Janis Jeffrey E, Ahmad Jamil, Lemmon Joshua A, Barnett Carlton C, Morrill Kevin C, McClelland Robert N
Dallas, Texas; and Denver, Colo. From the Department of Plastic Surgery, the Department of Surgery, and the Department of Neurological Surgery, University of Texas Southwestern Medical Center, and the Department of Surgery, Denver Health Medical Center, University of Colorado.
Plast Reconstr Surg. 2009 Oct;124(4):1165-1176. doi: 10.1097/PRS.0b013e3181b61169.
Hemicorporectomy involves amputation of the pelvis and lower extremities by disarticulation through the lumbar spine with concomitant transection of the aorta, inferior vena cava, and spinal cord. In addition, conduits are constructed for diversion of both the urinary and fecal streams. Of 57 cases reported in the literature, limited experience exists with hemicorporectomy for terminal pelvic osteomyelitis, with only 11 cases described. Furthermore, there is little information available regarding perioperative mortality and long-term survival. This article describes the largest reported series of hemicorporectomies performed for terminal pelvic osteomyelitis.
A retrospective review of the medical records for nine patients who underwent hemicorporectomy at the authors' institution was conducted followed by interviews with all surviving patients.
At follow-up, four patients were alive and five patients were dead. For all patients, the average survival after hemicorporectomy was 11.0 years (range, 1.7 to 22.0 years). There was no perioperative mortality within 30 days of surgery. None of the surviving patients suffered from recurrent decubitus ulcers.
Including this clinical series, a total of 66 hemicorporectomies have now been reported in the literature. Twenty cases were performed for terminal pelvic osteomyelitis with no mortality within 30 days of surgery, and 53.3 percent of patients were alive and well at long-term follow-up. Given the low perioperative mortality along with the ability of patients to achieve long-term survival following this operation, hemicorporectomy should be offered to appropriate patients suffering from terminal pelvic osteomyelitis.
半体切除术包括通过腰椎关节离断术截肢骨盆和下肢，同时横断主动脉、下腔静脉和脊髓。此外，还需构建管道以改道尿液和粪便流。在文献报道的57例病例中，针对终末期骨盆骨髓炎进行半体切除术的经验有限，仅描述了11例。此外，关于围手术期死亡率和长期生存率的信息很少。本文描述了针对终末期骨盆骨髓炎进行的半体切除术报道中最大的系列病例。
对作者所在机构9例行半体切除术患者的病历进行回顾性研究，并对所有存活患者进行访谈。
随访时，4例患者存活，5例患者死亡。所有患者半体切除术后的平均生存期为11.0年（范围1.7至22.0年）。手术30天内无围手术期死亡。所有存活患者均未出现复发性褥疮。
包括本临床系列在内，目前文献中已报道了66例半体切除术。20例针对终末期骨盆骨髓炎进行，手术30天内无死亡，53.3%的患者在长期随访中存活且状况良好。鉴于围手术期死亡率低以及患者在此手术后能够实现长期生存，对于患有终末期骨盆骨髓炎的合适患者应提供半体切除术。
