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OBJECTIVE@#To investigate the surgical technique and effectiveness of titanium elastic nail (TEN) assisted retrograde channel screw implantation of superior pubic branch.@*METHODS@#The clinical data of 31 patients with pelvic or acetabular fractures treated with retrograde channel screw implantation in superior pubic branch between January 2021 and April 2022 were retrospectively analyzed. Among them, 16 cases were implanted with assistance of TEN (study group) and 15 cases were implanted under the guidance of C-arm X-ray machine (control group). There was no significant difference in gender, age, cause of injury, Tile classification of pelvic fracture, Judet-Letournal classification of acetabular fracture, and time from injury to operation between the two groups ( P>0.05). The operation time, fluoroscopy times, and intraoperative blood loss of each superior pubic branch retrograde channel screw were recorded during operation. X-ray films and three-dimensional CT were reexamined after operation, the quality of fracture reduction was evaluated by Matta score standard, and the position of channel screw was evaluated by screw position classification standard. The fracture healing time was recorded during the follow-up, and the postoperative functional recovery was evaluated by Merle D'Aubigne Postel score system at last follow-up.@*RESULTS@#Nineteen and 20 retrograde channel screws of superior pubic branch were implanted in the study group and the control group, respectively. The operation time, fluoroscopy times, and intraoperative blood loss of each screw in the study group were significantly less than those in the control group ( P<0.05). According to the postoperative X-ray films and three-dimensional CT, none of the 19 screws in the study group penetrated out of the cortical bone or into the joint, and the excellent and good rate was 100% (19/19); in the control group, there were 4 screws of cortical bone penetration, and the excellent and good rate was 80% (16/20); the difference between the two groups was significant ( P<0.05). Matta score standard was used to evaluate the quality of fracture reduction, there was no patient in the two groups with poor reduction results, and the difference was not significant between the two groups ( P>0.05). The incisions of the two groups healed by first intention, and there was no complication such as incision infection, skin margin necrosis, and deep infection. All patients were followed up 8-22 months, with an average of 14.7 months. There was no significant difference in healing time between the two groups ( P>0.05). At last follow-up, the difference in functional recovery evaluated by the Merle D'Aubigne Postel scoring system between the two groups was not significant ( P>0.05).@*CONCLUSION@#TEN assisted implantation technique can significantly shorten the operation time of retrograde channel screw implantation of superior pubic branch, reduce the times of fluoroscopy, and have less intraoperative blood loss and accurate screw implantation, which provides a new safe and reliable method for minimally invasive treatment of pelvic and acetabular fractures.
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Humans , Titanium , Fracture Fixation, Internal/methods , Blood Loss, Surgical , Retrospective Studies , Bone Screws , Treatment Outcome , Fractures, Bone/surgery , Spinal Fractures , Hip FracturesABSTRACT
Lipid nanoemulsions are promising nanodrug delivery carriers that can improve the efficacy and safety of paclitaxel(PTX).However,no intravenous lipid emulsion of PTX has been approved for clinical treatment,and systemic safety profiles have not yet been reported.Here we outline the development of a PTX-loaded tumor-targeting intravenous lipid emulsion(PTX Emul)and describe its characteristics,colloidal stability,and systemic safety profiles in terms of acute toxicity,long-term toxicity,and tox-icokinetics.We also compare PTX Emul with conventional PTX injection.Results showed that PTX Emul exhibited an ideal average particle size(approximately 160 nm)with narrow size distribution and robust colloidal stability under different conditions.Hypersensitivity reaction and hemolysis tests revealed that PTX Emul did not induce hypersensitivity reactions and had no hemolytic potential.In addition,where the alleviated systemic toxicity of PTX Emul may be attributed to the altered toxicokinetic characteristics in beagle dogs,including the decreased AUC and increased plasma clearance and volume of distribution,PTX Emul alleviated acute and long-term toxicity as evidenced by the enhanced the median lethal dose and approximate lethal dose,moderate body weight change,decreased bone marrow suppression and organ toxicity compared with those under PTX injection at the same dose.A fundamental understanding of the systemic safety profiles,high tumor-targeting efficiency,and superior antitumor activity in vivo of PTX Emul can provide powerful evidence of its therapeutic potential as a future treatment for breast cancer.
