Resection and reconstruction for tumors of iliac bone / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To discuss the resection of tumors, reconstruction of defects.</p><p><b>METHODS</b>Sixty-one patients with tumors in ileum were treated surgically in People's Hospital from July 1998 to July 2004. The series comprised 38 males and 23 females with an average age of 43 years old (range from 12 to 78 years old). According to Enneking staging system, 36 cases had lesions in region I, 17 cases in region I and II, and 8 cases in region I and IV. After tumor resected, posterior fixation system of spine was applied to reconstruct the integrality of pelvic ring in series of region I cases. The four pedicle screws were implanted in the lumbar and sacrum superiorly, pubis and ischium inferiorly. For children patients, bone graft or bone cement and Steinmann's pins internal fixation was applied to reconstruct the pelvis.</p><p><b>RESULTS</b>Among all the 61 cases, 48 cases followed up from 16 months to 6 years. Thirty-three cases were survived and had no local recurrence or metastasis. Fifteen cases were dead. Oncology result: local recurrence were found in 19.4% patients with region I resection (7/36), the resection level was close to acetabulum (in order to reserve the acetabulum), and it might be the reason of recurrence. 35.3% of patients (6/17) with region I and II resection had local recurrence, the recurrence maybe related to residual tumor after curettage. 50.0% of the patients (4/8) with region I and IV resection had local recurrence, the tumor residual in sacrum might be the reason of recurrence. Functional result: all of the 36 cases received region I resection regained normal walking function. The hip joint function was normal in 17 cases received tumor curettage, bone cement or hip joint replacement.</p><p><b>CONCLUSIONS</b>The posterior fixation system of spine can be used to reconstruct the integrality of pelvic ring after resection of iliac tumors. Simple reconstruction is more favorable for child patients. Allograft or self-ileum can be implanted in the space of sacral wing and residual ileum, and the bone graft is fixed with compressional screw.</p>