Objective To evaluate the effects of sacrectomy extent on the stabil ity of lumbo-il iac fixation using single or dual il iac screw technique, and to determine which conditions require the dual il iac screw technique. Methods Nine fresh L2 to pelvic specimens were harvested from donated adult cadavers. After testing the intact state simulated by L3-5 pedicle screw fixation, sequential partial sacrectomies and L3 to il iac fixation using bilateral single il iac screw (Single) wereconducted on the same specimen as follows: in group A, under S1 partial sacrectomy and Single; in group B, under 1/2 S1 partial sacrectomy and Single; in group C, one-side (left) sacroil iac joint resection and Single; in group D, total sacrectomy and Single; and in group E, the single il iac screw was replaced by dual il iac screws based on group D. Biomechanical testing was performed on a material testing machine under 0-800 N compression and —7-7 N•m torsion loading modes for construct stiffness evaluation. Results The compressive stiffness of intact condition was (392 ± 119) N/mm, groups A, B, C, D, and E obtained 106.4% ± 9.5%, 102.7% ± 8.0%, 92.2% ± 10.1%, 72.7% ± 8.0%, and 107.7% ± 10.7% of intact condition, respectively. No significant differences were found among groups A, B, C, and the intact state (P gt; 0.05), however, the four groups showed significantly higher compressive stiffness than group D (P lt; 0.05). Although group E exhibited a comparable compressive stiffness with groups A, B, and intact state (P gt; 0.05), it displayed markedly higher compressive stiffness than groups C and D (P lt; 0.05). The torsional stiffness of intact state was (3.22 ± 1.23) N•m/deg. Groups A, B, C, D, and E acquired 105.4% ± 10.1%, 89.8% ± 12.3%, 75.9% ± 10.6%, 71.2% ± 10.2%, and 109.1% ± 16.9% of intact state, respectively. No significant differences were detected among groups A, B, E, and the intact state (P gt; 0.05). However, groups C and D showed remarkably lower torsional stiffness than groups A, E, and the intact state (P lt; 0.05). Importantly, group E offered remarkably higher torsional stiffness than group B (P lt; 0.05). Conclusion After under 1/2 S1 partial sacrectomy, single il iac screw technique could effectively restore local stabil ity; whereas it could hardly provide adequate stabil ity for further resection of one-side sacroil iac joint or total sacrectomy; in such situation, the use of dual il iac screw technique could obtain sufficient construct stabil ity. Therefore, in the surgical treatment of sacral tumor, the dual il iac screw technique should be considered for the unstable conditions of totalsacrectomy or under 1/2 S1 sacrectomy with one-side sacroil iac joint resection.
Objective To study the therapeutic effect of combining vacuum seal ing drainage (VSD) with gluteus maximus myocutaneous flap on the repair of soft tissue defect caused by the resection of sacral tumors. Methods From June2007 to June 2008, 6 patients with skin and soft tissue necrosis in the sacrococcygeal region, deep infection, and formation of cavity at 3-6 weeks after sacral tumors resection were treated. There were 4 males and 2 females aged 17-51 years old. The size of skin and soft tissue defects ranged from 15 cm × 11 cm × 6 cm to 20 cm × 18 cm × 7 cm. Every patient underwent VSD treatment for 7-10 days, and the recombinant bovine bFGF was injected into the wound intermittently for 7-14 days (250-300 U/ cm2 once, twice daily). The wound was repaired by either the gluteus maximus myocutaneous flap (5 cases) or the lumbar-gluteus flap (1 case), and those flaps were 9 cm × 9 cm-20 cm × 18 cm in size. The donor site were sutured or repaired with spl itthickness skin graft. Results All the flaps survived uneventfully. The wound healed by first intention in 5 cases, but 1 case suffered from fat l iquefaction 2 weeks after operation and healed after drainage and dressing change. All the donor sites healed by first intention, and all the skin grafts survived uneventfully. All the patients were followed up for 6-10 months, there was no relapse of sacral tumor, and the flaps showed no obvious swell ing with good color and elasticity. Conclusion With fewer compl ications, the combination of VSD and gluteus maximus myocutaneous flap is a safe and rel iable operative method for repairing the skin and soft tissue defects caused by the resection of sacral tumors.
