Application of CBL combined with 3D printing teaching in clinical teaching of sacral tumors / 中华医学教育探索杂志

Objective:To explore the application effect of case-based learning (CBL), teaching mode combined with 3D printing in clinical teaching of sacral tumors.Methods:A total of 108 undergraduate interns and standardized residency training students who studied in our hospital from 2017 to 2018 were divided into the CBL teaching group ( n = 53) and the CBL combined with 3D printing teaching group ( n = 55) according to their study time. The combined teaching group used computer tomography (CT) data to reconstruct and print out a 3D model of sacral tumors based on CBL, and performed preoperative teaching on the invasion of the surrounding tissues of the tumor. The scores of the students in the two groups were evaluated respectively, and the students were surveyed by self-identification questionnaire (learning interest, self-learning ability, teamwork ability, comprehensive analysis ability and clinical thinking ability). The t-test (one-sided) was used for comparison between groups using stata 14.0. Results:The score of CBL teaching group (75.90±6.70) was lower than that of CBL combined with 3D printing teaching group (83.60±7.40). In terms of critical thinking ability evaluation, self-learning ability, learning interest, comprehensive analysis ability and clinical thinking ability, the CBL combined 3D printing teaching group was superior to the CBL teaching group, and the difference was statistically significant ( P<0.001). In terms of teamwork ability, there was no statistical difference between the two groups. Conclusion:The CBL teaching mode combined with 3D printing can improve academic performance, students' learning interest and clinical thinking ability of sacral tumors in the teaching of undergraduate interns and standardized residency training students.

The primary exploration on the value of 3D visualization technique in the precise surgery for complex sacra tumor / 中国医学装备

Objective: To investigate the application value of 3D visualization technique in the precise surgery for complex sacra tumor. Methods: A 59-year-old female patient with the sacrum occupying for half a month was enrolled in the research. And then the original data of digital imaging and communication in medicine (DICOM), that were obtained through CT and MRI, were imported in computer to reconstruct 3D spatial model. Results: The reconstructive model that used 3D technique can not only clearly display the size of sacral tumor, but also reflect the anatomic morphology, the blood supply of tumor and the relationship between tumor and surrounding tissues. Under its guidance, the tumor could be completely removed, and the surrounding normal organs and nerve roots could be preserved as much as possible. Besides, the operation time was greatly decreased and the amount of bleeding was reduced. Conclusion: The application of 3D visualization technique in the surgical treatment for sacral tumor can enhance the safety of the tumorectomy of sacral tumor, and accelerate the operation speed, and increase the accuracy of operation, and protect vital organs and nerves, thus preserve the corresponding physiological function. Therefore, it has great application prospect in the precisely surgical treatment of spinal surgery.

Development and current situation of reconstruction methods following total sacrectomy / 中国修复重建外科杂志

Objective: To review the development of the reconstruction methods following total sacrectomy, and to provide reference for finding a better reconstruction method following total sacrectomy. Methods: The case reports and biomechanical and finite element studies of reconstruction following total sacrectomy at home and abroad were searched. Development and current situation were summarized. Results: After developing for nearly 30 years, great progress has been made in the reconstruction concept and fixation techniques. The fixation methods can be summarized as the following three strategies: spinopelvic fixation (SPF), posterior pelvic ring fixation (PPRF), and anterior spinal column fixation (ASCF). SPF has undergone technical progress from intrapelvic rod and hook constructs to pedicle and iliac screw-rod systems. PPRF and ASCF could improve the stability of the reconstruction system. Conclusion: Reconstruction following total sacrectomy remains a challenge. Reconstruction combining SPF, PPRF, and ASCF is the developmental direction to achieve mechanical stability. How to gain biological fixation to improve the long-term stability is an urgent problem to be solved.

