髂骨翼肿瘤的切除与重建

Resection and reconstruction for tumors of iliac bone

目的 探讨髂骨翼肿瘤切除及重建方式。方法1998年7月至2004年7月，61例髂骨翼肿瘤患者接受髂骨肿瘤切除重建手术。其中男38例，女23例；年龄12～78岁，平均43岁。根椐Enneking骨盆肿瘤分区：肿瘤累及Ⅰ区36例，Ⅰ、Ⅱ区17例，Ⅰ、Ⅳ区8例。肿瘤切除术后，检查骨缺损的大小，将钉棒系统应用于髂骨肿瘤切除后的缺损重建中。对于肿瘤累及Ⅳ区的患者，行钛网杯重建髋臼顶及全髋置换术。对于儿童患者，采用植骨或斯氏针＋骨水泥固定。结果61例髂骨肿瘤切除的患者中48例患者获得随访，随访时间为16个月至6年，平均43个月。其中33例存活，无肿瘤局部复发迹象；15例死亡。36例行Ⅰ区肿瘤切除的患者中，19．4％（7／36）出现局部复发；17例行Ⅰ、Ⅱ区肿瘤切刮、骨水泥填充、髋臼重建的患者中，35．3％（6／17）出现局部复发；8例行Ⅰ、Ⅳ区肿瘤切除的患者中，1例死于围手术期，50．0％（4／8）局部复发。功能结果：36例行Ⅰ区肿瘤切除的患者，术后有正常行走功能。17例行Ⅰ、Ⅱ区肿瘤刮除、骨水泥填充、髋臼顶重建、人工髋关节置换的患者，术后髋关节功能基本正常。结论可将钉棒系统应用于成人患者髂骨肿瘤切除后的缺损重建中，维持骨盆环的完整。对于儿童的髂骨肿瘤切除后的重建，应尽量采用比较简单的固定。可应用异体骨或自体髂骨（取自残存的部分髂骨）植于髂骨颈与骶骨翼之间，用加压螺丝钉固定。

Objective To discuss the resection of tumors, reconstruction of defects. Methods Sixty-one patients with tumors in ileum were treated surgically in People＇s Hospital from July 1998 to July 2004. The series comprised 38 males and 23 females with an average age of 43 years old （range from 12 to 78 years old）. According to Enneking staging system, 36 cases had lesions in region Ⅰ , 17 cases in region Ⅰ and Ⅱ ,and 8 cases in region Ⅰ and Ⅳ. Mter tumor resected, posterior fixation system of spine was applied to reconstruct the integrality of pelvic ring in series of region Ⅰ cases. The four pedicle screws were implanted in the lumbar and sacrum superiorly, pubis and ischium inferiorly. For children patients, bone graft or bone cement and Steinmann＇s pins internal fixation was applied to reconstruct the pelvis. Results Among all the 61 cases, 48 cases followed up from 16 months to 6 years. Thirty-three cases were survived and had no local recurrence or metastasis. Fifteen cases were dead. Oncology result： local recurrence were found in 19.4% patients with region Ⅰ resection（7/36）, the resection level was close to acetabulum（ in order to reserve the acetabulum） ,and it might be the reason of recurrence. 35. 3% of patients （6/17） with region Ⅰ and Ⅱ resection had local recurrence, the recurrence maybe related to residual tumor after curettage. 50.0% of the patiens （4/8） with region Ⅰ and Ⅳ resection had local recurrence, the tumor residual in sacrum might be the reason of recurrence. Functional result： all of the 36 cases received region Ⅰ resection regained normal walking function. The hip joint function was normal in 17 cases received tumor curettage, hone cement or hip joint replacement. Conclusions The posterior fixation system of spine can be used to reconstruct the integrality of pelvic ring after resection of iliac tumors. Simple reconstruction is more favorable for child patients. Allograft or self-ileum can be implanted in the space of sacral wing and residual ileum, and the bone graft is fixed with compressional screw.