Department of Orthopaedics, The 960th Hospital of PLA, Jinan, China.
Orthop Surg. 2019 Dec;11(6):1120-1126. doi: 10.1111/os.12563. Epub 2019 Nov 22.
To observe the process of sacroiliac joint invasion by primary malignant tumors of sacrum and iliac bone, and to explore the methods of surgical resection and reconstruction.
From January 2009 to November 2017, there were nine patients with primary malignant bone tumors involving sacroiliac joints, five males and four females, aged from 16 to 63 years, with an average age of 35 years. Of these there were three cases of primitive neuroectodermal tumors, three cases of chondrosarcoma, and three cases of osteosarcoma. Pelvic ring reconstruction was performed with longitudinal half sacrum, sacroiliac joint and partial iliac bone block excision and screw-rod system combined with bone grafting.
The operation time was 155-310 min, with an average of 245 ± 55 min, and the bleeding volume was 1400-8500 ml, with an average of 3111 ± 2189 ml. Follow-up ranged from 5 to 108 months, with a median follow-up of 24 months. Three patients (33.3%) had local recurrence, three patients (33.3%) survived without tumors, and one patient had lung metastasis 2 years after operation, and survived with tumors. Five patients (55.6%) died, of which four died of lung metastasis and one died of brain metastasis. Survival analysis showed that the 3-year overall survival rate was 57%. Bone grafts did not heal in four patients, and bone grafts healed in five patients. The healing time ranged from 5 to 7 months, with an average of 6.2 months.
one patient developed deep infection 2 months after operation; one patient had skin edge necrosis; titanium rod loosening and displacement were found in two patients with nonunion of bone graft, and no fracture of nail rod was found. The MSTS 93 functional score of nine patients ranged from 20% to 50%, with an average of 34%.
The tumors around the sacroiliac joint often invade the contralateral bone by ligament, and the en bloc resection and pelvic ring reconstruction for primary malignant bone tumors involving sacroiliac joint was feasible.
观察骶骨和髂骨原发性恶性骨肿瘤侵犯骶髂关节的过程，探讨手术切除和重建的方法。
自 2009 年 1 月至 2017 年 11 月，收治 9 例原发性恶性骨肿瘤累及骶髂关节患者，男 5 例，女 4 例；年龄 16~63 岁，平均 35 岁。其中原始神经外胚层肿瘤 3 例，软骨肉瘤 3 例，骨肉瘤 3 例。采用半骶骨、骶髂关节和部分髂骨块切除，钉棒系统结合植骨重建骨盆环。
手术时间 155310 min，平均 245±55 min；术中出血量 14008500 ml，平均 3111±2189 ml。随访 5108 个月，中位随访时间 24 个月。3 例（33.3%）局部复发，3 例（33.3%）无肿瘤生存，1 例术后 2 年发生肺转移，带瘤生存。5 例（55.6%）死亡，其中 4 例死于肺转移，1 例死于脑转移。生存分析显示，患者 3 年总生存率为 57%。4 例患者植骨未愈合，5 例患者植骨愈合。愈合时间 57 个月，平均 6.2 个月。
术后 2 个月 1 例发生深部感染，1 例发生皮缘坏死，2 例植骨不愈合患者出现钛棒松动移位，未发现钉棒断裂。9 例患者的 MSTS93 功能评分 20%~50%，平均 34%。
骶髂关节周围肿瘤常通过韧带侵犯对侧骨，整块切除联合骨盆环重建治疗原发性恶性骨肿瘤累及骶髂关节是可行的。
