Discusstion On Surgical Classfication And Operation Methods Of Sacral Tumors

Object To summarize the experience in the surgical treatment of60cases of sacral tumors and discuss the surgical classification and reconstruction methods of sacral tumors.Methods Retrospectively reveiwed60cases with surgery that were diagnosed as sacral tumors in the first affiliated hospital of Guangxi medical university from January2005to December2011. Sacrum was classified as upper sacral vertebrae(region Ⅰ)、lower sacral vertebrae(region Ⅱ) and lumbar vertebrae(region Ⅲ) bounded by the disc between S2and S3. Region I was further divided into four subregions (Ⅰa、Ⅰa’、 band Ⅰb’), according to the position away from anterior midline and border of sacroiliac joints. The surgical strategies were depended on preoperative imagings and the invasived range of tumors.Results1. There are20cases’tumors locating in region Ⅰ, and6cases underwent surgery with bilateral reconstructions for spine-pelvic stability,9cases with unilateral reconstruction,5cases without reconstructions due to favorable spine-pelvic stability. There are8cases’tumors locating in region Ⅱ and the patients underwent wide resection. Among25cases with tumors locating in both region Ⅰ and region Ⅱ,10cases with bilateral reconstructions,3cases with unilateral reconstruction while the other12cases without reconstruction. Of4cases with tumors locating in both region Ⅰ and region Ⅲ,3cases with bilateral reconstruction and the other one with unilateral reconstruction. Of3cases with tumors locating in region Ⅰ、Ⅱ and Ⅲ,2cases with unilateral reconstruction and one case with bilateral reconstruction.2. Among60cases, there were2cases with tumors locating in region Ⅰa, one in region Ⅰa’,5cases in region Ⅰa’b’,4cases in region Ⅰab,5cases in region Ⅰ aa’, one case in region Ⅰ aa’b,2cases in region Ⅰaa’bb’,8cases in region Ⅱ2cases in region Ⅰa Ⅱ,3cases in region Ⅰab Ⅱ,2cases in region Ⅰ a’b’Ⅱ12cases in region Ⅰaa’Ⅱ,1case in region Ⅰ aa’b Ⅱ,5cases in region Ⅰ aa’bb’Ⅱ, one in region Ⅰ abⅢ,2cases in region Ⅰaa’Ⅲ, one case in region Ⅰaa’bb’Ⅲ, one case in region Ⅰ aa’Ⅱ Ⅲ, one case in region Ⅰ aa’b Ⅱ Ⅲ, one case in region Ⅰa’b’Ⅱ Ⅲ.3. Surgical methods included single posterior approach in34cases, combined anterior-posterior approach in24cases. There was significant difference in operation time and blood loss between the two groups with different operation approach. While the significant difference in operation time and blood loss of group with vessel blocked and group with vessel unblocked was confirmed.4. Of34cases with all lumbosacral nerve roots preservation,30cases suffered from complete recovery of urine-fetal function and lower limbs’myodynamia,2cases with partial recovery while one case without any benefit during hospitalization.3cases were preserved with all nerve roots in unilaterally and some contralateral ones, and all of them had good function. Of9cases with bilateral lumbosacral nerve roots above S3preservation,5cases suffered from great recovery,2cases suffered from partial recovery and2cases benefited nothing. Of8cases with bilateral lumbosacral nerve roots above S2preservation, one had recovery to normal,3cases had great improvement, while one suffered increasely, one suffered from fetal defect because of bowel invasived by tumor, and one was dead.6cases were preserved with bilateral lumbosacral nerve roots above S1, among which2cases suffered from partial recovery and4cases benefited nothing.5.Complications were noted in29patients, including one died in perioperative period, cerebrospinal leak in4cases, delayed wound union or nonunion in7cases, wound infection in5cases, skin necrosis of incision in4cases, seroma in6cases, sinus tract formation in one, and deep vein thrombosis of lower limb in one case.Conclusion Surgical classification of sacrum is a great reference for the surgical strategy of sacral tumor. The decision of tumor excision extension should well be made as to reduce the recurrence rate as possible, while the preservation of sacral nerve roots and reduction of blood loss should also be well considered to preserve urine-fetal and sexual functions by surgeons. Appropriate internal fixations to maintain lumbosacral stability is necessary, especially in the case that the damage of sacroiliac joint surface beyond50%or disturbance of force line.