摘要
目的探讨累及高位（S1、S2）原发骶骨恶性肿瘤行单纯后路全骶骨切除术的手术指征、手术入路、手术切除方式及手术并发症。方法回顾性分析2010年3月至2011年3月，采用单纯后路全骶骨切除髂腰重建手术治疗5例原发骶骨恶性肿瘤患者资料，男3例，女2例；年龄32～55岁，平均41岁。影像学检查均显示溶骨性破坏，4例伴有明显的软组织肿块，1例有明显的骶孔扩张伴骨破坏。MRI示肿瘤位于S1-S5 1例，S1,2 1例，S1～S3 3例。肿瘤体积最小者为9．2cm×7．6cm×4．1cm，最大者为22．0cm×19．0cm×16．0cm。5例患者术前均行穿刺活检，病理诊断为脊索瘤2例，恶性神经鞘瘤1例，软骨肉瘤1例，血管内皮细胞肉瘤1例。5例患者术前均有腰骶部疼痛或腰腿痛，视觉模拟评分（visualanaloguescale，VAS）2例2分，2例6分，1例8分。5例均采用脊柱椎弓根钉棒系统行髂腰稳定性重建。结果5例患者平均手术时间6．5h（范围，4．5—11．0h），术中出血量平均3700ml（范围，2000—7200ml），围手术期无一例患者死亡。术后平均随访17个月（范围，9—23个月）。术中I例出现直肠损伤，遂行结肠造瘘，术后12周给予造瘘口还纳。术后2例出现伤口并发症，给予清创后冲洗引流，二期愈合，未发生深部感染；4例出现双下肢坐骨神经症状，足跖屈运动障碍，给予踝关节支具固定行走；术后5例患者均出现括约肌功能丧失。术后9个月1例出现局部复发，因无再次手术指征，故给予局部放疗，现随访13个月，带瘤生存。结论单纯后路全骶骨切除是治疗原发高位骶骨恶性肿瘤的有效手段，通过良好的外科切除边界，可获得良好的肿瘤学预后。单纯后路全骶骨切除术后并发症发生率较高，对患者的术后神经功能影响较大。
Objective To investigate the surgical indication, approach, resection methods and complications of total sacrectomy via posterior approach for primary malignant sacral tumors involving high level （S l, $2）. Methods 5 cases of primary malignant sacral tumors treated by total sacrectomy via posterior approach and iliolumbar reconstruction from March 2010 to March 2011 were analyzed retrospectively. There were 3 males and 2 females. The mean age was 41, ranging from 32 to 55. The imageolo- gy examination showed osteolytic destruction, among which there were 4 cases of obvious soft tissue mass, 1 case of obvious sacral foramina expansion with bone damage. MRI showed 1 case of the tumors in S1-S3, 1 case of the tumors in S1 ,S2, 1 case of the tumors in S1-S3. The smallest tumor was 9.2 cm×7.6 cm×4.1 cm, while the largest was 22.0 cmX 19.0 cmX 16.0 cm. Preoperative TTNB were done on the 5 patients. Pathological diagnosis： 2 cases of chordoma, 1 case of malignant neurilemmoma, 1 case of chondrosarcoma and 1 case of malignant hemangioendothelioma. 5 patients had sacrococcygeal pain or lumbocrural pain before the surgery. Visual analogue scale （VAS）： 2 cases of 2, 2 cases of 6 and 1 case of 8. Ilium stability reconstructions were all performed on 5 patients with spine pedicle screw-rod system. Results The mean operation time was 6.5 hours （range, 4.5-11 hours）, with the mean intraoperative blood loss of 3 700 ml （range, 2 000-7 200 ml）. There was no perioperative death. The mean follow-up time was 17 months （range, 9-23 months）. There were 2 cases of wound complications 2 weeks after surgery and healed by second in- tention with washing and drainage after debridement. There was no deep infection. 1 case of rectal injury, which was performed with colostomy during the operation, and stoma returned 12 weeks after surgery. 4 cases of sciatic nerve symptom of lower limbs and plantar flexion dyskinesia after bilateral S1 nerve roots resection. The patients walked with ankle brace fixed after the surger
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2014年第11期1097-1102,共6页
Chinese Journal of Orthopaedics
关键词
骶骨
骨肿瘤
外科手术
Sacrum
Bone neoplasms
Surgical procedures, operative