Sacrectomía parcial por abordaje posterior único / Partial sacrectomy by single posterior approach

Introducción: Los tumores del sacro representan <7% de los tumores espinales, prevalecen los tumores secundarios por mieloma múltiple o carcinomas de próstata, mama, pulmón o colón. El cordoma es el tumor maligno primario más frecuente y el tumor de células gigantes es la lesión benigna más común. Por su evolución, compromiso de estructuras extraóseas y la escasa respuesta a los tratamientos coadyuvantes, la cirugía es el tratamiento más utilizado, la vía de abordaje y la necesidad de instrumentación dependerán del tumor por tratar. Los objetivos de este trabajo son: evaluar el uso de la resección parcial del sacro, analizar la técnica quirúrgica y reconocer las complicaciones. Materiales y Métodos: Cuatro pacientes con diagnóstico de tumor sacro ubicado por debajo de S1, que consultan por dolor y cuyas imágenes confirman la lesión. A todos se les realiza una resección en bloque por vía posterior preservando S1. Se describe la técnica. Resultados: Los estudios anatomopatológicos revelaron: un cordoma, un tumor maligno de vaina nerviosa, un condrosarcoma y una metástasis de carcinoma prostático. Se preservó la función de S1 en todos los pacientes; uno tiene disfunción vesical permanente. Se observaron una dehiscencia de la herida, una infección y una fístula de líquido cefalorraquídeo. Todos permanecen sin la enfermedad tras un seguimiento de entre 6 y 24 meses. Conclusiones: La resección parcial del sacro por abordaje posterior único se puede indicar cuando la lesión compromete desde S2 hacia distal y no hay compromiso sacroilíaco. La preservación de raíces es de vital importancia para garantizar mejores resultados posoperatorios y una menor tasa de infección. Nivel de Evidencia: IV

Introduction: Tumors of the sacrum represent less than 7% of spinal tumors. Secondary tumors due to multiple myeloma or prostate, breast, lung and colon carcinomas predominate. Chordoma is the most frequent primary malignant tumor and giant cell tumor is the most common benign lesion. For its evolution, involvement of extra bone structures and poor response to the adyuvant therapy, surgery is the most commonly used treatment, the approach and the need for instrumentation depend on tumor to treat. The objectives of this study are to evaluate the use of partial resection of sacrum, analyze the surgical technique and assess complications. Methods: Four patients with diagnosis of sacral tumor below S1, who presented with pain and images confirming the injury. All underwent an en bloc resection by posterior via preserving S1. The technique is described. Results: The pathological results were: a chordoma, a malignant nerve sheath tumor, a chondrosarcoma and a metastasis of prostatic carcinoma. S1 function was preserved in all patients; one has permanent bladder dysfunction. Wound dehiscence, infection and cerebrospinal fluid fistula were detected. Patients are free of disease after a follow-up of 6-24 months. Conclusions: Partial resection of the sacrum using a unique posterior approach may be indicated when the injury involves from S2 distally and no sacroiliac involvement is observed. Root preservation is vital to guarantee the best postoperative results and a lower rate of infection. Level of Evidence: IV

The Application of Temporary Balloon Occlusion of the Abdominal Aorta in High-order Position Sacral Tumor Surgical Operation / 昆明医科大学学报

ObjectiveTo evaluate temporary balloon occlusion of the abdominal aorta in high-order position sacral tumor surgical operation as a useful adjuvant technique.MethodsReviewed 79 cases of patients from 2005 to 2015 treated in our department and the diagnosis of high-order position sacral tumor. Temporary balloon occlusion of abdominal aorta was used in 50 patients(male 29,female 21)during the sacral tumors surgical operations. The other 29 patients(male 18,female 11)with sacral tumors who received the non-temporary balloon occlusion therapy were used as control group. The statistical differences of the whole surgery time,the blood loss during the surgery,the happening of the postoperative deep vein thrombosis,the time of the postoperative extubation were analyzed. ResultsThe differences were statistically significant(P<0.001)in the whole surgery time of balloon occlusion group(146.36±29.38)min vs non-balloon occlusion group(206.03±125.93)min,the blood loss of balloon occlusion group(1610.70±491.14)ml vs non-balloon occlusion group(2658.62±562.213)mL, and the time of the postoperative extubation of balloon occlusion group(6.60±2.76)d vs non-balloon occlusion group(12.52±2.86)d. However,there was not significant difference of the happening of the postoperative deep vein thrombosis between balloon occlusion group and non- balloon occlusion group. ConclusionTemporary balloon occlusion of abdominal aorta is effective and reliable. It significantly reduced the time of operations,the loss of blood,mean days in hospital,effusion of post-operation and recurrence rate. It makes the operation of sacral tumors much more safer than before and is a technique worthy of popularizing.

