累及骶骨的骨盆恶性肿瘤切除及重建

Reconstruction of bony defect after resection of malignant pelvic tumor involvement of sacrum

目的探讨累及骶骨的骨盆恶性肿瘤合理的手术切除及重建方式。方法1999年7月至2007年7月，共有19例累及骶骨的骨盆恶性肿瘤患者在北京大学人民医院骨肿瘤科接受肿瘤切除重建手术。平均年龄37岁（12—78岁）；男性12例，女性7例。其中，软骨肉瘤5例、尤文肉瘤4例、骨肉瘤4例、恶性纤维组织细胞瘤（MFH）1例、骨巨细胞瘤1例、转移癌4例。切除髂骨翼及部分骶骨、保留髋臼手术10例，采用了钉棒系统内固定，其中5例患者同时进行了自体腓骨或髂骨植骨；切除部分骶骨、髂骨翼及髋臼手术9例，应用组配式人工半骨盆重建骨盆环完整性。结果肿瘤学结果：7例出现局部复发（7／19，36．9％），其中骨肉瘤2例、软骨肉瘤2例、尤文肉瘤2例及转移癌1例。19例患者随访时间为1至7年，平均4．5年。功能结果：9例保留髋臼、钉棒重建的患者术后正常行走，无步态异常。9例行Ⅱ区肿瘤切除、人工半骨盆重建的患者中，8例术后2个月能够扶拐行走。ISOLS评分平均20分以上，其中，良好3例，一般5例，较差1例。人工半骨盆重建的患者中，术后脱位1例，行切开复位；因深部感染取出假体1例。结论对于保留髋臼的髂骨肿瘤切除，采用钉棒内固定结合自体骨植骨是一种理想的重建骨盆环稳定性的方法，可使患者早期恢复行走功能。将股骨头颈植于骶骨侧方，将组配式人工半骨盆卡于质骨块的下方，重建累及骶骨及髋臼的骨盆切除，是一种可取的重建方式。

Objectives To review the patients with malignant pelvic tumors involving sacrum treated surgically and to discuss the methods of resection of tumors and reconstruction of defects. Methods Nineteen patients with malignant pelvic tumors involving the sacrum were treated surgically in People＇s Hospital between July 1999 and July 2007. The series comprised 12 males and 7 females. Five patients were diagnosed with ehondrosarcoma, 4 with Ewing sarcoma, 4 with osteosarcoma, 1 with malignant fibrohistiocytoma （MFH）, 1 with giant cell tumor （GCT）, and 4 with metastatic bone tumors. Acetabulum was preserved after resection of the iliae and sacral tumor and reconstructed with screw and rod system in 10 patients. Among this 10 patients, 5 of them were also clone bone graft. Acetabulum was not preserved after resection of the iliac and sacral tumor and the defect was reconstructed with modular hemipelvic prosthesis in 9 patients. Results Oncology result ： 7 patients （ 7/19, 36. 9% ） had local relapse, including of 2 osteosarcoma, 2 chondrosarcoma, 2 Ewing sarcoma and 1 metastatic tumor. Two of 4 osteosarcoma, 2 of 4 Ewing sarcoma, 1 of 5 chondrosarcoma and 1 MFH patients died of lung metastasis. Two patients with metastatic lung cancer died of the disease 1 year after surgery. One patient with kidney carcinoma and 1 with thyroid carcinoma alive without of disease. Functional result： 8 patients with acetabular reconstruction after resection of pelvic and sacral tumors could walk with a cane 2 months after surgery. Average ISOLS function score was 20, including good in 3, fair in 5 and poor in 1 patient. One of the patient with modular hemipelvic prosthetic reconstruction occured dislocation treated with 1 month after surgery and experienced open reduction. Hemipelvic prosthesis was took out in 1 patient because of the deep infection. Conclusions For patients with acetabulum preserved after resection of the iliac and sacral tumor, reconstructed with screw and rod system combining with bone graft is an ideal method for restoration. Bone graft with resected femoral head and neck on residual sacrum and modular hemipelvic prosthetic reconstruction after resection of the pelvic tumor involving of the secrum is a good choose.