高位骶骨肿瘤切除后的外科重建策略  

Surgical reconstruction strategy of high level sacral tumors after tumor resection

作　　者：吴强[1] 邵增务[1] 杨述华[1] 王佰川[1] 范磊[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022

出　　处：《中国骨与关节杂志》2013年第10期580-583,共4页Chinese Journal of Bone and Joint

摘　　要：目的探讨高位骶骨肿瘤切除后个性化重建方案。方法回顾分析自2000年9月至2011年12月,手术治疗的高位骶骨肿瘤11例,肿瘤类型包括骨巨细胞瘤、脊索瘤、软骨肉瘤、骨肉瘤及神经源性肿瘤。所有病例中,骶椎S_1均受累。根据骶骨及骶髂关节侵犯范围,选择最佳手术方案,进行个性化外科重建。结果全部11例无术中死亡病例,术中平均出血量3200ml。10例获得8个月至6年的随访,平均24个月,术后近期并发症1例为切口皮缘坏死和伤口延迟愈合;1例术后出现排尿困难,1例脑脊液漏。患者早期功能恢复良好,神经功能障碍改善率达66.7%。局部复发2例,分别为1例骨巨细胞瘤和1例软骨肉瘤,未出现远处转移病例。随访病例均未发现钉棒松动、断裂,以及同种异体腓骨植入后骨端吸收现象。结论良好的手术计划以及个性化的切除及重建方案可以保证手术的成功性。减少术中出血、合适地保留马尾神经功能以及骨盆环的重建是手术考虑的重点。Objective The surgery of high level sacrum is a challenge in the field of bone tumor therapy because of its special anatomic structure, large quantity of hemorrhage during the operation and the difficulty in reconstruction. This study is to investigate the individual reconstruction strategy of high level sacral tumor surgery. Methods The retrospective ＂study included 11 patients from September 2000 to December 2011. The tumor type included bone giant cell tumor, chordoma, chondrosarcoma, osteosarcoma and neurogenic tumor. In all cases, the sacral vertebrae S1 was involved. The individualized reconstruction strategy was conducted according to the invasion area of the sacrum and sacroiliac joint. Results No patients died during the operation. The average amount of bleeding was 3200 ml. 10 cases were followed up for 8 months to 6 years, 24 months in average. The recent complications included 1 case of incision skin edge necrosis and wound delay healing, 1 case of dysuria, and 1 cases of cerebrospinal fluid leakage. Most patients obtained good function at early stage and the improvement rate of nerve dysfunction was 66.7%. Local recurrence happened in 2 cases including 1 case of bone giant cell tumor and 1 case of chondrosarcoma. No metastasis occurred. No loosening or break of internal fixation appeared in all the cases. No end absorption of variant fibula fixation occurred in all the cases. Conclusions Good preoperative plan and individualized excision and reconstruction strategy are guarantees for high sacrum tumor surgery even of high risk. less blood loss hemorrhage, suitable reservation of the function of cauda equina and individualized reconstruction strategy for pelvic ring are the key points of the operation plan.

关 键 词：骶骨 骨肿瘤 修复外科手术 

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