Self-appraisal of Orthopedic Continuing Education
September 2xx? In March, 2XX, with the arrangement of the department and the approval of the hospital leaders, I studied in Shanghai Sixth People's Hospital, majoring in trauma orthopedics, joint replacement surgery and spinal surgery. Shanghai Sixth Hospital is a famous orthopedic hospital in China. Its technology and concept are in line with international standards and it has been at the forefront of the world. It is also the Shanghai Orthopedic Trauma Center, known as:? Shanghai orthopedic aircraft carrier? . Every year, about 15, orthopedic operations are completed (excluding emergency operations), including 6,5 cases of traumatic orthopedics, 1,2 cases of spinal surgery, 1,5 cases of joint replacement, 2XX cases of arthroscopy, 1,5 cases of orthopedic surgery and bone tumors, and 2,3 cases of rehabilitation and limb amputation wards, with an average daily operation volume of 6 cases. After studying for nearly half a year, I have learned a lot of advanced techniques and concepts, and I have greatly improved the diagnosis and treatment of common traumatic diseases, especially the diagnosis and treatment of fractures around joints and surgical skills. Have a full understanding of hip and knee replacement. It will have a positive and far-reaching impact on my future work and make me more confident in my future work. During my further study, I strictly abided by the rules and regulations of the Sixth Hospital, followed the arrangement of the department leaders, actively completed all the tasks assigned by the department, earnestly studied my business, and successfully completed the further study task. The work in the past six months is concluded as follows:
1. Microsurgery classes for limbs
From March 1 to March 16, according to the arrangement of further study in Shanghai Sixth Hospital, I participated in the microsurgery classes for limbs, which was mainly to improve the microsurgery and theoretical knowledge of advanced doctors. Through the lectures of teachers, I further consolidated and enriched my theoretical knowledge of microsurgery. In addition, the teachers' specimen teaching and operation demonstration have made them have a deeper understanding of the key steps of some operations. Director Li Yanjie has always emphasized that microsurgery is the basic skill of orthopedic surgeons. Through the study of microsurgery, I deeply understand its true connotation and outstanding knowledge.
second, the AO technical course
The AO technical course is another compulsory course before this study. This class is very formal. The lecturers include Professor Wu Zongjian from South Korea, Professor SuthornB from Thailand, Professor Luo Congfeng from Shanghai Sixth Hospital, Secretary General of AO Asia-Pacific Region, and some famous orthopedic experts in China. High quality and strict requirements. The content of this class, centering on the AO principle of fracture treatment, covers the basic theory and clinical treatment of basic fractures. First, the course arrangement is about the basic principles of fracture treatment and its biological effects on fracture healing. It expounds soft tissue related injuries, introduces the effects of direct reduction and indirect reduction on fracture healing, discusses the scientific principles of rigid fixation and stable fixation, explains the development of bone plate technology, and focuses on the concept of locking plate internal fixation. Another important content of the class is the operation of grouping specimens. Professor SuthornB and Professor Wu Zongjian taught me personally, which made me really master the basic fixation techniques of fractures, such as tension band fixation technique, compression screw fixation technique and external fixation bracket fixation technique. At the same time, through the study of AO basic class, I have a higher understanding of AO principles: anatomical reduction, firm fixation, protection of soft tissue blood supply and early functional exercise. Finally, I obtained the certificate of AO basic study class issued by the international AO organization, laying the foundation for becoming Aofellow in the future.
III. Study of Traumatic Orthopaedics
The Department of Traumatic Orthopaedics in Shanghai Sixth Hospital is divided into three wards, and I have gained a lot from studying in the three wards. There are many trauma patients in the Sixth Hospital, almost all kinds of patients and cases can be seen, and patients with the same fracture can be seen many times in the operating room. Through operation, patient explanation by teachers, careful postoperative summary and professional study, and consulting a large number of medical literature in the library, I have mastered the following technologies:
1. Application of Mippo (minimally invasive) technology
After lectures and operations by teachers, reading and summarizing after operation, I have a thorough understanding of Mippo technology, mastered this technology and grasped the technical essence. It is a relatively stable fracture technique, which is suitable for shaft fractures that are out of joint, severely comminuted and soft tissue conditions do not allow open reduction, such as supracondylar fracture of femur and distal tibial fracture. Mippo technique is not equal to small incision technique. No matter how big or small incision is performed, the blood supply of bone block should be preserved as much as possible, and anatomical reduction should not be based on destroying local and bone block blood supply. However, sometimes patients don't understand the meaning of functional reduction, and whether the fracture is anatomically reduced is the standard to measure the success or failure of the operation. The application of this technology requires good communication with patients before operation.