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Objective@#To evaluate the clinical efficacy of percutaneous kyphoplasty (PKP) in the treatment of stage Ⅲ Kümmell＇s disease with no neurological symptom.@*Methods@#From January 2009 to June 2018, 45 patients underwent PKP for stage Ⅲ Kümmell＇s disease with no neurological symptom at Department of Orthopaedics, The First Hospital Affiliated to Soochow University. They were 12 males and 33 females, aged from 61 to 85 years (average, 70.9 years). Their visual analog scale (VAS) scores for back pain, Oswestry disability indexes (ODI), heights of fractured vertebrae and kyphosis cob angles were recorded and compared between preoperation, one day, 3 months and final follow-up after operation.@*Results@#All the 45 patients were followed up for 12 to 48 months (average, 28.0 months). Their VAS scores (2.4±0.7, 2.2±0.7 and 2.3±0.6), ODI sores (34.7±6.8, 34.2±6.5 and 34.1±6.6) and cobb angles (15.7°±2.2°, 15.8°±2.2° and 15.9°±2.4°) at one day, 3 months and final follow-up after operation were significantly lower than those (8.2±1.1, 75.3±9.0 and 25.2°±3.9°) before operation (P<0.001). Their anterior height ratios of the fractured vertebra (54.0%±4.3%, 53.7%±4.2% and 53.6%±4.0%) and median height ratios of the fractured vertebra (56.8%±4.0%, 56.5%±3.9% and 56.6%±3.9%) at one day, 3 months and final follow-up after operation were significantly higher than those (25.8%±3.9% and 27.2%±3.1%) before operation (P<0.001). The rate of cement leakage was 13.3%(6/45). No patients had neurological symptoms after operation.@*Conclusion@#PKP is a minimally invasive, safe and effective treatment for stage Ⅲ Kümmell's disease with no neurological symptom, because it can relieve the symptoms of the patients, restore the height of the fractured vertebral body and reduce the local kyphosis cobb angle.
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Objective To evaluate the clinical efficacy of percutaneous kyphoplasty (PKP) in the treatment of stage Ⅲ Kümmell's disease with no neurological symptom.Methods From January 2009 to June 2018,45 patients underwent PKP for stage Ⅲ Ktimmell's disease with no neurological symptom at Department of Orthopaedics,The First Hospital Affiliated to Soochow University.They were 12 males and 33 females,aged from 61 to 85 years (average,70.9 years).Their visual analog scale (VAS) scores for back pain,Oswestry disability indexes (ODI),heights of fractured vertebrae and kyphosis cob angles were recorded and compared between preoperation,one day,3 months and final follow-up after operation.Results All the 45 patients were followed up for 12 to 48 months (average,28.0 months).Their VAS scores (2.4 ±0.7,2.2 ±0.7 and 2.3 ±0.6),ODI sores (34.7 ±6.8,34.2 ±6.5 and 34.1 ±6.6) and cobb angles (15.7°± 2.2°,15.8° ± 2.2° and 15.9° ± 2.4°) at one day,3 months and final follow-up after operation were significantly lower than those (8.2 ± 1.1,75.3 ±9.0 and 25.2°±3.9°) before operation (P ＜ 0.001).Their anterior height ratios of the fractured vertebra (54.0％ ±4.3％,53.7％ ±4.2％ and 53.6％ ±4.0％) and median height ratios of the fractured vertebra (56.8％ ± 4.0％,56.5％ ± 3.9％ and 56.6％ ± 3.9％) at one day,3 months and final follow-up after operation were significantly higher than those (25.8％ ± 3.9％ and 27.2％ ±3.1％) before operation (P ＜ 0.001).The rate of cement leakage was 13.3％ (6/45).No patients had neurological symptoms after operation.Conclusion PKP is a minimally invasive,safe and effective treatment for stage Ⅲ Kümmell's disease with no neurological symptom,because it can relieve the symptoms of the patients,restore the height of the fractured vertebral body and reduce the local kyphosis cobb angle.
