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Iliosacral resections of pelvic malignant tumors and reconstruction with nonvascular bilateral fibular autografts.
Ann Surg Oncol. 2012 Dec; 19(13):4043-51.AS

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Authors+Show Affiliations

Muskulaskeletal Oncology Department, First Affiliated Hospital of Zhongshan University, Guangzhou, Guangdong, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22948770

Citation

Wang, Jin, et al. "Iliosacral Resections of Pelvic Malignant Tumors and Reconstruction With Nonvascular Bilateral Fibular Autografts." Annals of Surgical Oncology, vol. 19, no. 13, 2012, pp. 4043-51.
Wang J, Tang Q, Xie X, et al. Iliosacral resections of pelvic malignant tumors and reconstruction with nonvascular bilateral fibular autografts. Ann Surg Oncol. 2012;19(13):4043-51.
Wang, J., Tang, Q., Xie, X., Yin, J., Zhao, Z., Li, Z., Zou, C., Huang, G., & Shen, J. (2012). Iliosacral resections of pelvic malignant tumors and reconstruction with nonvascular bilateral fibular autografts. Annals of Surgical Oncology, 19(13), 4043-51. https://doi.org/10.1245/s10434-012-2339-x
Wang J, et al. Iliosacral Resections of Pelvic Malignant Tumors and Reconstruction With Nonvascular Bilateral Fibular Autografts. Ann Surg Oncol. 2012;19(13):4043-51. PubMed PMID: 22948770.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Iliosacral resections of pelvic malignant tumors and reconstruction with nonvascular bilateral fibular autografts. AU - Wang,Jin, AU - Tang,Qinglian, AU - Xie,Xianbiao, AU - Yin,Junqiang, AU - Zhao,Zhiqiang, AU - Li,Zhibin, AU - Zou,Changye, AU - Huang,Gang, AU - Shen,Jingnan, Y1 - 2012/09/05/ PY - 2011/07/05/received PY - 2012/9/6/entrez PY - 2012/9/6/pubmed PY - 2013/5/15/medline SP - 4043 EP - 51 JF - Annals of surgical oncology JO - Ann. Surg. Oncol. VL - 19 IS - 13 N2 - BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SN - 1534-4681 UR - https://www.unboundmedicine.com/medline/citation/22948770/Iliosacral_resections_of_pelvic_malignant_tumors_and_reconstruction_with_nonvascular_bilateral_fibular_autografts_ L2 - https://dx.doi.org/10.1245/s10434-012-2339-x DB - PRIME DP - Unbound Medicine ER -