ISOLA脊柱内固定系统在高位骶骨肿瘤切除重建中的应用

Application of isola system in reconstruction of lumbosacral joint after resection of high-level sacral tumors

[目的]探讨采用脊柱ISOLA钉棒系统重建高位骶骨肿瘤切除后腰椎-骨盆连续性的适应证、手术方法及可行性。[方法]对2001年7月～2007年1月间收治的43例侵犯s。的高位骶骨肿瘤患者进行回顾性研究，所有患者行肿瘤切除术后双侧或单侧ISOLA系统腰椎-骨盆的连续性重建。其中单侧重建者11例（25．6％），双侧重建者32例（74．4％）。[结果]43例中，脊索瘤、骨巨细胞瘤、神经源性肿瘤共33例（77．1％）。术后34例（79．1％）经12～62个月随访，5例脊索瘤患者复发，29例得到良好局部控制。术后腰骶部疼痛及下肢根性疼痛症状均明显缓解，恢复正常负重及行走。无1例出现断钉、断棒或螺钉松动。X线片检查未发现钉孔扩大、骨盆内聚及腰椎下移（L5下沉）。国际保肢学会（ISOLS）评分功能优良率26例（76．5％）。[结论]对于高位骶骨肿瘤，采用ISOLA钉棒系统重建其切除后腰椎-骨盆连续性的手术方法简便，创伤小，并发症少，且固定确实，值得推广。

[ Objective] To investigate the operation indications and techniques of the ISOLA spinal system in reconstruction of the lumber - pelvis continuity after resection of high - level sacral tumors. [ Method ] A retrospective study was performed in 43 patients with high - level sacral tumor （HLST） between July 2001 to January 2007. Symptoms, signs, histological findings of the tumors and their outcomes were analyzed. All patients underwent resection of HLST and spinopelvic reconstruction with ISOLA spinal system, 11 unilateral and 32 bilateral. [Result] Among the 43 patients, 33 （77. 1% ） had chordoma, giant cell tumor of bone and neurogenic tumors. Thirty - four patients alive were followed - up for an average of 35 months （ 12 - 62 months）, 5 patients had a recurrence of chordoma and 29 patients with HLST were under control. The pain originated from the lumbosacral joint and the spinal nerve root was obviously relieved. The patients could stand and ambulate normally. No loose screw or broken rod were found. X - rays showed no signs of the enlarged screw canal or lowered lumbar spine. The effect was 76.5% （26/34） excellent judged by the ISOLS system. [ Conclusion] Spinopelvic reconstruction by ISOLA system after resection of HLST is characterized by easy manipulation, less complications and instant stable fixation. It may be widely used in the clinical practice.