全骶骨切除术后重建方法的发展及现状

Development and current situation of reconstruction methods following total sacrectomy

目的回顾全骶骨切除术后重建方法的发展历程,为寻找更好的全骶骨切除重建方法提供参考。方法查阅国内外全骶骨切除术后重建的案例报道和生物力学及有限元研究文献,对重建方法的发展过程及现状进行总结。结果全骶骨切除术后重建方式经过近30年的发展,在重建理念和固定技术上都取得了较大进展。重建方式可概括为3种策略:腰髂、后环和前柱。腰髂指腰椎与双侧髂骨之间的连接,后环指双侧髂骨之间的连接,前柱指邻近腰椎椎体和骨盆的连接。腰髂重建经历了从钩棒到椎弓根钉和髂骨钉棒的技术进步;后环和前柱重建可以提高重建系统的稳定性。结论为了达到力学稳定,腰髂、后环和前柱的联合重建是全骶骨切除术后重建的发展方向,如何实现生物固定提高重建结构远期稳定性,是亟待解决的问题。

Objective To review the development of the reconstruction methods following total sacrectomy, and to provide reference for finding a better reconstruction method following total sacrectomy. Methods The case reports and biomechanical and finite element studies of reconstruction following total sacrectomy at home and abroad were searched. Development and current situation were summarized. Results After developing for nearly 30 years, great progress has been made in the reconstruction concept and fixation techniques. The fixation methods can be summarized as the following three strategies： spinopelvic fixation（SPF）, posterior pelvic ring fixation（PPRF）, and anterior spinal column fixation（ASCF）. SPF has undergone technical progress from intrapelvic rod and hook constructs to pedicle and iliac screw-rod systems. PPRF and ASCF could improve the stability of the reconstruction system. Conclusion Reconstruction following total sacrectomy remains a challenge. Reconstruction combining SPF, PPRF, and ASCF is the developmental direction to achieve mechanical stability. How to gain biological fixation to improve the long-term stability is an urgent problem to be solved.