Su Min was alone outside, even though she came here as a student, but Su Min still didn't dare to do such a arrogant operation that was beyond her ability.

Peng Peng smiled, then looked at the others with great satisfaction and asked: "Did any of you read the patient's conversation and signed the informed consent form for surgery before the surgery?"

"Has anyone carefully checked the specific information on the patient's plain X-ray and MRI?"

This is not part of their job, because they are here only to learn, not to be doctors. Moreover, after a class, they only have such a short time, so it is impossible to complete the process of talking and signing, and naturally it is impossible to get the medical record to look at it.

This kind of thing happened.

They have long been accustomed to managing patients independently of medical records, but what about reading films?

Who could have imagined that Peng Peng would deliberately dig a hole for them?

Zhen Xing and Zhou Muyun even took another look at the patient's preoperative MRI scan from a distance.

The result is still the same!

The long head of the biceps tendon seen on MRI is very smooth without any loss of continuity. It is almost impossible to diagnose such a patient through auxiliary examinations!

However, the gold standard for diagnosis in sports medicine is not an MRI scan, but an arthroscopy!

Look at the scene on the arthroscope display screen again: the biceps tendon is ruptured far away from its insertion point...

What the hell?

Who could have imagined such a routine?

Moreover, such a diagnosis is inconsistent with the diagnosis of other patients in this section, unless the MRI of the next patient is replaced by this patient, and then the MRI of this patient is transferred to the next patient.

But it doesn’t make sense. Should this group of patients only have simple rotator cuff injuries?

So where is this patient's MRI?

"You want to try?" Peng Peng tried his best not to underestimate the strength of the five little ones this time.

Zhen Xing, he had a rough idea of ​​Yu Heng's abilities. Now that the operation had left Su Min in limbo, there were still Zhou Muyun and Zhou Cheng who could give him something to look forward to.

Zhou Muyun was in the same group as Zhen Xing, and Zhou Cheng, Su Min, and Yu Heng formed a group. Of course, priority was given to those in the group.

Zhou Chengcheng asked: "In this case, Teacher Peng, do you still think we can perform the surgery?"

This diagnosis and treatment procedure needs to be clarified. When Peng Peng spoke, it was Su Min who said that he was unable to do what he wanted and had given up the power of the main operator. The first priority was given to Peng Peng. So, if Zhou Cheng wants to take over, then

It must be confirmed that Peng Peng has made an assessment that they can perform the surgery.

Only in this way can it be called authorization.

What if there is a misunderstanding?

"If you feel confident, you can try it." Peng Peng said.

Both Su Min and Yu Heng looked at Zhou Cheng. Su Min looked a little expectant, but also a little scared. Yu Heng was quite suspicious. But amid the suspicion, there was also a trace of fear.

Yu Heng knew Yang Yifeng, so after learning that Zhou Cheng was from Xiang Province, he asked Yang Yifeng why he didn't arrive.

Who is Zhou Cheng? How could it be possible that Yang Yifeng from Hunan Province did not come, but Zhou Cheng came instead? And this has been unheard of before. This is very inappropriate!

After Zhou Cheng took over the position of chief surgeon, he didn't waste much time because Yu Heng and Su Min next to him were both knowledgeable people and their skills were not weak.

Therefore, showing that he knows arthroscopy skills in front of them will not seem out of place at all, but will only feel natural. In fact, it would be strange if Zhou Cheng didn't know anything.

Under such circumstances, it was a good performance that week.

After Zhou Cheng took over Su Min's position as surgeon, he politely said to Su Min and Yu Heng, "Thank you for your hard work, you two."

Su Min and Yu Heng just opened their eyes and responded without saying a word, but their meaning was obvious. Why are you chatting when you go do something?

Zhou Cheng held the arthroscope and examined the anterior part of the inferior glenohumeral ligament and the middle glenohumeral ligament further downward.

Under normal circumstances, the anterior bundle of the inferior glenohumeral ligament is attached to the glenoid neck between two and four o'clock. The anterior joint capsule contains three independent ligaments with different attachment points. The attachment of these ligaments is normal, and only

A small amount of synovial membrane attachment.

Then Zhou Cheng controlled the arthroscope to enter the inferior recess and rotated the arthroscope toward the top of the glenoid to inspect the glenohumeral ligament and labrum. The integrity of the glenohumeral ligament and labrum was still acceptable.

However, even at this moment, Zhou Cheng did not rush to open the next hole, but gently rotated the upper limb externally. If the arthroscope can easily move forward in the joint, this phenomenon is called "Warren's Passing Sign".

There is widespread ligamentous laxity.

Fortunately, this situation does not exist. Peng Peng and others may not know what they are doing, but as the chief surgeon, Zhou Cheng also has to pay attention to all the details that should be paid attention to.

But even so, Zhou Cheng still frowned deeply!

Peng Peng walked out of the laboratory at this time without saying a word and not knowing what he wanted to do.

Zhou Cheng and others noticed Peng Peng leaving. Zhou Cheng frowned slightly. What did Peng Peng mean?

