中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2014年
11期
1097-1102
,共6页
骶骨%骨肿瘤%外科手术
骶骨%骨腫瘤%外科手術
저골%골종류%외과수술
Sacrum%Bone neoplasms%Surgical procedures,operative
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～S51例,S1.21例,S1～S33例.肿瘤体积最小者为9.2 cm×7.6 cm×4.1 cm,最大者为22.0 cm×19.0 cm×16.0 cm.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(visual analogue scale,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6.5 h(范围,4.5～11.0 h),术中出血量平均3 700 ml(范围,2 000～7 200 ml),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1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.
目的 探討纍及高位(S1、S2)原髮骶骨噁性腫瘤行單純後路全骶骨切除術的手術指徵、手術入路、手術切除方式及手術併髮癥.方法 迴顧性分析2010年3月至2011年3月,採用單純後路全骶骨切除髂腰重建手術治療5例原髮骶骨噁性腫瘤患者資料,男3例,女2例;年齡32～ 55歲,平均41歲.影像學檢查均顯示溶骨性破壞,4例伴有明顯的軟組織腫塊,1例有明顯的骶孔擴張伴骨破壞.MRI示腫瘤位于S1～S51例,S1.21例,S1～S33例.腫瘤體積最小者為9.2 cm×7.6 cm×4.1 cm,最大者為22.0 cm×19.0 cm×16.0 cm.5例患者術前均行穿刺活檢,病理診斷為脊索瘤2例,噁性神經鞘瘤1例,軟骨肉瘤1例,血管內皮細胞肉瘤1例.5例患者術前均有腰骶部疼痛或腰腿痛,視覺模擬評分(visual analogue scale,VAS)2例2分,2例6分,1例8分.5例均採用脊柱椎弓根釘棒繫統行髂腰穩定性重建.結果 5例患者平均手術時間6.5 h(範圍,4.5～11.0 h),術中齣血量平均3 700 ml(範圍,2 000～7 200 ml),圍手術期無一例患者死亡.術後平均隨訪17箇月(範圍,9～23箇月).術中1例齣現直腸損傷,遂行結腸造瘺,術後12週給予造瘺口還納.術後2例齣現傷口併髮癥,給予清創後遲洗引流,二期愈閤,未髮生深部感染;4例齣現雙下肢坐骨神經癥狀,足蹠屈運動障礙,給予踝關節支具固定行走;術後5例患者均齣現括約肌功能喪失.術後9箇月1例齣現跼部複髮,因無再次手術指徵,故給予跼部放療,現隨訪13箇月,帶瘤生存.結論 單純後路全骶骨切除是治療原髮高位骶骨噁性腫瘤的有效手段,通過良好的外科切除邊界,可穫得良好的腫瘤學預後.單純後路全骶骨切除術後併髮癥髮生率較高,對患者的術後神經功能影響較大.
목적 탐토루급고위(S1、S2)원발저골악성종류행단순후로전저골절제술적수술지정、수술입로、수술절제방식급수술병발증.방법 회고성분석2010년3월지2011년3월,채용단순후로전저골절제가요중건수술치료5례원발저골악성종류환자자료,남3례,녀2례;년령32～ 55세,평균41세.영상학검사균현시용골성파배,4례반유명현적연조직종괴,1례유명현적저공확장반골파배.MRI시종류위우S1～S51례,S1.21례,S1～S33례.종류체적최소자위9.2 cm×7.6 cm×4.1 cm,최대자위22.0 cm×19.0 cm×16.0 cm.5례환자술전균행천자활검,병리진단위척색류2례,악성신경초류1례,연골육류1례,혈관내피세포육류1례.5례환자술전균유요저부동통혹요퇴통,시각모의평분(visual analogue scale,VAS)2례2분,2례6분,1례8분.5례균채용척주추궁근정봉계통행가요은정성중건.결과 5례환자평균수술시간6.5 h(범위,4.5～11.0 h),술중출혈량평균3 700 ml(범위,2 000～7 200 ml),위수술기무일례환자사망.술후평균수방17개월(범위,9～23개월).술중1례출현직장손상,수행결장조루,술후12주급여조루구환납.술후2례출현상구병발증,급여청창후충세인류,이기유합,미발생심부감염;4례출현쌍하지좌골신경증상,족척굴운동장애,급여과관절지구고정행주;술후5례환자균출현괄약기공능상실.술후9개월1례출현국부복발,인무재차수술지정,고급여국부방료,현수방13개월,대류생존.결론 단순후로전저골절제시치료원발고위저골악성종류적유효수단,통과량호적외과절제변계,가획득량호적종류학예후.단순후로전저골절제술후병발증발생솔교고,대환자적술후신경공능영향교대.
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 (S1,S2).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 imageology 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-S5,1 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 cm× 19.0 cm× 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 intention 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 surgery.There was 1 case of implant breakage and no obvious spine down.5 patients had functional disability in sphincter after surgery.1 case of hemangioendothelioma recurred locally 9 months later.Local radiotherapy was performed since there was no reoperation indication.The patient is currently on the 13th month follow-up and survives with tumors.Compared with combined approach,the selection of posterior approach alone has relatively strict surgery indications.Conclusion Total sacrectomy via posterior approach is an effective way to treat the primary high-level malignant sacral tumors.The good surgical resection boundary is important to achieve the good oncology prognosis.The occurrence rate of postoperative complication is high,which has great influence on patients' postoperative neurological function.
