practitioner that he agreed to practice for you, but the requirement is that the operation should not exceed three hours."

"This is a very good teaching material."

"Ding Dian, don't waste time."

"Do you want to try it?" Lin Ziyuan asked as if he knew where Zhou Cheng was from.

Zhou Cheng thought for a while, then took the arthroscopic lens, and then followed his own ideas and conducted a detailed investigation——

The arthroscope has an inlet pipe and an outlet pipe. After the water is released, the structure inside will become clear.

The glenohumeral space was very refreshing, and Zhou 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." Zhou Cheng reminded him when he saw that the teacher in charge of arthroscopy was still a little indifferent.

Professor Lin Ziyuan saw that Zhou Cheng's movements were a little nimble and seemed to be very proficient, but he was not quite used to the arthroscopic instruments in their hospital, so he took the initiative to explain: "This is not the kind of auxiliary arthroscopic instrument, you directly operate it yourself."

You can complete the shooting action with the handle here.”

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.

What Zhou Cheng said about asking the teacher to take pictures is another kind of arthroscopic instrument, which is relatively old-fashioned. Just because Zhou Cheng understands the old-fashioned arthroscopic operating system, it does not mean that Zhou Cheng is unsophisticated.

Zhou Cheng nodded, and under Lin Ziyuan's explanation, he automatically took a photo.

"Give me some explanation. I think your operation is quite smooth." Lin Ziyuan then made it more difficult for Zhou Cheng.

Sometimes, some people know what to do, but don’t know why they do it. The difficulty of demonstration operations and demonstration explanations increases at least three to four times.

Zhou Cheng then said to Ding Dian, who was now standing in the assistant position: "Sister, please help me rotate the shoulder internally and externally at this time, so that I can fully observe the humeral head and the cartilage part of the shoulder glenoid."

"Then we move the camera forward and observe the upper and lower surfaces of the biceps tendon, the attachment point of the biceps tendon and the superior labrum for partial tears."

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

At this time, Zhou Cheng himself automatically pressed the photo button on the operating handle. The display screen flashed several times, and negatives were left. These photos were used for a clear diagnosis.

The gold standard for diagnosing rotator cuff injury is not MRI, but arthroscopy!

Then Zhou 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. Under normal circumstances, 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 Zhou Cheng said this, Ding Dian standing next to her was a little confused, because this area was an area that she had never been to before, and it was a wild area!

For shoulder arthroscopy, there is a common area and a wild area.

Zhou Cheng's move made Du Kunning and Lin Ziyuan's eyes immediately light up. Zhou Cheng's move just now was obviously an unexpected surprise.

As for the attending physician, Lu Mo, his eyelids flickered, and his upper and lower eyelids seemed to be trembling slightly and feeling a little hairy.

Then the other graduate students and professional doctors, who were still crowding around, took half a step back slightly. Their eyes were full of doubts, but amid the doubts, there was also a trace of respect!

The reason why the wild area is called the wild area is because it is rarely accessible and difficult to reach!

Lin Ziyuan was quite surprised and said, "Xiao Zhou, slow down a little."

At this time, Zhou Cheng slowed down his speed and said slowly: "At this time, we enter the arthroscope into the inferior recess and rotate the arthroscope toward the top of the scapular glenoid 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 rear part 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."
To be continued...