There is poetry and calligraphy in the belly (please subscribe)

Author: Jiangdi Youbai

There is poetry and calligraphy in the belly (please subscribe)

"Brother Crab." Guan Yun and Cao Zhiyuan understood each other and shouted politely.

Fu Qianjin is not only the ward director of the Trauma Surgery Department, but also the chief director of the Department of Orthopedics of the National People's University Hospital. The new employees he appoints will definitely join the hospital if they have good academic qualifications and skills.

Guan Yun still has more than a year to study for a professional master's degree, and Cao Zhiyuan still has more than a year to study for social training. There will definitely be times when he gets along with Wu Xie. Even if he feels sour lemons in his heart after the first meeting, it is not good.

express directly.

Wu Xie didn't take the initiative to talk to him. He just followed Guan Yun and the others down to the dressing room of the operating room and looked around to see no one before he took the initiative to ask: "How are the tempers of Director Fu and Teacher Zhou? I love you."

Swearing?"

Wu Xie was once a member of the resident doctors, at the lowest level, and it was also in Tongji Hospital, so Wu Xie could quickly find the same points of sympathy with the two of them.

Of course, as a student of Fu Qianjin, Guan Yun could not have had a close relationship with Wu Xie.

Cao Zhiyuan replied: "Is there any director who doesn't curse? But he only curses a few times when he does something wrong."

"That's good. That's good." Wu Xie nodded when he heard the words. After putting on the mask, his eyes narrowed, as if the stone in his heart was relieved.

Wu Xie's words actually made Guan Yun and Cao Zhiyuan look at Wu Xie twice.

The recruitment announcement of Minda Hospital states that the minimum requirement for recruitment is a master's degree, and a doctorate is preferred. Generally speaking, only a very small number of graduate students in our hospital have the opportunity to stay in the hospital.

Wu Xie has a master's degree from Tongji Hospital affiliated to Huazhong University of Science and Technology, and is welcome to come to Renmin University Hospital.

But in fact, Wu Xie does not have eight legs and four mouths, and is more maverick than ordinary people. Instead, he is alone in the process of looking for a job. Even if he has a harmonious relationship, he is still nervous inside.

So Guan Yun said: "Brother Crab, today is the weekend, and Teacher Zhou's surgery is scheduled. Professor Zhou rarely curses."

Then Cao Zhiyuan and Guan Yun didn't say much. After entering the operating room, they began the pre-operative preparations.

Wu Xie only took the opportunity to help lift his upper arm during disinfection.

Then during disinfection, Wu Xie also asked about the full name of the surgery: "Double nerve bundle transposition from the ulnar nerve and median nerve to the brachialis muscle."

The patient's current diagnosis is brachial plexus injury.

Brachial plexus injury is a common type of peripheral nerve injury.

This was the only information Wu Xie could get during the disinfection process. After the disinfection and draping was completed, Associate Professor Zhou Xiaoning, Director Fu Qianjin, and Deputy Director Huang Yaolong came down to the operating room and took over the operation.

Including Guan Yun and Cao Zhiyuan, there were already five people on the stage, so there was basically no place for Wu Xie to stand and no chance to take the stage.

Under such circumstances, Wu Xie would not be able to go on stage and squeeze people if Director Fu Qianjin did not take the initiative to invite people.

However, Wu Xie was not in a hurry. He was not familiar with the patient's condition and only had a general understanding of the diagnosis. After seeing that Associate Professor Zhou Xiaoning had begun to expose the nerve deformation, Wu Xie came to the side first and started

Review the patient's medical record.

The patient had been engaged in physical labor for a long time. He reported that "the right biceps became weak after repeated labor 2-3 years ago. In the past year, the shoulder muscles have gradually atrophied, and the limitation of activities has worsened."

After coming to see a doctor, the skin sensation in the biceps area decreased, the muscle atrophied and the muscle strength was only level 2. The electromyogram showed damage to the musculocutaneous nerve that innervates the biceps. No obvious abnormalities were found in the ulnar nerve and the median nerve. Ultrasound of the axillary nerve showed no abnormality.

See obvious compression...

The patient visited many hospitals while working abroad, but his condition did not improve and his muscle atrophy gradually worsened...

This was the patient's medical history. Then Wu Xie looked at his neuroelectromyogram and found that the potential of the musculocutaneous nerve was abnormal, suggesting possible damage.

However, neuroelectromyography can only identify which nerve has been damaged, but it cannot actually locate which segment of the nerve has suffered any damage.

Wu Xie, who has expertise in nerve transposition surgery, knows that neuroelectromyography is a qualitative functional test that determines whether there is a disease or not. If there is no neurological damage, then there is no need to consider related diseases.

And if so, more precise positioning is needed.

Without being able to go to the hospital in advance to observe patients and their medical history, and without having the opportunity to undergo surgery, Wu Xie was still looking for opportunities for himself to learn.

Only by learning the medical history more thoroughly and making the surgical process more transparent can you master the entire surgical process and discover some key points that you need to pay attention to during the learning process.

Wu Xie is good at learning.

The learning modes of unsupervised learning are completely different and cannot be confused.

