骨盆软骨肉瘤的外科治疗（附13例报告）

目的探讨骨盆软骨肉瘤的外科治疗方法、并发症。方法回顾性分析13例骨盆软骨肉瘤患者，根据En—neking骨盆肿瘤分区：Ⅰ区1例，Ⅱ区3例，Ⅲ区4例，Ⅰ＋Ⅱ区2例，Ⅰ＋Ⅳ区2例，Ⅰ＋Ⅱ＋Ⅲ区1例。单纯切除术5例，半骨盆截肢术1例。肿瘤切除、TSRH内固定、植骨重建术2例。半骨盆假体重建术2例，同侧股骨近端截骨并普通髋关节假体重建术1例。肿瘤切除股骨坐骨融合术2例，其中1例切除术后复发行肿瘤再切除股骨懦：骨融合术。结果随访3—57个月，中位随访时问为27．5个月，单纯Ⅰ区和Ⅲ区肿瘤切除后无重建，术后功能恢复良好，半盆截肢患者术后功能评估最差，MSTS平均评分为76．4％。所在患者随访时未发现肺转移。并发症出现于4例患者，其中切口感染、切口延迟愈合各2例。外科边界：3例为边缘切除，1例广泛切除但肿瘤污染，其余为广泛切除。结论骨盆软骨肉瘤的治疗主要以手术切除为主，广泛的外科切除边界是患者长期存活、降低局部复发率的主要因旧紊，个体化的切除重建方式是获得相对良好功能的关键。

Surgical treatment of pelvic chondrosarcoma: retrospective study of 13 cases

Objective To investigate procedures and complications in the treatment of pelvic chondrosarcoma. Methods A total of 13 patients suffered from pelvic chondrosarcoma were reviewed retrospectively. According to Enneking＇ s division, there were 1 case with lesion in region Ⅰ, 3 in region Ⅱ, 4 in region m, 2 in region I and Ⅱ, 2 in region I and IV, and 1 in region I, Ⅱ and Ⅲ. The surgical procedures included 5 cases with resection, 1 with hemipelvectomy, 2 with resecion, TSRH instrumentation and autograft reconstruction, 2 with hemipelvic prosthesis, 1 with resection, ipsilateral femoral auto- graft reconstruction and conventional hip joint replacement, 2 with resection, ischiofemoral artbodesis, 1 with a second resec- tion and iliofemoral arthrodesis after local recurrence. Results The median follow-up time was 27.5 months （3-57 months）. The patients with lesion in region I and Ⅲ maintained better function after tumor resection. The average function evaluation score was 76.4%. The function was worse in the patients with hemipelvectomy. Lung metastasis wa~s not found in all the pa- tients. There were 4 patients with complications including incision infection in 2 patients and delayed healing of incision in 2 patients. The surgical margin was as follow ： marginal resection in 3 patients, wide resection but tumor contamination in 1 patient, wide resection in the other patients. Conclusion The surgical resection was a primary treatment for pelvic ehondrosar- coma. Wide resection was a significant prognosis factor for the long-term survival and local recurrence decrease. Individual reconstruction was a key to maintain a good function.