手术治疗高位骶骨肿瘤  

Comparative study of the different internal fixation methods to treatment superior sacral tumors

作　　者：张晋煜[1] 许建波[1] 袁涛[1] 马翔[1] 杨腾蛟[1] 

机构地区：[1]昆明医学院第三附属医院云南省肿瘤医院骨科,云南昆明650118

出　　处：《临床骨科杂志》2010年第6期608-610,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨不同重建技术治疗高位骶骨肿瘤的临床疗效。方法对38例骶骨肿瘤患者采用骶骨肿瘤切除＋骨水泥填充＋改良Gaveston内固定技术重建。记录术中出血量,休克死亡、骶神经损伤、切口愈合情况及肿瘤术后1年复发等并发症情况。结果手术时间430~720 min,术中出血量平均（2 400±1 656）ml,手术过程中无休克死亡。38例均获随访,时间6~33个月。患者腰骶部疼痛及神经功能有不同程度改善。7例术后出现排尿困难,6个月后恢复;6例术后切口感染延迟愈合;4例术后出现脑脊液漏。2例脊索瘤患者于术后6个月复发,1例转移癌患者3个月复发;1例尤因肉瘤患者13个月复发。2例转移癌患者分别于术后14和20个月因全身衰竭死亡。结论高位骶骨肿瘤切除＋骨水泥填充＋改良Gaveston内固定技术重建虽然手术时间延长,出血量增加,但腰椎骨盆稳定性重建有利于骨盆和脊柱的稳定性以及神经功能的恢复,术后可早期活动,近期疗效均较满意。Objective To investigate the internal fixation methods effect on superior sacral tumors.Methods 38 patients with superior sacrum tumor were underwent sacral tumor resection,cement filling and improved Gaveston reconstruction.The different complications were observed such as the loss of blood,shock or death,sacral nerves injury,one-year relapse rate.Results During operation,no patients died,the average operating time was 430～720 min,and the volume of blood loss was 2 400±1 656 ml.In the follow-up period of 6～33 months,the results of short term were satisfactory with the lumbosacral pain reduced and 7 cases the neurological function improved in different degrees after 6 months.2 cases with chordana after 6 months,1 case with metastasis cancer after 3 months,and 1 case with Ewing,sarcoma after 13 months were recurrenced.4 cases experienced cerebrospinal fluid leakage and 6 cases experienced wound infection and delayed healing.2 cases with metastasis cancer died of exhaustion,14 and 20 months respectively.Conclusions During the resection of superior sacrum tumor,it is effective to reconstruct lumbosacral stability after tumor excision with Gaveston internal fixation,which is helpful for early mobilization.

关 键 词：骶骨肿瘤 骨黏合剂 改良Gaveston内固定 骨盆稳定 

分 类 号：R738.1[医药卫生—肿瘤] R687.3[医药卫生—临床医学]