高位骶骨肿瘤的手术治疗

目的：探讨侵犯S1、S2的高位骶骨肿瘤（HLST，High Level Sacral Tumor）治疗策略。方法：对2003年1月至2009年12月间我科及长海医院骨科收治的35例高位骶骨肿瘤患者进行回顾性研究，所有患者均接受了骶骨肿瘤切除与重建手术。患者手术时平均年龄为42.8岁（范围为18-69岁）。女性17例，男性18例。其中骨巨细胞瘤、神经源性肿瘤、脊索瘤占25例。10例采用前后路联合人路，25例采用单纯后路。采用双侧或单侧ISOLA固定L4、L5椎体及髂骨进行功能重建。结果：所有患者无手术死亡，29例患者存活并获得随访，平均随访时间53月（20—72月），2例脊索瘤患者复发，3例术后因转移死亡，24例得到良好局部控制（82．8％）。国际保肢学会（ISOLS）评分功能优良率20例（69．0％），无严重并发症。结论尽管存在着很多潜在的并发症，在高位骶骨肿瘤的治疗中手术切除还是一个行之有效的方法，利用ISOLA系统重建腰骶功能简便牢固，疗效良好。

The surgical management of high-level sacral tumor

Objective： The purpose of this study was to investigate the therapeutic strategy of High Level Sacral Tumor（HLST）,which encroaches on S1 and/or S2. Methods： A retrospective study was to review records in 35 patients with High Level Sacral Tumor （HLST） between January 2003 and December 2009 in Department of Orthopaedic Oncology of Xuzhou Central Hospital and Department of Orthopaedics Surgery of Changhai Hospital,all patients were underwent resection and reconstruction of HLST.The average age of the patients in operation time was 42.8（range： 18-69）.In this series,seventeen were female,eighteen were male.There are twenty-five with giant cell tumor of bone,neurogenie tumors and chordoma between thirty-five patients, ten patients received sacrum resec, tion by anterior combined posterior approach,twenty-five patients were by single posterior approach. The method of Lumbopelvic reconstruction was to fix L4 and/or L5 to ilium bilaterally or unilateral by ISOLA instrumentation. Results： Over all,no patients were dead in the operation bed,there were twenty-nine patients alive by follow-up,the average time of follow-up is 53 months（20-72 months）,two patient with ehordoma were recurred; three patients were died for tumor metastasis,twenty-four patients with HLST were under controlled （82.8%）. The rate of fineness is 69.0%（20/29） judged by ISOLS method. No major complications were occurred. Conclusion： Despite the potential for complications,sacrectomy can be performed successfully in the treatment of HLST. Lumbopelvic reconstruction by ISOLA instrumentation was a convenient and effective method for these procedures.