Research on Biomechanical Stability of Pelvis after Subdivided Sacrectomy_West China Medical Journal

Authors：

LUO Yi ¹ , JIANG Yong ² , ZHANG Xuelei ¹ , TANG Fan ¹ , ZHOU Yong ¹ , MIN Li ¹ , ZHANG Wenli ¹ , DUAN Hong ¹ ,  TU Chongqi. ¹

1 Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China; 2 Department of Orthopedics and Traumatology, the First Affiliated Hospital of Henan College of Traditional Chinese Medicine, Zhengzhou, Henan 450000, P. R. China.;

Corresponding?author：

TU Chongqi., Email: 851733278@qq.com

Keywords：

骶骨腫瘤; 骶髂關節; 切除術; 穩定性; 生物力學

DOI：

10.7507/1002-0179.20130486

Video：

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目的　通過對保留不同平面骶骨的新鮮人骨盆模型進行生物力學測試，分析骶骨切除平面與骨盆穩定性的關系，明確骶骨切除保留至何種程度時需行腰骶髂穩定性重建。方法　選用6具正常成年男性新鮮尸體腰5-骨盆標本，采用200 N增量分級加載，以1.4 mm/min速率平穩加載直至1 000 N，依次測試保留完整骶骨及不同平面骶骨切除骨盆模型的最大主應力、剪切應力、位移及剛度變化，比較各組間的差異。最后測量1/2S1組骨盆環的極限載荷，記錄骨折發生部位和骨折類型。結果　隨骶骨切除平面增高，最大主應力、剪切力及骶骨下沉位移在各測試點均有不同程度增大，骨盆的軸向剛度不斷減小。當切除平面達骶1時，變化明顯，尤其以經過骶1下1/4～下1/2時變化顯著，與完整骶骨組比較，差異有統計學意義（P＜0.05）。骶1椎體下1/2平面切除后，骨盆的極限載荷是（2 375.97 ± 162.41）N，骨盆的破壞形態為經骶髂關節或骶椎的骨折。結論　骶骨切除范圍與骨盆環的穩定性密切相關，隨著骶骨切除平面升高，殘留骶髂關節各種應力急劇增高，骨盆的穩定性明顯下降。當骶骨切除涉及骶1椎
體時，極易發生骨折，需要進行腰骶髂局部重建以增強骶髂關節的穩定性。

Citation： LUO Yi,JIANG Yong,ZHANG Xuelei,TANG Fan,ZHOU Yong,MIN Li,ZHANG Wenli,DUAN Hong,TU Chongqi.. Research on Biomechanical Stability of Pelvis after Subdivided Sacrectomy. West China Medical Journal, 2013, 28(10): 1536-1540. doi: 10.7507/1002-0179.20130486 Copy

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6.	Stener B, Gunterberg B. High amputation of the sacrum for extirpation of tumors: principles and technique[J]. Spine (Phila Pa 1976), 1978, 3(4): 351-366.
7.	Gunterberg B, Romanus B, Stener B, et al. Pelvic strength after major amputation of the sacrum. An exerimental study[J]. Acta Orthop Scand, 1976, 47(6): 635-642.
8.	吳寅良, 楊惠林, 王以進, 等. 骶骨不同水平切除對骨盆穩定性影響的生物力學研究[J]. 中華骨科雜志, 2008, 28(3): 218-223.
9.	Mosiello G, Gatti C, De Gennaro M, et al. Neurovesical dysfunction in children after treating pelvic neoplasms[J]. BJU Int, 2003, 92(3): 289-292.
10.	Todd LT, Yaszemski MJ, Currier BL, et al. Bowel and bladder function after major sacral resection[J]. Clin Orthop Relat Res, 2002, 4(397): 36-39.
11.	Gunterberg B. Effects of major resection of the sacrum. Clinical studies on urogenital and anorectal function and a biomechanical study on pelvic strength[J]. Acta Orthop Scand Suppl, 1976, 162(397): 1-38.
12.	Moshirfar A, Rand FF, Sponseller PD, et al. Pelvic fixation in spine surgery. Historical overview, indications, biomechanical relevance, and current techniques[J]. J Bone Joint Surg Am, 2005, 87(Suppl 2): 89-106.
13.	Sung WH, Shu WP, Wang HM, et al. Surgical treatment of primary tumors of the sacrum[J]. Clin Orthop Relat Res, 1987(215): 91-98.
14.	楊慶誠, 陳實, 曾炳芳. 后路骶骨次全切除的相關應用解剖[J]. 上海醫學, 2005, 28(7): 561-564.
15.	鄧娟, 范璐, 華晶, 等. 經第1～3骶后孔上下緣水平切除骶骨對骶髂關節面面積的影響[J]. 局解手術學雜志, 2005, 14(4): 239-240.