Tumor maligno de vaina de nervio periférico: reporte de caso / Malignant peripheral nerve sheath tumor: case report

Se presenta un caso de tumor sacro voluminoso con características de Tumor Maligno de Vaina de Nervio Periférico (MPNST) que tras una resección inicial y recidiva se reintervino y trató con radioterapia complementaria. Tras ocho años se ha observado una buena evolución.

A case of voluminous sacral tumor with Malignant Peripheral Nerve Sheath Tumor (MPNST) characteristics is reported, that after a first resection and later recurrence is reoperated and treated with complementary radiotherapy. After eight years a good evolution has been observed.

Angiographic study of the feeding arteries of sacral tumors：analysis of 27 cases / 介入放射学杂志

Objective To study the feeding arteries of sacral tumors with digital substraction angiography (DSA). Methods A total of 27 patients with sacral tumors, who were encountered at authors’ hospital during the period from January 2006 to December 2012 , were enrolled in this study. DSA of abdominal aorta, bilateral internal iliac arteries, median sacral artery and lumbar arteries was performed in all patients. The origins, branches of the feeding arteries were determined, and the results were analyzed. Results Of the 27 cases with sacral tumors, DSA demonstrated median sacral artery in 20 (20 arteries in total), lateral sacral artery in 22 (36 arteries in total), ilio-lumbar artery in 18 (27 arteries in total), lumbar artery in 10 (15 arteries in total), inferior gluteal artery in 3 (3 arteries in total) and superior gluteal artery in 2 (2 arteries in total). Conclusion In our series, the blood supply of the sacral tumors is mainly from the median sacral artery, lateral sacral artery, ilio-lumbar artery and lumbar artery. Occasionally, superior and inferior gluteal arteries also participate in the blood supply of the sacral tumors. For the evaluation of sacral tumors, attention should be paid to the presence of rare feeding arteries.

Analysis of risk factors of wound complications following the abdominal aorta balloon occlusion / 中国综合临床

Objective To investigate the risk factors of wound complications following the abdominal aorta balloon occlusion in order to provide the basis for the preoperative management and reduce postoperative complications.Methods Two hundred and sixty-one patients with the sacral tumor aged over 18 were selected as subjects who hospitalized at Peking University People's Hospital from January 2006 to December 2012.All subjects were underwent sacral tumor posterior resection operation after occlusion of the distal abdominal aorta.Patients were divided into two groups according to the existence of postoperative wound disorder.The general information of the patients was collected including intra-operative data and post-operative data.SPSS19.0 software was applied for statistic analysis Results Among 261 cases,89 cases were with incision complications,and the incidence of complications was 34.1％ (89/261).There was no significant difference regarding of age,weight,preoperative complications (P ＜ 0.05).Compared with that of no complications group,operation time of wound complications group was longer ((218.27 ± 72.08) min vs.(197.40 ± 53.92) min,P =0.046),and intra-operative bleeding was more ((2368.0 ± 1984.7) ml vs.(1701.6 ±958.8) ml,P =0.000),as well as a longer balloon occlusion time ((78.0 ± 23.8) rain vs.(65.2 ± 17.8) min,P =0.005).Moreover long hospitalized periods was in wound complications group ((47.6 ± 26.3) d,vs.(26.7 ± 9.0) d,P ＜ 0.05).Single factor analysis showed that the factors including operation time,intra-operative bleeding volume,time and times of balloon occlusion balloon occlusion were related to postoperative wound complications.Non conditional logistic regression analysis shows that factors of the balloon occlusion time(OR 1.028,95％ CI 1.012-1.045,P =0.001) and block number(OR 6.266,95％ CI 1.186-33.119,P =0.031) were related to the wound healing following balloon occlusion the abdominal aorta.Conclusion The risk factors of wound complications following the abdominal aorta balloon occlusion included occurrence balloon occlusion time and blocking times.That single balloon occlusion with 60 min reduced wound complication rate.

