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[目的]探讨采用脊柱ISOLA钉棒系统重建高位骶骨肿瘤切除后腰椎-骨盆连续性的适应证、手术方法及可行性。[方法]对2001年7月~2007年1月间收治的43例侵犯S1、2的高位骶骨肿瘤患者进行回顾性研究,所有患者行肿瘤切除术后双侧或单侧ISOLA系统腰椎-骨盆的连续性重建。其中单侧重建者11例(25.6%),双侧重建者32例(74.4%)。[结果]43例中,脊索瘤、骨巨细胞瘤、神经源性肿瘤共33例(77.1%)。术后34例(79.1%)经12~62个月随访,5例脊索瘤患者复发,29例得到良好局部控制。术后腰骶部疼痛及下肢根性疼痛症状均明显缓解,恢复正常负重及行走。无1例出现断钉、断棒或螺钉松动。X线片检查未发现钉孔扩大、骨盆内聚及腰椎下移(L5下沉)。国际保肢学会(ISOLS)评分功能优良率26例(76.5%)。[结论]对于高位骶骨肿瘤,采用ISOLA钉棒系统重建其切除后腰椎-骨盆连续性的手术方法简便,创伤小,并发症少,且固定确实,值得推广。
[Objective] To explore the indications, surgical methods and feasibility of reconstructing lumbar-pelvic continuity after high-sacral tumor resection by using ISOLA screw spine system. [Methods] A retrospective study was performed on 43 patients with high sacral tumor infiltrated with S1,2 between July 2001 and January 2007. All patients underwent resection of the lumbar vertebra-pelvis of the bilateral or unilateral ISOLA system Continuity reconstruction. Eleven patients (25.6%) had unilateral reconstruction and 32 patients (74.4%) had bilateral reconstruction. [Results] Thirty-three cases (77.1%) were chordoma, giant cell tumor of bone and neurogenic tumor. After operation, 34 cases (79.1%) were followed up for 12 to 62 months. Five patients with chordoma recurred and 29 patients received good local control. Postoperative lumbosacral pain and lower limb root pain symptoms were significantly relieved, return to normal weight and walking. No cases of broken nails, broken rods or screws loose. X-ray examination found no nail hole enlargement, pelvis cohesion and lumbar shift (L5 sink). ISOLS score excellent function rate of 26 cases (76.5%). [Conclusion] For high sacral tumors, ISOLA pedicle screw system reconstruction of lumbar-pelvis continuity after resection of the surgical method is simple, less trauma, fewer complications, and fixed indeed, it is worth promoting.