From beginning to end, Professor Min, Zhu Queguang and others did not mention a word. It was Zhuo Yuan who was able to figure out the patient's diagnosis and the basis for diagnosis, and these two points alone had to convince Liu Zhi and the others.

You must know that Zhuo Yuan is only in his third year of graduate school, and he can summarize the key points of the diagnosis so accurately, which is much better than they have worked for more than ten years.

Of course, they also know that graduate students like Zhuoyuan generally have a solid foundation, otherwise it will be difficult to be admitted to graduate school.

There was no operation on Tuesday, and there was plenty of time, so Professor Min was not in a hurry at all, and glanced at Lu Cheng, which directly made the latter panic slightly.

Sure enough, Professor Min spoke, "Xiao Lu, do you have any thoughts on this patient?"

Lu Cheng did not answer immediately, but took the film.

The professors of surgery are all neat and tidy, and they don't drag mud and water.

If Senior Brother Zhuoyuan and these two eldest brothers who are studying have figured out the diagnosis, with their personalities, they will definitely have to go to the next bed again.

Since Professor Min has not left, he must not have fully understood the diagnosis.

Surely it can't be wrong.

The professor of surgery is very direct, and it simply causes their temper to be very direct, and if something is wrong, then it is likely to be asked rhetorically.

Is this it?

How do you spot this?

Since there is no right or wrong, it can only be said that there is no whole.

Lu Cheng looked at the film carefully, and at the same time, the medical record collection system had collected the basic information of the patient clearly.

Patient characteristics: elderly, female.

Clinical manifestations: Pain in the right hip without obvious cause for 12 years and aggravated for more than 3 years.

Aggravating relieving factors: pain worsens at night and after walking, and is relieved at rest.

Physical examination: positive figure 4 sign, anterior hip tenderness.

Pelvic plain radiograph: shows hip arthritis.

Medical history: no history of alcohol consumption and no history of trauma.

Preliminary diagnosis: stage 3 hip arthritis.

The things that the medical records systematically sorted out are all summarized by Brother Zhuo Yuan and the two elder brothers, and the only difference is that they are classified according to the medical history.

No triggers.

Hip arthritis?

Although it also meets the characteristics of older women, but is it worse after walking and pain at night?

Have night pain?

These three words suddenly made Lu Cheng light up slightly, he didn't rush to answer, and whispered: "Professor Min, can I ask about the medical history again?"

"Of course, we're not in a hurry. Professor Min still smiled elegantly, as if it was indescribably meaningful.

Lin You and Chen Hui had already retreated and gave up their position to Lu Cheng.

Lu Cheng thought for a while before he slowly asked, "Old man, did it start hurting twelve years ago?"

"Yes, I had a little pain twelve years ago, I took some Chinese medicine, I also saw a doctor, and I was prescribed painkillers, but it didn't get better. Three years ago, the pain was getting worse and worse. ”

"Then I couldn't walk anymore, and I was more lame than before. ”

When Lao Xiaoyu said this, he suddenly stretched out his thumb and said: "But your medical skills are really high, yesterday after I entered the hospital, I took a pill, which made me sleep well, and I slept until half past seven, and I drank a bowl of noodles." ”

"It's been a long time since I've slept so comfortably. ”

The patient is not professional, and when asked about the medical history, she will say a lot of irrelevant things.

These things, a lot of them are nonsense, but.

There are many times, but it is possible to search for very important information from these few words.

Lu Cheng's thinking and medical record collection system captured a sentence almost at the same time, and he was even more lame than before.

Lu Cheng hurriedly asked: "Old man, you just said that you are more lame now than before, when was it before, after it started to hurt, or before?"

At the same time, Lu Cheng had already used his spare eyes to catch a glimpse of the pelvic x-ray, and a lot of information that could not be seen on it seemed to be drilling into Lu Cheng's mind again.

Shen Tong line.

Congenital hip subluxation - DDH.

This may be the cause of hip arthritis.

There must be a reason for the diagnosis, for example, at least one heavy physical work?

"I've been like this since I was a child, I didn't walk very well, I went to the county hospital earlier, but we couldn't help it at that time, I was a little lame when I was a child, otherwise I might have gone to high school. "The old man's eyes were cloudy and not scarlet, but they naturally hid too many stories.

These stories, of course, have little to do with the condition.

Congenital hip subluxation is innate, and if it is not corrected as a child, it can cause the hip to swing too much and produce an abnormal gait.

If a little girl and a girl of marriageable age have such a gait, then life can be imagined without Lu Cheng thinking about it.

Lu Cheng pursed his lips, met the words of Professor Min and Lin You, who had not spoken, and replied: "Professor Min, combined with the tips of Senior Brother Zhuoyuan and Senior Brother Liu, and based on the medical history I have asked now, I think the patient's diagnosis is DDH of the right hip and hip arthritis is more likely. And the possibility of necrosis of the femoral head cannot be ruled out. ”

"Although the patient has no history of trauma and no history of alcohol consumption, the symptoms of pain at night are obvious, indicating that the synovitis in the hip joint is very severe, or the femoral head is necrotic, but according to the patient's current examination data, it cannot be diagnosed. ”

According to Brother Liu's previous diagnostic criteria, the patient currently has stage 3 hip arthritis and has strong symptoms, which meets the indications for total hip arthroplasty. ”

Professor Min glanced at Lin You, who was still standing in the distance and didn't give any hints, so he became even more interested.

Professor Min knew that this was Lin You's first student, but he himself had brought a lot of graduate students, and it was not easy for him to capture so many details from Zhuoyuan's mouth and the words of the patient after only half a month of entering the department!

How much Zhuo Yuan's level can be, he is still very clear.

Professor Min thought for a moment and nodded, "You go on, then what do you think should be done?"

"Considering that the patient has congenital DDH and the acetabulum development is shallow, the acetabulum is polished and deepened according to the situation during the operation, and even acetabular capping bone grafting. It's like changing her current pan into the shape of a normal pan, which is more conducive to accommodating the femoral head. Reduce the risk of postoperative dislocation. ”

Speaking of this, Lu Chengcheng said more and more smoothly: "Since the patient has decided to have surgery, there is no need for MR of the hip to diagnose femoral head necrosis for the time being, because regardless of whether there is femoral head necrosis or not, there is already cartilage damage in the femoral head, and the old man is older than 65 years old, which meets the surgical indications for total hip arthroplasty." ”

As soon as these words came out, the piece in Lu Cheng's hand was given out.

Zhuo Yuan, Liu Zhi and others copied the pelvic plain film again, Zhuo Yuan suddenly slapped his forehead and whispered: "I'll just look at the joint gap." And I read the report of the radiology department again. ”

Of course, Professor Min knew that Zhuo Yuan, Liu Zhi and others basically only read the report, and he actually did not expect that the level of Zhuo Yuan's graduate students would be higher than that of professors in the radiology department.

But there are some professional problems, in his eyes, but he will not take the radiology report as a dogma.

Professor Min was very satisfied with Lu Cheng's answer, but if he only said this, of course, it would not be in line with the purpose of teaching ward rounds.

But then asked Lu Cheng again, that was to be a little embarrassed for him, but turned the question to Lin You: "Xiao Lu is very good, Xiao Youyou." What are your thoughts on the patient's recovery after surgery?"

What Professor Min means is that your apprentice has completed the first half, and the next postoperative rehabilitation guidance, you shouldn't dump this task on me again, right?