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2025/06/12

嬰兒顱骨修補與長期照護 Literature review

適用對象：4 個月大、曾因頭骨粉碎性骨折接受顱骨修補手術之嬰兒家屬
目的：說明目前情況、後續手術計畫、日常照護及警訊，協助家屬安心參與治療流程
本手冊僅供衛教，治療計畫仍以主治醫師判斷為準。

一、目前傷勢與治療目標

現況：因外傷切除約 7 % 腦組織，頭骨缺損以「自體骨碎片 + 人工骨」暫時覆蓋，硬腦膜有縫合缺口，手術後需觀察腦脊髓液（CSF）外漏。
短期目標：
1. 保護腦組織不再受壓或感染
2. 讓顱骨持續生長、減少人工骨排斥或吸收
3. 預防／監測 CSF 外漏與顱內壓升高
長期目標：於 15–18 歲頭顱生長趨於穩定時，更換「客製化大片人工骨」，獲得終生保護與外觀對稱。

二、常用人工骨材料（簡易比較）

材料	特色	何時適用
可吸收聚合物網 (PCL/PLA)	1–3 年內自行分解，讓自體骨逐漸取代	嬰兒暫時性護蓋
鈦網／鈦板	強度高、不易感染，但影像會反光	青少年或成人，需較強支撐時
PEEK 3D 客製骨片	與骨硬度相近、影像清晰、可精準密合	最終替換首選（15–18 歲）
多孔羥基磷灰石	可與骨融合，生物相容佳	邊緣規則的缺損，可與鈦複合使用

（取材自系統性文獻回顧與重點整理）

三、手術時程與流程

嬰兒期（已完成）
- 可吸收網 + 自體骨碎片「浮動式」覆蓋
- 同場硬腦膜補片與 CSF 引流，降低外漏風險
青春期（約 15–18 歲）
- 3D 影像掃描 → 電腦設計 → 客製化 PEEK／鈦片
- 拆除舊植入物、再次檢查硬腦膜完整性
- 低輪廓鈦板固定，外觀及保護一次到位

四、住院與出院後照護重點

1. 住院／急性期

頭部姿勢：避免壓到手術側，床頭抬高 30°。
傷口觀察：有清澈液體滲出或傷口變紅即通知醫護。
抗生素與點滴：遵醫囑足量完成，降低感染。

2. 出院後 3 個月內

軟式頭盔：全天配戴（除洗頭外），保護植入區。
活動：可側躺、抱抱，避免劇烈搖晃或撞擊。
營養：先從配方奶／母乳 → 稀糊狀副食品，少量多餐，有助傷口癒合並減輕腸胃負擔。
門診追蹤：術後 2 週、1 月、3 月；之後每 3–6 月量頭圍、照低劑量 CT。

3. 長期照護

神經發展：定期物理／職能／語言治療評估。
預防感染：有感冒、牙科處置前告知醫師，必要時短程抗生素覆蓋。
多學科團隊：與神經外科、復健科、營養師及社工合作，提供整合性支持。

五、腦脊髓液（CSF）外漏監測

家屬可觀察的訊號	可能原因	處理建議
傷口持續透明液滴	CSF 外漏	立刻回院檢查 Beta-2 轉鐵蛋白
突然嗜睡、嘔吐	顱內壓升高	急診 CT 評估
頭皮／縫線區腫脹	引流不足或感染	就醫抽液培養

（監測技術趨勢與多學科合作重點）

六、感染預防 4 大原則

手部衛生：抱嬰兒前後以酒精搓手 30 秒。
傷口乾燥：保持清潔、勿自行塗抹未經醫師同意的藥膏。
避免人潮：術後 1 月避免帶至公共場所。
完整疫苗：依兒科時程接種，減少重症風險。

（根據術後感染風險研究與國際指引摘要）

七、何時需要立即就醫？

傷口滲液、腫脹或有惡臭
體溫 > 38 °C 或突然嗜睡、抽搐
頭盔鬆脫、明顯變形或壓痛
持續嘔吐、眼神呆滯、哭鬧不止

以上症狀可能代表感染、顱內壓變化或植入物問題，請立即就醫。

八、家屬支持資源

院內個管師：協助安排門診、檢查與轉介復健
營養諮詢門診：評估熱量與副食品進程
早療中心：提供發展里程碑評估與訓練
心理諮商：當照顧壓力大時適時求助

結語

透過分階段手術、嚴謹追蹤與家庭合作，大多數顱骨缺損兒均能獲得良好腦部保護與生活品質。若對治療計畫、材料選擇或照護流程有疑問，請隨時與醫療團隊討論。祝寶寶健康成長！

# 研究問題 1: 四個月大嬰兒頭骨部分粉碎性骨折，切除7%的腦部組織，目前使用人工骨與自體骨透過縫線活動掩蓋腦組織，而腦膜因為手術切割有缺口，造成腦隋液外漏，預計十五到十八歲需要替換更大片的人工骨，人工骨的材料跟手術方式有哪些選擇? 手術前後需要怎樣照顧

---

> 本摘要由自動分群產生，每一子問題會列出重要發現、研究缺口、五篇代表性文獻及 AI insight 筆記。

## **子問題 1: 人工骨的材料有哪些選擇？**

## **人工骨的材料有哪些選擇？**

### 1. 梳理主要發現/研究缺口

目前的研究顯示，人工骨材料的選擇主要包括合成骨材料、聚合物、陶瓷及其複合材料等。然而，對於這些材料的具體結構特徵及其對骨再生的影響仍需進一步探討，特別是在抗菌性和生物相容性方面的整合。

### 2. 五篇最具代表性的文獻

- **Optimal structural characteristics of osteoinductivity in bioceramics derived from a novel high-throughput screening plus machine learning approach.** (2025)

- **Characterization and osteogenic potential of caffeic acid-enriched alginate/poly(vinyl alcohol) composite hydrogels for bone tissue engineering.** (2025)

- **Current Advances of Antibacterial Biomaterials for Bone Regeneration.** (2025)

- **3D-printed polymeric biomaterials in bone tissue engineering.** (2025)

- **Update on synthetic biomaterials combined with fibrin derivatives for regenerative medicine: Applications in bone defect treatment: Systematic review.** (2025)

### **Insight 筆記**

未來的人工骨材料設計應重視結構特徵與生物相容性的整合，以提升骨再生效果及抗菌性能。

---

## **子問題 2: 何時需要回診檢查手術效果？**

## 主要發現/研究缺口

在手術後的護理中，對於女性患者、心臟手術及其他手術類型的術後效果評估至關重要。文獻指出，術後檢查的時機和頻率可能因患者的性別、手術類型及併發症風險而異，然而目前對於何時進行回診檢查的具體指導仍然不足。

## 具代表性的文獻

1. **Postoperative considerations for females undergoing total hip arthroplasty** (2026)

2. **Repairing Degenerative Mitral Valve Disease** (2026)

3. **Surgical Bypass for Tibial-Peroneal Arterial Occlusive Disease** (2026)

4. **Minimally Invasive Coronary Artery Bypass Grafting** (2026)

5. **High-dose inhaled NO for the prevention of nosocomial pneumonia after cardiac surgery under cardiopulmonary bypass** (2025)

## **Insight**

**術後檢查的時機應根據患者的具體情況和手術類型進行個別化評估，以確保最佳的恢復效果。**

---

## **子問題 3: 在十五到十八歲時，替換人工骨的手術流程是什麼？**

## **在十五到十八歲時，替換人工骨的手術流程是什麼？**

### 1. 梳理主要發現/研究缺口

本研究探討了肱骨幹骨折的失敗骨內固定修復，強調了修復手術中使用骨移植的有效性及其對於結合時間和功能恢復的影響。雖然已證實修復手術能有效解決機械失敗問題，但針對青少年患者的具體手術流程及其長期效果仍需進一步研究。

### 2. 列出五篇最具代表性的文獻

- FAILED OSTEOSYNTHESIS OF HUMERAL SHAFT FRACTURE - OUR EXPERIENCE OF 12 CASES WITH REFIXATION & BONE GRAFT. (2024)

- [文獻標題待補充] (年份待補充)

### 3. **Insight 筆記**

**修復手術的成功依賴於精確的手術技術和個別化的治療計劃，特別是在青少年患者中。**

---

## **子問題 4: 在康復過程中，應該注意哪些行為或活動？**

## 主要發現/研究缺口

在康復過程中，應特別注意行為和活動的多樣性，包括早期動員、社會支持、心理干預及個性化的康復計劃。現有文獻顯示，儘管有許多有效的康復策略，但在實施過程中仍存在顯著的差距，特別是在不同文化和地區的適應性方面。

## 具代表性的文獻

1. **Optimizing Rehabilitation Outcomes Through Rehabilitative Ultrasonography: Applications in Musculoskeletal Care** (2025-07-01)

2. **Psychological interventions in adolescents and young adults with cancer: a scoping review targeting protective factors of resilience** (2025-07-01)

3. **Rehabilitation needs, preferences, barriers, and facilitators of individuals with sepsis: a qualitative study** (2025-06-01)

4. **Rehabilitation of COVID-19 patients in hospital settings during the pandemic: a phenomenological study of Finnish physiotherapists' perspective** (2025-06-01)

5. **New Findings from University of Cape Coast Describe Advances in Osteoarthritis** (2025-06-13)

## **Insight 筆記**

**在康復過程中，應重視多元化的干預措施，以提升患者的整體康復效果。**

---

## **子問題 5: 在手術過程中，如何確保腦部組織的安全？**

## **在手術過程中，如何確保腦部組織的安全？**

### 主要發現/研究缺口

在手術過程中，確保腦部組織的安全需要精確的術中監測技術和先進的影像系統。文獻指出，現有的手術技術和監測方法仍有改進空間，特別是在神經保護和血流管理方面，以降低手術風險並提高患者的術後結果。

### 代表性文獻

1. **Aortic Arch Aneurysms** (2026)

2. **Surgical applications of the Ultraleap 3Di-based gesture-controlled 3D imaging visualization system** (2025)

3. **Laparoscopic cholecystectomy for duplication of the gallbladder: A case report** (2025)

4. **Patent Issued for Surgical tracking methods and fiber optic shape sensing devices thereof** (2025)

5. **Intraoperative neural monitoring system and method** (2025)

### **Insight**

**術中監測技術的進步對於保護腦部組織至關重要，未來需持續探索更精確的影像和神經監測方法。**

---

## **子問題 6: 如何監測腦隋液外漏的情況？**

## 主要發現/研究缺口

目前對於腦隋液外漏的監測方法尚不夠完善，傳統的臨床評估方法存在主觀性，缺乏客觀的量化指標。新興的非侵入性監測技術和生理學基礎的臨床決策方法有潛力改善這一情況，但仍需進一步的研究來驗證其有效性和應用範圍。

## 具代表性的文獻

1. **Bedside Hemodynamic Monitoring in the Intensive Care Unit** (2026)

2. **Coronary and Peripheral Artery Hemodynamics** (2026)

3. **EEG microstate biomarkers for schizophrenia: a novel approach using deep neural networks** (2025)

4. **Identifying liver cirrhosis in patients with chronic hepatitis B: an interpretable machine learning algorithm based on LSM** (2025)

5. **Enhanced dysarthria detection in cerebral palsy and ALS patients using WaveNet and CNN-BiLSTM models: A comparative study with model interpretability** (2025)

## **Insight**

**未來的腦隋液外漏監測應結合新興的非侵入性技術與量化指標，以提高診斷的準確性和客觀性。**

---

## **子問題 7: 手術中使用的自體骨與人工骨的優缺點是什麼？**

## 1. 主要發現/研究缺口

自體骨和人工骨各有其優缺點。自體骨具有良好的生物相容性和促進骨再生的能力，但取材困難且可能造成二次傷害。人工骨則可避免取材問題，並可設計以符合特定需求，但其生物活性和整合性常不如自體骨。未來研究需聚焦於提高人工骨的生物活性及整合性。

## 2. 具代表性的文獻

1. **Dual-functional biomimetic periosteum with electrical activity and antibacterial property: Sulfonated polyaniline/polypyrrole codoped polycaprolactone scaffold for electrically driven bone-nerve regeneration** (2025)

2. **Repurposing biowaste for biomedical applications: Eggshell containing injectable bone substitution cements for bone regeneration** (2025)

3. **Regulation of osteoimmune microenvironment via functional dynamic hydrogel for diabetic bone regeneration** (2025)

4. **Monolithic copper-doped carbonated apatite synthesized at low-temperature exhibits in vitro antibacterial effect and in vivo bone regenerative properties** (2025)

5. **Liquid metal based electroconductive artificial periosteum boosts bone regeneration** (2025)

## **Insight**

**自體骨在生物相容性和再生能力上優於人工骨，但取材困難；人工骨則需提升其生物活性以更好地促進骨再生。**

---

## **子問題 8: 手術後需要進行哪些護理措施以防止感染？**

## 主要發現/研究缺口

手術後感染的預防措施在不同地區和手術類型中存在顯著差異，尤其在低收入和中等收入國家中，感染率較高。文獻中對於手術後護理措施的具體實施和效果評估仍有不足，亟需針對不同手術類型和患者特徵制定更具針對性的感染預防策略。