1. 　鄭誠功. 骨科生物力學的進展[J]. 中華創傷骨科雜志, 2005, 7(10): 901-902.
2. 　Mindea SA, Chinthakunta S, Moldavsky M, et al. Biomechanical comparison of spinopelvic reconstruction techniques in the setting of total sacrectomy[J]. Spine (Phila Pa 1976), 2012, 37(26): 1622-1627.
3. 　Cunningham BW, Gordon JD, Dmitriev AE, et al. Biomechanical evaluation of total disc replacement arthroplasty: an in vitro human cadaveric model[J]. Spine (Phila Pa 1976), 2003, 28(20): s110-s117.
4. 　Hugate RR Jr, Dickey ID, Phimolsarnti R, et al. Mechanical effects of partial sacrectomy: when is reconstruction necessary[J]. Clin Orthop Relat Res, 2006, 450: 82-88.
5. 　Hays RP. Resection of the sacrum for benign giant cell tumor; a case report[J]. Ann Surg, 1953, 138(1): 115-120.
6. 　Stener B, Gunterberg B. High amputation of the sacrum for extirpation of tumors: principles and technique[J]. Spine (Phila Pa 1976), 1978, 3(4): 351-366.
7. 　Gunterberg B, Romanus B, Stener B, et al. Pelvic strength after major amputation of the sacrum. An exerimental study[J]. Acta Orthop Scand, 1976, 47(6): 635-642.
8. 　吳寅良, 楊惠林, 王以進, 等. 骶骨不同水平切除對骨盆穩定性影響的生物力學研究[J]. 中華骨科雜志, 2008, 28(3): 218-223.
9. 　Mosiello G, Gatti C, De Gennaro M, et al. Neurovesical dysfunction in children after treating pelvic neoplasms[J]. BJU Int, 2003, 92(3): 289-292.
10. 　Todd LT, Yaszemski MJ, Currier BL, et al. Bowel and bladder function after major sacral resection[J]. Clin Orthop Relat Res, 2002, 4(397): 36-39.
11. 　Gunterberg B. Effects of major resection of the sacrum. Clinical studies on urogenital and anorectal function and a biomechanical study on pelvic strength[J]. Acta Orthop Scand Suppl, 1976, 162(397): 1-38.
12. 　Moshirfar A, Rand FF, Sponseller PD, et al. Pelvic fixation in spine surgery. Historical overview, indications, biomechanical relevance, and current techniques[J]. J Bone Joint Surg Am, 2005, 87(Suppl 2): 89-106.
13. 　Sung WH, Shu WP, Wang HM, et al. Surgical treatment of primary tumors of the sacrum[J]. Clin Orthop Relat Res, 1987(215): 91-98.
14. 　楊慶誠, 陳實, 曾炳芳. 后路骶骨次全切除的相關應用解剖[J]. 上海醫學, 2005, 28(7): 561-564.
15. 　鄧娟, 范璐, 華晶, 等. 經第1～3骶后孔上下緣水平切除骶骨對骶髂關節面面積的影響[J]. 局解手術學雜志, 2005, 14(4): 239-240.

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