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Objective To investigate the risk of atopic disease in infants with a atopic mothers. Methods The level of CCL22 and total IgE in the cord blood were measured using ELISA for 33 newborns with atopic mothers and for 44 newborns with non-atopic mothers. Correlation between the two factors was examined. Periodic follow-ups were conducted on the newborns to observe the risk of atopic diseases. Results The atopic group showed a higher level of CCL22 than that in non-atopic group, and the difference was statistically significant (Z=5.20, P=0.000). When 0.9 kU/L was taken as the threshold of an elevated IgE level in cord blood, the positive rates of the atopic group (11/33) was much higher than that of the non-atopic group (4/44) (χ2=7.07, P=0.008). Furthermore, the level of CCL22 and the level of IgE were significantly positively correlated (r=0.808, P=0.000; r=0.348, P=0.021) in the atopic group and the non-atopic group, respectively. During the 12 months of follow-up, the number of atopic diseases occurred in the infants in the atopic group (24/33) was much higher than that in the non-atopic group (10/44) (χ2=19.12, P<0.001).Significant correlation exists between levels CCL22 and total IgE in cord blood and infant atopic diseases (Z=5.36, P=0.000; Z=4.44, P=0.000). Conclusions At birth, the infants with an atopic mother are already in a sensitization state and have a tendency to develop potential atopic diseases. There is a correlation between the history of atopic diseases in the mothers and the elevated level of CCL22 in the cord blood of the newborns, and the probability of developing atopic diseases for the newborns is significantly higher when the level of CCL22 is elevated. The combined detection of CCL22 and IgE levels impact significantly on the prediction of the risk of atopic diseases clinically.
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Objective To investigate the effects of different treatments on elderly patients with breast cancer, and to analyze the factors that affect the treatment effect.MethodsA retrospective analysis was used to analysis the clinical data of elderly patients with breast cancer treated in our hospital from March 2012 to October 2013 were selected as the study object and according to the treatment methods, which were divided into three groups (A, B, C, which a group by breast modified radical surgery combined with intravenous chemotherapy and endocrine therapy, group B with breast modified radical mastectomy+endocrine therapy, group C with breast mass resection and endocrine therapy.The differences of survival rate of 1 groups after three years, 2 years and 3 years were observed, and the difference of survival rate of patients with different clinical pathological characteristics after 3 years was compared.The factors influencing the survival rate of patients after operation were analyzed.ResultsThere was no significant difference in survival rate between the three groups after 1 years, 2 years and 3 years;High differentiation, lymph node metastasis, depth of invasion, T1+T2, TNM stage I+II, immune group of non Yin in the elderly patients with breast cancer of the 3 year survival rate was higher, while patients of different age and diameter of the tumor patients and 3 years survival rate had no significant difference;Will the elderly breast cancer patients age, differentiation degree, tumor size, lymph node metastasis, depth of invasion, clinical stage, immune group of three yin as independent variables, will survival in patients with multi factors logistic regression analysis was used.Statistical analysis available, lymph node metastasis, infiltration depth and the three Yin of the immune group were the risk factors affecting the treatment effect of patients, their OR values were 4.412, 5.138 and 4.085.ConclusionDifferent treatment methods have no significant effect on the survival rate of elderly patients with breast cancer, and lymph node metastasis, depth of invasion and the three Yin of the immune group are the factors that affect the treatment effect.
