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目的探讨高位骶骨肿瘤切除后个性化重建方案。方法回顾分析自2000年9月至2011年12月,手术治疗的高位骶骨肿瘤11例,肿瘤类型包括骨巨细胞瘤、脊索瘤、软骨肉瘤、骨肉瘤及神经源性肿瘤。所有病例中,骶椎S_1均受累。根据骶骨及骶髂关节侵犯范围,选择最佳手术方案,进行个性化外科重建。结果全部11例无术中死亡病例,术中平均出血量3200ml。10例获得8个月至6年的随访,平均24个月,术后近期并发症1例为切口皮缘坏死和伤口延迟愈合;1例术后出现排尿困难,1例脑脊液漏。患者早期功能恢复良好,神经功能障碍改善率达66.7%。局部复发2例,分别为1例骨巨细胞瘤和1例软骨肉瘤,未出现远处转移病例。随访病例均未发现钉棒松动、断裂,以及同种异体腓骨植入后骨端吸收现象。结论良好的手术计划以及个性化的切除及重建方案可以保证手术的成功性。减少术中出血、合适地保留马尾神经功能以及骨盆环的重建是手术考虑的重点。
Objective To investigate the personalized reconstruction of high sacral tumor after resection. Methods From September 2000 to December 2011, 11 cases of sacral tumors were treated surgically. The tumor types included giant cell tumor of bone, chordoma, chondrosarcoma, osteosarcoma and neurogenic tumor. In all cases, sacral S 1 was involved. According to the scope of sacrum and sacroiliac joint violations, choose the best surgical options for personalized surgical reconstruction. Results All 11 cases without intraoperative deaths, the average blood loss 3200ml. Ten patients were followed up for 8 months to 6 years with an average of 24 months. One case of postoperative short-term complications was necrosis of skin incision and delayed wound healing. One patient had dysuria and one had cerebrospinal fluid leakage. Early recovery of patients with good function, neurological dysfunction improved rate of 66.7%. Local recurrence in 2 cases, respectively, 1 case of giant cell tumor of bone and 1 case of chondrosarcoma, no cases of distant metastasis. No follow-up cases were found to loose the nail, fracture, and bone allograft fibula bone absorption. Conclusion Good surgical planning and personalized resection and reconstruction programs can ensure the success of the operation. Reduce intraoperative bleeding, proper preservation of cauda equina function and reconstruction of the pelvic ring is the surgical focus.