But in the end, Zhou Cheng continued to do it. With Peng Peng's authorization, he didn't stop. The current situation was not beyond my expectation. At least all the steps of shoulder arthroscopy were restored one by one according to the regular process.

.

I looked at the glenohumeral space before, now I need to look at the subacromial space.

Immediately afterwards, Zhou Cheng took the arthroscope out slightly from the glenohumeral joint, inserted the lever, and entered the subacromial space diagonally upward!

The arthroscope is entered through the arthroscopic sleeve again, and then the subacromial space is observed again!

The gap under the acromion has also become a mess!

There was a large amount of synovial hyperplasia inside, and the specific structure could not be seen clearly, and the arthroscope also punctured the synovium when it entered.

Bleeding profusely and red.

"Lumbar puncture needle!" Zhou Cheng shouted to the handwashing nurse.

Peng Peng washed his hands and came in. Seeing Zhou Cheng still continuing to operate, he raised his eyebrows, but he immediately understood what Zhou Cheng meant! He started to put on his own clothes.

Then an assistant, Su Min, immediately inserted the lumbar puncture needle from the front entrance into the subacromial space to drain the water. Zhou Cheng immediately put in the flushing fluid before flushing the blood cleanly and restored the arthroscopic field of vision.

Zhou Cheng took the lumbar puncture needle and moved it up and down.

The needle of the lumbar puncture needle was found in the field of view.

"sharp knife!"

After Zhou Cheng took the sharp knife, he made another incision along the waist with a needle. After opening it with straight pliers, he immediately started cauterizing it with a plasma electric knife.

After cleaning the joint cavity, only a small part of it was cleaned, and the shoulder joint capsule could be roughly seen clearly, Zhou Cheng called the hand-washing nurse to bring over the probe hook.

At this time, Peng Peng also finished washing his hands again and walked around the stage. He seemed a little uneasy.

Moreover, Zhen Xing and Zhou Muyun, who were watching from the side, also washed their hands, put on their clothes, and came to take a closer look.

Then Peng Peng noticed that Zhou Cheng suddenly ran into the gap under the acromion again. He frowned and asked, "Zhou Cheng, what are you doing?"

The tone was exactly the same as before, as if he was simply asking Zhou Cheng what he was doing.

Zhou Cheng said while operating: "I suspect that this patient also has a rotator cuff injury. Under normal circumstances, when the type 3 acromion wears out the biceps tendon, the supraspinatus muscle closest to the acromion will definitely not be special.

good."

"However, this patient's situation is a bit special."

"He doesn't have type III acromion." Zhou Cheng calmly told Peng Peng what he saw, and moved the arthroscope to a position where he could just see the acromion.

Zhou Cheng then looked at Su Min: "Does this patient have a history of trauma?"

"I remember that he had a history of trauma." During the previous ward rounds, Su Min asked about his medical history. Although everyone heard it, it was definitely Su Min who remembered it the most.

"Yes! It was the fifth day after the trauma when I was admitted to the hospital. I came to the outpatient clinic because of unbearable pain, and then was admitted to the hospital. The patient is currently 52 years old. An MRI was taken in the outpatient clinic, which showed acromion impingement syndrome. His age is also

If it suits me, I'll take it in." Su Min quickly nodded and replied.

During the previous diagnosis process, it was only thought that the patient had acromial impingement syndrome and suspected rotator cuff injury.

However, after opening it, the first thing you see is the rupture of the biceps tendon!

This made Su Min a little doubtful about life.

"However, I just saw that the injury to this patient's biceps tendon is fresh, not old. And during the physical examination, no muscle atrophy was seen!"

"And the patient's MRI showed no edema in the tendon. Therefore, the patient is most likely to have an MRI problem."

Peng Peng reached out and took the patient's shoulder joint capsule. After just briefly exploring the shape of the supraspinatus muscle, he suddenly saw the contracted supraspinatus muscle.

Then he continued: "You continue. Now you are the chief surgeon, and we are your assistants."

Peng Peng was very relaxed and didn't say anything professional-related to disturb Zhou Cheng's thoughts.

Zhou Chenggong said: "I just looked at the patient's supraspinatus. It's a huge rotator cuff, and the retraction must be more than 5cm. This patient may eventually need biceps tendon transfer surgery!"

"Yes, you are right, you continue. We have prepared the corresponding instruments. Tour, open the instrument package!" Peng Peng immediately said to the circulating nurse in the operating room.

"????" Zhou Cheng raised his head and looked at Peng Peng.

Did you already know this patient’s diagnosis, or did you not know it earlier? You already knew it, so why didn’t you tell him the correct diagnosis in advance? If you didn’t know it in advance, what happened to the prepared instrument kit?

Could it be that you deliberately concealed your medical history in order to test us?

Oh My God?

You are a superior and a teacher. Can we still trust you?

Peng Peng said: "You don't need to look at me. In this course, all the patient's medical history, diagnosis, physical examination results and film reading results, as well as the choice of surgical method, are all up to you. I didn't say a word."
To be continued...