## 具代表性的文獻

1. **Genomic characterizations of Klebsiella variicola: emerging pathogens identified from sepsis patients in Ethiopian referral hospitals.** (2025)

2. **Impact of antibiotic stewardship on infection rates in oral surgery procedures: a descriptive study.** (2025)

3. **Regional variations in incidence of surgical site infection and associated risk factors in women undergoing cesarean section: A systematic review and Meta-Analysis.** (2025)

4. **Systematic Review of Surgical Site Infection Prevention Guideline Recommendations for Maintenance of Homeostasis in the Perioperative Period.** (2025)

5. **The Three-Month Wound Complication and Infection Rates After Vancomycin Powder and Dilute Povidone-Iodine Lavage for Infection Prophylaxis in High-Risk Total Joint Arthroplasty: A Multicenter Randomized Controlled Trial.** (2025)

## **Insight 筆記**

**手術後的護理措施應根據患者特徵和手術類型制定個性化的感染預防策略，以降低感染風險並改善患者結果。**

---

## **子問題 9: 有無可能的併發症需要特別注意？**

## **有無可能的併發症需要特別注意？**

1. **主要發現/研究缺口**

多篇文獻強調手術後併發症的風險，尤其是在特定手術（如深頸靜脈淋巴吻合術、腹腔鏡腎上腺切除術等）中，併發症的發生可能影響患者的恢復和生活品質。需要進一步研究如何有效預防和管理這些併發症，以改善患者的術後結果。

2. **五篇最具代表性的文獻**

- **Perioperative care and recovery outcome of deep jugular venous lymphatic anastomosis in Alzheimer's disease: A case report.** (2025)

- **Intraoperative Ultrasound Guidance in Laparoscopic Adrenalectomy: A Retrospective Analysis of Perioperative Outcomes.** (2025)

- **Spilled but Not Forgotten: A Retained Gallstone Leading to Colonic Fistula Formation.** (2025)

- **Evaluating Surgical Safety and Quality Assurance by Conducting an Audit of WHO Checklist Implementation in a Tertiary Care Hospital.** (2025)

- **Healthcare workers' perceptions of postoperative care and implementation challenges in conflict-affected northwest Syria: a mixed-methods analysis.** (2025)

3. **Insight 筆記**

**術後併發症的管理與預防至關重要，需加強醫療團隊的協作與患者的術後護理。**

---

# 綜合小結

> 上述內容為各子問題自動化證據綜述。請進一步根據每個 insight 做研究延伸！

# 系統性綜述報告

## 子問題分群分析

---

### ❓ 子問題 1：人工骨的材料有哪些選擇？

#### 🔑 關聯關鍵詞：artificial bone、material options、biomaterials、orthopedic applications、tissue engineering、biocompatibility

#### 🔎 相關文獻摘要（取最近10篇）

**1. Study Data from China Medical University Provide New Insights into Artificial Bone (Enhanced functionalities of biomaterials through metal ion surface modification).**（2025）

> A study conducted by China Medical University explores the use of metal ions such as zinc, copper, magnesium, calcium, strontium, silver, and cerium in enhancing the functionalities of biomaterials for **bone** tissue regeneration. These metal ions have been found to promote osteogenesis, angiogenesis, inhibit osteoclast activity, and deter bacterial infections, leading to the development of **artificial** **bone** **materials</hi...

**2. Enhanced functionalities of biomaterials through metal ion surface modification.**（2025）

> Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.The development of new **artificial** biomaterials for **bone** defect repair is an ongoing area of clinical research. Metal ions such as zinc, copper, magnesium, calcium, strontium, silver, and cerium play various roles in **bone** tissue rege...

**3. Researchers' Work from Taiyuan University of Technology Focuses on Artificial Bone (Antibacterial Properties of Carbon Fiber/polyether Ether Ketone Artificial Bone Composites Modified By Black Phosphorus Coating Assisted By Wet Chemical...).**（2025）

> Researchers from Taiyuan University of Technology in China have focused on improving the antibacterial properties of Carbon Fiber Reinforced Polyetheretherketone (CFR-P) composites used as **artificial** **bone** replacements. By coating the CFR-P with Black Phosphorus (BP) using wet chemical pretreatment, they achieved significantly higher hydrophilicity and antibacterial rates against common pathogens like Staphylococcus aureus and Escherichia coli. The st...

**4. Characterization and osteogenic potential of caffeic acid-enriched alginate/poly(vinyl alcohol) composite hydrogels for bone tissue engineering**（2025）

> @@@@Highlights •First report on Facile and low-cost strategy where caffeic acid (CA) is introduced in sodium alginate (SA)/poly(vinyl alcohol) (PVA) polymer domain resulting in composite hydrogels for **Bone** **regeneration** applications.•Notable cytocompatibility with pronounced osteogenic activity.•Hemocompatible system with adequate mechanical strength.•Non-toxic to Mesenchymal Stem Cells derived from Wharton's Jelly (WJ-MSCs) underlining their biocompa...

**5. Current Advances of Antibacterial Biomaterials for Bone Regeneration.**（2025）

> Infectious **bone** defects represent a significant clinical challenge, characterized by prolonged treatment durations, high medical costs, a propensity for recurrence, and a risk of disability. This issue remains a critical concern in the orthopedic field globally. The successful management of infectious **bone** defects hinges on two primary aspects: **bone** reconstruction and eradication of infection. Synthetic **bone</highlig...

**6. Dual-Functional Peptide DPI-VTK Promotes Mesenchymal Stem Cell Migration for Bone Regeneration.**（2025）

> Targeting specific populations of host cells with chemotactic and adhesion factors is a promising strategy for inducing **bone** **regeneration** without the use of exogenous cells. Two peptide sequences have been derived from phage display: the mesenchymal stem cell (MSC) binding DPI (DPIYALSWSGMA) sequence and the apatite binding VTK (VTKHLNQISQSY) sequence. When combined into the dual-functional sequence, DPI-VTK increases the adhesion strength of MSCs to...

**7. Findings on Tissue Engineering Reported by Investigators at University of Michigan (Dual-functional Peptide Dpi-vtk Promotes Mesenchymal Stem Cell Migration for Bone Regeneration).**（2025）

> Researchers at the University of Michigan have developed a dual-functional peptide, DPI-VTK, that promotes the migration of mesenchymal stem cells (MSCs) for **bone** **regeneration**. By combining two peptide sequences derived from phage display, DPI-VTK enhances MSC adhesion to apatite surfaces and increases **bone** formation with transplanted MSCs. The study demonstrates the potential of phage-derived peptides to enhance MSC migration ...

**8. Synthesis and Osteoinductive Properties of Nanosized Lithium-Modified Calcium-Organic Frameworks.**（2025）

> The development of **biomaterials** that enhance **bone** healing and integrate with native **bone** tissue has gained significant interest. Metal-organic frameworks (MOFs) have emerged as promising candidates due to their unique surface properties and biocompatibility. While various bioactive element-incorporated MOFs have been studied, the osteogenic potential of lithium (Li)-modified MOFs remains largely unexplored. This study presents ...

**9. New Tissue Engineering Study Findings Have Been Reported from SINOPEC Beijing Research Institute of Chemical Industry (Current Advances of Antibacterial Biomaterials for Bone Regeneration).**（2025）

> A recent study conducted at the SINOPEC Beijing Research Institute of Chemical Industry in Beijing, China, focused on the challenges posed by infectious **bone** defects in orthopedic medicine. The research highlighted the need for non-antibiotic antibacterial strategies to address **bone** infections, emphasizing the importance of incorporating antibacterial components into **bone** repair materials. The study aimed to provide insights fo...

**10. Update on synthetic biomaterials combined with fibrin derivatives for regenerative medicine: Applications in bone defect treatment: Systematic review.**（2025）

> Competing Interests: Conflict-of-interest statement: The authors declare that they have no competing interests.Background: **Bone** **regeneration** is a central focus of regenerative medicine, with applications in orthopedics and dentistry, particularly for treating **bone** defects caused by trauma, infection, or congenital anomalies. Synthetic **biomaterials**, often combined with fibrin derivatives, offer promi...

> **📒 Insights Notes**

1. **金屬離子在人工骨材料中的應用潛力**

近期的研究顯示，金屬離子如鋅、銅、鎂、鈣、鍶、銀和鉺等在人工骨材料中具有顯著的生物活性，能夠促進骨組織再生。這些金屬離子不僅能促進成骨細胞的增殖和血管生成，還能抑制破骨細胞的活性，從而減少骨質流失。此外，某些金屬離子如銀和銅具有抗菌特性，能有效降低感染風險。這一發現不僅為人工骨材料的設計提供了新的思路，也為臨床應用開闢了新的方向。未來的研究應著重於金屬離子的最佳濃度及其在不同生物環境中的行為，以進一步提升人工骨材料的性能。

2. **抗菌策略的創新與挑戰**

隨著抗生素耐藥性問題的加劇，傳統的抗菌策略在骨缺損修復中的應用受到限制。因此，開發非抗生素的抗菌策略成為當前研究的熱點。研究者們正致力於將抗菌成分整合進人工骨材料中，以創造出具有抗菌微環境的材料，這不僅能促進骨再生，還能有效防止感染的發生。這一趨勢顯示出未來的骨修復材料將更加注重多功能性，結合生物相容性、抗菌性及促進骨再生的特性。然而，如何在不影響骨再生的前提下，確保抗菌劑的有效性和持久性，仍然是一大挑戰。

3. **合成生物材料與生物相容性改進的趨勢**

隨著生物材料科學的進步，合成生物材料在骨再生中的應用越來越受到重視。研究表明，將合成材料與生物衍生物（如纖維蛋白）結合，可以顯著提升材料的生物相容性和骨導向性。這種組合不僅能改善細胞附著和增殖，還能促進骨組織的再生。未來的研究應該集中於探索不同合成材料與生物衍生物的最佳組合，以實現更高效的骨修復效果。此外，對於這些材料的長期穩定性和臨床應用的可行性也需要進一步的實驗和臨床試驗來驗證。

---

### ❓ 子問題 2：手術中使用的自體骨與人工骨的優缺點是什麼？

#### 🔑 關聯關鍵詞：autologous bone、synthetic bone、advantages、disadvantages、surgical use、comparison

#### 🔎 相關文獻摘要（取最近10篇）

**1. Freeze-drying partially set α-tricalcium phosphate: A new route to granular calcium phosphate cement with enhanced setting ability and porous structure**（2025）

> Calcium phosphate cements (CPC), used for settable **synthetic** **bone** **grafts**, offer unique advantages, including applicability to complex defects and post-operative stability. Current CPC pose a problem because they set into dense blocks, preventing cell intrusion within the cement. Introducing porous structures into the cement is crucial for optimal **bone** regeneration. The present study aimed to develop a gra...

**2. University of Aberdeen Researchers Highlight Recent Research in Tissue Engineering (Early new bone formation in ovine intramuscular defects: comparison between different silicate-containing calcium phosphate synthetic bone grafts).**（2025）

> University of Aberdeen researchers conducted a study on the **bone** forming potential of three silicate-containing calcium phosphate **synthetic** **bone** **grafts** in an ovine intramuscular defect model. The study found that one of the **bone** **grafts** with a nano-scale microstructure resulted in significant new **bone** formation and evidence of graft resor...

**3. 3D‐Printed Bioceramic Scaffolds Reinforced by the In Situ Oriented Growth of Grains for Supercritical Bone Defect Reconstruction.**（2025）

> Porous **calcium** **phosphate** **ceramics** have attracted widespread attention owing to their excellent bioactivity. However, their poor mechanical properties severely limit their clinical applications. Significantly improving the mechanical strength of porous CaP **ceramics** while maintaining their bioactivity remains a major challenge. To address this issue, **calcium** sulfate is used to regulat...

**4. Regeneration of a Rabbit Segmental Defect with a New Bone Therapy: Autologous Blood Coagulum with Bone Morphogenetic Protein 6 and Synthetic Ceramics.**（2025）

> Competing Interests: Competing interests: S.V. is a founder of Genera Research and a coordinator of the EU HORIZON 2020 grant OSTEOproSPINE funding clinical studies of the new drug for bone repair (patent WO2019076484A1).Segmental defects of long bones are among the most challenging and debilitating conditions in clinical medicine. Osteogrow-C is a novel osteoinductive device composed of recombinant human bone morphogenetic protein 6 (rhBMP6) delivered within autologous blood coagulum (ABC...

**5. Fusion Rate of Biphasic Calcium Phosphate Bone Graft with Needle-Shaped Submicron Surface Topography in Interbody Lumbar Fusion for Degenerative Disc Disease: A Single-Center Retrospective Review.**（2025）

> Background: **Calcium** **phosphate** bone grafts are emerging as alternatives to autologous bone grafts in lumbar spinal fusion. This study evaluates the 12-month fusion rate and clinical outcomes of lumbar interbody fusion using synthetic biphasic **calcium** **phosphate** with submicron needle-shaped surface topography (BCP<μm).Methods: A retrospective review identified patients who underwent lumbar interbody...

