Chapter 190 The gods want to fight! (Please subscribe!)

"Hip joint infection." Zhou Cheng turned his head and said after thinking for a while.

Luo Yun took another look at the film sent by Professor Song, and asked again without directly asking the reason:

"What about the first ones? What are your considerations?" Asking the specific reason for a flat film is not the main purpose of Professor Song taking out this set of flat films.

Zhou Cheng's memory does not have a photographic memory, but the characteristics of the previous flat film are still in his mind. Zhou Cheng is not completely sure of the answer, so he said:

"The first case should be hip tuberculosis, and the second case is, as Professor Liu said, DDH and femoral head necrosis."

"The third picture, I would consider bilateral hip synovitis."

"In the third plain film, do you want to consider synovitis?" Luo Yun frowned.

The reason why he asked Zhou Cheng was that he actually had an answer in his mind, but he couldn't confirm it. However, he also thought that the set of films Professor Song showed was very interesting, so he wanted to explore it with Zhou Cheng.

It can not only confirm your own guess about the diagnosis, but also teach Zhou Cheng.

However, when taking the third plain radiograph, Luo Yun was considering bilateral hip osteoarthritis!

This seems to be a bit inconsistent.

However, after Luo Yun thought about it for a moment based on Zhou Cheng's prompts, he suddenly realized it!

With a half-smile on his lips, he said: "You boy, Professor Song has led others into the trap, and you are still standing outside the trap?"

The cases Professor Song brought were naturally joint surgery cases, and they were all hip joint cases.

Hip tuberculosis, hip osteoarthritis, hip dysplasia and avascular necrosis of the femoral head, hip infection!

These are four classic cases of differential diagnosis of hip joints. To complete the diagnosis, you need to rely on many auxiliary examination methods to confirm the diagnosis.

But that’s for ordinary doctors. For top joint surgeons, hip tuberculosis, osteoarthritis, dysplasia and infection all have different symptoms, and they are even displayed in the amount of information.

Among the least flat films.

If you can make a diagnosis through this, that's all it takes.

It's just that Zhou Cheng's thinking is quite extraordinary when it comes to detecting synovitis from ordinary plain films.

Zhou Cheng pursed his lips and said, "Teacher Luo, this kind of hip synovitis was something you specifically pointed out to me when we were in the clinic together. We also checked the information together later."

The incident happened on the weekend of last week. At that time, Luo Yun had not seen an outpatient clinic for a long time, and it was Zhou Cheng's first time visiting an outpatient clinic at that time, so Luo Yun explained the cases that Zhou Cheng didn't understand.

However, another situation is that Luo Yun was licked to death by Zhou Cheng in the simulated world!~

He also passively gave out an academic gift package, which contained knowledge points such as plain radiograph reading of synovitis. It's just that Luo Yun may not have called it out in time, but Zhou Cheng now has a perfect level of skills of up to 50+

!

It can be said that the knowledge reserve is extremely rich, so there is no problem in mobilizing these knowledge structures, and only then can I see something different.

"That's MRI. The signs of synovitis on MRI are completely different from the signs on ordinary X-ray films." Luo Yun was very satisfied with Zhou Cheng's talent, but, Zhou Cheng's

Modesty and stability were things he had never liked.

Even though I have clearly seen it, I still have to find a reason to explain it away. Although this is a consensus among all disciplines at present, everyone has to live with it...

But you have to know that if you give more face in daily communication, you may feel that you are very powerful during the process of complimenting each other, and you will not study or delve into it in depth.

"No one raised their hands?"

Professor Song looked around and saw that no one raised their hands anymore. He was quite satisfied with the effect of this set of flat films he had brought.

Of course, Professor Song didn't know whether Mr. Xu and Mr. Kong saw it, but he probably saw it and wouldn't say anything.

Luo Yun touched Zhou Cheng: "You raise your hand to answer the question?"

Zhou Cheng quickly shrank back and said with a slight tremor: "Teacher Luo, me? Now?"

Then Zhou Cheng suddenly shook his head and shook his head like a rattle.

Just kidding, when facing Yan Haihan in the department on weekdays, he felt as if he were looking at a mountain, trembling with fear. Although Yan Haihan has now resigned from the position of director, Zhou Cheng saw that Yan Haihan was still a little nervous.

fear.

And if Yan Haihan, the director of No. 8 Hospital, is a landowner, then he has to admit it when facing Ding Changle. Ding Changle is currently the leader of trauma surgery in Hunan Province.

Ding Changle is just the director and professor of trauma surgery in one of the three hospitals affiliated with Xiangnan University. Compared with the resume of a senior director and dean like Lei Zhong, it is a little less interesting.

This Professor Song, according to Luo Yun’s introduction, is currently the administrative vice president of the Second Affiliated Hospital of Xiangnan University and Professor Li’s senior!

