Iliosacral Resections of Pelvic Malignant Tumors and Reconstruction with Nonvascular Bilateral Fibular Autografts
- 531 Downloads
Iliosacral resection of pelvic malignant tumors and subsequent reconstruction have tested the ingenuity of orthopedic oncologists because of the difficulty of oncological wide resection and the complex biomechanics of the sacroiliac joint render reconstruction challenging. This study compared the functional and surgical outcomes of a biological reconstruction technique with the lack of reconstruction following iliosacral resection.
Twenty-six consecutive cases with malignant iliac tumors involving the sacrum were retrospectively reviewed. These cases underwent iliosacral resection (type I/IV) followed by no reconstruction or a biological reconstruction blinded to authors between 1997 and 2007. After iliosacral resection, 12 cases underwent reconstruction with nonvascular fibular grafts and plate and/or pedicle screw-rod; the other 14 cases did not undergo reconstruction.
The median follow-up was 84.42 (range, 32–165) months. The local recurrence rate in the reconstruction group was 8.33 % (1/12) with 14.29 % (2/14) in the group without reconstruction. The functional score of the biological reconstruction group was significantly higher than that of the no-reconstruction group as determined by Student’s t test. In the biological reconstruction group, bone fusion occurred in 91 % of cases and fibula hypertrophy was observed in 41.7 %. Complications included sciatic nerve palsy, broken screws, intractable pain, nonunion, pelvic oblique, and leg-length discrepancy.
After iliosacral resections of pelvic malignant tumors, the biologic reconstruction of these defects could restore spinopelvic stability and continuity. The double-barrel fibular autograft combined with the plate or pedicle screw-rod system is an effective reconstruction method for both optimal short- and long-term stability.
KeywordsLocal Recurrence Rate Functional Score Pelvic Ring Fibular Graft Oblique Pelvis
Supported by Sun Yat-sen University Clinical Research 5010 Program and the National Natural Science Foundation of China, serial no. 30872967, 81072193.
- 6.Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980:106–20.Google Scholar
- 13.Wirbel RJ, Schulte M, Mutschler WE. Surgical treatment of pelvic sarcomas: oncologic and functional outcome. Clin Orthop Relat Res. 2001:190–205.Google Scholar
- 14.Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993:241–6.Google Scholar
- 15.Masterson EL, Davis AM, Wunder JS, Bell RS. Hindquarter amputation for pelvic tumors. The importance of patient selection. Clin Orthop Relat Res. 1998:187–94.Google Scholar
- 17.Fuchs B, O’Connor MI, Kaufman KR, Padgett DJ, Sim FH. Iliofemoral arthrodesis and pseudarthrosis: a long-term functional outcome evaluation. Clin Orthop Relat Res. 2002:29–35.Google Scholar
- 18.Khan SN, Hofer MA, Gupta MC. Lumbar degenerative scoliosis: outcomes of combined anterior and posterior pelvis surgery with minimum 2-year follow-up. Orthopedics. 2009;32.Google Scholar
- 24.Langlais F, Lambotte JC, Thomazeau H. Long-term results of hemipelvis reconstruction with allografts. Clin Orthop Relat Res. 2001:178–86.Google Scholar
- 25.Pring ME, Weber KL, Unni KK, Sim FH. Chondrosarcoma of the pelvis. A review of sixty-four cases. J Bone Joint Surg Am. 2001;83-A:1630–42.Google Scholar
- 26.Missenard G, Dubousset J, Genin J. [Large resection of the sacroiliac joint. Technique, reconstruction, anatomical and functional results]. Rev Chir Orthop Reparatrice Appar Mot. 1991;77:14–24.Google Scholar
- 29.Aho AJ et al. Incorporation and clinical results of large allografts of the extremities and pelvis. Clin Orthop Relat Res. 1994:200–13.Google Scholar
- 30.Mankin HJ, Doppelt S, Tomford W. Clinical experience with allograft implantation. The first ten years. Clin Orthop Relat Res. 1983:69–86.Google Scholar
- 34.Jia YW et al. A finite element analysis of the pelvic reconstruction using fibular transplantation fixed with four different rod-screw systems after type I resection. Chin Med J (Engl). 2008;121:321–6.Google Scholar
- 35.Shin KH, Rougraff BT, Simon MA. Oncologic outcomes of primary bone sarcomas of the pelvis. Clin Orthop Relat Res. 1994:207–17.Google Scholar