Wuisman P, Lieshout O, Sugihara S, van Dijk M
Department of Orthopaedic Surgery, University Hospital, Vrije Universiteit, Amsterdam, The Netherlands.
Clin Orthop Relat Res. 2000 Dec(381):192-203. doi: 10.1097/00003086-200012000-00023.
The oncologic and functional outcomes of nine patients who were treated by total sacrectomy through L5 (three cases) or L5-S1 (six cases) were reviewed. Histologic diagnoses were one osteosarcoma, two giant cell tumors, two chondrosarcomas, and four chordomas. Patients' ages ranged from 17 to 70 years (mean age, 44.5 years). Resection margins were intralesional (giant cell tumors) in two, marginal in one, and wide in six patients (one contaminated). Reconstruction was performed using polymethylmethacrylate in two, screw and plate fixation in one, and a custom-made device in one. In five patients no reconstruction was performed. Five patients (45.5%) had wound complications: one had a wound dehiscence and two had deep infection; all needed surgical reintervention. In addition, in one a ventral and in another a dorsal hernia developed; only the ventral hernia was revised successfully. One patient had a deep vein thrombosis that was treated with a Coumadin derivate. Three patients (33%) died after 14, 18, and 50 months postoperatively respectively. One died of lung and widespread metastases, and two died of local recurrence and metastases. One patient with a giant cell tumor had a solitary lung metastasis. After resection the patient has been disease-free more than 90 months. At followup, six patients had no evidence of disease (mean followup, 73 months; range, 30-120 months). Functionally, there was no correlation between patients who had a reconstruction and those who had not. Total sacrectomy is a valuable procedure to secure local tumor control and overall survival, despite potential complications and neurologic and sexual dysfunction.
回顾了9例经L5（3例）或L5-S1（6例）行全骶骨切除术患者的肿瘤学和功能结局。组织学诊断为1例骨肉瘤、2例骨巨细胞瘤、2例软骨肉瘤和4例脊索瘤。患者年龄为17至70岁（平均年龄44.5岁）。切除边缘2例为瘤内（骨巨细胞瘤）、1例为边缘性、6例为广泛性（1例污染）。2例行聚甲基丙烯酸甲酯重建，1例行螺钉钢板固定，1例行定制装置重建。5例未进行重建。5例患者（45.5%）出现伤口并发症：1例伤口裂开，2例深部感染；均需再次手术干预。此外，1例出现腹侧疝，另1例出现背侧疝；仅腹侧疝成功修复。1例患者发生深静脉血栓形成，接受香豆素衍生物治疗。3例患者（33%）分别在术后14、18和50个月死亡。1例死于肺和广泛转移，2例死于局部复发和转移。1例骨巨细胞瘤患者出现孤立性肺转移。切除术后该患者无病生存超过90个月。随访时，6例患者无疾病证据（平均随访73个月；范围30 - 120个月）。在功能方面，进行重建和未进行重建的患者之间无相关性。尽管存在潜在并发症以及神经和性功能障碍，全骶骨切除术仍是确保局部肿瘤控制和总体生存的有价值手术。