Professor Li and Professor Lei Zhong are the same generation!

Even Professor Liu Yiping will be respectful to Professor Song. Will he answer this question?

Let's forget it, there are too many levels of difference.

"Teacher Luo, you answer." Zhou Cheng waved his hands repeatedly and lowered his head.

Luo Yun sighed and said: "What are you afraid of? Just say it if you know it. If you say something wrong, of course an old professor will come and correct it for you. You can remember it for the rest of your life."

But Zhou Cheng still doesn't dare to be in the limelight, mainly because he is not used to it yet. He has never taken a class in the department and has been in such limelight. Now that he is asked to be in the limelight, Zhou Cheng is really unwilling.

Through the simulated copies, Zhou Cheng came to know more and more how difficult it is to promote the development of a subject.

Although the skills Zhou Cheng has acquired so far may be the perfect point for this era, in a few decades, the ceiling of these skills may be redefined.

I have a simulated copy, so I can take shortcuts, while everyone else has achieved fame through their own hard work and talent.

Zhou Cheng can stand up and answer questions, and he can also attract everyone's attention, but showing off his skills is not Zhou Cheng's original intention.

Zhou Cheng rubbed his hair and didn't say much.

…

When Professor Song saw that no one raised their hands, he stopped wasting time and took the initiative to clear up the confusion:

"The surface of this plain radiograph is very similar to the first plain radiograph I listed. However, it is only similar, not the same plain radiograph of the same patient."

"As you can see, these four plain films have a wide range of enhancements, which can also be called whitening!"

"This wide range of whitening phenomenon will basically consider the infection of the joint cavity! It is not enough to simply see the infection step."

"At this time, we can use some other special factors to make detailed distinctions one by one."

Professor Song said, flipping through the plain films to the first one: "The last case just now, the medical history only lasted for one year!"

"And there are no symptoms of tenderness around the hip joint! This shows that the articular surface in our joint cavity has not been severely eroded, and it may not even have invaded the pain layer."

"But in this first picture, we can also see extensive enhancement, but its history has lasted for more than 20 years!"

Professor Song said, holding up two fingers.

"It has not been discovered for twenty years. This means that the patient does not have the symptoms of high fever, chills and other symptoms associated with ordinary hip joint infections. Otherwise, this infection focus may have been discovered long ago."

"If it's not a hot infection, then it can only be a cold infection focus."

Hot infection will have traditional infectious symptoms after infection, but cold infection focus is not necessarily the case. Often the patient does not have many symptoms and is ignored.

"No matter how cold infection lasts for more than ten years before getting worse, we have to consider whether this patient has tuberculosis."

"Tuberculosis in the joint cavity may not be detected by a complete set of ordinary blood tests for tuberculosis and tuberculosis antibody and antigen tests."

"There will not even be corresponding typical symptoms, and the diagnosis can only be confirmed by biopsy and culture."

"So, how can we make a diagnosis through this film?"

"It can only be distinguished through medical history."

As Professor Song spoke, he turned to the fourth picture and apologized to the person who answered the diagnosis:

"When we doctors read the films, we not only have to look at the plain films, but we also have to take into account the patient's medical history and age."

"If she had hip osteoarthritis, she would have been in pain for more than 20 years!"

"Will she still have joint space? But when we look at this film, the gap is only slightly narrow, but we can see some small insect-like cavities, so we have to consider infection, right?"

"So on the first plain radiograph, we can also initially consider hip tuberculosis and septic hip arthritis."

In this regard, Professor Song made a point and made it clear the identification of tuberculosis and common joint infections. Professor Song did not stop any longer, but continued to read the second and third plain films.

"Next, let's look at the second picture. This picture is the best one among today's group of pictures. It's about congenital hip dysplasia and femoral head necrosis. This should be our joint surgeon.

Essential basic skills.”

"First of all, we can see that the CE angle of the hip joint is outside the normal range. At the same time, we can also see that the bone quality on the femoral head is uneven, with local and regular decreases, necrosis and collapse.

The possibility is higher.”

"Let's not worry about this film. If you don't know how to read it, you should go home and study it hard. Don't forget about the entrance of joint surgery after we have been engaged in joint surgery all our lives. That would be ridiculous!"

"The third picture! This is a very interesting flat picture."

"We should consider patients with intermittent claudication."

"In addition to neurogenic and vascular diseases, we also need to consider our own orthopedic diseases,"

"Hip synovitis."

"The tenderness in the front of the hip joint has lasted for 8 years and worsened for two years. We cannot see the narrowing of the joint space and the formation of osteophytes. Instead, we can see that the local imaging density in the joint space has increased."

"In this way, sciatic neuritis caused by compression of the sciatic nerve by the hip joint can be temporarily ruled out. Although synovitis is relatively rare, if we also consider..."
To be continued...