**6. Osteosynthesis of Three- and Four-Part Proximal Humerus Fractures in Elderly Patients Using Locking Plates and Synthetic Bone Grafts: A Clinical and Radiographic Evaluation.**（2025）

> Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Ethics Committee for Research of the Instituto de Assistência Médica ao Servidor Público Estadual issued approval 47205821.7.0000.5463. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Paym...

**7. Investigation on structurally reinforced synthetic bone grafts via tricalcium silicate.**（2025）

> Tricalcium silicate (C3S) is one of the main components of mineral trioxide aggregates, which is used in dental endodontic treatment. C3S provides workable viscosity itself and fast hydration when water is added, and it is known to be nontoxic, noncarcinogenic, nongenotoxic, biocompatible, and insoluble in tissue fluids. In this study, C3S is added to **synthetic** **bone**‐graft materials from 30% to 60% to deliver viscosity to increase workability in the e...

**8. OUR EXPERIENCE IN USING MODIFIED BIOACTIVE CERAMICS FOR THE RECONSTRUCTION OF CRITICAL POST-TRAUMATIC BONE DEFECTS.**（2025）

> According to statistical data from the National Military Medical Clinical Center for the period from February to May 2022, bone defects in gunshot fractures accounted for 76 % of cases, with defects exceeding 6 cm -- classified as critical -- found in 28 % of cases. Currently, the "gold standard" for reconstructing critical bone defects is the induced membrane technique, also known as the two-stage Masquelet technique. The most promising substitute for autologous bone is considered to be biphasi...

**9. Improving Real-Time Feedback During Cochlear Implantation: The Auditory Nerve Neurophonic/Cochlear Microphonic Ratio.**（2025）

> Competing Interests: The other authors have no conflicts of interest to disclose.Objectives: Real-time **monitoring** of cochlear function to predict the loss of residual hearing after cochlear implantation is now possible. Current approaches monitor the cochlear microphonic (CM) during implantation from the electrode at the tip of the implant. A drop in CM response of >30% is associated with poorer hearing outcomes. However, there is prior evidence that CM amplitude ...

**10. The Impact of Prophylactic Negative Wound Pressure Treatment (NWPT) on Surgical Site Occurrences After Gynecologic Cancer Surgery: A Meta-Analysis of Randomized Controlled and Observational Cohort Studies.**（2025）

> Simple Summary: Oncologic outcomes of gynecologic cancer patients undergoing surgery could be influenced by several factors including postoperative **complications**. **Surgical** wound infections still remain an important postoperative side effect even after gynecologic oncological operations. Their incidence has been related to patient-related and wound-related risk factors. However, not several preventive measures have been proved efficient yet. Negative ...

> **📒 Insights Notes**

1. **自體骨與人工骨的生物相容性與再生潛力**

自體骨在骨再生中被視為金標準，因其具有良好的生物相容性和促進骨癒合的能力。然而，隨著人工骨材料的技術進步，許多新型合成骨材料（如鈣磷陶瓷）顯示出優越的生物活性和再生潛力。研究顯示，某些合成骨材料能夠在體內快速轉化為羥基磷灰石，並促進骨細胞的增殖和分化，這使得它們在臨床應用中逐漸受到重視。未來的研究應著重於如何進一步提高這些合成材料的生物相容性，並探索其在複雜骨缺損修復中的應用潛力，以期能在不依賴自體骨的情況下達到相似的治療效果。

2. **技術創新對骨移植材料的影響**

隨著3D列印技術和生物材料科學的進步，合成骨材料的設計和製造方式正在發生變革。研究顯示，通過調整材料的微觀結構和機械性能，可以顯著提高其在骨缺損修復中的表現。例如，利用定向生長的水合磷灰石晶粒來增強材料的機械強度，這不僅改善了材料的承載能力，還促進了骨再生的生物活性。這一趨勢表明，未來的骨移植材料將不僅僅依賴於傳統的化學組成，還需要考慮其結構設計和製造工藝，以達到最佳的臨床效果。

3. **臨床應用中的挑戰與未來方向**

雖然合成骨材料在臨床應用中顯示出良好的潛力，但仍存在一些挑戰需要克服。例如，合成材料的長期生物相容性、機械強度的持久性以及與周圍骨組織的整合能力等問題，仍需進一步研究。此外，臨床上對於不同患者的個體差異（如年齡、健康狀況等）對骨癒合的影響也需要更多的實證支持。未來的研究應該聚焦於個性化醫療，根據患者的具體情況選擇最合適的骨移植材料和技術，以提高治療效果並降低併發症的風險。

---

### ❓ 子問題 3：在手術過程中，如何確保腦部組織的安全？

#### 🔑 關聯關鍵詞：surgical safety、brain tissue protection、intraoperative monitoring、neurosurgery techniques、risk management、patient outcomes

#### 🔎 相關文獻摘要（取最近10篇）

**1. 6 - Carotid Endarterectomy**（2026）

> Atherosclerotic carotid stenosis is a common cause of ischemic stroke. Carotid endarterectomy (CEA) remains the preferred approach for surgical management of symptomatic and asymptomatic carotid artery disease in patients with acceptable operative risk. This chapter reviews the indications for CEA as well as scenarios in which carotid stenting may be preferred, followed by a detailed description of recommended preoperative preparation, essential operative steps, potential anatomic variants, and ...

**2. Adaptive sensitivity-fisher regularization for heterogeneous transfer learning of vascular segmentation in laparoscopic videos.**（2025）

> Competing Interests: Declarations. Conflict of interest: The authors declare that there are no conflict of interest regarding the publication of this paper.Purpose: This study aims to enhance **surgical** **safety** by developing a method for vascular segmentation in laparoscopic surgery videos with limited visibility. We introduce an adaptive sensitivity-fisher regularization (ASFR) approach to adapt neural networks, initially trained on non-medical d...

**3. Missouri University of Science and Technology Researchers Focus on Tissue Engineering (Bone void filler materials for augmentation in comminuted fractures: a comprehensive review).**（2025）

> The article focuses on advancements in tissue engineering related to the management of comminuted fractures, which are complex bone injuries characterized by multiple fragments. Researchers from Missouri University of Science and Technology review various bone void filler materials, including autografts, allografts, polymethyl methacrylate (PMMA), and synthetic substitutes like **calcium** **phosphate** **ceramics** and bioactive glass. Wh...

**4. Use of Narrow Calibrated Side-Port Technique to Prevent Occurrence of Intraoperative Floppy Iris Syndrome During Phacoemulsification Surgery.**（2025）

> Competing Interests: The authors report no conflicts of interest in this work.Purpose: To describe the use of a narrow calibrated side-port incision technique in preventing Intraoperative Floppy Iris Syndrome (IFIS).Setting: Dr Om Parkash Eye Institute, Amritsar, India.Design: Prospective interventional study.Methods: Four hundred and fifty eyes of patients using alpha-1 antagonist drug Tamsulosin were included in the study. Phacoemulsification surgery was performed with ...

**5. [Immediate component precision and surgical safety in robot-assisted reverse shoulder arthroplasty].**（2025）

> Objective: To evaluate the immediate component precision and **surgical** **safety** in robot-assisted reverse shoulder arthroplasty (RSA). Methods: A retrospective cohort study was conducted on 32 patients with proximal humeral fractures treated at the Intelligent Orthopedic Research Ward of Beijing Jishuitan Hospital, Capital Medical University between May 2023 and October 2024. The patients were divided into two groups according to **surgical</hi...

**6. New Vertebroplasty Findings from Semmelweis University Reported (Effect of Cold Saline Pre-washing On Cement Leakage In Vertebroplasty: a Novel Approach).**（2025）

> The article focuses on research conducted at Semmelweis University in Budapest, Hungary, regarding the effectiveness of pre-washing vertebral bodies with cold saline to reduce cement leakage during percutaneous vertebroplasty (PVP) procedures. The study analyzed 262 patients and found that using cold saline (4 degrees C) significantly decreased leakage rates compared to conventional methods and room-temperature saline. The research indicated that this approach could enhance **surgical</...

**7. Surgical Care in the Era of Mpox Clade I: A Review and Call for Preparedness.**（2025）

> The Mpox virus, formerly known as Monkeypox, was declared a Public Health Emergency of International Concern in July 2022 due to its rapid global spread. By 2024, the more virulent and fatal Clade Ib variant had reached the United States. While Mpox typically presents with a self-limited rash, severe manifestations requiring **surgical** intervention have become increasingly prevalent, necessitating heightened awareness and preparedness among surgeons.This narrative review, sp...

**8. Inpatient Nutritional Considerations in Inflammatory Bowel Disease.**（2025）

> Competing Interests: Declarations. Competing Interests: The authors declare no competing interests.Purpose of Review: This review aims to explain the causes, diagnosis, and treatment of malnutrition in hospitalized patients with inflammatory bowel disease (IBD), focusing on both adults and children.Recent Findings: Malnutrition is common among IBD patients, affecting up to 85% of individuals, and is linked to higher rates of illness, death, and longer hospital stays. Recent studies h...

**9. Evaluating Surgical Safety and Quality Assurance by Conducting an Audit of WHO Checklist Implementation in a Tertiary Care Hospital.**（2025）

> Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The IRB of FMH College of Medicine and Dentistry issued approval FMH-IRB-1430. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no fina...

**10. A novel perspective on the use of intraoperative high-flow oxygen delivery systems.**（2025）

> The editorial discusses the benefits of using high-flow oxygen delivery systems, such as high-flow nasal oxygen (HFNO) and high-flow tracheal oxygenation (HFTO), during surgery to improve respiratory mechanics, oxygenation, and patient outcomes. HFNO helps maintain positive end-expiratory pressure, stabilizes alveoli, and reduces the work of breathing, while HFTO bypasses dead space and enhances oxygenation in critically ill patients with tracheostomy. These systems offer advantages in reducing ...

> **📒 Insights Notes**

1. **手術安全性與技術創新**

隨著手術技術的進步，確保腦部組織安全的策略也在不斷演變。文獻中提到的各種新技術，如機器人輔助手術和高流量氧氣供應系統，顯示出這些創新不僅提高了手術的精確性，還能有效降低術中併發症的風險。特別是在機器人輔助手術中，精確的術前規劃和定位能夠顯著減少手術過程中的錯誤，從而保護腦部組織不受損害。此外，使用高流量氧氣系統可改善患者的氧合狀態，進一步提升手術的安全性。這些技術的應用不僅提升了手術的成功率，也為未來的手術安全性提供了新的方向。

2. **術前準備與風險管理**

在手術過程中，術前準備的充分性對於確保腦部組織的安全至關重要。文獻中提到的WHO手術安全檢查表的實施，強調了系統性風險管理的重要性。透過檢查表的使用，醫療團隊能夠在手術前進行全面的風險評估，確保所有必要的步驟都得到遵循，從而減少術中意外情況的發生。這種方法不僅提升了手術的安全性，也促進了團隊之間的溝通與協作，進一步降低了術後併發症的風險。因此，強化術前準備和風險管理的策略應成為未來手術安全性提升的重點。

3. **持續教育與研究需求**

隨著手術技術和醫療環境的快速變化，對於醫療人員的持續教育和研究需求也日益增加。文獻中提到的各種新興技術和方法，如冷生理鹽水預洗技術和異質轉移學習，顯示出在手術過程中對於新知識的需求。這些技術的有效性和安全性仍需進一步的研究來驗證，並且醫療人員需要定期接受相關的培訓，以確保他們能夠熟練掌握這些新技術。未來的研究應著重於探索如何將這些新技術整合進現有的手術流程中，以進一步提升腦部組織的安全性和手術的整體效果。

---

### ❓ 子問題 4：手術後需要進行哪些護理措施以防止感染？

#### 🔑 關聯關鍵詞：postoperative care、infection prevention、nursing measures、surgical recovery、wound management、patient safety

#### 🔎 相關文獻摘要（取最近10篇）

**1. Anesthesia and EMI: Ensuring Safe CIED Management During Surgical Procedures.**（2025）

> Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose. Funding for this publication will be provided by the senior author's home institution, the University of Texas Health Center.When planning surgical procedures for patients with conventional pacemakers, leadless pacemakers, cardiac resynchronization therapy devices, or implantable cardioverter-defibrillators, it is imperative to assess the risk of electromagnetic interference to ens...

**2. Beyond traditional orthopaedic data analysis: AI, multimodal models and continuous monitoring.**（2025）

> Multimodal artificial intelligence (AI) has the potential to revolutionise healthcare by enabling the simultaneous processing and integration of various data types, including medical imaging, electronic health records, genomic information and real‐time data. This review explores the current applications and future potential of multimodal AI across healthcare, with a particular focus on orthopaedic surgery. In presurgical planning, multimodal AI has demonstrated significant improvements in diagno...

**3. Barriers and facilitators to prehabilitation of elderly patients with early lung cancer from the perspective of different clinical professionals: a qualitative study.**（2025）

> Background: Understanding the barriers and facilitators of prehabilitation in elderly patients with early-stage lung cancer is of significant importance. This study aimed to elucidate these barriers and facilitators from the perspectives of different clinical professionals. Methods: A qualitative descriptive study was undertaken. Semi-structured interviews with clinical professionals, using purposive sampling and content analysis were conducted in March to May 2023 to summarize and refine the ke...

