骶骨肿瘤患者行全骶骨切除后腰骶部稳定性的重建  

The spinopelvic reconstruction after total sacrectomy

作　　者：董森[1] 汤小东[1] 姬涛[1] 郭卫[1] DONG Sen;TANG Xiaodong;JI Tao;GUO Wei(Musculoskeletal Tumor Center,Peking University People＇s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院骨与软组织肿瘤治疗中心,北京100044

出　　处：《中华骨与关节外科杂志》2018年第7期481-485,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:骶骨肿瘤切除是骨肿瘤外科治疗的一个难题。既往文献报道多侧重于肿瘤的切除方法,对于骶骨肿瘤切除后稳定性重建的研究较少。目的:探讨全骶骨肿瘤切除后腰骶部稳定性重建的方法。方法:回顾分析2000年7月至2015年12月,63例全骶骨肿瘤切除后腰骶部稳定性重建患者的临床资料。男38例,女25例,年龄18-62岁,平均42.1岁。病理诊断:软骨肉瘤9例,脊索瘤25例,骶骨恶性神经鞘瘤5例,骨肉瘤13例,尤文肉瘤4例,孤立性转移瘤2例,未分化肉瘤2例,骨巨细胞瘤3例。前后路联合全骶骨切除术23例,单纯后路全骶骨切除术40例。结果:所有患者随访时间5~97个月,平均45个月。16例内固定失败出现在术后8~24个月,平均17.1个月。本组病例中共9例出现螺钉松动移位,7例患者出现金属棒断裂。6例患者出现植骨未愈合,其中3例术后曾接受放射治疗。结论:全骶骨肿瘤切除后,钉棒系统重建最常出现金属连接棒的断裂。内固定失败可能与金属连接棒过细,固定节段不合理,植骨不愈合有关。通过合理的翻修手术可以较好地解决内固定断裂问题。Background：Resection of sacral tumor is a difficult point in surgical treatment of bone tumors.Previous studies have focused on the resection of tumors,and there are few studies on the reconstruction after total sacrectomy.Objective：To retrospectively review the rate and category of mechanical fixation in patients with spinopelvic reconstruction after total sacrectomy.Methods：Between July 2000 and December 2015,spinopelvic reconstruction following total sacrectomy were carried out in 63 patients.There were 38 males and 25 females with a mean age of 42.1 years（range,18-62 years）.The pathological diagnosis included 9 chondrosarcomas,25 chordomas,5 malignant schwannomas,13 osteosarcomas,4 Ewing sarcomas,2 solitary metastatic tumors,2 undifferentiated pleomorphic sarcomas,and 3 giant cell tumors.Total sacrectomy was performed in 23 patients through combined anterior and posterior approaches,in the other 40 patients through single posterior approach.Results：The mean duration of follow-up was 45 months（range,5-97 months）.Mechanical fixation failure occurred in 25% of patients（16/63） at a mean time of 17.1 months（range,8-24 months） postoperatively.Rods breakage and pedicle screws failure occurred in 7 and 9 patients,respectively.Nonunion of bone grafts was observed in 6 patients,and three of them received radiotherapy.Conclusions：Rods breakage is frequently encountered in reconstruction after total sacrectomy.The failure of the reconstruction may be related to extremely slim rod,improper internal fixation and nonunion of bone grafts.Revision surgery should be carried out in these patients.

关 键 词：全骶骨切除 骶骨肿瘤 腰骶部重建 内固定断裂 

分 类 号：R738.1[医药卫生—肿瘤]