2. Intramedullary nail technology
In recent years, with the increase of life expectancy, China has entered an aging society, and there are more than 6 million patients with osteoporosis. According to reports, there is a patient with hip fracture every 5 minutes in China. In the past six months, I have come into contact with many elderly patients with hip fracture. The fixation is no longer limited to hollow screws and DHS, but many international advanced intramedullary fixation systems, such as PFN, PFNA, Ganma nail, Ganma3, intertan and so on. Its advantages are short lever arm, small bending arm, less surgical trauma and less blood loss, which can relieve the pain of patients and reduce surgical complications, and is especially suitable for patients with subtrochanteric fractures. At present, the treatment of hip fracture with intramedullary nail technology has become? Gold standard? It can be seen from international conferences, internal conferences and various magazine articles. However, most of these implants are imported materials, which are expensive, but I believe that with the emergence of a large number of domestic instruments, intramedullary nailing technology will inevitably become the mainstream in the treatment of hip fractures. Therefore, I also focused on learning this technique, including closed reduction to implant. After repeated practice, I have mastered it skillfully.
3. Application of ilizarov External Fixation Bracket
Before, I only heard about Ilizarov External Fixation Bracket in books and magazines. This bracket is used in orthopedic surgery and the treatment of complex trauma, which has solved many problems that orthopedic surgery could not treat in the past, especially in the treatment of bone defect, nonunion and bone joint deformity. Where does Ilizarov's therapeutic principle come from? Traction osteogenesis? This fact. During my study in the Sixth Hospital, I had many operations with Professor Kang Qinglin and Professor Bao Kun, and asked them about their key points. I had time to read relevant books and took the opportunity of ilizarov external fixation stent exhibition to learn from the technical director of this stent. The reason why I am interested in this technology is that there were cases of large bone defects in our department before, and finally the treatment was delayed because there was no good way to treat them. In my opinion, this technology can provide us with a treatment for nonunion, bone defect, tibialis anterior muscle injury caused by high-energy violence, foot drop deformity and other injuries. At present, this technique is widely used by Professor Xia Hetao of Beijing Institute of External Fixation. I will continue to study this technology and hope that it can be carried out in our hospital one day.
In addition, I personally witnessed the application of navigation technology by Professor Luo Congfeng in the study of trauma orthopedics. Tibial plateau fracture? Three-column typing theory? Practical application of; Treatment of Lisfrac injury by professor Shi zhongmin, an expert in foot and ankle surgery; Professor Chen Yunfeng, a shoulder joint expert, reconstructed acromioclavicular ligament and coracoclavicular ligament for acromioclavicular dislocation; Professor zhong Biao, an elbow expert, is interested in elbow joint? Terror triad? The treatment of the fracture around elbow joint has a deeper understanding of the future trauma treatment.
IV. Study of Joint Surgery
After hard work, I was lucky enough to study in joint surgery. There are about 6, joint replacement patients in Shanghai every year, including 1,5 in the Sixth Hospital, with an average of 6 joint replacement operations every day. My tutor is Dr. Wu Haishan, a famous expert in joint surgery in China, and Dr. Dai Kerong, both of whom are doctoral supervisors. Its theory and technology are very strong. Through the study of joint surgery, I have mastered the basic surgical skills of hip and knee replacement and the treatment of complications.
Self-appraisal of Orthopedic Continuing Education Part II
From xx to September xx, I studied in Beijing XX Orthopedics for one year, and the time was not rich but very substantial. I really benefited a lot from my personal experience and empathy.
Looking back on my one-year study in xx Orthopaedics, I saw scenes such as when I asked about my medical history, when I had a serious physical examination, when I was quietly listening to the class, when I was busy taking the patient for additional examination, when I stood on the operating table honestly for a day, when I was reading books and documents, and so on, which were presented to my mind when I wrote a review summary. Although some work is already familiar, I can rediscover my own shortcomings in my clinical practice with Dr. xx every day, such as making rounds, asking medical history, physical examination and so on. From the normative point of view, there is a far cry, so this year is not in vain. From the most basic learning, I not only learned their profound spinal joint routines, but also standardized my behavior from the perspective of clinicians.
I remember the habit of making rounds twice a day. They have made it a habit to make rounds every morning and evening, and really observed the illness carefully. Ward rounds to understand the changes in the condition and check the results; Listen to patients' feelings and give priority to family members' opinions. Find problems in time and deal with them in time.
define the concept of bed management doctor. In fact, the definition of the concept of tube bed doctor is the best interpretation for clinicians. Bed-management doctors should do a good job in writing medical records of patients in their beds, complete relevant examinations and pre-and post-operative consultations, deal with common perioperative complications of patients, and report problems to higher-level doctors in time. Therefore, it is common for residents to stay and work overtime, because their work is complicated and heavy, and they will not leave today's work until tomorrow. Only by managing your bed well every day can you be a real clinician. Doing a good job as a resident doctor can lay a solid foundation for the future career.
tireless pursuit of professionalism. As the center for the diagnosis and treatment of difficult diseases in China, xx often encounters many rare diseases in the field of orthopedics. When they encounter diseases that they have never seen before, they will consult a large number of documents and organize general practitioners to study the consulted documents and discuss treatment plans. Although medicine is an empirical science, it is very important to accumulate experience, but it is more important to respect the evidence of evidence-based medicine. They will keep all the cases that have been treated well, so as to sum up the treatment experience.