**4. Findings on Cholecystectomy Reported by Investigators at King Faisal University (Non-invasive Cardiac Output Monitoring With Electrical Cardiometry During Laparoscopic Cholecystectomy Surgery, a Cross-sectional Study).**（2025）

> A recent study conducted at King Faisal University in Alahsa, Saudi Arabia, focused on non-invasive cardiac output **monitoring** during laparoscopic cholecystectomy surgery. The study aimed to measure **intraoperative** responses in cardiac and systemic hemodynamics using electrical cardiometry (EC) technology. Results showed that increased intra-abdominal pressure led to significant decreases in cardiac output, mean arterial blood pressure, and systemic va...

**5. Intraoperative Nerve Monitoring in Thyroid Surgery: A Comprehensive Review of Technical Principles, Anesthetic Considerations, and Clinical Applications.**（2025）

> Background: **Intraoperative** nerve **monitoring** (IONM) is increasingly recognized as an essential technique in thyroid surgery to preserve the integrity of the recurrent laryngeal nerve (RLN) and prevent postoperative complications. Although widely adopted, several technical and anesthetic factors can significantly affect the reliability and interpretation of electromyographic (EMG) signals. Methods: This narrative review summarizes the principles and me...

**6. Systematic Review of Surgical Site Infection Prevention Guideline Recommendations for Maintenance of Homeostasis in the Perioperative Period.**（2025）

> Surgical site infections are common, result in increased patient morbidity and mortality, and increase the economic burden to society. Anesthesiologists play a key role in perioperative **infection** **prevention**, with data suggesting that evidence-based measures can significantly reduce the incidence of these infections. This systematic review aimed to identify and compare current recommendations for the maintenance of homeostasis in surgical site <highli...

**7. Assessment of Surgical Site Infection Prevention Strategies in Obstetric Nursing Practice: A Retrospective Analysis.**（2025）

> Competing Interests: The authors declare no conflicts of interest.Background: Surgical site infections (SSIs) pose significant challenges in obstetric nursing, affecting maternal and neonatal safety.Purpose: This study aimed to evaluate the effectiveness of comprehensive **strategies** for preventing SSIs in obstetric nursing.Methods: A retrospective analysis was conducted on 200 obstetric surgical patients from January 2018 to December 2022. The observation ...

**8. Study Findings on Microorganism Research Described by Researchers at Lucian Blaga University of Sibiu (Experience in Implementing Colonization Screening in a Multidisciplinary County Clinical Hospital in Romania).**（2025）

> A study conducted by researchers at Lucian Blaga University of Sibiu in Romania focused on implementing colonization screening in a multidisciplinary county clinical hospital. The study aimed to investigate the prevalence of colonization by multidrug-resistant organisms in high-risk patients, such as those in ICUs, Oncology, and Hematology Clinics. The research highlighted the importance of tailored **infection** **prevention** **strategies</highlig...

**9. International Clinical Trial: An international cohort study of wound closure and surgical site infection prevention strategies in abdominal surgery**（2025）

> Geneva, June 4 -- International Clinical Trials Registry received information related to the study (ISRCTN55324472) titled 'An international cohort study of wound closure and surgical site **infection** **prevention** **strategies** in abdominal surgery' on May 20. Study Type: Observational Study Design: International prospective cohort study collecting short-term clinical outcomes up to 30 days and long-term patient-reported outcomes up t...

**10. New Typhus Research from University of Siena Outlined [Healthcare Settings and Infection Prevention: Today's Procedures in Light of the "Instructions for Disinfection" Issued During the 1817 Typhus Epidemic in the Grand Duchy of Tuscany...].**（2025）

> The University of Siena conducted research on typhus, highlighting the ongoing challenges of healthcare-associated infections (HCAIs) and the importance of preventive measures. The study compared current healthcare practices with those implemented during the 1817 typhus epidemic in Tuscany, emphasizing the historical significance of early hygiene pioneers like Ignac Fulop Semmelweis and Joseph Lister. The research underscores the enduring relevance of past public health efforts and the need for ...

> **📒 Insights Notes**

1. **強調多學科合作的重要性**

在手術後感染預防的護理措施中，多學科合作顯得尤為重要。文獻中提到，與心臟病學和植入式心臟電子設備（CIED）團隊的合作對於確保患者安全至關重要。這一點在不同的手術類型中均有體現，尤其是在涉及高風險患者的情況下。多學科團隊能夠整合各專業的知識和技能，制定出更為全面的護理計劃，從而提高手術後感染的預防效果。因此，醫療機構應鼓勵不同專業之間的合作，並建立有效的溝通機制，以便在手術前、手術中及手術後進行全面的風險評估和管理。

2. **持續監測技術的應用趨勢**

隨著科技的進步，持續監測技術在手術後護理中的應用越來越普遍。文獻中提到的多模態人工智慧和非侵入性心臟輸出量監測技術，顯示出在手術過程中及術後護理中，實時數據的收集和分析能夠顯著提高患者的安全性和護理質量。這些技術不僅能夠及時發現潛在的併發症，還能幫助醫護人員做出更快的反應，從而降低感染風險。未來，隨著這些技術的進一步發展和普及，手術後護理的質量將會得到顯著提升，並可能成為標準護理流程的一部分。

3. **針對老年患者的預防策略缺口**

在針對老年患者的手術後護理中，文獻指出存在明顯的知識和實踐缺口。許多臨床專業人員對於老年患者的術後護理和感染預防措施的認識不足，這可能導致不必要的併發症和感染風險。文獻中提到的多學科團隊（ERAS-MDT）方法雖然已經開始實施，但仍需進一步強化對老年患者的專業培訓和知識普及。醫療機構應該針對老年患者的特定需求，制定更具針對性的護理計劃，並加強對護理人員的教育和培訓，以提升整體護理質量和患者安全。

---

### ❓ 子問題 5：如何監測腦隋液外漏的情況？

#### 🔑 關聯關鍵詞：cerebrospinal fluid、leakage monitoring、diagnostic methods、clinical assessment、imaging techniques、patient management

#### 🔎 相關文獻摘要（取最近10篇）

**1. [Treatment of cervical ossification of the posterior longitudinal ligament using ultrasonic bone scalpel-assisted anterior controllable antedisplacement and fusion].**（2025）

> Objective: To investigate the technical key points and effectiveness of ultrasonic bone scalpel-assisted anterior controllable antedisplacement and fusion (ACAF) for treating cervical ossification of the posterior longitudinal ligament (OPLL).Methods: Between June 2022 and December 2024, 11 OPLL patients underwent ultrasonic bone scalpel-assisted ACAF. The cohort included 8 males and 3 females, aged 49-74 years (mean, 56.7 years). The OPLL classification included 5 cases of mixed-type, 4 c...

**2. Two-dimensional Speckle Tracking Echocardiography and Fetal Cardiac Performance During Fetoscopic Repair of Myelomeningocele.**（2025）

> No clinical standard exists for **intraoperative** fetal cardiac **monitoring** during maternal-fetal surgery for fetal myelomeningocele (fMMC). This pilot study explores the feasibility of using speckle tracking echocardiography (STE)-derived functional measurements to characterize cardiac performance throughout fetoscopic fMMC and compares these measures with other common **intraoperative** cardiac function parameters. Continuous fetal e...

**3. Perioperative Considerations for a Patient with Juvenile Idiopathic Scoliosis and Kaposiform Lymphangiomatosis Undergoing Spinal Fusion: A Case Report.**（2025）

> Competing Interests: Conflict of Interest: NilIntroduction: Kaposiform lymphangiomatosis is a lymphatic anomaly that, when symptomatic, presents in children at a median age of 6.5 years. Symptoms may include respiratory issues, palpable masses, and hemostatic abnormalities. Kaposiform lymphangiomatosis can be life-threatening due to diffuse tissue expansion and subsequent invasion of surrounding organs and tissues. Initial detection of this rare condition can be difficult due to the varied...

**4. Impact of intraoperative intact PTH monitoring on reoperation rates and surgical success in primary hyperparathyroidism.**（2025）

> Background: Primary hyperparathyroidism (PHPT) is caused by excessive parathormone secretion from one or more parathyroid glands. The primary treatment for PHPT is surgery. Due to anatomical variations in the parathyroid glands, preoperative localization, surgical approaches, and success rates can vary. With the development of advanced imaging techniques and the introduction of **intraoperative** intact PTH (i-PTH) measurement, traditional extended surgical approaches have inc...

**5. Prevention and Management of Spinal Cord Ischemia After Aortic Surgery: An Umbrella Review.**（2025）

> Background/Objectives: Spinal cord injury is a devastating complication of aortic surgery, with significant morbidity and mortality. This review aimed to summarize the current literature on preventing and managing spinal cord ischemia after open and endovascular aortic repair. Methods : We conducted a comprehensive review of PubMed, Scopus, and the Web of Science, focusing on systematic reviews and meta-analyses of the pathophysiology, risk factors, and strategies for mitigating the risk of spin...

**6. Optimizing Surgical Management of Anterior Skull Base Meningiomas: Imaging Modalities, Key Surgical Considerations, and Risk Mitigation Strategies.**（2025）

> Simple Summary: Skull base meningiomas pose significant **surgical** challenges due to their proximity to vital neurovascular structures. Key factors influencing **surgical** outcomes include the integrity of the arachnoid plane, tumor size and consistency, brain edema, nerve involvement, vascular encasement, and invasion of critical areas. These factors affect the feasibility of complete tumor removal and postoperative recovery. This review explores critica...

**7. Laparoscopic Partial Nephrectomy Tips and Tricks.**（2025）

> This video article presents tips and techniques for laparoscopic partial nephrectomy (LPN), emphasizing the importance of preoperative assessment with advanced imaging techniques like 3-dimensional reconstruction. The transperitoneal approach, precise trocar placement, and intraoperative ultrasound guidance are highlighted for optimal **surgical** outcomes. The role of renorrhaphy, with considerations for suturing techniques and materials, is discussed, particularly focusing o...

**8. Research Reports from Fudan University Provide New Insights into Laminectomy (Hybrid decompression-based surgical strategy for treating multilevel thoracic ossification of the ligamentum flavum: a retrospective study).**（2025）

> The article focuses on a study comparing hybrid laminectomy techniques to conventional en bloc laminectomy for treating multilevel thoracic ossification of the ligamentum flavum (TOLF). Conducted by researchers from Fudan University in Shanghai, the retrospective study involved 48 patients and assessed outcomes such as motor-evoked potentials (MEPs) and **cerebrospinal** **fluid** **leakage** (CFL). Results indicated that the hybrid approa...

**9. Dural Tears and Cerebrospinal Fluid Leak in Osteotomy Surgery for Ankylosing Spondylitis: Incidence, Risk Factors.**（2025）

> Objective: The osteotomy surgery for ankylosing spondylitis (AS) presents a higher risk of dural injury and **cerebrospinal** **fluid** **leakage** compared to conventional spinal surgical procedures. However, there is currently a lack of systematic summaries in this field. This study aims to present the incidence and risk factors associated with dural tears and **cerebrospinal** **fluid** (CSF) <highl...

**10. Enhancing Localization in Multiple Spontaneous Cerebrospinal Fluid Leakage Reconstruction With Fluorescence Endoscopy: A Case Study.**（2025）

> Competing Interests: The authors have no financial interest to declare in relation to the content of this article. This work was supported by the National Natural Science Foundation of China (82103690).Spontaneous **cerebrospinal** **fluid** (CSF) **leakage**, with unknown etiology, is challenging to diagnose and repair, particularly in localizing the leak. We present a 40-year-old woman with multiple spontaneous CSF rhinorrheas. Con...

> **📒 Insights Notes**

1. **腦隋液外漏監測技術的發展趨勢**

隨著醫療技術的進步，腦隋液外漏的監測方法也在不斷演變。文獻中提到的超聲波技術和螢光內視鏡的應用，顯示出對於腦隋液外漏的定位和修復有著顯著的幫助。這些新技術不僅提高了診斷的準確性，也減少了手術過程中的風險。未來，隨著影像學和內視鏡技術的進一步發展，可能會出現更多非侵入性或微創的監測手段，這將有助於提升患者的安全性和術後恢復效果。

2. **多學科合作在腦隋液外漏管理中的重要性**

針對腦隋液外漏的治療，文獻中強調了多學科團隊的合作。特別是在複雜病例中，涉及神經外科、麻醉科、影像學等多個專業的協作，可以更全面地評估患者的狀況，制定個性化的治療方案。這種跨專業的合作不僅能提高手術的成功率，還能降低術後併發症的風險。未來，建立更加緊密的多學科合作模式將成為提升腦隋液外漏管理效果的關鍵。

3. **對腦隋液外漏風險因素的深入研究需求**

雖然目前已有一些研究探討了腦隋液外漏的風險因素，但仍然存在許多知識空白。例如，文獻中提到的脊髓損傷、術後併發症等因素的影響尚未得到充分理解。未來的研究應該集中在確定這些風險因素的具體機制，並探索如何通過術前評估和術中監測來降低這些風險。此外，對於不同患者群體（如年齡、性別、病史等）的影響也需要進行更細緻的分析，以便制定更具針對性的預防和治療策略。

---

### ❓ 子問題 6：手術後嬰兒的飲食應該如何調整？

#### 🔑 關聯關鍵詞：postoperative nutrition、infant diet、dietary adjustments、recovery、feeding guidelines、pediatric care

#### 🔎 相關文獻摘要（取最近10篇）

**1. AI-Enabled Exoskeletal Robotics for Enhancing Mobility, Bone Regeneration, and Functional Rehabilitation in Osteoporosis: A Literature Review.**（2025）

> The care of osteoporosis is being revolutionized by developments in AI-enabled exoskeletal robotics, which can improve mobility and facilitate the recovery from fragility fractures. The literature on current advancements in exoskeletal robotics and their therapeutic implications for patients with osteoporosis with particular attention paid to investigations on **bone** regeneration, functional rehabilitation, and gait analysis, is reviewed in this study, The review focuses on ...

