Surgical reconstruction strategy of high level sacral tumors after tumor resection

WU Qiang; SHAO Zeng-wu; YANG Shu-hua; WANG Bai-chuang; FAN Lei

doi:10.3969/j.issn.2095-252X.2013.10.008

Abstract：Objective The surgery of high level sacrum is a challenge in the ifeld of bone tumor therapy because of its special anatomic structure, large quantity of hemorrhage during the operation and the difficulty in reconstruction. This study is to investigate the individual reconstruction strategy of high level sacral tumor surgery. Methods The retrospective study included 11 patients from September 2000 to December 2011. The tumor type included bone giant cell tumor, chordoma, chondrosarcoma, osteosarcoma and neurogenic tumor. In all cases, the sacral vertebrae S1 was involved. The individualized reconstruction strategy was conducted according to the invasion area of the sacrum and sacroiliac joint. Results No patients died during the operation. The average amount of bleeding was 3200 ml. 10 cases were followed up for 8 months to 6 years, 24 months in average. The recent complications included 1 case of incision skin edge necrosis and wound delay healing, 1 case of dysuria, and 1 cases of cerebrospinal lfuid leakage. Most patients obtained good function at early stage and the improvement rate of nerve dysfunction was 66.7%. Local recurrence happened in 2 cases including 1 case of bone giant cell tumor and 1 case of chondrosarcoma. No metastasis occurred. No loosening or break of internal fixation appeared in all the cases. No end absorption of variant ifbula ifxation occurred in all the cases. Conclusions Good preoperative plan and individualized excision and reconstruction strategy are guarantees for high sacrum tumor surgery even of high risk. less blood loss hemorrhage, suitable reservation of the function of cauda equina and individualized reconstruction strategy for pelvic ring are the key points of the operation plan.