2018年 · 第56卷第02期

Primary aneurysmal bone cysts (ABC) are benign bone lesions, and open surgery has been considered to be the main method^[1,2,3]。 Because of the high incidence of complications and impaired function after open surgery, some scholars suggest embolization, sclerotherapy injection and radiotherapy^[4,5,6]Conservative approach to treatment. However, the above methods are often not effective for adolescent patients with axial bone (spine, pelvis) or pathological fractures. Denosumab is a humanized monoclonal antibody against receptor activator for nuclear factor-κ B ligand (RANKL), which has been confirmed by clinical trials to effectively control the progression of giant cell tumor of bone^[7,8]。 Given the similarity of ABC histological features and signal transduction pathway with giant cell tumor of bone^[9]We administered Denosumab perioperatively to 6 patients with complex and refractory ABC as an individualized treatment regimen, and all 6 patients benefited from the treatment without denosumab-related complications.

Because of the deep location and hidden onset of sacral pelvic tumors, patients often have a large tumor volume and squeeze the pelvic organs when they have symptoms. It is difficult to surgically remove the tumor at this site, and the recurrence rate is high, which is as high as 75% reported in literature^[1,2,3]。 In recent years, with the development of surgical techniques, especially the improvement of intraoperative bleeding control techniques^[4]So that surgical resection can obtain a better surgical boundary, and the patient survival rate is significantly improved^[3,5]。 For giant naive or recurrent pelvisacral tumors, hemipelvic amputation or super-hemipelvic amputation is often required to obtain a satisfactory surgical boundary. However, when the tumor invades or involves the pelvic organs, simple pelvic amputation cannot obtain satisfactory surgical boundary. It is necessary to consider the use of super-hemipelvic amputation combined with total pelvic exenteration (TPE) in order to obtain R0 resection and achieve satisfactory local control effect. However, this type of surgery is complicated and requires the coordination of relevant professional doctors. The surgery is traumatic, so it is necessary to strictly grasp the indications and select suitable cases. In order to explore the effective surgical treatment of giant pelvisacral tumors and to understand the safety and therapeutic efficacy of hyperhemipelvic amputation (combined with TPE if necessary), we retrospectively analyzed the clinical data of 6 patients who underwent this procedure in our center and are reported below.