骨盆Ⅰ-Ⅱ-Ⅳ区肉瘤整块切除后腰盆钉棒重建系统  

Enbloc resection of pelvic sarcoma involving region Ⅰ, Ⅱ, Ⅳ and reconstruction with the prosthetic acetabulum pedicle screw and rod system

作　　者：沈靖南[1] 王晋[1] 尹军强[1] 黄纲[1] 雍碧城[1] 李浩淼[1] 邹昌业[1] 

机构地区：[1]中山大学附属第一医院骨肿瘤科,广州510080

出　　处：《中华关节外科杂志（电子版）》2012年第3期8-11,共4页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨骨盆Ⅰ-Ⅱ-Ⅳ区肉瘤整块切除后新设计的腰盆钉棒重建系统的临床应用。方法回顾性研究中山大学附属第一医院骨肿瘤科,2009年6月到2010年12月期间,行骨盆Ⅰ区、Ⅱ区和Ⅳ区肉瘤整块切除和腰盆钉棒系统重建术的病例资料,评价该术式的治疗效果及术后并发症。入选条件:穿刺活检证实骨盆原发性肉瘤;肺部CT未见转移灶,Eneking分期为ⅡB期;患者能完成规范的新辅助化疗;术前MRI评估证实肉瘤未侵犯髂外动静脉、坐骨神经和盆腔脏器,确认肉瘤累及骨盆Ⅰ-Ⅱ-Ⅳ三个区域。结果 4例累及骨盆Ⅰ区、Ⅱ区和Ⅳ区的原发性肉瘤患者接受肿瘤整块切除后腰盆钉棒系统重建。患者男3例,女1例;平均年龄29.75岁(18～45岁)。病理类型包括:尤文肉瘤2例,软骨肉瘤1例和骨肉瘤1例,尤文肉瘤和骨肉瘤完成新辅助化疗。肉瘤整块切除范围包括骨盆Ⅰ区、Ⅱ区和Ⅳ区肿瘤、肿瘤累及的髂肌、臀中小肌和部分臀大肌,同时采用骨盆髋臼和腰椎椎弓根钉棒系统重建髋臼、骨盆环和腰骶连接。术后3周患者开始进行康复治疗,术后3个月可扶拐行走。术后平均随访14个月(9～19个月),目前尚未发现复发和转移。MSTS功能评分平均为66.67%(63%～73%);Harris髋关节评分良2例,差2例。结论骨盆原发性肉瘤治疗的主要目标是通过广泛切除而获得治愈,通过骨盆环重建挽救下肢的主要功能。骨盆Ⅰ区、Ⅱ区和Ⅳ区肉瘤整块切除和腰盆钉棒系统既能完整的切除肿瘤,又能有效重建骨盆和腰骶连接功能。这种重建方式近期疗效观察能够达到患者及骨肿瘤专科医生的功能期望。Objective This study is to evaluate the effect of en bloc resection of pelvic sarcoma involving region Ⅰ-Ⅱ-Ⅳ and reconstruction with the prosthetic acetabulum pedicle screw and rod system. Methods A continuous and retrospective analysis was carried out in patients with pelvic sarcoma in region Ⅰ-Ⅱ-Ⅳ who were treated by en bloc resection and reconstruction with the prosthetic acetabulum pedicle screw and rod system in orthopaedics oncology department of the first affiliated hospital of Zhongshan University from June 2009 to December 2010. The treatment effect and postoperative complications were evaluated. Inclusion criteria were as follows ： primary pelvic sarcoma; no metastasis was detected in chest CT scan ; stage H B according to Enneking classification ; very likely to finish all courses of rico-adjuvant chemotherapy if required; external iliac vessels, sciatic nerve or pelvic viscera involvement was not detected by preoperative MRI; sarcoma was found involving at least three pelvic regions （regions Ⅰ-Ⅱ-Ⅳ ）. Results Four patients with pelvic sarcoma involving region Ⅰ-Ⅱ-Ⅳ underwent en bloc resection and reconstruction with the prosthetic acetabulum pedicle screw and rod system. There were three males and one female whose average age was 29.75 （from 18 to 45 ）. Pathological classification included Ewing＇ s sarcoma （ two cases） , chondrosareoma （ one case） , and osteosareoma （ one ease）. Patients with Ewing＇s sarcoma and osteosarcoma finished their neo-adjuvent chemotherapy. En bloc resection included tumor in pelvic region Ⅰ-Ⅱ-Ⅳ, the tumor-invloved iliacus muscle, gluteus medius muscle, gluteus minius muscle and part of the gluteus maximus muscle. After resection, acetabulum, pelvic ring and lumbosacro region were reconstructed with the prosthetic acetabulum pedicle screw and rod system. Rehabilitation began three weeks after operation. Three months later, patients could walk with the crutches. Average follow-up time was 14 months （range from nine to 1

关 键 词：下肢 挽救疗法 骨肿瘤 假体和植入物 

分 类 号：R738[医药卫生—肿瘤]