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目的:探讨对骶骨多节段恶性肿瘤施行全骶骨切除术的手术入路、手术方式及适应证。方法:2007年7月至2009年7月,共有6例骶骨恶性肿瘤患者在我院骨肿瘤科接受一期前后联合入路全骶骨切除钉棒系统内固定重建腰骶稳定性手术。其中男性4例,女性2例。年龄20～59岁,平均38.8岁。肿瘤位于S1～S54例,S1～S31例,L5～S41例。脊索瘤2例,软骨肉瘤2例,恶性神经鞘瘤1例,尤文肉瘤1例。结果:6例患者均安全度过围手术期。手术时间11～13h,平均12h。术中出血量3800～5500ml,平均4500ml。6例患者均未出现直肠、膀胱瘘等严重并发症。术中6例患者切断双侧S1神经根,术后出现双足跖屈运动障碍。所有患者经钉棒系统固定重建恢复了腰骶部连续性,术后6例患者均定制矫形鞋,术后6周穿矫形鞋扶拐可下地行走。随访3～25个月,平均10.3个月,未发现局部复发及远处转移病例。结论:一期前后联合入路全骶骨切除重建腰骶稳定性手术对于累及骶骨多个节段的恶性肿瘤可以获得满意的肿瘤学切除边界,但手术难度大,应严格把握手术适应证。
Objective: To investigate the surgical approach, surgical approach and indications of total sacrectomy for multi-segment sacral tumors. Methods: From July 2007 to July 2009, a total of 6 patients with sacral malignancy undergoing total lumbosacral stabilization surgery underwent total sacral resection and pedicle screw fixation in our department of bone oncology. There were 4 males and 2 females. Age 20 to 59 years old, average 38.8 years old. Tumors located in S1 ~ S54 cases, S1 ~ S31 cases, L5 ~ S41 cases. 2 cases of chordoma, 2 cases of chondrosarcoma, 1 case of malignant schwannoma, 1 case of ewing sarcoma. Results: Six patients were safely perioperatively. Operation time 11 ~ 13h, an average of 12h. Intraoperative blood loss of 3800 ~ 5500ml, an average of 4500ml. 6 patients did not appear rectum, bladder fistula and other serious complications. Six patients underwent bilateral S1 nerve root excision, and plantar flexion dyskinesia occurred after operation. All patients were restored with lumbar and sacral continuity by means of screw-rod system fixation. All 6 patients underwent orthopedic shoes after operation, and orthopedic shoes were allowed to walk 6 weeks after operation. All cases were followed up for 3 ~ 25 months with an average of 10.3 months. No local recurrence or distant metastasis was found. Conclusions: Total sacral resection and reconstruction of lumbo-sacral stability surgery combined with anterior and posterior approach can achieve a satisfactory oncological resection margin for malignant tumors involving multiple segments of the sacrum. However, the operation is difficult and should be strictly controlled.