骶骨肿瘤的分区切除与重建方式的选择

Zoning sacrectomy and reconstruction in treating sacral tumor

目的:探讨对骶骨肿瘤按其发生部位进行分区切除,选择相应重建方式的方法及疗效。方法:1988年2月￣2005年1月手术治疗43例骶骨肿瘤患者,按肿瘤侵及部位(即上段骶骨、骶髂关节及骶髂关节水平向外的髂骨是否被破坏)对骶骨肿瘤进行分区切除并重建,相应的手术及重建方式包括单纯切除、钢针加塑形骨水泥(CPC)重建骶骨、钢板螺钉固定或骶骨螺钉固定重建骶髂关节、不同长度的Luque棒或髂骨棒加钢丝缠扎或TSRH或Isola或CGWS腰椎骨盆内固定。并给予相应的放疗与化疗。结果:术后出现脑脊液漏2例,切口感染及延期愈合3例,切口皮肤边缘坏死1例,下肢深静脉血栓形成1例,经积极处理后均治愈。随访1～17年,平均75个月,43例患者中39例(90.7%)术后疼痛得到缓解,视觉模拟疼痛评分由术前平均8.5分降低到术后3.4分(P<0.01)。14例有神经功能损害的患者中,11例术后症状改善,3例无改善。20例行自体和或异体植骨的患者术后1年16例获得骨性融合。3例脊索瘤、3例恶性纤维组织细胞瘤和4例骨巨细胞瘤患者于术后1年因复发而进行1次或多次手术,其中有5例和1例骨髓瘤、1例转移癌患者于术后17～50个月因肺部和全身转移死亡。发生断棒2例,均再次手术更换断棒。结论:按肿瘤部位进行分区切除,选择相应的重建方式,达到尽可能广泛切除肿瘤组织和维持脊柱及骨盆稳定性的目的,是取得良好疗效的重要保证。

Objective：To investigate the feasibility of zoning sacrectomy of sacral tumor and corresponding reconstructive methods.Method：From February 1988 to January 2005,43 patients with sacral bone tumor were encrolled in our hospital.Zoning sacrectomy was performed at upper sacral bone or sacroiliac joint or iliac bone outside the sacroiliac joint.Operations were performed as follow：resection alone,resection and reconstruction with CPC （calcium phosphate cement） and pins serving as artificial sacrum,sacroiliac fusion or lumbopelvic fusion was performed using different type of instrument.Corresponding chemotherapy and radiotherapy were also performed for 3 weeks after operation.Result：All patiens were followed up for 1 to 17 years（mean 75 months ）.The lumbosacral pain were alleviated（39/43） and the neurological function were improved to some degrees （14/17）.However,bladder and rectum dysfunction and sexual dysfunction were observed in 3 patients, cerebrospinal fluid leakage in 2 cases,wound infection and delayed healing in 3 cases,perephary skin necrosis in 1 case,one patient developed deep vein thrombosis which was treated with coumadin derivate.3 cases with chordoma,3 cases with malignant fibrous histocystoma and 4 cases with giant cell tumor recurred one year after operation,5 of them and 1 case of multiple myeloma and 1 case of metastasis cancer died of lung and widespread metastases after 17-50 months postoperatively respectively.Instrument failure occured in 2 patients who accepted the revisional surgery.Conclusion：Zoning resection on the basis of location encroached by tumor and selecting corresponding reconstructive method can ensure wide resection of tumor to a great extent as well as retain the stability of spine and pelvis.