Muskulaskeletal Oncology Department, First Affiliated Hospital of Zhongshan University, Guangzhou, Guangdong, China.
Ann Surg Oncol. 2012 Dec;19(13):4043-51. doi: 10.1245/s10434-012-2339-x. Epub 2012 Sep 5.
Iliosacral resection of pelvic malignant tumors and subsequent reconstruction have tested the ingenuity of orthopedic oncologists because of the difficulty of oncological wide resection and the complex biomechanics of the sacroiliac joint render reconstruction challenging. This study compared the functional and surgical outcomes of a biological reconstruction technique with the lack of reconstruction following iliosacral resection.
Twenty-six consecutive cases with malignant iliac tumors involving the sacrum were retrospectively reviewed. These cases underwent iliosacral resection (type I/IV) followed by no reconstruction or a biological reconstruction blinded to authors between 1997 and 2007. After iliosacral resection, 12 cases underwent reconstruction with nonvascular fibular grafts and plate and/or pedicle screw-rod; the other 14 cases did not undergo reconstruction.
The median follow-up was 84.42 (range, 32-165) months. The local recurrence rate in the reconstruction group was 8.33 % (1/12) with 14.29 % (2/14) in the group without reconstruction. The functional score of the biological reconstruction group was significantly higher than that of the no-reconstruction group as determined by Student's t test. In the biological reconstruction group, bone fusion occurred in 91 % of cases and fibula hypertrophy was observed in 41.7 %. Complications included sciatic nerve palsy, broken screws, intractable pain, nonunion, pelvic oblique, and leg-length discrepancy.
After iliosacral resections of pelvic malignant tumors, the biologic reconstruction of these defects could restore spinopelvic stability and continuity. The double-barrel fibular autograft combined with the plate or pedicle screw-rod system is an effective reconstruction method for both optimal short- and long-term stability.
骨盆恶性肿瘤的髂骨切除和随后的重建对骨科肿瘤学家的创造力提出了挑战，因为在进行肿瘤学广泛切除时存在困难，且骶髂关节的复杂生物力学使得重建具有挑战性。本研究比较了生物重建技术与髂骨切除后不进行重建的功能和手术结果。
回顾性分析了 1997 年至 2007 年间连续 26 例涉及骶骨的恶性髂骨肿瘤患者。这些患者接受了髂骨切除（I 型/IV 型），随后在作者不知情的情况下，12 例患者进行了非血管腓骨移植和钢板/或椎弓根螺钉-棒的生物重建，而 14 例患者未进行重建。
中位随访时间为 84.42 个月（范围为 32-165 个月）。重建组的局部复发率为 8.33%（1/12），未重建组为 14.29%（2/14）。通过学生 t 检验，生物重建组的功能评分明显高于未重建组。在生物重建组中，91%的病例发生骨融合，41.7%的病例出现腓骨肥大。并发症包括坐骨神经麻痹、螺钉断裂、顽固性疼痛、骨不连、骨盆倾斜和肢体长度差异。
在骨盆恶性肿瘤切除后，对这些缺损进行生物重建可以恢复脊柱骨盆的稳定性和连续性。双管腓骨自体移植结合钢板或椎弓根螺钉-棒系统是一种有效的重建方法，可实现最佳的短期和长期稳定性。
