Guo Wei, Yang Rong-li, Ji Tao
Musculoskeletal Tumor Center, Peking University, People's Hospital, Beijing 100044, China.
Zhonghua Wai Ke Za Zhi. 2009 May 15;47(10):766-9.
To review the patients with malignant pelvic tumors involving sacrum treated surgically and to discuss the methods of resection of tumors and reconstruction of defects.
Nineteen patients with malignant pelvic tumors involving the sacrum were treated surgically in People's Hospital between July 1999 and July 2007. The series comprised 12 males and 7 females. Five patients were diagnosed with chondrosarcoma, 4 with Ewing sarcoma, 4 with osteosarcoma, 1 with malignant fibrohistiocytoma (MFH), 1 with giant cell tumor (GCT), and 4 with metastatic bone tumors. Acetabulum was preserved after resection of the iliac and sacral tumor and reconstructed with screw and rod system in 10 patients. Among this 10 patients, 5 of them were also done bone graft. Acetabulum was not preserved after resection of the iliac and sacral tumor and the defect was reconstructed with modular hemipelvic prosthesis in 9 patients.
Oncology result: 7 patients (7/19, 36.9%) had local relapse, including of 2 osteosarcoma, 2 chondrosarcoma, 2 Ewing sarcoma and 1 metastatic tumor. Two of 4 osteosarcoma, 2 of 4 Ewing sarcoma, 1 of 5 chondrosarcoma and 1 MFH patients died of lung metastasis. Two patients with metastatic lung cancer died of the disease 1 year after surgery. One patient with kidney carcinoma and 1 with thyroid carcinoma alive without of disease. Functional result: 8 patients with acetabular reconstruction after resection of pelvic and sacral tumors could walk with a cane 2 months after surgery. Average ISOLS function score was 20, including good in 3, fair in 5 and poor in 1 patient. One of the patient with modular hemipelvic prosthetic reconstruction occurred dislocation treated with 1 month after surgery and experienced open reduction. Hemipelvic prosthesis was took out in 1 patient because of the deep infection.
For patients with acetabulum preserved after resection of the iliac and sacral tumor, reconstructed with screw and rod system combining with bone graft is an ideal method for restoration. Bone graft with resected femoral head and neck on residual sacrum and modular hemipelvic prosthetic reconstruction after resection of the pelvic tumor involving of the secrum is a good choose.
回顾性分析手术治疗累及骶骨的骨盆恶性肿瘤患者，探讨肿瘤切除及缺损重建方法。
1999年7月至2007年7月期间，我院共收治19例累及骶骨的骨盆恶性肿瘤患者，其中男性12例，女性7例。病理诊断：软骨肉瘤5例，尤因肉瘤4例，骨肉瘤4例，恶性纤维组织细胞瘤1例，骨巨细胞瘤1例，骨转移瘤4例。10例患者在切除髂骨和骶骨肿瘤后保留髋臼，采用螺钉和棒系统重建；其中5例同时行植骨。9例患者在切除髂骨和骶骨肿瘤后未保留髋臼，采用半骨盆假体模块重建缺损。
肿瘤学结果：7例（7/19，36.9%）局部复发，其中骨肉瘤2例，软骨肉瘤2例，尤因肉瘤2例，转移瘤1例。4例骨肉瘤患者中有2例，4例尤因肉瘤患者中有2例，5例软骨肉瘤患者中有1例，1例恶性纤维组织细胞瘤患者死于肺转移。2例肺癌转移患者术后1年死于疾病。1例肾癌和1例甲状腺癌患者存活且无疾病。功能结果：10例患者在切除骨盆和骶骨肿瘤后行髋臼重建，术后2个月可拄拐行走。ISOLS功能评分平均为20分，其中优3例，良5例，差1例。1例采用半骨盆假体模块重建的患者术后1个月发生脱位，行切开复位。1例患者因深部感染取出半骨盆假体。
对于切除髂骨和骶骨肿瘤后保留髋臼的患者，采用螺钉和棒系统结合植骨重建是理想的修复方法。对于累及骶骨的骨盆肿瘤切除后，采用残余骶骨上切除的股骨头和颈植骨及半骨盆假体模块重建是较好的选择。
