Sun Mengxiong, Zuo Dongqing, Wang Hongsheng, Sheng Jiakang, Ma Xiaojun, Wang Chongren, Zan Pengfei, Hua Yingqi, Sun Wei, Cai Zhengdong
Department of Orthopedics, Shanghai General Hospital, Shanghai, China.
Front Oncol. 2021 Jun 25;11:640933. doi: 10.3389/fonc.2021.640933. eCollection 2021.
This study intends to retrospectively analyze the data of patients with sacral metastases in our center, and analyze the treatment methods and therapeutic effects of sacral metastases.
73 patients with sacral metastases treated in our hospital from June 2013 to June 2019 were retrospectively analyzed. There were 54 cases of neurological symptoms, 42 cases of sacroiliac joint instability, 24 cases of lower limb muscle weakness and 19 cases of abnormal urination and defecation. Four patients with tumors below S3 underwent complete tumor resection, 23 patients with tumors above S3 and without sacroiliac joint instability underwent tumor curettage and nerve root lysis, 34 patients with tumors above S3 and sacroiliac joint instability underwent tumor curettage, nerve root release and screw rod reconstruction. 12 patients with multiple metastases underwent percutaneous radiofrequency ablation and sacroplasty. VAS was used to evaluate the preoperative and postoperative pain scores, and the postoperative pain relief, neurological function, bowel function, wound healing and complications were evaluated.
There were no perioperative death, 8 cases of poor wound healing, 5 cases of nerve injury, postoperative sensory and motor loss of lower limbs. Cerebrospinal fluid (CSF) leak in 7 cases. The patients were followed up for 6-25 months (mean 12 months). The VAS scores of patients with pain symptoms were 7 points before operation and 1.44 points after operation, In 19 patients with abnormal urination and defecation function, 12 patients recovered to normal 3-6 months after operation, 5 cases had no significant change compared with preoperative, and 2 cases had aggravated symptoms; 17 cases of patients with lower limb muscle strength were significantly recovered after operation, and the average muscle strength was increased by 2 grades; 30 cases of patients with unstable sacroiliac joint got internal fixation had significantly pain relief. Pain symptoms of 9 patients were significantly relieved after percutaneous radiofrequency ablation.
the operation of sacral metastases mainly adopts a relatively conservative surgical method, which can effectively improve the quality of life of patients with sacral metastases by retaining the nerve function and relieving the pain of patients, combining with radiofrequency ablation, sacroplasty and targeted drugs.
本研究旨在回顾性分析我院骶骨转移瘤患者的数据，分析骶骨转移瘤的治疗方法及疗效。
回顾性分析2013年6月至2019年6月在我院治疗的73例骶骨转移瘤患者。有神经症状54例，骶髂关节不稳42例，下肢肌肉无力24例，排尿排便异常19例。4例S3以下肿瘤患者行肿瘤全切术，23例S3以上且无骶髂关节不稳的肿瘤患者行肿瘤刮除及神经根松解术，34例S3以上且伴有骶髂关节不稳的肿瘤患者行肿瘤刮除、神经根松解及螺钉重建术。12例多发转移患者行经皮射频消融及骶骨成形术。采用视觉模拟评分法（VAS）评估术前及术后疼痛评分，并对术后疼痛缓解情况、神经功能、肠道功能、伤口愈合及并发症进行评估。
无围手术期死亡，伤口愈合不良8例，神经损伤5例，术后下肢感觉及运动丧失。脑脊液漏7例。患者随访6～25个月（平均12个月）。疼痛症状患者术前VAS评分为7分，术后为1.44分。19例排尿排便功能异常患者中，12例术后3～6个月恢复正常，5例与术前相比无明显变化，2例症状加重；17例下肢肌力患者术后明显恢复，平均肌力提高2级；30例行内固定的骶髂关节不稳患者疼痛明显缓解。9例经皮射频消融术后疼痛症状明显缓解。
骶骨转移瘤手术主要采用相对保守的手术方式，通过保留神经功能、缓解患者疼痛，联合射频消融、骶骨成形术及靶向药物，可有效提高骶骨转移瘤患者的生活质量。
