title: Iliosacral resections of pelvic malignant tumors and reconstruction with nonvascular bilateral fibular autografts.
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.affiliation: Muskulaskeletal Oncology Department, First Affiliated Hospital of Zhongshan University, Guangzhou, Guangdong, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.forename: Qinglian
authors.initials: Q
authors.lastname: Tang
authors.forename: Xianbiao
authors.initials: X
authors.lastname: Xie
authors.forename: Junqiang
authors.initials: J
authors.lastname: Yin
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Zhao
authors.forename: Zhibin
authors.initials: Z
authors.lastname: Li
authors.forename: Changye
authors.initials: C
authors.lastname: Zou
authors.forename: Gang
authors.initials: G
authors.lastname: Huang
authors.forename: Jingnan
authors.initials: J
authors.lastname: Shen
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000601:surgery*; D005260:Female; D005360:Fibula / Q000601:surgery / Q000637:transplantation*; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000601:surgery; D010384:Pelvic Bones / Q000601:surgery*; D010386:Pelvic Neoplasms / Q000601:surgery*; D011379:Prognosis; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery*; D015996:Survival Rate; D014182:Transplantation, Autologous; D055815:Young Adult