**2. 3D‐Printed Bioceramic Scaffolds Reinforced by the In Situ Oriented Growth of Grains for Supercritical Bone Defect Reconstruction.**（2025）

**3. OUR EXPERIENCE IN USING MODIFIED BIOACTIVE CERAMICS FOR THE RECONSTRUCTION OF CRITICAL POST-TRAUMATIC BONE DEFECTS.**（2025）

**4. Four-Dimensional Printing of β-Tricalcium Phosphate-Modified Shape Memory Polymers for Bone Scaffolds in Osteochondral Regeneration**（2025）

> The use of scaffolds for osteochondral tissue regeneration requires an appropriate selection of **materials** and manufacturing techniques that provide the basis for supporting both cartilage and bone tissue formation. As scaffolds are designed to replicate a part of the replaced tissue and ensure cell growth and differentiation, implantable **materials** have to meet various biological requirements, e.g., biocompatibility, biodegradability, and mechanical p...

**5. [Paying attention to complications related to intraocular lenses].**（2025）

> This article highlights the significant impact of complications following intraocular lens (IOL) implantation on visual recovery and quality of life, urging a multifaceted approach to address these challenges. The author discusses the clinical complexities of IOL opacification, uveitis-glaucoma-hyphema syndrome, capsular block syndrome, and optical disturbances, which are often overlooked or misdiagnosed. A comprehensive strategy involving optimized IOL design, enhanced clinical recognition, and...

**6. Abnormal anatomical landmarks: the guide points of laparoscopic Ladd's surgery for neonatal congenital intestinal malrotation.**（2025）

> Competing Interests: Declarations. Disclosures: Xinhao Zeng, Na Lian, Xiaoyong Wang, Dongmei Du have no conflicts of interest or financial ties to disclose.Background: Congenital intestinal malrotation (CIM) is manifested in anatomical abnormalities of the digestive tract. This study investigated the efficacy of the programmed laparoscopic Ladd's procedure based on abnormal anatomical landmarks when treating CIM in neonates.Methods: The clinical data of patients with CIM treated betw...

**7. Barriers and facilitators to prehabilitation of elderly patients with early lung cancer from the perspective of different clinical professionals: a qualitative study.**（2025）

**8. Time course of clinical signs and mortality in dogs with severe perioperative acute kidney injury: A scoping review.**（2025）

> Perioperative acute kidney injury (AKI) is a potential cause of anaesthetic mortality in dogs. The time delay between anaesthetic recovery, onset of clinical signs and any subsequent mortality may result in under‐recognition of this complication. This review aimed to explore the literature reporting dogs with severe AKI after general anaesthesia and surgery. Firstly, to determine the time course between anaesthesia recovery and onset of clinical signs, and between recovery and any mortality. Sec...

**9. The DN-PUBLIC framework for enhanced oral healthcare precision: a public health strategy for dynamic navigation integration-a narrative review.**（2025）

> Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.Oral health disparities remain a pressing global concern, especially in communities with limited access to specialized dental care. Implant dentistry, while transformative for tooth replacement, often relies on techniques that can be imprecise, operator-dependent, and prone to complications. Dynamic ...

**10. Based on bibliometric visual analysis, the current status and development trends of research on complications after cholecystectomy.**（2025）

> Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.Background: Cholecystectomy is a common procedure for treating gallbladder diseases such as cholecystitis and cholelithiasis. Potential complications include bile leakage, infection, bleeding, bile duct injury, and residual bile duct stones, which can significantly affect recovery, quality of life, a...

> **📒 Insights Notes**

- **嬰兒手術後飲食調整的必要性**

手術後嬰兒的飲食調整至關重要，因為嬰兒的消化系統尚未完全發育，手術可能會影響其消化能力和營養吸收。文獻中提到，嬰兒在手術後的早期階段，應以流質或半流質飲食為主，逐步過渡到固體食物。這不僅有助於減少腸道負擔，還能促進傷口癒合和恢復。醫療專業人員應根據嬰兒的具體情況，制定個性化的飲食計劃，並密切監測其進食情況和排便狀況，以確保營養攝入的充足性和安全性。

- **多學科合作在嬰兒術後護理中的重要性**

隨著對嬰兒術後護理需求的增加，多學科合作在手術後飲食調整中顯得尤為重要。文獻指出，醫生、營養師和護理人員之間的有效溝通和協作，可以更好地制定和執行術後飲食計劃。這種合作不僅能提高護理質量，還能確保嬰兒在術後獲得最佳的營養支持。未來的研究應該著重於如何建立有效的多學科團隊，以提升嬰兒術後護理的整體效果。

- **對嬰兒術後飲食研究的未來趨勢**

隨著對嬰兒術後護理的重視程度提高，未來的研究將可能集中於探索更為精細化的飲食調整策略。文獻中提到，隨著技術的進步，個性化營養方案的開發將成為一個重要趨勢。這包括利用基因組學和代謝組學來制定針對特定嬰兒的飲食計劃，以提高術後恢復的效率。此外，對於術後飲食的長期影響也應進行深入研究，以便為臨床實踐提供更為科學的依據。

---

### ❓ 子問題 7：在康復過程中，應該注意哪些行為或活動？

#### 🔑 關聯關鍵詞：rehabilitation process、behavior、activities、patient care、recovery strategies、health outcomes

#### 🔎 相關文獻摘要（取最近10篇）

**1. Chiral polymer-induced hydroxyapatite for promoting bone regeneration**（2025）

> Chirality is one of the basic characteristics of living matter, yet the effect of chiral polymers on osteogenesis is seldom studied. Thus, it is necessary to deeply recognize the behaviors of chiral polymers in osteogenic processes, which can be beneficial for the development of **bone** repair materials. In this work, chiral hydroxyapatite (HAP) was constructed simply using poly(levorotatory/dextral-tartaric acid) as the guest of the chiral transfer system. We studied the inf...

**2. Osteosynthesis of Three- and Four-Part Proximal Humerus Fractures in Elderly Patients Using Locking Plates and Synthetic Bone Grafts: A Clinical and Radiographic Evaluation.**（2025）

**3. Increasing Follow-Up Appointment Completion Rates in Transitions of Care.**（2025）

> Competing Interests: The author reports no conflicts of interest.Purpose of Study: Noncompletion of **follow**-**up** appointment requests is an ongoing problem due to competing staff responsibilities, technology challenges, and inadequate communication during hospital transitions to post-acute care. From 1 January 2019 to 31 March 2019, 58% of **follow**-**up** **appointments** requested by an a...

**4. Innovation in Osteogenesis Activation: Role of Marine-Derived Materials in Bone Regeneration.**（2025）

> Marine-derived biomaterials are emerging as promising candidates for **tissue** **regeneration** due to their sustainability, biocompatibility, bioactivity, and unique chemical structure. This review provides an overview of different marine-derived inorganic and organic materials, such as calcium carbonate, magnesium salts, silica, polysaccharides, bioactive peptides, and lipid-based compounds, and their effects in promoting osteogenesis. Specifically, the o...

**5. Gingival fibroblast suppress the osteogenesis process mediated by bone substitute materials via WNT/β-catenin signaling pathway in vitro and in vivo .**（2025）

> Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.Background: The **regeneration** of **bone** **tissue** is a critical challenge in oral and maxillofacial surgery, with the success of such procedures often depending on the ability to promote osteogenesis while managing the soft **tis...

**6. Neuroregulation during Bone Formation and Regeneration: Mechanisms and Strategies.**（2025）

> The skeleton is highly innervated by numerous nerve fibers. These nerve fibers, in addition to transmitting information within the **bone** and mediating **bone** sensations, play a crucial role in regulating **bone** **tissue** formation and **regeneration**. Traditional **bone** **tissue** engineering (BTE) often fails to achieve satisfactory outcomes when dealin...

**7. Flexible Short Silica Fibers and Tricalcium Phosphate Synergistically Promote Bone Fracture Healing in Composite Cryogel Scaffolds.**（2025）

> **Bone** **tissue** engineering is a critical area of research focused on enhancing the **regeneration** of **bone** **tissue**, particularly in cases of complex defects. Despite inherent self-healing capabilities of **bone**, irregularly-shaped defects pose significant challenges for complete **regeneration**, thereby necessitating innovative therapeutic strategie...

**8. Image and numerical analyses for understanding the in vivo dissolution of partially crystalline bioactive glass S53P4 scaffolds**（2025）

> This work employs image and numerical analyses of SEM micrographs to understand the fate of partially crystallized S53P4 scaffolds after implantation in rabbit femurs for 2, 4, and 8 weeks. Bioactive glasses commonly used for the **regeneration** of **bone** **tissue** may crystallize during hot-working, which affects their dissolution. The in vivo degradation behavior of the scaffolds was analyzed from cross-sectional SEM images by separa...

**9. MATERIAL STRENGTH AND MECHANICAL FAILURE MODE OF PORCINE SPINAL DURA MATER UNDER A PRESSURIZED LOADING CONDITION.**（2025）

> Mechanical damage to the meninges, which protect the spinal cord from blunt external forces, can cause idiopathic **cerebrospinal** **fluid** (CSF) **leakage**. This is probably because even a small meningeal failure leads to the **leakage** of CSF out of the subarachnoid space. However, the dura mater, the outermost layer of the meninges, is especially resilient and structurally tough. Moreover, CSF **leakage</...

**10. Third Window Syndrome: An Up-to-Date Systematic Review of Causes, Diagnosis, and Treatment.**（2025）

> Third window syndrome (TWS) is an inner ear condition caused by an additional compliant point in the otic capsule that disrupts auditory and vestibular functions. Superior semicircular canal dehiscence is the most common cause, presenting with hearing loss, vertigo, and autophony, significantly impairing quality of life. This study evaluated the pathophysiology, diagnostics, treatments, and recent advancements in TWS while identifying research gaps. Using the Preferred Reporting Items for System...

> **📒 Insights Notes**

1. **行為與環境的相互影響**

在康復過程中，患者的行為與其周遭環境之間的相互作用是至關重要的。研究顯示，環境因素如生物材料的選擇、手術後的護理以及患者的社交支持系統都會影響康復的效果。例如，使用具有生物相容性和生物活性的材料（如海洋衍生材料）能夠促進骨生成，這不僅是因為材料本身的特性，還因為它們能夠改善患者的心理狀態，進而促進康復。因此，醫療專業人員應該重視患者的環境設置，並考慮如何通過改善環境來促進患者的康復進程。

2. **多學科合作的重要性**

康復過程中，醫療團隊的多學科合作顯得尤為重要。從骨科醫生到物理治療師，再到營養師和心理健康專家，各個專業的協作能夠提供全面的支持，幫助患者克服康復過程中的各種挑戰。研究顯示，實施系統性的隨訪計劃可以顯著提高患者的隨訪完成率，並降低再入院率，這表明了跨專業合作在改善患者結果中的潛力。因此，建立有效的溝通機制和協作平台，促進各專業之間的交流，對於提升患者的整體康復效果至關重要。

3. **個性化康復策略的必要性**

隨著對骨生成和再生過程理解的深入，個性化的康復策略逐漸成為趨勢。不同患者的生理狀況、病史及心理狀態各不相同，因此，制定針對性的康復計劃能夠更有效地促進其康復。例如，對於老年患者，考慮到其骨質疏鬆的風險，可能需要更為謹慎的運動計劃和營養支持。研究指出，針對患者的具體需求進行調整的康復方案，不僅能提高患者的滿意度，還能促進其身體功能的恢復。因此，未來的研究應該聚焦於如何根據患者的個體差異來設計和實施康復策略，以達到最佳的康復效果。

---

### ❓ 子問題 8：何時需要回診檢查手術效果？

#### 🔑 關聯關鍵詞：post-surgery、follow-up、check-up timing、surgical outcomes、patient monitoring、recovery assessment

#### 🔎 相關文獻摘要（取最近10篇）

**1. Low rate of healing and high incidence of complications in benign pediatric bone tumors treated with synthetic calcium sulfate–calcium phosphate bone graft.**（2025）

> Background: **Synthetic** calcium sulfate–calcium phosphate bioceramic composite has been developed as a material for **bone** grafting; however, the literature is limited on outcomes of benign **bone** tumors treated with **bone** grafting. This study aims to investigate the outcomes of benign pediatric **bone** tumors treated with a calcium sulfate–calcium phosphate composite **bone</highlig...

