Ozaki Toshifumi, Rödl Robert, Gosheger Georg, Hoffmann Christiane, Poremba Christopher, Winkelmann Winfried, Lindner Norbert
Department of Orthopaedics, Westfälische Wilhelms-University, Münster, Germany.
Clin Orthop Relat Res. 2003 Feb(407):152-8. doi: 10.1097/00003086-200302000-00023.
The incidence and characteristics of sacral infiltration in pelvic sarcomas were analyzed. Fifty-one patients with a pelvic sarcoma (chondrosarcoma, 15 patients; Ewing's sarcoma, 23 patients; and osteosarcoma, 13 patients) abutting the sacroiliac joint had surgical treatment. Tumor infiltration into the sacrum was suspected based on preoperative images in 18 patients; 15 of 18 patients had histologic tumor invasion. There was a significant difference of median volume of sarcomas with and without infiltration. One of 23 Ewing's sarcomas, seven of 15 chondrosarcomas, and seven of 13 osteosarcomas penetrated the sacroiliac joint into the sacrum. Logistic regression test showed that diagnosis was the most important factor influencing sacral infiltration. Twelve tumors infiltrated through the posterior part of the joint, two tumors infiltrated through the anterior part, and one large tumor infiltrated through an unknown route. To obtain wide surgical margins, patients at risk (elderly, large tumor, or diagnosis of osteosarcoma or chondrosarcoma) for sacral involvement may require extended internal hemipelvectomy with the medial margin extending into the sacrum. High quality imaging studies should be used to assess the need for transarticular resection.
分析骨盆肉瘤中骶骨浸润的发生率及特征。51例骨盆肉瘤（软骨肉瘤15例、尤因肉瘤23例、骨肉瘤13例）累及骶髂关节的患者接受了手术治疗。术前影像学检查怀疑18例患者肿瘤浸润至骶骨；18例患者中有15例存在组织学肿瘤侵犯。有浸润和无浸润的肉瘤中位体积存在显著差异。23例尤因肉瘤中有1例、15例软骨肉瘤中有7例、13例骨肉瘤中有7例穿透骶髂关节至骶骨。逻辑回归分析显示诊断是影响骶骨浸润的最重要因素。12例肿瘤通过关节后部浸润，2例肿瘤通过前部浸润，1例大肿瘤通过未知途径浸润。为获得广泛的手术切缘，有骶骨受累风险（老年、肿瘤大、诊断为骨肉瘤或软骨肉瘤）的患者可能需要进行扩大的内侧半骨盆切除术，内侧切缘延伸至骶骨。应使用高质量的影像学检查来评估经关节切除的必要性。
