骨盆部分切除术治疗骨盆肿瘤的部位分型与术式选择

Classification and related operation procedures of pelvic tumor treated with partial pelvic resection

目的探讨对骨盆部肿瘤按其发生部位进行分型，选择相应的手术方式，以最大限度保留患侧肢体的功能。方法通过对１９８０年～１９９５年２０例骨盆肿瘤手术的总结，提出按肿瘤侵及部位即骶髂关节及髋关节是否被破坏将骨盆肿瘤分为四型：Ⅰ型单纯坐、耻骨支破坏，Ⅱ型髂骨及骶髂关节破坏，Ⅲ型肿瘤侵及髋臼，Ⅳ型骶髂关节及髋关节均有破坏。以此提出相应的三种手术方式：单纯切除、切除加骶髂部连续性重建及切除加股骨头旷置术。对Ⅳ型肿瘤则采用传统的半侧骨盆离断术。结果术后随访４个月～１４年，平均５１７个月，术后均达到保留患肢功能和骨盆稳定性的目的。Ⅰ、Ⅱ型术后步态改变不明显，Ⅲ型术后有肢体短缩（４０～８０ｃｍ）、跛行，需穿矫形鞋，肢体短缩超过８０ｃｍ者有时需扶单拐行走。远期无血管、神经损伤。经３个月功能锻炼，髋关节周围肌力达Ⅲ～Ⅴ级，基本恢复行走功能，生活自理。结论不同部位的骨盆肿瘤其手术方式的选择不尽相同。根据按肿瘤部位分型法选择相应术式。

Objective To establish a classification system of pelvic tumor in terms of the location of lesion in order to project surgical treatment with less extent of damage to the affected limb function. Method Thirty six cases were treated by partial pelvic resection with limb salvage, and 20 were followed up. The lesions were divided into four groups on the basis of sacral iliac and/or hip joint involved. In group Ⅰ, lesion was noted in the ischium or pubis only;in group Ⅱ the lesion was located at sacral iliac joint or hip joint. The patients with acetabulum involved were classified into group Ⅲ both sacral iliac joint and hip joint were destroyed by tumor in group Ⅳ. Surgical treatment was designed as resection, resection with sacral iliac joint reconstruction, resection without hip joint reconstruction according to the classification of the lesion. The patients in group Ⅳ were treated with traditional hemi pelvic amputation. Result Patients were followed up from 4 months to 14 years (average 51 7 months). The limb function was preserved to some extent, and pelvic stability was satisfactory. Walking gait was not chlanged significant in group Ⅰ and Ⅱ. But resection without hip joint reconstruction in group Ⅲ resulted in limb discrepancy(4 0～8 0 cm) and walking lamely. The patients needed custom made shoes with heightened heel, but some of them walked with crutch when the discrepancy exceeded 8 cm. There were no nerve and vessel injury in the long run. The strength of muscles around hip joint was Ⅲ～Ⅳ grade after postoperative excercise, and the capability of walking and viability recovered 3 months after the operation. Conclusion Different surgical treatments should be selected according to the site of pelvic tumor. The classification system depending on the lesion′s location in pelvic tumor is useful in selecting operative procedure to retain limb function to great extent.