Background: Pelvic resections represent some of the most challenging procedures in orthopedic oncology, often necessitating the sacrifice of large bone segments and, subsequently, the loss of nearby soft tissues. Our study aims to evaluate the impact of surgical resections of pelvic bone tumors on the performance of the pelvic floor and digestive, urinary, and genital systems. Methods: We evaluated all malignant or locally aggressive pelvic bone tumors treated with bone resection in our institution between January 2017 and January 2024. The reconstructive approaches were recorded. Pre- and post-operative MRI and CT scans were used to evaluate the grade of pelvic prolapse. The prolapse of the pelvic floor was assessed with the M-line, the H-line, and the anorectal angle. Hydronephrosis was also evaluated. Urinary and fecal incontinence were evaluated with the Pelvic Floor Impact Questionnaire (PFIQ7). Results: Thirty cases were included in our study. Nine cases were treated with custom-made prostheses, five had ice-cone prostheses, two massive allografts, and one composite allograft-prosthesis. The others had no bone reconstruction. Meshes were used to reconstruct the pelvic floor in 9 cases. Patients with discontinuity of the pelvic ring had a significantly higher grade of pelvic prolapse (M-line) and worse PFIQ7 scores. Conclusions: The resection of pelvic bone tumors represents one of the main challenges in orthopedic oncology. While planning surgical demolition and performing the subsequent reconstruction, surgeons should also consider the impact of the surgical treatment on the pelvic floor and surrounding organs. Intra-operative reconstructions and post-operative rehabilitation are advisable.
背景：骨盆切除术是骨科肿瘤学中最具挑战性的手术之一，通常需要切除大段骨骼，并随之损失邻近的软组织。本研究旨在评估骨盆骨肿瘤手术切除对盆底功能及消化、泌尿和生殖系统的影响。方法：我们评估了2017年1月至2024年1月期间在我院接受骨切除治疗的所有恶性或局部侵袭性骨盆骨肿瘤。记录了重建方法。术前和术后的磁共振成像（MRI）和计算机断层扫描（CT）用于评估盆腔脱垂的程度。盆底脱垂通过M线、H线和肛门直肠角进行评估。同时评估了肾积水情况。尿失禁和粪失禁通过盆底影响问卷（PFIQ7）进行评估。结果：本研究共纳入30例病例。其中9例采用定制假体治疗，5例使用冰锥假体，2例采用大块同种异体移植物，1例采用复合异体移植物-假体。其余病例未进行骨重建。9例病例使用网片重建盆底。骨盆环不连续的患者盆腔脱垂（M线）程度显著更高，PFIQ7评分也更差。结论：骨盆骨肿瘤的切除是骨科肿瘤学的主要挑战之一。在规划手术切除及后续重建时，外科医生还应考虑手术治疗对盆底及周围器官的影响。建议进行术中重建和术后康复。
Pelvic Floor Functionality and Outcomes in Oncologic Patients Treated with Pelvic Bone Resection
肿瘤(癌症)患者之家