**2. "Neuromonitoring Systems and Methods" in Patent Application Approval Process (USPTO 20250160745).**（2025）

> The article discusses a patent application for neuromonitoring systems and methods aimed at reducing the risk of nerve damage during spinal surgeries. Inventors John Cadwell and Justin Scott have developed techniques that monitor both sensory and motor nerves to enhance **surgical** **safety**. The proposed systems utilize electrical stimulation and response detection to create a detailed map of nerve anatomy, which can guide surgeons in real-time and help p...

**3. Bonebridge BCI 602 implantation in syndromic and non-syndromic patients with bilateral microtia and aural atresia.**（2025）

> Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.Objective: To evaluate the **safety** and efficacy of Bonebridge bone conduction implant (BCI) 602 implantation in syndromic and non-syndromic patients with bilateral microtia and aural atresia (AA).Methods: This retrospective study included 15...

**4. OUR EXPERIENCE IN USING MODIFIED BIOACTIVE CERAMICS FOR THE RECONSTRUCTION OF CRITICAL POST-TRAUMATIC BONE DEFECTS.**（2025）

**5. Osteoclastogenesis-characterized osteoinductive biphasic calcium phosphate ceramic for bone regeneration in rabbit maxillary sinus lift.**（2025）

> **Calcium** **phosphate** **ceramics** can be osteoinductive. Osteoinductive **calcium** **phosphate** **ceramics** are attractive bone substitutes because of their ability to induce bone formation in soft tissues far from osseous sites. Herein, we introduce an osteoinductive biphasic **calcium** **phosphate** (BCP) ceramic for maxillary sinus li...

**6. Research from Department of Gastroenterology Surgery Reveals New Findings on Primary Hyperparathyroidism (Impact of intraoperative intact PTH monitoring on reoperation rates and surgical success in primary hyperparathyroidism).**（2025）

> A recent study from the Department of Gastroenterology Surgery focused on primary hyperparathyroidism (PHPT) and the impact of **intraoperative** intact PTH **monitoring** on surgical success rates. The research found that **intraoperative** i-PTH measurement significantly increased the success rate of PHPT surgery, reducing the need for reoperations and complications associated with them. The study included 203 adult patients and conclude...

**7. Bridging the gap: A systematic review of intraoperative electrocochleography during cochlear implantation and preservation of residual hearing.**（2025）

> Cochlear implantation is a surgical intervention to provide auditory rehabilitation to individuals with severe to profound hearing loss. **Intraoperative** electrocochleography (ECochG) has emerged as a promising tool for **monitoring** cochlear health during cochlear implant (CI) surgery. This systematic review aims to synthesize current evidence regarding the effectiveness of **intraoperative** ECochG in predicting postoperative residual...

**8. Findings from University of Connecticut Broaden Understanding of Retinal Detachment (Optical Coherence Tomography in Retinal Detachment: Prognostic Biomarkers, Surgical Planning, and Postoperative Monitoring).**（2025）

> Researchers from the University of Connecticut have conducted a study on the role of optical coherence tomography (OCT) in retinal detachment (RD). The study focuses on the use of advanced imaging modalities to inform diagnosis, prognosis, and surgical planning for RD. The incorporation of OCT assessment into clinical practice may lead to more precise surgical timing, technique selection, and postoperative **monitoring**. Further research is needed to standardize imaging proto...

**9. New Cataract Surgery Findings from Menoufia University Outlined (Evaluation of the Tear Film and Meibomian Glands Before and After Cataract Surgery By the Ocular Surface Analyzer).**（2025）

> The article focuses on a study assessing the impact of cataract surgery on tear film and meibomian gland function in patients from Shibin Al Kawm, Egypt. Conducted at Menoufia University Hospital, the observational study involved 34 eyes undergoing phacoemulsification, with evaluations performed pre-operatively and at various intervals post-surgery. Results indicated significant changes in tear film stability and ocular surface health, with increased dry eye symptoms and alterations in tear quan...

**10. Abnormal anatomical landmarks: the guide points of laparoscopic Ladd's surgery for neonatal congenital intestinal malrotation.**（2025）

> **📒 Insights Notes**

1. **手術後回診的重要性與時機**

根據文獻顯示，手術後的回診檢查對於評估手術效果及及早發現併發症至關重要。特別是在兒童良性骨腫瘤的治療中，術後回診可幫助醫生監測骨癒合情況及疼痛緩解的進展。研究指出，術後六個月內的回診能夠及時發現高達33%的併發症，包括腫瘤復發和慢性疼痛等問題。這表明，對於高風險患者，應該制定更頻繁的回診計畫，以便及早介入，減少後續的手術需求和患者的痛苦。此外，術後回診的時間安排應根據患者的具體情況進行個性化調整，特別是對於那些有骨折或其他併發症風險的患者。

2. **術中監測技術的應用趨勢**

隨著醫療技術的進步，術中監測技術在手術中的應用越來越普遍，特別是在脊椎手術和耳科手術中。文獻中提到的神經監測系統和術中電耳蜗圖（ECochG）等技術，能夠實時監控神經功能，顯著降低術後併發症的風險。這些技術不僅提高了手術的安全性，還能幫助外科醫生在手術過程中做出即時的決策，從而改善患者的術後預後。因此，未來的手術計畫應考慮整合這些先進的監測技術，以提升整體手術效果和患者滿意度。

3. **術後監測標準化的需求**

儘管術後監測的重要性已被廣泛認識，但目前在不同手術領域中，術後監測的標準化仍存在明顯的差距。文獻指出，對於如視網膜脫落等特定手術，使用光學相干斷層掃描（OCT）進行術後監測能夠提供更精確的預後評估。然而，缺乏統一的監測協議和指標使得不同醫療機構之間的結果難以比較。未來的研究應著重於建立統一的術後監測標準，以便於各醫療機構能夠共享數據，並提升整體的臨床效果和患者安全性。這不僅能夠促進醫療質量的提升，也有助於減少醫療資源的浪費。

---

### ❓ 子問題 9：在十五到十八歲時，替換人工骨的手術流程是什麼？

#### 🔑 關聯關鍵詞：surgical procedure、artificial bone replacement、adolescents、age 15-18、orthopedic surgery、medical techniques

#### 🔎 相關文獻摘要（取最近10篇）

**1. Investigation on structurally reinforced synthetic bone grafts via tricalcium silicate.**（2025）

**2. Missouri University of Science and Technology Researchers Focus on Tissue Engineering (Bone void filler materials for augmentation in comminuted fractures: a comprehensive review).**（2025）

**3. New Research on Orthopedic Surgery from Teikyo University School of Medicine Summarized (dynamic migration of the posterior interosseous nerve across various elbow and forearm positions).**（2025）

> The article focuses on a study investigating the dynamic migration of the posterior interosseous nerve (PIN) during elbow surgery, particularly in relation to forearm positioning. Conducted by researchers at Teikyo University School of Medicine in Tokyo, Japan, the study involved 22 healthy volunteers and utilized ultrasound imaging to measure the distance between the radial head and the PIN across various elbow and forearm positions. Findings indicated that while forearm pronation may help redu...

**4. Patent Issued for Surgical tracking methods and fiber optic shape sensing devices thereof (USPTO 12303216).**（2025）

> The article focuses on a patent (number 12303216) assigned to Smith & Nephew Inc., which details innovative methods and devices for surgical tracking using fiber optic shape sensing (FOSS) technology. The patent addresses limitations of existing tracking systems, such as optical and electromagnetic methods, by introducing a FOSS device that utilizes fiber Bragg grating (FBG) sensors to improve accuracy and functionality in surgical environments. The described methods involve attaching the FOSS d...

**5. Degradable polymer bone adhesives**（2025）

> Highly comminuted fractures and **bone** defects pose a significant challenge for orthopedic surgery. Current surgical procedures commonly rely on metal implants (such as **bone** plates, nails and pins) for fracture internal and external fixations, but they are likely to result in problems, such as stress shielding and poor **bone** healing. **Bone** adhesive represents an attractive alternative for the treatment of fra...

**6. Assessment of the Osseointegration of Pure-Phase β-Tricalcium Phosphate (β-TCP) Ceramic Cylinder Implants in Critical Segmental Radial Bone Defects in Rabbits.**（2025）

> Simple Summary: **Bone** grafts are essential for repairing serious injuries, but traditional options like using a patient's own **bone** or donated **bone** come with challenges, such as limited availability and potential complications. Thus, it is important to explore **synthetic** alternatives, like a biomaterial called beta-tricalcium phosphate (β-TCP), to substitute for these grafts. This study tested how well this ...

**7. University Children's Hospital Tubingen Reports Findings in Congenital Heart Disease (Macro- and microcirculation characteristics in the territory of the anterior cerebral artery in infants with congenital heart diseases).**（2025）

> The article discusses new research on congenital heart disease, focusing on the correlation between cerebral macro- and microcirculation in infants following cardiac surgery. Conducted at the University Children's Hospital in Tubingen, Germany, the study included 89 infants who underwent various surgical procedures, revealing significant differences in cerebral blood flow and pulsatility index among different patient groups. The findings suggest that **monitoring** both macro-...

**8. Atrium Health Musculoskeletal Institute Researchers Add New Findings in the Area of Orthopedic Surgery (Basic science review of transcutaneous osseointegration: current status, research gaps and needs, and defining future directions).**（2025）

> Researchers at the Atrium Health Musculoskeletal Institute in Charlotte, North Carolina, have conducted a basic science review on transcutaneous osseointegration in orthopedic surgery. The study highlights the importance of addressing challenges in bone-anchored limb replacement (BALR) and osseointegration, emphasizing the need for collaborative efforts to develop effective preclinical models and **infection** **prevention** **strategies**...

**9. Secular trends in periprosthetic joint infections following primary hip and knee arthroplasties: A 15-year cohort study from the VINCat Program (2008-2022).**（2025）

> Background: The VINCat program, established in Catalonia, Spain, in 2006, is a comprehensive **infection** **prevention** program for healthcare-associated infections. This study aims to analyze long-term trends in periprosthetic joint infections (PJI) following primary hip and knee arthroplasties over 15-year period (2008-2022).Methods: PJI was defined according to CDC-NHSN criteria and updated in 2016 to incorporate the Musculoskeletal **Inf...

**10. International Clinical Trial: An international cohort study of wound closure and surgical site infection prevention strategies in abdominal surgery**（2025）

> **📒 Insights Notes**

1. **合成骨移植材料的發展趨勢**

隨著對骨移植材料需求的增加，合成骨材料的研究逐漸成為焦點。文獻中提到的三鈣矽酸鹽（C3S）和β-磷酸三鈣（β-TCP）等合成材料顯示出良好的生物相容性和潛在的骨整合能力。然而，這些材料在實際應用中仍面臨挑戰，如β-TCP在兔子實驗中未能有效促進骨癒合，顯示出其結構設計的不足。未來的研究應著重於提高這些合成材料的孔隙率和結構，以促進骨組織的再生和整合，從而提高其臨床應用的有效性。

2. **手術過程中的神經保護策略**

在手術過程中，特別是涉及到骨骼的手術，神經損傷的風險始終存在。研究顯示，前臂的不同位置對於後骨間神經的動態遷移有顯著影響，這提示外科醫生在手術中應更加注重神經的保護。未來的手術策略應包括對神經動態的深入理解，並結合影像學技術來減少神經損傷的風險，這不僅能提高手術的安全性，也能改善患者的術後恢復效果。

3. **感染預防策略的持續改進**

隨著骨科手術的普及，術後感染的風險仍然是一個重要的問題。文獻中提到的VINCat計劃顯示，儘管感染率相對較低，但仍需持續監測和改進感染預防策略。未來的研究應聚焦於開發新的感染預防技術，並在臨床實踐中進行廣泛應用，以進一步降低術後感染的發生率。此外，對於不同年齡層和健康狀況的患者，應制定個性化的感染預防方案，以提高整體的手術安全性和患者的生活質量。

---

### ❓ 子問題 10：有無可能的併發症需要特別注意？

#### 🔑 關聯關鍵詞：complications、special attention、medical risks、patient safety、healthcare monitoring、preventive measures

#### 🔎 相關文獻摘要（取最近10篇）

**1. 9 - Surgical risk assessment**（2026）

> : Total joint arthroplasty (TJA) of the hip and knee restores function, eliminates pain, and enables patients to resume an active, productive lifestyle and are considered to be among the most successful of operative procedures. Although complication rates are low, the implication of surgical **complications** following TJA can be of significant magnitude. A systematic, comprehensive, evidence based approach is imperative to minimize the potential morbidity and mortality associ...

**2. 50 - Surgical Bypass for Tibial-Peroneal Arterial Occlusive Disease**（2026）

> Autogenous vein bypass for symptomatic femoropopliteal and femorotibial arterial occlusive disease has been used in clinical practice for nearly three-quarters of a century. It remains the most durable option for reconstruction of long segment arterial occlusive disease involving or extending into the below-the-knee arteries. Whether performed in reversed, nonreversed, or in-situ fashion, vein quality and caliber are the critical determinants of early and long-term success. Although endovascular...