目的 通过对保留不同平面骶骨的新鲜人骨盆模型进行生物力学测试，分析骶骨切除平面与骨盆稳定性的关系，明确骶骨切除保留至何种程度时需行腰骶髂稳定性重建。 方法 选用6具正常成年男性新鲜尸体腰5-骨盆标本，采用200 N增量分级加载，以1.4 mm/min速率平稳加载直至1 000 N，依次测试保留完整骶骨及不同平面骶骨切除骨盆模型的最大主应力、剪切应力、位移及刚度变化，比较各组间的差异。最后测量1/2S1组骨盆环的极限载荷，记录骨折发生部位和骨折类型。 结果 随骶骨切除平面增高，最大主应力、剪切力及骶骨下沉位移在各测试点均有不同程度增大，骨盆的轴向刚度不断减小。当切除平面达骶1时，变化明显，尤其以经过骶1下1/4～下1/2时变化显著，与完整骶骨组比较，差异有统计学意义（P＜0.05）。骶1椎体下1/2平面切除后，骨盆的极限载荷是（2 375.97 ± 162.41）N，骨盆的破坏形态为经骶髂关节或骶椎的骨折。 结论 骶骨切除范围与骨盆环的稳定性密切相关，随着骶骨切除平面升高，残留骶髂关节各种应力急剧增高，骨盆的稳定性明显下降。当骶骨切除涉及骶1椎体时，极易发生骨折，需要进行腰骶髂局部重建以增强骶髂关节的稳定性。
目的 探讨“医护一体化”疼痛管理模式在骶骨肿瘤患者围手术期的应用效果。 方法 以2011年1月－10月选取的23例骶骨肿瘤患者作为研究对象，根据科室疼痛管理的规范化流程，在“医护一体化”工作模式下由护士进行疼痛评估、医生护士共同制定疼痛管理方案，护士落实个体化疼痛护理措施、规范用药指导、综合心理护理和镇痛效果反馈等。 结果 经“医护一体化”疼痛管理，患者疼痛情况大为改观，20例患者疼痛评分＜3分，占总例数的87.0%，由入院初期的中、重度疼痛患者居多转变为轻度疼痛患者占主导。 结论 运用医护一体化多模式疼痛管理可以有效减轻患者疼痛，提高护理服务质量。
ObjectiveTo evaluate the clinical efficiency of balloon occlusion of the lower abdominal aorta in blood loss control during resections of pelvic or sacral tumor. MethodsFrom April 2006 to April 2010, 24 patients diagnosed as pelvic or sacral tumor in this hospital were collected. Balloon occlusion of the lower abdominal aorta to control blood loss was used in these cases. Balloon catheters were placed via femoral artery to occlude the abdominal aorta before operation. Resections of pelvic or sacral tumors were performed after occlusion of abdominal aorta, duration no longer than 60 min per occlusion, if repeated occlusions needed, 10－15 min release in between. Results Average operative time was 153 min (range 40－245 min) and average blood loss was 310 ml (range 200－650 ml) in this series, and the procedure helped in clearly identifying the surgical margin, neurovascular structures, and adjacent organs. The blood pressure were stable in all the cases. No postoperative renal function impairment was found in all the cases, no side injuries to adjacent organs was identified. One case complicated with thrombosis in iliac artery at same puncture side was successfully treated with catheter thrombectomy. ConclusionIntraoperative abdominal aorta balloon occluding in pelvic and sacral tumor surgical operation could reduce blood loss, and improve the safety of operation.
