Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Orthop Surg. 2020 Dec;12(6):2013-2017. doi: 10.1111/os.12783. Epub 2020 Oct 11.
Resection of malignant bone tumors in the posterior ilium may result in pelvic ring disruption. Preserving the pelvic ring and keeping an adequate surgical margin is ideal, but is challenging, especially when the tumor extends to the sacroiliac joint. The current report proposes a line from the lateral point of the second sacral dorsal foramen to the anterior surface of sacral ala (S -sacral ala line), and cutting from the line to the ilium over the sciatic notch and to the sacral wing using thread saws. This preserves the cortex at the sciatic notch and the distal sacroiliac joint. Two posterior iliac tumors extending to the sacroiliac joint, a metastatic melanoma in a 75-year-old male, and an osteosarcoma in a 56-year-old male were resected. The resections were performed along the S -sacral ala line, and consequently lumbo-sacro-pelvic fusions were performed. Both patients were able to walk with one crutch. Indications for the method using the S -sacral ala line for iliac tumors may be limited. However, the method can increase pelvic ring preservation in cases with posterior iliac malignant bone tumors.
后路髂骨恶性骨肿瘤切除可能导致骨盆环破裂。保留骨盆环并保持足够的手术切缘是理想的，但具有挑战性，特别是当肿瘤延伸至骶髂关节时。本报告提出了一条从第二骶骨背侧孔外侧点到骶骨翼前缘的线（S-骶骨翼线），并使用线锯从该线到坐骨切迹上方的髂骨，再到骶骨翼切割。这样可以保留坐骨切迹处的皮质和远端骶髂关节。对 2 例延伸至骶髂关节的后路髂骨肿瘤进行了切除，1 例为 75 岁男性的转移性黑色素瘤，1 例为 56 岁男性的骨肉瘤。切除是沿着 S-骶骨翼线进行的，随后进行了腰-骶-骨盆融合。两名患者均能单拐行走。使用 S-骶骨翼线治疗髂骨肿瘤的适应证可能有限。然而，该方法可以增加后路髂骨恶性骨肿瘤患者的骨盆环保留率。