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Objective To investigate the correlation between diabetic distress and coping styles among patients with type 2 diabetes. Method One hundred inpatients with type 2 diabetes were engaged in the investigation of their diabetes distress and coping styles by the diabetes distress scale (DDS) and medical coping modes questionnaire (MCMQ) and the correlation between them. Results The average score of diabetic distress was (2.17 ± 0.71), which was at mild level. 57%of them were at the higher level of diabetic distress. Confrontation and avoidance dimensions were lower than the norm in coping styles, and the acceptance dimension was higher than the norm (all P<0.01). The average scores of diabetic distress, regimen-related distress and physician-related distress subscales were negatively correlated with confrontation (all P<0.05). The average score on diabetic distress and the subscales were positively correlated with avoidance and acceptance dimension (all P<0.01). Conclusions Diabetic distress is prevalent in type 2 diabetic patients and the degree of positive coping is still not insufficient. The diabetic distress is negatively correlated to the confrontation, and positively correlated to the avoidance and the acceptance dimension. The medical staff should instruct the patients to adopt positive coping styles, and avoid negative coping styles to reduce diabetic distress. It will be conductive to the physical and mental rehabilitation of the patients as well.
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<p><b>OBJECTIVE</b>To retrospectively analyze the clinicopathology of patients with gastric gastrointestinal stromal tumor(gGIST) who underwent radical excision within 18 years in 10 domestic medical centers in order to understand the status of domestic surgical treatment of gGIST.</p><p><b>METHODS</b>Clinicopathological data of gGIST patients undergoing radical excision in 10 medical centers from January 1998 to January 2016 were collected, and their operational conditions, postoperative adjuvant therapy, gene detection and survival were analyzed retrospectively.</p><p><b>RESULTS</b>A total of 1 846 cases were recruited in this study, including 246 cases from Guangdong General Hospital, 331 cases from Sun Yat-sen University Cancer Center, 374 cases from Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, 342 cases from Nanfang Hospital of Southern Medical University, 265 cases from Fujian Medical University Union Hospital, 148 cases from Fudan University Shanghai Cancer Center, 49 cases from West China Hospital of Sichuan University, 43 cases from Peking University Cancer Hospital and Institute, 28 cases from the 81st Hospital of Pepole's Liberation Army(PLA), 20 cases from Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute. There were 918 male (49.7%) and 928 female patients (50.3%) with median onset age of 59(18 to 95) years old. Fundus(735 cases, 39.8%) and body (781 cases, 42.3%) of stomach were the common sites of lesions. The average size of tumor was (5.3±4.6) cm. There were 1 421 cases with mitotic count ≤5(77.0%). According to the operation procedure, 924 cases (50.1%) underwent laparoscopic surgery, 759 cases (41.1%) laparotomy, 120 cases (6.5%) endoscopic surgery, and 20 cases (1.1%) laparoscopic combined with endoscopic surgery, 6 cases (0.3%) laparoscopic excision surgery through gastric wall and cavity, and 17 cases (0.9%) laparoscopy and then were transferred to laparotomy. Wedge excision were performed in 1 308 cases (70.9%), proximal gastric excision in 226 cases(12.2%), distal gastric excision in 92 cases (5.0%), total gastrectomy in 94 cases (5.1%), and local gastrectomy in 126 cases(6.8%). Multi-visceral excision was performed in 138 cases, and the splenectomy was performed in 83 cases(60.1%)with the highest ratio. According to modified NIH classification, 399 cases(21.6%) were extreme low risk, 580 cases(31.4%) were low risk, 424 cases(23.0%) were moderate risk, 443 cases (24.0%) were high risk. A total of 461 cases received postoperative imatinib adjuvant therapy, accounting for 53.2%(461/867) of patients with moderate and high risk. Among 1 846 cases, 1 402 cases (75.9%) had complete follow-up data and the median follow-up time was 33.6 (0.1 to 158) months. The 5-year survival rates of extreme low risk, low risk, moderate risk and high risk were 100%, 98.5%, 92.5%, and 79.2% with significant difference(P=0.000).</p><p><b>CONCLUSIONS</b>Gastric GIST occurs mostly in fundus and body of stomach in China. Wedge excision is the main operational procedure and laparoscopic operation is over 50%. General prognosis of gastric GIST is quite good.</p>
