原发性骶骨巨细胞瘤的切除与重建:22例分析

Resection and reconstruction for primary giant cell tumor of the sacrum:analysis of 22 cases

目的探讨原发性骶骨巨细胞瘤的外科治疗方法。方法对2000年2月～2008年2月收治的22例原发性骶骨巨细胞瘤患者进行回顾性研究,其中侵犯S_2及以下8例,侵犯达S_1者14例。行后路单纯肿瘤切除3例,前后路联合切除、腰骶重建7例,单纯后路肿瘤切除、腰骶重建12例。结果22例患者无围手术期死亡。3例出现切口延迟愈合,2例经换药愈合,1例行臀大肌肌瓣转移覆盖后愈合。20例患者获随访,平均随访时间44个月(16～85个月)。4例复发,3例经再次手术获得良好控制,1例带瘤生存。4例患者出现术后大小便功能障碍,其中3例在术后2周出院时已有缓解,另1例经理疗后于术后1年内逐渐改善。1例术后11个月出现内固定松动,取出内固定。其余患者腰骶部症状缓解,双下肢感觉及运动功能良好。结论合理的手术方式和应用ISOLA等有效的腰骶部重建方式可使骶骨巨细胞瘤患者获得良好的局部控制,并可最大程度保留术后功能。

Objective To investigate the surgical treatment of primary giant cell tumor of the sacrum. Methods A retrospective analysis was done on 22 patients with primary giant cell tumor of the sacrum who were treated in our hospital between February 2000 and February 2008. The lesion was present on S2 and the segments below in 8 patients, and on SI in 14 patients. 3 patients underwent resection with only posterior approach; 7 underwent resection with anterior-posterior approach, combined with lumbosacral reconstruction; 12 underwent resection with posterior approach and lumbosacral reconstruction. Results No patient died peri-operatively. 3 patients delayed healing of the incision. The wound healed after dressing change in 2 of them. 1 underwent gluteus maximus pushing muscle flap and the wound healed. 20 patients were followed up for 44 months on average（16-85 months）. 4 patients relapsed. The lesion in 3 of them was well controlled after secondary operation, and 1 survived with cancer. 4 patients developed bowel and urine dysfunction after surgery. 3 of them were released 2 weeks after surgery with remission. The other gradually improved within 1 year after physiotherapy. 1 patient had screw loosening 11 months after surgery, and the internal fixator was removed. All the other patients＇ lumbosacral symptoms relieved, and the sense and motion function of both lower extremities were good. Conclusions Proper surgical treatment and lumbosacral reconstruction, such as ISOLA, can achieve good outcomes for patients with giant cell tumor of the sacrum, and preserve the original function to the maximum.