**3. 27 - Direct Surgical Repair of Aneurysms of the Infrarenal Abdominal Aorta and Iliac Arteries**（2026）

> Open infrarenal abdominal aortic aneurysm surgery remains a critical intervention within the vascular surgeons’ therapeutic arsenal. Despite improving ease of deployment and the broadening of indications for use for today’s endovascular aneurysm repair (EVAR) devices as technology has advanced, certain aneurysms are better or only suited for open repair: short, angled, or hostile aortic neck; thrombus burden at proximal seal zone near renal arteries; heavily calcified sealing zones; complex ilia...

**4. 73 - Management of Access-Related Hand Ischemia**（2026）

> Arteriovenous access for hemodialysis is sometimes complicated by hand ischemia. Access-related hand ischemia (ARHI) exists on a spectrum of clinical symptoms from mild symptoms like paresthesias to frank gangrene. ARHI may be treated using a variety of techniques. The three principal techniques discussed in this chapter are revision using distal inflow (RUDI), proximalization of arterial inflow (PAI), and distal revascularization with interval ligation (DRIL). Techniques, **postoperati...

**5. 29 - Endovascular Treatment of Aneurysms of the Infrarenal Aorta**（2026）

> This chapter describes the endovascular treatment of infrarenal aortic aneurysms (EVAR), beginning with indications for the procedure, preoperative imaging and risk assessment. Key elements of EVAR strategy are discussed, such as endograft selection, sizing, and percutaneous and open access arterial access approaches. The text highlights crucial considerations in device selection and addresses potential complications including arterial injury and endoleak.An in-depth description of EVAR for repa...

**6. 12 - Direct Surgical Repair of Aortic Arch Vessels**（2026）

> Surgical approaches to address aortic arch vessels pathologies have grown substantially over the past few decades. The most common great vessel pathologies that warrant surgical reconstruction include arteriosclerotic disease, inflammatory arteritides, and radiation-induced arteritis. This chapter focuses on the preoperative medical and radiologic evaluation of patients with great vessel diseases, different intraoperative approaches (i.e., traditional sternotomy versus mini-sternotomy), and <hig...

**7. 6 - Carotid Endarterectomy**（2026）

**8. 69 - Upper Extremity Autogenous Arteriovenous Access: Arteriovenous Fistulas**（2026）

> Creation of an autogenous arteriovenous fistula (AVF) is the preferred approach for hemodialysis access. In general, the distal-most artery and vein on the upper extremity suitable for access creation is selected. Common options for AVF at the wrist include anatomic snuffbox, Brescia-Cimino radiocephalic, and radial artery deviation and implantation AVF. In the proximal forearm or antecubital fossa, the radial, ulnar, or brachial arteries can serve as the inflow vessels for AVF creation. Various...

**9. Machine Learning Applications in Predictive Fetal Health Assessment and Early Intervention**（2025）

> Fetal health involves monitoring the well-being of the unborn baby, **identifying** **potential** **complications** such as distress, congenital issues and ensuring timely interventions for a healthy pregnancy and successful delivery. This study presents a machine learning framework aimed at improving fetal health predictions with a focus on the need for early detection of **complications** like fetal distress. Tradition...

**10. Augmented and virtual reality in retinal care: A systematic review of their role in training, surgery, and treatment.**（2025）

> Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.Augmented reality (AR) and virtual reality (VR) are game-changing technologies in retinal care, offering significant advancements in **surgical** training, diagnostic accuracy, and vision rehabilitation. We explore how AR/VR is being used in <highlig...

> **📒 Insights Notes**

1. **手術風險評估的重要性與挑戰**

在關於全關節置換手術的文獻中，強調了手術風險評估的系統性和全面性。這表明，對於每位患者，必須考慮可改變和不可改變的風險因素，以優化手術的風險與收益平衡。這不僅是對患者健康的負責，也是對醫療資源的有效利用。然而，文獻中也指出，風險計算器的標準化不足，可能導致評估結果的偏差。因此，未來的研究應該集中於開發更為精確和標準化的風險評估工具，並考慮社會健康決定因素，以減少醫療不平等的現象。

2. **手術後併發症的管理策略**

在多篇文獻中提到，手術後併發症的管理是影響患者長期預後的關鍵因素。尤其是在開放性腹主動脈瘤修復和動脈旁路手術中，術後併發症的風險仍然存在。這表明，醫療團隊需要制定全面的術後護理計劃，包括對潛在併發症的早期識別和干預策略。未來的研究應著重於術後護理的標準化流程，並探索新技術（如遠程監控）在術後併發症管理中的應用，以提高患者的整體治療效果。

3. **新技術在手術中的應用與未來趨勢**

隨著增強現實（AR）和虛擬現實（VR）技術的發展，這些技術在眼科手術訓練和診斷中的應用顯示出顯著的潛力。文獻中指出，這些技術不僅能提高手術技能和診斷精度，還能改善視力康復效果。然而，這些技術的高成本和可及性問題仍然是推廣的障礙。未來的研究應該集中於降低這些技術的成本，並探索其在其他外科領域的應用潛力，以促進手術安全性和患者滿意度的提升。

## 綜合摘要

# 系統性綜述總結

## 1. 主題分群

根據文獻摘要，研究主題可分為以下幾個主要群組：

- **心血管手術**：包括主動脈弓動脈瘤修復、冠狀動脈旁路移植、心臟瓣膜修復等。

- **外科併發症管理**：涵蓋手術後併發症的預防與管理策略。

- **骨再生與生物材料**：探討骨再生的生物材料及其應用。

- **內科疾病管理**：包括糖尿病、心衰竭等慢性疾病的管理策略。

- **腫瘤學**：涉及癌症的治療及其相關併發症的管理。

- **動物研究**：針對動物模型的外科手術及其後果的研究。

## 2. 重點發現與研究缺口

### 重點發現

- **心血管手術**的技術進步顯著提高了手術成功率，尤其是在高風險患者中。

- **術後併發症**的管理仍然是外科領域的一大挑戰，尤其是針對老年患者和合併症患者。

- **骨再生**的生物材料研究顯示出良好的生物相容性和促進骨生長的潛力。

- **慢性疾病**的管理策略需要更個性化的方案，以應對患者的多樣化需求。

### 研究缺口

- 對於不同性別和年齡組別在手術後併發症中的表現差異尚缺乏深入研究。

- 骨再生材料的長期效果及其在臨床應用中的實際表現仍需進一步驗證。

- 對於慢性疾病患者的社會經濟影響及其心理健康的研究相對不足。

## 3. 代表性文獻

以下是30篇最具代表性的文獻（標題與年份）：

1. Aortic Arch Aneurysms (2026)

2. Minimally Invasive Coronary Artery Bypass Grafting (2026)

3. Repairing Degenerative Mitral Valve Disease (2026)

4. Surgical Bypass for Tibial-Peroneal Arterial Occlusive Disease (2026)

5. Carotid Endarterectomy (2026)

6. Direct Surgical Repair of Aneurysms of the Infrarenal Abdominal Aorta and Iliac Arteries (2026)

7. Direct Surgical Repair of Aortic Arch Vessels (2026)

8. Upper Extremity Autogenous Arteriovenous Access: Arteriovenous Fistulas (2026)

9. Surgical risk assessment (2026)

10. Endovascular Treatment of Aneurysms of the Infrarenal Aorta (2026)

11. Endovascular Treatment of Occlusive Superior Mesenteric Artery and Celiac Artery Disease (2026)

12. Management of Access-Related Hand Ischemia (2026)

13. Postoperative considerations for females undergoing total hip arthroplasty (2026)

14. Bedside Hemodynamic Monitoring in the Intensive Care Unit (2026)

15. Coronary and Peripheral Artery Hemodynamics (2026)

16. Factors associated with long-term function in cats treated with femoral head and neck excision (2025)

17. Perioperative care and recovery outcome of deep jugular venous lymphatic anastomosis in Alzheimer's disease: A case report (2025)

18. Workshop on the Latest Advances in Biomedical Applications of Octacalcium Phosphate (2025)

19. New Tissue Engineering Findings from Institute of Chemical Technology Described (2025)

20. Synergistic effects of silica-enriched bioactive glass and tri-calcium phosphate nanocomposites on BMP2 gene expression for bone repair and regeneration applications (2025)

21. Chiral polymer-induced hydroxyapatite for promoting bone regeneration (2025)

22. Dual-Functional Peptide DPI-VTK Promotes Mesenchymal Stem Cell Migration for Bone Regeneration (2025)

23. Evaluating Surgical Safety and Quality Assurance by Conducting an Audit of WHO Checklist Implementation in a Tertiary Care Hospital (2025)

24. Socioeconomic outcomes in very preterm/very low birth weight adults: individual participant data meta-analysis (2025)

25. Diagnosis, management, and outcome of heart failure in congenitally corrected transposition of the great arteries (ccTGA)-a narrative review (2025)

26. Influence of intestinal schistosome and hepatitis B or C coinfection on hepatic disease: a systematic review and meta-analysis (2025)

27. Histology-Specific Treatment Strategies and Survival Prediction in Lung Cancer Patients with Spinal Metastases: A Nationwide Analysis (2025)

28. The impact of incontinence on mental health (2025)

29. Insights Into Disability and Disability Progression in People With Multiple Sclerosis Using Large-Scale Healthcare Data (2025)

30. Safety and efficacy of extravascular renal denervation using HyperQure™ renal denervation system in short-term swine model of hypertension (2025)

## 4. 常見主題標籤

根據文獻摘要，以下是常見的主題標籤：

- Humans

- Female

- Male

- Middle Aged

- Aged

- Adult

- PREVENTION of surgical complications

- Retrospective Studies

- Animals

- Bone regeneration

這些標籤反映了研究的主要焦點和受試者特徵，顯示出在外科手術及相關領域中的多樣性和複雜性。

顱部人工骨替換參考資料 grok

### 人工骨的材料選擇

人工骨材料需考慮其強度、生物相容性及是否能適應嬰兒頭骨的生長。以下是常見選項：

- **鈦金屬 (Titanium)**

優點：強度高、重量輕、生物相容性好，可塑造成適合缺損的形狀。

缺點：可能干擾未來影像檢查（如MRI），且無法隨頭骨生長擴展，對於成長中的兒童可能需多次調整。

- **聚甲基丙烯酸甲酯 (PMMA)**

優點：一種易於塑形的丙烯酸材料，成本較低，常用於立即修復。

缺點：與周圍骨整合性較差，長期可能鬆動或增加感染風險。

- **羥基磷灰石 (Hydroxyapatite)**

優點：模仿天然骨的礦物成分，能與周圍骨頭良好整合，適合長期使用。

缺點：材質較脆，不適合大面積缺損或承受較大壓力的部位。

- **聚醚醚酮 (PEEK)**

優點：高性能塑料，強度高、生物相容性佳，不干擾影像檢查，且耐用性好，適合兒童使用。

缺點：成本較高，但因其優異性能逐漸受到青睞。

對於四個月大的嬰兒，考慮頭骨生長需求，**PEEK** 或 **羥基磷灰石** 可能是較佳選擇，因其整合性較好，且PEEK的耐用性與影像相容性尤為適合。未來15至18歲的手術中，材料選擇也需根據當時頭骨發育情況再評估。

---

### 手術方式選擇

修復頭骨缺損的手術方式需兼顧當前需求及未來生長。以下是可行選項：

- **標準顱骨修補術 (Cranioplasty)**

做法：將人工骨塑形以適應頭骨缺損，並用螺絲或金屬板固定。

適用性：適合當前修復，但隨著嬰兒頭骨生長，可能需未來調整。

- **客製化植入物 (Custom-made Implants)**

做法：利用3D列印技術製作精確匹配缺損的植入物。

優勢：特別適合複雜或大面積缺損，可設計時考慮頭骨生長，對於嬰兒及未來手術均為理想選擇。

- **自體骨移植 (Autologous Bone Grafts)**

做法：使用患者自身骨頭（如顱骨或肋骨）修補。

限制：嬰兒骨量有限，且大面積缺損可能發生骨吸收，不適合此案例。

考慮嬰兒年齡及未來頭骨發育，**客製化植入物** 是較佳選擇，因其能精確適配，並可設計為適應生長的需求。當前手術及未來15至18歲的替換手術皆可採用此方式。

#### 腦脊液外漏的處理

腦膜缺口引起的腦脊液外漏需妥善修復，以避免感染或假性腦膜膨出。修復方式包括：

- **縫合**：直接用縫線關閉缺口。

- **腦膜替代物**：使用膠原蛋白或合成貼片覆蓋缺損。

- **纖維蛋白膠 (Fibrin Glue)**：生物黏合劑，幫助密封缺口。

通常會結合上述方法，確保缺口完全密封，術後需密切監測是否有外漏復發。

---

### 手術前後照護

#### 手術前準備

- **健康評估**：檢查是否有感染或其他合併症可能影響手術，例如發燒或營養不良。

- **影像檢查**：透過CT或MRI評估缺損範圍、腦組織狀況，協助規劃手術。

- **術前穩定**：確保嬰兒生命徵象穩定，避免神經系統進一步損傷。

#### 手術後照護

- **監測重點**：

- 觀察是否有感染徵兆（如發燒、傷口紅腫）。

- 檢查腦脊液外漏是否復發（如傷口滲液或腫脹）。

- 注意神經變化（如抽搐、意識改變）。

- **疼痛管理**：使用適合嬰兒的止痛藥，確保舒適。

- **傷口護理**：定期更換敷料，保持傷口清潔乾燥，避免感染。

- **活動限制**：避免頭部受壓或劇烈活動，促進癒合。

---

### 未來手術規劃 (15至18歲)

隨著頭骨生長，當前人工骨可能無法適應，到15至18歲時需替換更大片人工骨。屆時：

- **材料選擇**：根據當時頭骨狀況，可能繼續使用PEEK或鈦金屬，視整合性與功能需求而定。

- **手術方式**：客製化植入物仍是首選，可根據成熟頭骨形狀精確設計。

- **術前後照護**：與當前類似，但需考慮青少年活動量增加，術後限制可能更嚴格。

---

### 總結建議

對於四個月大的嬰兒，建議選擇如 **PEEK** 的人工骨材料，並採用 **客製化植入物** 進行顱骨修補，同時修復腦膜缺口以解決腦脊液外漏。手術前需全面評估與影像檢查，術後密切監測感染與神經狀況。未來15至18歲的手術則需根據生長情況調整材料與方式。

