Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan.
Department of Orthopaedic Surgery, Otsu Red Cross Hospital, Shiga, Japan.
Int Orthop. 2021 Jul;45(7):1793-1802. doi: 10.1007/s00264-021-05096-0. Epub 2021 Jun 4.
Reconstruction of the pelvic ring after the resection of pelvic tumours involving the sacroiliac joint is challenging. Although pedicle screw and rod system reconstructions are commonly performed, failure at the early stage has been reported. Surgical procedures Reconstruction involving two or more strong anchor screws (iliac, ischial, and pubis screws) into the residual pelvis, connecting with at least two rods with minimal bending to the residual lumbosacral vertebra and contralateral pelvis.
The above reconstruction was performed for six malignant bone and soft-tissue pelvic tumours requiring Enneking type I + IV resection. A double-barreled free non-vascularized fibular graft was used in all patients, except for one. Patients were followed up for a mean period of 51 months (range, 9 to 96 months), and peri-operative complications, implant failure within the follow-up period, and the clinical results of surgery were investigated.
The mean age of four females and two males at the initial surgery was 37.2 years. One patient developed a deep wound infection. Two patients died due to metastasis of the tumor. All patients were able to walk on their own within 12 weeks of surgery. There was no implant failure, except in two patients with contralateral lumbosacral rod fracture three and four years after surgery, for which one patient required rod replacement.
The incidence of implant failure, particularly around the resection site, was low, which may be attributed to multiple periacetabular screws and rods with minimal bending. Our rigid reconstruction method enables the rapid resumption of walking.
涉及骶髂关节的骨盆肿瘤切除术后重建骨盆环具有挑战性。虽然经常进行椎弓根螺钉和棒系统重建，但有报道称早期会出现失败。手术步骤：将两个或更多强固定锚螺钉（髂骨、坐骨和耻骨螺钉）重建到残留骨盆中，用至少两根杆连接，尽量减少对残留腰骶椎和对侧骨盆的弯曲。
对 6 例需要 Enneking Ⅰ+Ⅳ型切除的恶性骨和软组织骨盆肿瘤进行了上述重建。除 1 例患者外，所有患者均使用双管游离非血管化腓骨移植物。所有患者平均随访 51 个月（范围 9 至 96 个月），调查围手术期并发症、随访期内植入物失败以及手术的临床结果。
初始手术时，4 名女性和 2 名男性的平均年龄为 37.2 岁。1 例患者发生深部伤口感染。2 例患者因肿瘤转移死亡。所有患者均能在手术后 12 周内自行行走。除 2 例患者在手术后 3 年和 4 年发生对侧腰骶杆骨折外，无植入物失败，其中 1 例患者需要更换杆。
特别是在切除部位周围，植入物失败的发生率较低，这可能与多枚髋臼周围螺钉和杆的最小弯曲有关。我们的刚性重建方法可使患者快速恢复行走能力。