When cooperating with Long Yuan and Duan Hong, one was a senior brother and the other was a master. Even if Wu Xie did not understand the overall principles of surgery and could not grasp the entire process of the entire surgery, they would still figure out the details and key points.

Make you notice.

It is equivalent to actively telling you the key points and difficulties of the operation, and you only need to pay attention to the corresponding operations at that time.

But when learning surgery with other people, no one tells you the difficulties and key points. Even when others have specific teaching objects, they only focus on the difficulties of their teaching objects, rather than on you.

instructional design.

So in such a situation, if Zhou Xiaoning's junior fellow deputy director Huang Yaolong is in control of some of the more important details, the two of them might slip past each other without you noticing.

Both of them can do it, so it’s not particularly important, but if you don’t, you’ll just be confused.

This kind of learning is no longer the so-called principle that the upper and lower height differences of the connector determine the learning efficiency.

This is called chicken grabbing rice. You can catch it, but you can't catch it if you eat a few grains. If it's too late, even the food sprinkled to you later will definitely not be as precise as the operation during the operation.

Therefore, Wu Xie continued to take a closer look at the patient's MRI images.

To diagnose nerve injury, you only need to look at the anatomy. Find the anatomical shape of the musculocutaneous nerve and biceps brachii on MRI, and then look at the biceps brachii branch of the musculocutaneous nerve to see if any defects can be found.

This will help you diagnose musculocutaneous nerve injuries and determine the specific nature of the injury.

There is no one to teach you. This step is extremely difficult. Even with Wu Xie’s current reading level, he can’t do it without looking at the medical records and starting over! Associate Professor Zhou Xiaoning and the others will definitely not teach you how to diagnose from the beginning.

But no one teaches me, so I have to repeat the path that others have already diagnosed and find out the location of the injury. Only then can I better find the location of the injury during the reading operation.

Correspond to the nature of the injury that you have prepared mentally in advance.

This is a wild apprentice, you have to work harder.

No one is right or wrong, everyone's identity is different.

Although the expert-level MRI reading technology is not so clearly able to clarify the layers of each layer and achieve the sense of layering that the senior brother always talks about, it is still not difficult to look at the anatomical structure.

At the same time, we must also rely on the knowledge of basic anatomy——

The musculocutaneous nerve originates from the lateral bundle of the brachial plexus, penetrates the coracobrachialis muscle, and descends between the biceps brachii and brachialis muscles. Its branches are distributed in the coracobrachialis, biceps and brachialis muscles, and end at the biceps tendon.

The outer edge passes out near the cubital fossa and becomes the lateral cutaneous nerve of the forearm.

This is the general anatomy and the inherent shape of the musculocutaneous nerves. It is the basic homework that you need to do in advance.

Only in this way can the musculocutaneous nerve be found on MRI.

There are three key points, one is the lateral bundle of the brachial plexus and the other is the coracobrachialis muscle, passing through it.

Wu Xie carefully found the corresponding structure on the MRI, and sure enough, he found the very slender nerve course of the musculocutaneous nerve between the biceps brachii and brachialis muscles.

Wu Xie is a little happy, this is a sense of accomplishment.

Having expert-level MRI reading skills and expert-level basic anatomy only means that you have the ability to diagnose nerve injuries, but it does not mean that you are very skilled and can create something from scratch on the spot.

In hand surgery, the diagnosis and treatment of peripheral nerves have always been a huge difficulty, otherwise most prefecture-level hospitals would not be able to perform such surgeries.

step by step.

Continue to learn more about anatomy——

Branches of the musculocutaneous nerve: coracobrachialis branch, biceps brachii branch, and brachialis branch.

There are three branches, but the only one to focus on is the biceps branch.

Biceps brachii branch, of which 2 to 3 branches are common, and the musculocutaneous nerve sends to the biceps brachii branch?

Don't rush, take your time to retrieve the memories.

Oh yes.

The first branch originates approximately 10 to 15cm below the midpoint of the clavicle!

Wu Xie continued to use his fingers to trace on the MRI, and then he discovered that the patient's biceps branch had two branches coming out, and there was no separate branch. Some patients could send out up to five branches.

sure?

Wu Xie asked himself questions from the perspective of Senior Brother Long Yuan to improve his participation and communication in the learning process.

The shape of the musculocutaneous nerve——

Sure, there are only two, and the two are in the shape of double bird claws.

The proximal and distal ends of the collinear segment have bifurcations, similar to an X shape.

The location of the injury is at the proximal end of the collinear segment! The nature of the injury currently determined is chronic injury with a small capsule.

Inflammation? Entrapment? Or schwannoma?

Not necessarily, it is possible that the previous stretching process caused the rupture of the nerve bundle, and when the scar healed, a Ф structure was formed.

In this way, Wu Xie could safely and boldly bring the key diagnostic elements to the operating table.

Chronic injury to the biceps branch of the musculocutaneous nerve can be seen as damage to the two branches at the proximal end of the collinear segment. There are lumps at the injury site, and infection or other signs cannot be completely ruled out.

He relied on his own basic skills to hone these things bit by bit, so Wu Xie's memory is very deep.
To be continued...