Cordoma sacral / Sacral chordomas

Cordomas são neoplasias raras que se originam dos remanescentes da notocorda primitiva 50% dos casos têm localização sacral, sendo mais frequente ao nível de S4/S5. Nós descrevemos um caso de cordoma sacral ao nível de S1 e discutimos a apresentação clínica, achados de imagem, tratamento cirúrgico e evolução.

Chordomas are rare neoplasias originating from the remaining primitive notochord. 50% of the cases have sacral localization, being more frequent at levels S4/S5. Here we report a case of sacral chordoma at level S1 and discuss its clinical presentation, imaging findings, surgical treatment, and progress.

The prevention of hemorrhoea after superior position sacral tumor was resected / 中国基层医药

Objective To investigate methods and effect of preventing hemorrhoea when superior position sacral tumor was resected.Methods 36 patients with superior position sacral tumor were operated by excision of presacral tumor from May 2000 to May 2007.14 cases were performed with double hypogastric artery ligation.Hy- pogastric arteries were embolismed temporarily through intervention in 7 cases and permanently in 10 cases.Distal end of abdominal aorta was placed with sacculus in advance in 5 cases.Average volume of blood was calculated ac- cording to different methods of preventing blood.Results Blood loss was 500～2000ml(average 1100ml)by hy- pogastric artery ligation.Blood loss was 600～2100ml(average 1200ml)by temporary double hypogastric arterial em- bolism while blood loss was 550～1900ml(average 1150ml)by temporary embolism.Blood loss was 200～1000ml (average 560ml)by placing sacculus in advance at distal end of abdominal aorta.Conclusion Hemorrhoea may be prevented completely through temporarily or temporarily reducing blood supply of pars sacralis when sacral tumor was resected.Especially,it is a best method when distal end of abdominal aorta was placed with sacculus in advance.

Clinical evaluation of temporary balloon occlusion of the abdominal aorta in sacral tumors surgical operation / 中国矫形外科杂志

[Objective]To evaluate temporary balloon occlusion of the abdominal aorta in sacral tumors surgical operation as a useful adjuvant technique.[Method]Temporary balloon occlusion of abdominal aorta was used in 36 patients during the sacral tumors surgical operations(study group).Another 32 patients with sacral tumors who receive the preoperative arterial embolization theraphy were used as control group.The quantity of blood loss during the surgery,the whole surgery time,the complication,mean days in hospital,recovery days post-operation and recurrence rate were recorded.The results in two groups were compared with each other.[Result]The time of operations of study group was(149.19?73.81)minutes.The loss of blood was(826.67?509.11)ml.Two cases had complication after operation.Mean days in hospital were(26.05?7.08)d.Recovery days post-operation were(34.61? 8.22)d.Recurrence rate of six months was 5.5 %.Recurrence rate of one year was 11%.Recurrence rate of two years was 16%.The time of operations of control group was(221.33?45.19)min.The loss of blood was( 1 652 ?706.99)ml.Eight cases had complications after operation.Mean days in hospital were(37.93?7.63)d.Recovery days post-operation were(46.03?9.67)d.Recurrence rate of six months was 18%.Recurrence rate of one year was 31%.Recurrence rate of two years was 40.6%.[Conclusion]The effect of temporary balloon occlusion of abdominal aorta is reliable.It significantly reduced the time of operations,the loss of blood,complications,mean days in hospital,recovery days post-operation and recurrence rate.It makes the operation of sacral tumors much more safer than before.

Rehabilitation Nursing of the Sacral Tumor Resection at the Peri-operative Period / 中国康复理论与实践

@#ObjectiveTo evaluate the effect of rehabilitation nursing in the peri-operative period of the first-stage combined anterior-posterior approach surgery in the sacral tumor resection.Methods15 patients with sacral tumor received psychological intervention, gastrointestinal preparation, exercises of perineum sphincter contraction and relaxation training before the operation. Changes of patients' vital signs and nerve function were observed after the operation, and rehabilitation training and instruction were performed.ResultsAll cases were followed up for 2～37 months. Except one case died of tumor transfered to lung, all of other cases had a satisfactory curative effect in the near future, and their local symptom released and the functions of urination and defecation were kept well.ConclusionRehabilitation nursing in the peri-operative period plays an important role in surgical treatment of sacral tumor. It affects the rehabilitation and function restitution obviously and can reduce the occurrence of complication effectively.