ObjectiveTo investigate the clinical efficiency of pelvic and sacrum tumor surgery using sizing balloon occlusion of the lower abdominal aorta. MethodsFrom January 2005 to June 2011, 156 patients were diagnosed to have sacrum or pelvic tumor and underwent surgery in our institution. Temporary balloon occlusion of abdominal aorta was used in 51 patients during the resection of sacrum and pelvic tumors (balloon group). Another 105 patients received the traditional surgery resection (control group). The results of the whole operation time, the volume of blood loss and transfusion, the complication and the total days of stay in hospital in the two groups were compared with each other. ResultsAfter the abdominal aorta was occluded, 92.2% of the patients in the balloon group had holistic resection or edge resection, while the number was 86.7% for the control group. In the balloon group, the average operation time was (171.96±65.16) minutes, the average intraoperative blood loss was (746.86±722.73) mL, and the blood transfusion was (411.76±613.73) mL. The postoperative lead flow was (294.50±146.09) mL, and the postoperative tube removal was within (2.98±1.07) days. Improvement of patients'condition was significantly better than the control group (P<0.05). No significant difference was found in the total days of stay in hospital and the postoperative complications between the two groups (P>0.05). ConclusionUsing abdominal aorta occlusion can effectively control intraoperative hemorrhage, and show the operation field clearly. It also can reduce operation time and control the blood transfusions. Appropriately extended balloon blocking time can obviously improve the tumor removal rate and the safety of the operation.
ObjectiveTo study the value of CT angiography (CTA) in the surgical treatment of bone tumors with the temporary balloon blocking technique. MethodsA retrospective analysis was made on the clinical data of 36 bone tumor patients between April 2008 and October 2013. There were 22 males and 14 females, aged from 25 to 83 years (mean, 46 years). The tumor located at the sacrococcygeal region in 17 cases, at the ilium in 12 cases, at the pubis in 5 cases, and at the proximal femur in 2 cases. Before surgery, CTA was performed to measure the external diameter of aortaventralis and arteria iliac communis, and the distance between the low renal artery and the abdominal aortic bifurcation as well as mark the anatomical relationship between the low renal artery, the abdominal aortic bifurcation and bony landmarks of vertebral body. According to these data, suitable balloon was chosen and the balloon positioning was guided in the surgery to completely excise tumor assisted by balloon blocking technique. ResultsThe CTA results showed that the external diameter of aortaventralis and arteria iliaca communis was (1.545±0.248) cm and (1.060±0.205) cm respectively, and the distance between the low renal artery and the abdominal aortic bifurcation was (10.818±1.165) cm. The three-dimensional reconstruction showed that the opening of the low renal artery was mainly located at L1 (16/36, 44.4%) and the abdominal aortic bifurcation mainly located at L4 (22/36, 61.1%). Effective block of abdomial aorta was performed; the blood pressure obviously increased in 3 cases after balloon inflation, and pulse of the left dorsal artery of the foot decreased in 1 case after removal of balloon, which were relieved after expectant treatment. The operation time was 118-311 minutes; the intraoperative blood loss was 200-1 800 mL, 21 patients were given blood transfusion, and the amount of blood transfusion was 400-1200 mL; and the aortic clamping time was 40-136 minutes. All patients were followed up 5-44 months (mean, 21 months). According to Enneking standard, the results were excellent in 9 cases, good in 20 cases, fair in 5 cases, and poor in 2 cases at 3 months after operation. There were 10 cases of dysfunction of urination and defecation, 2 cases of tumor recurrence, and 3 cases of death after surgery. ConclusionCTA and three-dimensional reconstructions technique can accurately measure the external diameter of aortaventralis and arteria iliaca communis and the distance between low renal artery and abdominal aortic bifurcation and offer great help to choose appropriate balloon and locate the balloon during surgery. The balloon blocking technique under the assistance of CTA can obviously reduce intraoperative blood loss and tumor recurrence, supply a clear view in surgery and shorten the operation time.
ObjectiveTo summarize the research progress of surgical treatment for primary sacrum tumor. MethodThe domestic and foreign related literature about surgical treatment of primary sacrum tumor, and many aspects of its surgical procedures, intraoperative hemostasis, pelvic reconstruction, protection of sacral nerve, complications, and prognosis was summarized and analyzed. ResultsThe operation is the major therapy for primary sacrum tumor. However, surgical procedures, protection of sacral nerve, and the way of intraoperative hemostasis remain controversial. Meanwhile, the complexity of pelvic reconstruction, the diversity of complications, and prognosis related with many factors bring difficulties and challenges to the surgical treatment. ConclusionsIt is urgent need to develop an effective unified standard to conduct diagnosis and treatment of primary sacrum tumor.