背景:骶骨肿瘤切除是骨肿瘤外科治疗的一个难题.既往文献报道多侧重于肿瘤的切除方法,对于骶骨肿瘤切除后稳定性重建的研究较少.目的:探讨全骶骨肿瘤切除后腰骶部稳定性重建的方法.方法:回顾分析2000年7月至2015年12月,63例全骶骨肿瘤切除后腰骶部稳定性重建患者的临床资料.男38例,女25例,年龄18-62岁,平均42.1岁.病理诊断:软骨肉瘤9例,脊索瘤25例,骶骨恶性神经鞘瘤5例,骨肉瘤13例,尤文肉瘤4例,孤立性转移瘤2例,未分化肉瘤2例,骨巨细胞瘤3例.前后路联合全骶骨切除术23例,单纯后路全骶骨切除术40例.结果:所有患者随访时间5~97个月,平均45个月.16例内固定失败出现在术后8~24个月,平均17.1个月.本组病例中共9例出现螺钉松动移位,7例患者出现金属棒断裂.6例患者出现植骨未愈合,其中3例术后曾接受放射治疗.结论:全骶骨肿瘤切除后,钉棒系统重建最常出现金属连接棒的断裂.内固定失败可能与金属连接棒过细,固定节段不合理,植骨不愈合有关.通过合理的翻修手术可以较好地解决内固定断裂问题.%Background: Resection of sacral tumor is a difficult point in surgical treatment of bone tumors. Previous studies have focused on the resection of tumors, and there are few studies on the reconstruction after total sacrectomy. Objective: To retrospectively review the rate and category of mechanical fixation in patients with spinopelvic reconstruction after total sa-crectomy. Methods: Between July 2000 and December 2015, spinopelvic reconstruction following total sacrectomy were carried out in 63 patients. There were 38 males and 25 females with a mean age of 42.1 years (range, 18-62 years). The path-ological diagnosis included 9 chondrosarcomas, 25 chordomas, 5 malignant schwannomas, 13 osteosarcomas, 4 Ewing sar-comas, 2 solitary metastatic tumors, 2 undifferentiated pleomorphic sarcomas, and 3 giant cell tumors. Total sacrectomy was performed in 23 patients through combined anterior and posterior approaches, in the other 40 patients through single posteri-or approach. Results: The mean duration of follow-up was 45 months (range, 5-97 months). Mechanical fixation failure oc-curred in 25% of patients (16/63) at a mean time of 17.1 months (range, 8-24 months) postoperatively. Rods breakage and pedicle screws failure occurred in 7 and 9 patients, respectively. Nonunion of bone grafts was observed in 6 patients, and three of them received radiotherapy. Conclusions: Rods breakage is frequently encountered in reconstruction after total sa-crectomy. The failure of the reconstruction may be related to extremely slim rod, improper internal fixation and nonunion of bone grafts. Revision surgery should be carried out in these patients.
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