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Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Antineoplastic Agents , Therapeutic Uses , China , Combined Modality Therapy , Gastrectomy , Gastrointestinal Neoplasms , Gastrointestinal Stromal Tumors , Pathology , General Surgery , Imatinib Mesylate , Therapeutic Uses , Laparoscopy , Laparotomy , Postoperative Period , Prognosis , Retrospective Studies , Splenectomy , Stomach Neoplasms , Pathology , General Surgery , Survival RateABSTRACT
Objective To explore the correlations of perceived social support and burnout with general well-being among caregivers in nursing homes. Methods One hundred nursing workers were selected from three nursing homes in Guangzhou. Perceived social support scale ( PSSS ) , Maslach burnout inventory ( MBI ) and general well-being schedule ( GWBS ) were used to investigate the status of their support, burnout and general well-being and analyze the correlations between them. Results The scores on perceived social support, job burnout and general well-being were (59.00 ± 9.00), (2.49 ± 0.88), (77.19 ±9 .90), respectively, all at moderate level. The scores on emotional exhaustion and depersonalization were significantly higher than the norms (both P<0.001). Job burnout together with its three dimensions was negatively correlated with general well-being (all P<0.01), while perceived social support was positively correlated with general well-being ( P < 0 . 01 ) . The exogenous family support , emotional exhaustion and personal accomplishment influenced caregiver′s general well-being (all P<0.01). Conclusions Perceived social support, job burnout and general well-being are all at moderate level in caregivers of nursing homes. The higher the perceived social support, the lower the job burnout, the higher the passion and the general well-being in care workers. The general well-being of caregivers of the nursing homes was not high. The managers should pay more attention to them and measures should be taken to promote their physical and mental health.
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ObjectiveTo investigate changes of Th17/Treg ratio in peripheral blood of patients with traumatic sepsis and discuss the underlying clinical significance.MethodsThrity-five multi-trauma patients enrolled in the study were divided into trauma group (n =22) and sepsis group (n =13 ).Another nine healthy volunteers were designed as the control group.Peripheral blood was collected from all the groups so as to determine the ratios of Th17 and Treg by flow cytometry,detect the mRNA expressions of RORγt and FoxP3 by real time fluorescence quantitative PCR and measure serum levels of IL-4,IL-6,IL-10,IL-17A,IL-23,transforming growth factor-β (TGF-β),interferon-γ (IFN-γ) and C-reaction protein (CRP) by ELISA.Further,the change of Th17/Treg ratio and its clinical significance were analyzed.ResultsThe proportion of Th17 in the trauma group showed no significant difference with that in the control group, whereas the ratio of Th17/Treg was lower than that in the control group (P ＜ 0.05).The proportion of Th17 and ratio of Th17/Treg in the sepsis group were higher than those in the trauma group and control group (P ＜ 0.01 ).Serum concentrations of TGF-β,IL-6 and IL-23 in the sepsis group were all significantly higher than those in the control group ( P ＜ 0.01 ).Serum levels of TGF-β had no significant difference between the sepsis group and the trauma group,while serum concentrations of IL-6 and IL-23 in the sepsis group were higher than those in the trauma group ( P ＜ 0.01 ).Serum level of IL-17A and mRNA expression of RORγt in the sepsis group were higher than those in the trauma and control groups ( both P ＜ 0.01 ).ConclusionTh17/Treg imbalance is closely correlated with the development of sepsis in patients with severe trauma.
