腰椎骨盆重建内固定术在骶骨肿瘤切除后的应用.docVIP

腰椎骨盆重建内固定术在骶骨肿瘤切除后的应用 【摘要】 探讨骶骨切除术后腰椎与骨盆TSRH3d内固定重建方法及其作用。［方法］本院于2001年12月~2006年12月，收治68例腰骶段骨肿瘤患者，其中原发肿瘤48例，转移癌20例，L5S127例，L5~S211例，L5~S312例，S1~38例；肿瘤切除方式:本组患者术中尽可能保留骶神经，低位骶骨肿瘤保留S1~3神经，原发肿瘤行植骨，转移癌行骨水泥填塞成型，肿瘤切除术后给予腰椎与骨盆TSRH3 d腰骨盆固定术,并给予相应的放疗与化疗。［结果］术后随访8~48个月，近期效果满意，3例出现排尿困难，5例出现脑脊液漏，2例切口感染及延迟愈合，5例转移癌患者，分别于术后14、17、20、25、23个月因多处转移，全身衰竭死亡。患者腰骶部疼痛及神经功能有不同程度改善,恢复正常负重及行走。X线检查未见钉孔扩大、骨盆内聚及腰椎下移（L5下沉）。所有患者均未发生断钉、断棒或螺钉松动。［结论］骶骨肿瘤切除与重建术有利于保持腰椎及骨盆稳定性，可减轻疼痛，保留患者的行走功能。 【关键词】 骶骨 肿瘤切除 重建术 Abstract：［Objective］Investigate the resection of sacrum tunor and the way duration of the spinal pelvic TSRH3d internal fixation.［Method］From Dec.2001 to Dec.2006,68 cases with sacral tumor were enrolled in our hospital,including 48 cases with primary tumors and 20 with metastasis cancers,and with 27 cases involving in L5S1,11 in L5~S2,12 in L5~S3,8 in S1~3.The operative method:the sacral nerve was reserved as possible.The S1~3 were reserved in the cases of lower sacral region.The bone graft ,shaping with bone cement，radiotherapy and chemotherapy were emphasized following the course of fixation.All cases were followed by lumbopelvic TSRH3d internal fixation and corresponding chemotherapy and radiotherapy.［Result］All cases were followedup for 8~48 months,the results of shortterm were satisfactory with the lumbosacral pain reduced and the neurological function improved in different degrees,others 5 cases experienced cerebrospinal fluid leakage and 2 cases experienced perative infection and delayed healing.Three cases with chondrosarcoma recurred.The pains of the lumbarsacrum joint and the spinal nerve root were relieved obviously.There was no appearance of the enlarge screw passage,the lessened pelvic and lowed L5 spine.［Conclusion］Lumbosacral tumor and reconstruction are effective for achieving stabilization,providing significant paint relief and preserving ambulatory capacity. Key words:sacral spine； tumor resection; reconstruction 骶骨是脊柱肿瘤中较