Department of Orthopedic Surgery and Center for Preservation and Transplantation of Musculoskeletal Tissues, Cairo University Hospitals, 47 Iran St Dokki, Giza, Egypt.
Clin Orthop Relat Res. 2010 May;468(5):1362-72. doi: 10.1007/s11999-009-1031-3. Epub 2009 Aug 19.
En bloc resection of iliosacral sarcomas is a surgical challenge. There are substantial risks of inadequate margins, local recurrence, and nerve root loss when pelvic sarcomas involve sacral root canals and foramina. The decancellation technique uses principles similar to transpedicle decancellation in spinal deformity correction to perform the sacral osteotomy in iliosacral tumor resection. The technique aims at improving sacral margins and minimizing loss of neural function. We performed a decancellation osteotomy in five patients with sarcomas requiring difficult oblique or sagittal sacral osteotomies and selective root sacrifice. Through laminectomy and without anterior exposure, a precise full-thickness osteotomy of the sacrum was performed without major technique-related morbidities or complications. This was followed by formal pelvic resection and reconstruction. Surgical margins were adequate in all patients and all tumor-free nerve roots were preserved.
整块切除骨盆骶骨肉瘤是一个手术挑战。当盆腔肉瘤累及骶神经根管和骶孔时，会有切缘不足、局部复发和神经根丢失的巨大风险。去半骺板技术利用脊柱畸形矫正中经椎弓根去半骺板的相似原理，在骨盆骶骨肿瘤切除中完成骶骨截骨术。该技术旨在改善骶骨切缘并最大限度地减少神经功能的丧失。我们对 5 例需要进行困难的斜向或矢状位骶骨截骨术和选择性神经根牺牲的肉瘤患者进行了去半骺板截骨术。通过椎板切除术而无需前路暴露，在不发生主要与技术相关的并发症的情况下，对骶骨进行了精确的全层截骨术。随后进行了正式的骨盆切除和重建。所有患者的手术切缘均充足，所有无肿瘤的神经根均得以保留。
