Kanay Enes, Bulut Halil Ibrahim, Okay Erhan, Batıbay Sefa, Demiröz Serdar, Ozkan Korhan
Acıbadem Ataşehir Hospital, Istanbul, Turkey.
Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Eur Spine J. 2025 Apr 10. doi: 10.1007/s00586-025-08840-x.
Sacral surgeries, especially sacrectomies, are complex due to the sacrum's anatomical intricacies and its proximity to vital neurovascular structures. These procedures are primarily performed for the treatment of primary sacral malignancies, metastatic lesions, and traumatic injuries. Infection is a significant concern in sacrectomies, given the large incisions, extensive soft tissue dissection, and compromised immune systems in many patients. This retrospective study aims to evaluate the outcomes of sacrectomy surgeries, focusing on surgical approaches, reconstruction methods, and infection profiles, to better understand the challenges and outcomes associated with these procedures.
This retrospective study included 18 patients with sacral pathologies, such as chordomas, malignant mesenchymal tumors, and sacral metastases. Data was collected on demographics, tumor characteristics, surgical approaches, nerve root sacrifice, and reconstructive techniques like VRAM flaps. Postoperative outcomes, including wound complications, neurological issues, recurrence rates, and infections, were analyzed. The data was analyzed using SPSS, and Kaplan-Meier analysis was performed to estimate survival.
The study involved 18 patients (94.4% male) with a median age of 64 years. Tumor size ranged from 30 mm to 200 mm, and volume from 60 cm³ to 6,500 cm³. Most patients underwent partial sacrectomy (83.3%). Flap reconstruction was performed in 27.8% of cases. Wound complications occurred in 50%, and neurological complications in 55.6%. Recurrence was observed in 27.8%, and 5 patients (27.8%) died during follow-up, with an estimated 5-year survival rate of approximately 75%. Infections in VRAM flap patients were predominantly E. coli and polymicrobial anaerobes, requiring debridement with hospital stays ranging from 9 to 21 days. Non-flap patients had more resistant infections, including Pseudomonas aeruginosa, Acinetobacter baumannii requiring extended hospital stays (15-37 days) and multiple debridements. No significant difference in infection rates was found between VRAM flap and non-flap groups, though VRAM cases had larger tumors and longer surgeries.
In conclusion, surgical site infections remain a significant challenge in sacrectomy patients. Vascularized flaps may offer protection against resistant Gram-negative strain infections, while surgical debridement is essential for managing anaerobic infections. Future research should focus on optimizing infection prevention, improving wound healing strategies, and enhancing nutritional support to improve outcomes for sacrectomy patients.
由于骶骨解剖结构复杂且靠近重要神经血管结构，骶骨手术，尤其是骶骨切除术，操作复杂。这些手术主要用于治疗原发性骶骨恶性肿瘤、转移性病变和创伤性损伤。鉴于许多患者手术切口大、软组织广泛解剖且免疫系统受损，感染是骶骨切除术中的一个重大问题。这项回顾性研究旨在评估骶骨切除术的手术效果，重点关注手术入路、重建方法和感染情况，以更好地了解这些手术相关的挑战和结果。
这项回顾性研究纳入了18例患有骶骨病变的患者，如脊索瘤、恶性间叶组织肿瘤和骶骨转移瘤。收集了患者的人口统计学资料、肿瘤特征、手术入路、神经根牺牲情况以及腹直肌肌皮瓣（VRAM瓣）等重建技术的数据。分析术后结果，包括伤口并发症、神经问题、复发率和感染情况。使用SPSS软件对数据进行分析，并进行Kaplan-Meier分析以估计生存率。
该研究涉及18例患者（男性占94.4%），中位年龄为64岁。肿瘤大小从30毫米至200毫米不等，体积从60立方厘米至6500立方厘米。大多数患者接受了部分骶骨切除术（83.3%）。27.8%的病例进行了皮瓣重建。50%的患者出现伤口并发症，55.6%的患者出现神经并发症。27.8%的患者出现复发，5例患者（27.8%）在随访期间死亡，估计5年生存率约为75%。VRAM瓣患者的感染主要为大肠杆菌和多种厌氧菌，需要清创，住院时间为9至21天。非皮瓣患者的感染更具耐药性，包括铜绿假单胞菌、鲍曼不动杆菌，需要延长住院时间（15至37天）并多次清创。尽管VRAM瓣组的肿瘤更大、手术时间更长，但VRAM瓣组和非皮瓣组的感染率没有显著差异。
总之，手术部位感染仍然是骶骨切除术患者面临的重大挑战。带血管蒂皮瓣可能对耐药革兰氏阴性菌感染有保护作用，而手术清创对于处理厌氧菌感染至关重要。未来的研究应集中在优化感染预防、改进伤口愈合策略以及加强营养支持，以改善骶骨切除术患者的治疗效果。
