Wuisman P, Lieshout O, van Dijk M, van Diest P
Departments of Orthopaedic Surgery and Pathology, Free University Hospital, Amsterdam, The Netherlands.
Spine (Phila Pa 1976). 2001 Feb 15;26(4):431-9. doi: 10.1097/00007632-200102150-00021.
A report of an innovative technique to restore the lumbosacral junction after resection of primary highly malignant osteosarcoma of the sacrum involving the whole sacrum, soft tissues, and adjacent posterior parts of both iliac wings.
To describe the planning and design of a custom-made sacral prosthesis, the surgical technique, and clinical and functional outcome of the patient.
Although there have been case reports about reconstruction methods after total sacrectomy, to date, there has not been a reported clinical case of successful reconstruction using an individual designed prosthesis based on a three-dimensional real-sized model.
A 42-year-old woman was referred with progressive neurologic impairment due to primary osteosarcoma of the sacrum invading surrounding structures. Based on a three-dimensional real-sized model, a detailed surgical plan was developed to assure safe, wide surgical margins. In addition, the model enabled design and testing of a custom-made sacral prosthesis, to provide stable lumbosacral reconstruction.
After induction chemotherapy, a staged anteroposterior resection-reconstruction was successfully performed. After surgery, a superficial wound dehiscence was promptly treated. Within 3 weeks after surgery, mobilization began, and the adjuvant chemotherapy was continued. At the 36-month follow-up, the patient was disease free, had a stable, painless spinopelvic junction, and could walk short distances using ankle orthoses and crutches. Radiographs show complete incorporation of the pelvic grafts and unchanged position of the implant.
In planning and performing a total sacrectomy, including substantial parts of iliac wings, a three-dimensional real-sized model offers surgeons distinct advantages. Wide bony resection margins can be drawn on the model, and an individual custom-made prosthesis to re-establish spinopelvic continuity can be designed and tested before the intervention.
一份关于在切除累及整个骶骨、软组织及双侧髂骨翼相邻后部的原发性高度恶性骶骨骨肉瘤后恢复腰骶关节的创新技术报告。
描述定制骶骨假体的规划与设计、手术技术以及患者的临床和功能结果。
尽管已有全骶骨切除术后重建方法的病例报告，但迄今为止，尚无基于三维实体模型设计的个体化假体成功重建的临床病例报道。
一名42岁女性因骶骨原发性骨肉瘤侵犯周围结构导致进行性神经功能障碍前来就诊。基于三维实体模型制定了详细的手术计划，以确保安全、广泛的手术切缘。此外，该模型还能用于定制骶骨假体的设计和测试，以提供稳定的腰骶重建。
诱导化疗后，成功进行了分期前后路切除重建手术。术后及时处理了浅表伤口裂开。术后3周内开始活动，并继续辅助化疗。在36个月的随访中，患者无疾病，脊柱骨盆连接稳定、无痛，使用踝足矫形器和拐杖能短距离行走。X线片显示骨盆移植骨完全融合，植入物位置未变。
在规划和实施包括大部分髂骨翼的全骶骨切除术时，三维实体模型为外科医生提供了明显优势。可以在模型上画出广泛的骨切除切缘，并且在干预前可以设计和测试用于重建脊柱骨盆连续性所需的个体化定制假体。