Every Thursday morning reading meeting and rounds are opportunities for general practice communication. The morning reading meeting of xx Orthopaedics every Thursday morning is actually a small lecture, which is taught by teachers above associate professors, and their expertise is used to explain a topic. After the lecture, questions can be asked and exchanged. In xx hospital, it has gained fame and won praise from hospital leaders. The big rounds are to summarize the surgical patients in the past week and discuss the surgical plan for the preoperative patients in the next week.
strict aseptic concept on the operating table. Advanced laminar flow equipment and modern disinfection instruments in the operating room can provide a more sterile environment and tools for surgery, but if surgeons and nurses in the operating room don't know enough about the concept of sterility, the most advanced and modern are all floating clouds. From the asepsis in the first lesson to the knowledge of the professors on asepsis every time they go on stage, it shows that asepsis has become a habit for them. To do the most successful operation, if infection will be a disaster, especially if implants are placed in orthopedics, infection will definitely lead to the failure of the operation.
communication between doctors and patients. It is well known that the establishment of a good relationship between doctors and patients requires good communication between doctors and patients and their families, but to get good communication, it is definitely not for you to perform surgery on patients. Of course, this may be necessary. After xx orthopedic patients are admitted to the hospital, the doctor will introduce himself first, so that the patient can know that you are his bed-managing doctor, and you can find something during hospitalization. I think this is really important. Patiently listening to the patient's complaints, carefully explaining the illness, handling the illness in time, even caring for the patient in life, personally accompanying the patient for examination, and often guiding the preoperative and postoperative training and rehabilitation are all good ways to communicate with the patient. Doctors should gain the trust of patients in medical practice, which is the most effective way of communication.
Self-appraisal of Orthopedic Continuing Education Part III
What is the main direction of my continuing education? Neck, shoulder, back and leg pain? Conservative treatment and? Broken limbs? Surgical treatment. The further education departments are neck, shoulder, lumbocrural pain, upper limb injury and hand surgery. The neck, shoulder, back and leg pain treatment center consists of 4 departments with a total of 17 beds, which is the largest Chinese medicine treatment department for cervical and lumbar spondylosis in China. The department of upper limb injury and hand surgery are the departments for surgical treatment of limb fractures and vascular and nerve injuries.
1. Further study:
Go to the hospital for ward round at 7: every morning to check the treatment of patients, ask their feelings and seek their treatment opinions, with emphasis on newly admitted patients and patients after surgery (or restoration). Answer the patient's questions and doubts, report the problems that you can't solve to the teacher in time, ask the teacher for advice, solve them with the teacher, and complete the treatment of the patient in time (such as dressing change, doctor's advice, etc.).
During my study in the department of neck, shoulder, back and leg pain, I mastered a set of effective non-surgical treatments for neck, shoulder, back and leg pain, that is, Luoyang bonesetting therapy.
excellent traction method: the bedside multifunctional traction frame is adopted, and the corresponding traction angle, traction weight and traction time are adopted according to the patients' different conditions, so as to achieve the therapeutic effect of setting bones and regulating tendons.
Chinese medicine treatment: Pingle bonesetting divides this kind of disease into three types: one is qi stagnation and blood stasis, the other is cold-dampness stagnation, and the third is liver and kidney deficiency. Luoyang Orthopedic Hospital adopts self-developed Jingtongxiao Pill, Intervertebral Disc Pill and Qizhong Yaoshu Pill, and treats them by stages according to the three types, and uses traditional Chinese medicine fumigation, iontophoresis and other traditional Chinese medicines for external use to warm channels and dispel cold, dredge channels and activate collaterals, so that the methods of external treatment can play the role of internal treatment.
Zhanjindan rubbing medicine: Zhanjindan rubbing medicine method is based on acupuncture? The hole is wide open and unobstructed, causing evil spirits to fly? Principle, combined with the specific condition of neck, shoulder, back and leg pain, select the corresponding acupoints or reaction points, spread Zhanjin Dan (powder) on it, and at the same time apply specific kneading and massage techniques to make the drugs and techniques play their roles together, and play the roles of promoting blood circulation and relieving pain, dredging meridians and relaxing collaterals.
Manipulation therapy: divided into tendon manipulation and bone manipulation. The main methods of tendon treatment are rational tendon, flexible tendon and loose tendon. Bone-healing techniques are mainly various joint movements, including lifting presumption, three-dimensional traction bed fixed-point rotation and so on. This manipulation can effectively adjust the position of spinal intervertebral disc and facet joints, and change the anatomical position relationship between protrusion or osteophyte and stimulated nerve roots or spinal cord and blood vessels (that is, displacement theory), so as to reduce the tension of nerve roots or the stimulation of osteophyte to nerves and blood vessels, and achieve the purpose of bone healing and pain relief. Closely combine the manipulation of tendon therapy with the manipulation of bone therapy, and relax the dynamic muscles around the spine with the manipulation of activating tendons, regulating tendons and loosening tendons, such as clicking, pressing, pushing and kneading, so as to achieve the effect of relaxing tendons and relieving pain.
ozone injection therapy and sacral canal therapy.
functional exercise: according to patients' different physical endowments and specific conditions, formulate corresponding personalized functional exercise programs, and selectively apply neck, waist and back muscles and spine.