骶骨肿瘤外科分型法初探  

Primary discussion on surgical classification of sacral tumors

作　　者：蔡郑东[1] 李国东[1] 傅强[1] 何大为[1] 王季[1] 汝鸣[1] 纪方[1] 

机构地区：[1]第二军医大学附属长海医院骨科,上海200433

出　　处：《中华骨科杂志》2008年第2期101-105,共5页Chinese Journal of Orthopaedics

摘　　要：目的总结92例骶骨肿瘤外科治疗经验，提出新的骶骨肿瘤外科分型方法，对手术方式的选择提供指导。方法对2000年1月至2005年8月间上海长海医院骨科及普外科收治并进行手术切除的92例骶骨肿瘤患者进行回顾性研究。根据肿瘤的影像学特征表现和外科手术治疗情况将肿瘤分类：首先按照MRI矢状面解剖位置将骶骨肿瘤分为两个大型，Ⅰ型即凡累及S1、S2节段的骶骨肿瘤，Ⅱ型为仅累及S3-S5节段的骶骨肿瘤；根据肿瘤前缘突入盆腔的距离参数D进一步将I型和Ⅱ型骶骨肿瘤分成四个亚型：Ⅰa、Ⅰb、Ⅱa、Ⅱb（D〈5cm为a，D≥5em为b）；亚型分区：根据横切面解剖位置将四个亚型的骶骨肿瘤进行解剖分区（1、2、3区分别代表骶前区、骶髂关节区和骶后区），确定16个亚型分区。依据肿瘤分型分区可确定手术入路和切除范围。结果92例骶骨肿瘤中，依据骶骨肿瘤外科分型方法：Ⅰ型42例，Ⅱ型50例；16个解剖分区统计：Ⅰa1型2例，Ⅰa2型1例，Ⅰa3型2例，Ⅰa12型9例，Ⅰa13型无，Ⅰa23型2例，Ⅰa123型8例，Ⅰb1型2例，Ⅰb12型8例，Ⅰb13型1例，Ⅰb123型7例，Ⅱa1型5例，Ⅱa3型1例，Ⅱa13型17例，Ⅱb1型5例，Ⅱb13型22例。单纯前方入路者14例（15．2％），单纯后方入路者40例（43．5％），前后联合入路者38例（41-3％）。35例（38．0％）行腰椎一骨盆连续性重建（ISOLA脊柱内固定系统）。结论骶骨肿瘤外科分型对指导手术入路、选择重建方式等有较大意义；但尚不能反映肿瘤生物学特性，须进一步完善。Objective To summarize the experience in surgical treatment of 92 cases of sacral tumors and discuss the surgical classification of sacral tumors and evaluate its guiding function during operation. Methods 92 consecutive patients underwent resections of sacral neoplasms in Department of Orthopaedics and General Surgery of Changhai Hospital between January 2000 and August 2005. The records of these patients were retrospectively reviewed. A new surgical classification of sacral tumors based on the ra- diological findings and the surgical requirements was proposed to decide the approach and the range of resection. According to the new classification method, the 92 patients were firstly divided into 2 types according to the involvement in sagittal plane： type Ⅰ （sacral tumors involving S1 and/or S2 segments） and type Ⅱ （sacral tumors involving S3 to S5）. Then the 2 types were further divided into 4 subtypies （ Ⅰ a, Ⅰ b, Ⅱa and Ⅱ b） according to a new parameter D which represents the distance（＂a＂ represets D〈5 cm while ＂b＂ represets D≥5 cm）from the front of the tumor to the sacrum. The 4 subtypies were finally divided into 16 groups according to tumor involvement in the axial plane （region 1, 2 and 3 represents the pre-sacral, the sacroiliac joints and the post-sacral regions respectively）. The classification helps to decide the approach of the operation and the range of resection. Results Among the 92 cases, typeⅠ 42 cases, type Ⅱ50 cases. The 16 regional groups according to the classification are as follows：Ⅰal 2 cases, Ⅰ a2 1 case, Ⅰ a3 2 cases, Ⅰ a12 9 cases, Ⅰa13 0 case, Ⅰa23 2 cases, Ⅰ a123 8 cases,Ⅰ bl 2 cases, Ⅰ b12 8 cases, Ⅰ b13 1 case, Ⅰ b123 7 cases, Ⅱ al 5 cases,Ⅱ a3 1 case, Ⅱa13 17 cases, Ⅱ b1 5 cases, Ⅱ b13 22 cases. Anterior approach（14, 15.2%）, posterior approach（40, 43.5%） and combined approach（38, 41.3%） were used in the operations, The reconstruction of the continuity of lumber-pelvis was performed in 35

关 键 词：骶骨 骨肿瘤 外科手术 

分 类 号：R738[医药卫生—肿瘤]