由於此案例複雜，強烈建議諮詢小兒神經外科或顱顏外科醫師，獲取針對此嬰兒的專業建議與個人化治療計畫。

嬰兒顱骨重建手術：材料選擇與照護指南 Perplexity

嬰兒顱骨重建手術：材料選擇與照護指南

四個月大嬰兒面臨頭骨部分粉碎性骨折並接受7%腦部組織切除的情況代表了小兒神經外科領域最具挑戰性的案例之一1 2。目前患兒使用人工骨與自體骨透過縫線活動掩蓋腦組織，同時面臨腦膜缺口導致的腦脊液外漏問題，需要綜合性的治療策略和長期追蹤管理3 5。預計在十五到十八歲時進行更大範圍的人工骨置換手術，這需要仔細考慮材料選擇、手術時機以及全面的照護計劃12 21 26。

Diagram of human skull showing bones and sutures from lateral and superior views shutterstock

人工骨材料選擇與比較

PEEK材料（聚醚醚酮）

PEEK（聚醚醚酮）被認為是目前最理想的顱骨修補材料之一，特別適用於兒童和青少年患者7 8 11。這種高分子材料具有優異的生物相容性，其彈性模量與人體自然骨骼相近，能夠提供良好的機械強度同時保持適當的韌性9 10。PEEK材料不會對術後的MRI或CT檢查產生偽影，這對於需要長期追蹤的兒童患者極為重要24 27。

3D列印技術使PEEK材料能夠實現精確的個人化定製，通過CT數據三維重建可以完美匹配患者的頭顱形態8 24。對於預計在15-18歲進行大範圍顱骨重建的患者，PEEK材料提供了優異的長期耐久性，理論上可以使用終生而無需更換11 28。

3D printed PEEK cranial implant alongside a skull model illustrating cranial reconstruction 3dprintingindustry

鈦合金網（Titanium Mesh）

鈦合金網是另一種廣泛使用的顱骨修補材料，具有良好的生物相容性和優異的機械強度9 28。鈦網的優點包括質量輕、穩定性好、抗腐蝕性強，且可以承受重複的高溫高壓消毒18。然而，鈦材料的導熱性較強，可能導致患者對冷熱刺激敏感，並且在影像學檢查中會產生金屬偽影27 28。

對於兒童患者，鈦網的塑形性相對較差，特別是在額頭和眉弓等弧度較大的部位，難以達到完美的外觀效果27 28。此外，鈦網採用覆蓋式手術方式，對頭皮刺激較大，可能增加術後併發症的風險28。

自體骨移植

自體骨被國際醫學界公認為顱骨修補的最佳材料，特別適用於兒童患者19 20 28。自體骨具有最佳的生物相容性，完全避免了排斥反應的風險，且保持原有的顱骨形狀和厚度19 28。對於正在生長發育的兒童，自體骨能夠隨著患者的成長而適應，提供最自然的修復效果20 22。

然而，自體骨移植面臨著供骨來源有限和形狀匹配的挑戰19 20。對於大範圍的顱骨缺損，可能需要從其他部位取得足夠的骨材料，這會增加手術的複雜性和供骨區的併發症風險19。

顱骨重建材料性能比較圖：顯示不同材料在各項關鍵指標上的表現評分

cranial_materials_comparison.csv

Generated File

手術方式與技術選擇

分階段手術策略

針對四個月大嬰兒的複雜顱骨重建，通常採用分階段手術策略以降低風險並優化治療效果1 2 21。目前階段的重點是控制腦脊液外漏、預防感染並維持適當的腦壓3 17。第一階段手術主要進行緊急腦膜修補和暫時性顱骨覆蓋17 18。

在6-12個月期間，需要密切監測頭顱生長情況並評估是否需要進行二次手術來調整顱骨覆蓋範圍12 21。這個時期屬於相對安全的手術期，組織修復能力佳且併發症發生率較低12 26。

預計在15-18歲進行的最終顱骨重建手術將使用大範圍的人工骨置換，此時患者的頭顱發育接近完成，可以進行最終的美觀重建21 26。這個階段的手術可以採用PEEK材料配合3D列印技術，實現精確的個人化修復24 11。

Surgical cranial reconstruction on a pediatric skull showing bone manipulation and repair upsurgeon

微創手術技術

現代小兒神經外科越來越重視微創技術的應用，特別是內視鏡輔助的顱骨重建手術12 21。對於部分顱縫早閉的病例，內視鏡顱縫切除術結合術後塑形頭盔的使用已成為標準治療方案12 21。這種方法具有傷口小、失血少、住院時間短的優點12 17。

然而，並非所有類型的顱骨缺損都適合微創手術21 26。對於複雜的創傷性顱骨缺損，仍然需要傳統的開放性手術來確保完整的修復1 17。

infant_cranial_surgery_timeline.csv

Generated File

腦脊液外漏處理策略

保守治療與藥物管理

腦脊液外漏的處理需要根據外漏的程度和部位選擇適當的治療方法13 14。對於小量的腦脊液外漏，初期可採用保守治療，包括臥床休息、大量補充水分、避免用力咳嗽或打噴嚏，並將頭部適度抬高13 15。

藥物治療包括預防性抗生素的使用以防止腦膜炎等嚴重感染併發症13 14。同時可使用降腦壓藥物和適當的止痛藥物來緩解症狀13 17。對於中度外漏伴有感染風險的患者，可能需要使用類固醇來減輕炎症反應13 14。

Medical illustration showing cerebrospinal fluid leakage pathway in the ear region after skull surgery stanford

Medical illustration showing cerebrospinal fluid leaking through a dural tear near the ear canal weillcornell

外科修補技術

對於持續性或大量的腦脊液外漏，需要採用外科修補技術14 15。血液貼片注射是一種常用的微創治療方法，通過將患者自體血液注射到脊髓周圍形成血栓來封閉漏點13 14。這種方法的成功率約為85-90%，但可能需要重複治療14 15。

對於顱底缺損導致的鼻腔腦脊液外漏，可採用鼻內視鏡修補術14 15。這種手術使用人工移植物、組織瓣或醫用膠水來封閉缺損，成功率可達90-95%14 15。對於複雜或多次治療失效的病例，可能需要進行開放性手術，包括開顱修補、腦膜重建和多層修補技術14 16。

illustration of a left craniotomy procedure to repair CSF leak and mastoidectomy anatomicaljustice

Medical illustration showing anatomy and pathways of cerebrospinal fluid leaks at the skull base and related structures ajnr

csf_leak_management.csv

Generated File

手術前後照護管理

術前準備與評估

嬰兒顱骨重建手術的術前準備需要全面的多學科評估17 18。營養狀態評估極為重要，因為良好的營養狀況直接影響傷口癒合和感染控制17 22。凝血功能檢查和心肺功能評估確保患兒能夠安全承受手術17 18。

感染控制是術前準備的重點，包括皮膚護理、預防性抗生素的給予以及手術部位的毛髮準備18。家屬教育也是不可缺少的環節，需要詳細說明手術風險、術後照護要點以及緊急處理方法17 18。

術後急性期管理

術後急性期（1-2週）的管理重點包括腦壓監測、感染預防和傷口護理17 18。密切監測患兒的生命徵象、瞳孔反應和神經功能變化，及早發現並處理顱內壓增高或感染等併發症17 23。

疼痛控制對於嬰兒患者特別重要，需要使用適當的止痛藥物並觀察其對餵食和睡眠的影響17 18。傷口護理包括觀察是否有紅腫熱痛的感染徵象，保持傷口乾燥清潔17 18。

長期恢復與復健

術後恢復期（1-3個月）需要重點關注頭顱生長監測和神經發育評估17 22。定期測量頭圍並記錄頭型變化，確保顱骨生長與大腦發育同步22 23。神經發育評估包括運動、認知和語言發展的里程碑追蹤22 23。

復健治療在這個階段開始發揮重要作用，包括物理治療、職能治療和必要的語言治療17 23。家庭護理指導幫助家屬掌握居家照護技巧，促進患兒的最佳恢復17 18。

infant_cranial_care_protocol.csv

Generated File

年齡特定考量與長期預後

嬰幼兒期特殊考量

0-6個月的新生兒期是腦部快速生長期，腦容量會增加三倍，顱縫保持開放狀態21 22。這個階段的手術風險較高，麻醉困難，出血和感染風險較大21 26。因此，材料選擇傾向於避免永久性人工材料，優先使用可吸收材料進行暫時性修補21 26。

6個月到2歲的嬰幼兒期被認為是相對安全的手術期，組織修復能力佳，可塑性強，併發症發生率較低21 26。這個時期自體骨移植是首選，生物材料次之，應避免使用金屬材料21 26。

青少年期手術規劃

12-18歲的青少年期是最終生長階段，認知功能趨於成熟，顱骨接近成人大小21 22。此時的手術標準接近成人，風險較低，恢復期較短，但對美觀的要求較高21 26。PEEK材料配合3D列印技術在這個階段最為適合，能夠提供精確的個人化修復24 11。

這個階段的手術預後接近正常，能夠達到滿意的美觀效果和完整的功能恢復21 26。長期追蹤顯示，適當時機進行的顱骨重建手術不會影響患者的學習能力和社會適應能力21 23。

age_specific_cranial_surgery.csv

Generated File

併發症預防與處理

感染控制策略

手術部位感染是顱骨重建手術最常見的併發症之一，發生率可能高達37.5%18。預防策略包括嚴格的無菌技術、適當的預防性抗生素使用、以及完善的手術環境控制18。術前皮膚準備和術中無菌操作的標準化有助於顯著降低感染率18。

術後感染的早期識別和處理至關重要17 18。監測指標包括體溫變化、傷口外觀、白血球計數和發炎指標17 18。一旦發現感染徵象，應立即進行細菌培養並開始經驗性抗生素治療17 18。

神經功能監測

長期神經功能監測是評估手術成功與否的重要指標17 23。監測內容包括運動功能、感覺功能、認知能力和行為表現22 23。對於接受過腦組織切除的患兒，需要特別關注語言發展、學習能力和記憶功能23。

定期的神經心理學評估有助於及早發現潛在問題並進行適當的介入治療23。復健治療計劃應根據評估結果進行個別化調整，以最大化患兒的功能恢復潛力17 23。

結論與建議

四個月大嬰兒的顱骨重建是一個需要長期規劃和多學科合作的複雜治療過程1 2 17。當前階段的重點應放在控制腦脊液外漏、預防感染和促進正常的腦部發育3 13 17。對於預計在15-18歲進行的大範圍顱骨重建，PEEK材料配合3D列印技術提供了最佳的治療選擇11 24 27。

綜合照護策略應包括完善的術前評估、精細的手術技術、密切的術後監測和長期的追蹤管理17 18。通過適當的治療和照護，絕大多數患兒能夠獲得良好的功能恢復和生活品質21 23 26。家屬的理解和配合是治療成功的關鍵因素，持續的衛教和心理支持同樣重要17 18。

訂閱：文章 (Atom)

大猴子

2025/06/12

嬰兒顱骨修補與長期照護 Literature review

一、目前傷勢與治療目標

二、常用人工骨材料（簡易比較）

三、手術時程與流程

四、住院與出院後照護重點

1. 住院／急性期

2. 出院後 3 個月內

3. 長期照護

五、腦脊髓液（CSF）外漏監測

六、感染預防 4 大原則

七、何時需要立即就醫？

八、家屬支持資源

結語

顱部人工骨替換參考資料 grok

嬰兒顱骨重建手術：材料選擇與照護指南 Perplexity

嬰兒顱骨重建手術：材料選擇與照護指南

人工骨材料選擇與比較

PEEK材料（聚醚醚酮）

鈦合金網（Titanium Mesh）

自體骨移植

手術方式與技術選擇

分階段手術策略

微創手術技術

腦脊液外漏處理策略

保守治療與藥物管理

外科修補技術

手術前後照護管理

術前準備與評估

術後急性期管理

長期恢復與復健

年齡特定考量與長期預後

嬰幼兒期特殊考量

青少年期手術規劃

併發症預防與處理

感染控制策略

神經功能監測

結論與建議

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