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ObjectiveTo investigate the effect of vacuum sealing drainage (VSD) with different negative pressures on variation of oxygen partial pressure (PtO2 ) and wound healing in the rabbits.MethodsTwelve rabbit wound models were made and randomly (random number) divided into two groups, namely vacuum group ( n =6 )in which rabbits were treated with VSD by different negative pressures ( - 75 mmHg,- 125 mmHg,- 225 mmHg and - 350 mmHg) for 7 days, and routine treatment group ( n =6). At each interval of measurement, variation of PtO2 was measured by oxygen partial pressure admeasuring device, and area of VSD dressing and surface of wound were measured by vernier caliper, and growth of anaerobic bacteria was detected by bacterial culture, and morphological change and the course of wound healing were observed under by light microscope after HE tissue staining. Meanwhile anther two groups (n =6, in each) were set for comparing, including normal group, sham operation group. ResultsAverage PtO2 value of vacuum group was in the range of ( 1.87 +0. 19) kPa to ( 1.54 ±0. 21 ) kPa which was decreased gradually in 7 days under different negative pressures. Average PtO2 value of routine treatment group and normal group were ( 2. 82 ± 0. 37 ) kPa and ( 5.79 + 0. 50 ) kPa, respectively which weresignificant higher than that in vacuum group ( P ＜ 0. 01 ). PtO2 was fell to 80. 94％ of its original value after VSD for 5 seconds, and continued the downward trend with the increasing of negative pressure at the same interval of measuring. Area of VSD dressing significantly decreased to 65. 36％ of its original area after VDS for5 minutes (P＜0.01). Surface of wound was minimized to 62. 82％ of its original area after VSD for 7 days ( P ＜ 0. 01 ), and variations of those in - 350 mmHg group were significant greater than those in other groups ( P ＜ 0. 01 ). There was no evidence of anaerobic bacteria growth in vacuum group during this experiment. ConclusionsPtO2 could be down-regulated by VSD significantly without growth of anaerobic bacteria, and minimization of VSD dressing at - 350 mmHg was significantly helpful to reduce the area of wound for promoting the healing.
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OBJECTIVE@#To determine the effectiveness of external fixator combined with limited internal fixation for Tile B pelvic fractures.@*METHODS@#Fourteen patients with Tile B pelvic fracture were treated by external fixator combined with limited internal fixation between September 2004 and June 2009.@*RESULTS@#All the patients were followed for 6-49 (20.2 +/- 10.2) months. According to the Matta standard, the outcome of 9 patients was excellent, 4 patients were good, while the other one patient was fair.@*CONCLUSION@#External fixator combined with limited internal fixation is effective for Tile B pelvic fracture. It can not only reduce the anatomic position of the pelvis, but also strengthen the stability of the pelvis as a whole. This method is less invasive and traumatic, which promotes the recovery of patients.
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Adult , Female , Humans , Male , Middle Aged , Young Adult , External Fixators , Fracture Fixation , Methods , Fracture Fixation, Internal , Methods , Fractures, Bone , General Surgery , Pelvic Bones , Wounds and Injuries , General SurgeryABSTRACT
Chronic pelvic pain is a common symptom of gynecological diseases,traditional Chinese medicine treatment is a important method in treating chronic pelvic pain without operation indication.According to his clinical experience of more than sixty years,famous gynecological professor XU Run-san suggested that deficient syndrome of chronic pelvic pain possesses a definite proportion in clinic;most of chronic repeated pelvic pain of long course has the pathogenesis of qi,yang deficiency,stagnation of blood circulation and deficiency complicated with blood stasis.The etiology of chronic pelvic pain is complicated,according to the TCM theory of "treating different diseases with the same method",tonifying method such as nourishing qi and raising yang,warming spleen and stomach,nourishing qi and activating blood,warming meridian and resolving stasis can be used for syndrome of qi,yang deficiency.Treatment with tonifying decoctions such as buzhongyiqi decoction,huangqijianzhong decoction based on syndrome differentiation is the key to improve the curative effect.
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Objective To study the methods for treatment of distal femoral complicated fractures.Methods Twenty-seven cases were treated using condyle sustain plate after open reduction.Results In 27 patients,all were followed-up for average 1 5 years,complications included two cases of phocomelia and another two patients with valgus deformity.According to Merchan standards,the rate of the excellent and the good was 73 9%.Conclusion Sustain plate is an excellent alternative for the treatment of distal femoral supracondylar fracture and intercondylar comminuted fracture.
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Objective To study the methods for reconstruction of pelvic ring after subtotal sacrectomy of primary sacral bone tumor.Methods The pelvic ring of nine patients with primary sacral bone tumor were reconstructed by internal fixation after sacrectomy.Results In 9 patients,all were followed-up and got satisfactory functional recovery, the pelvic ring was stable without dislocation.Conclusions Operation should be considered and adopted for primary sacral bone tumor. Reconstruction of sacrum with internal fixation can improve the stability of the pelvis.