TSRH-3D在高位骶骨肿瘤切除和腰椎骨盆稳定性重建中的作用

Evaluation of lumbo-pelvic reconstruction with TSRH-3D following high-sacrum tumors resections

目的评价TSRH-3D在高位骶骨肿瘤切除、腰椎骨盆重建中的作用和效果。方法经前后联合入路或腰骶椎后路手术治疗61例高位骶骨肿瘤患者。肿瘤切除方式:L5～S1椎节切除4例,L5～S2椎节切除7例,全骶骨切除17例,骶骨部分切除33例。肿瘤切除后应用TSRH-3D系统进行腰椎骨盆重建,并给予相应的放疗与化疗。结果术中出血量500～6000(2700±800)ml。手术时间150～380(220±80)min。未出现手术相关的死亡。61例均获随访,时间3～50(18±15)个月,近期疗效均较满意。腰骶部疼痛均减轻或缓解,神经功能有不同程度的改善。2例出现一侧髂骨螺钉断钉,7例出现排尿困难,4例出现脑脊液漏,2例切口延期愈合,复发7例,因肿瘤复发转移出现全身衰竭死亡3例。结论TSRH-3D腰椎骨盆重建系统安装方便,手术操作容易,创伤小,对脊柱的稳定性破坏小,便于植骨,容易获得植骨融合而达到长期稳定的效果,适合在高位骶骨肿瘤切除和腰椎骨盆稳定性重建中应用。

Objective To evaluate the effect of lumbo-pelvic reconstruction with TSRH-3D following high-sacrum tumor resections. Methods Sixty-one patients following high sacral tumors recection were given lumbo-pelvic reconstruction using TSRH-3D instrumentation, and some of them were given corresponding chemotherapy and radiotherapy. The style of resections includes L5 - S1 vertebra removing in 4 cases, L5 - S2 vertebra removing in 7 cases, total sacrectomy in 17 cases,and subtotal sacrectomy in 33 cases. Results The amount of blood loss was 500 to 6 000 （ 2 700 ± 800） ml, The operation time was 220 ± 80 （ 150 to 380 ） minutes. No surgical mortality was noted. The median follow-up was 18 ± 15 months （ranged 3 to 50 months）. The short-term results were satisfactory with the lumbosacral pain reduced and the neurological function improved in different degrees. However, instrument breakage was found in 2 cases without serious result. Dysuria occurred in 7 eases. 4 cases experienced cerebrospinal fluid leakage and 2 cases experienced delayed healing. 7 cases recurred after surgery. 3 cases suffered from metastasis and died of systemic failure after surgery. Conclusions TSRH-3D instrumentation can be easily manipulated. It allows for maxi- mum graft volume, and has less impairment to the stability of the spine. It can maximize the procedural efficiency and results, and provide good result in the lumbo-pelvic stability reconstruction following sacrum tumors resection.