Adequate margins are technically difficult to achieve for malignant tumors involving the sacroiliac joint due to limited accessibility and viewing window. In order to address the technical difficulties faced in iliosacral tumor resection, we proposed a technique for precise osteotomy, which involved the use of canulated screws and Gigli saw (CSGS) that facilitated directional control, anteroposterior linkage of resection points and adequate surgical margins. The purpose of the current study was to evaluate whether CSGS technique facilitated sagittal osteotomy at sacral side, and were adequate surgical margins achieved? Also functional and oncological outcomes was determined along with the noteworthy complications. From April 2018 to November 2019, we retrospectively reviewed 15 patients who underwent resections for primary tumors of pelvis or sacrum necessitating iliosacral joint removal using the proposed CSGS technique. Chondrosarcoma was the most common diagnosis. The osteotomy site within sacrum was at ipsilateral ventral sacral foramina in 8 cases, midline of sacrum in 5 cases, and contralateral ventral sacral foramina and sacral ala with 1 case each. The average intraoperative blood loss was 3640 mL (range, 1200 and 6000 mL) with a mean operation duration of 7.4 hours (range, 5 to 12 hours). The mean follow-up was 23.0 months (range, 18 and 39 months) for alive patients. Surgical margins were wide in 12 patients (80%), wide-contaminated in 1 patient (6.7%), and marginal in 2 patients (13.3%). R0 resection was achieved in 12 (80%) patients and R1 resection in 3 patients. There were three local recurrences (20%) occurred at a mean time of 11 months postoperatively. No local recurrence was observed at sacral osteotomy. The overall one-year and three-year survival rate was 86.7% and 72.7% respectively.Complications occurred in three patients. The current study demonstrated that CSGS technique for tumor resection within the sacrum and pelvis was feasible and can achieve ideal resection accuracies. The use of CSGS was associated with high likelihood of negative margin resections in the current series. Intraoperative use of CSGS appeared to be technically straightforward and allowed achievement of planned surgical margins. It is worthwhile to consider the use of CSGS technique in resection of pelvic tumors with sacral invasion and iliosacral tumors, however further follow-up at mid to long-term is warranted to observe local recurrence rate.

中文翻译：

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使用空心螺钉引导的 Gigli 锯切除髂骶骨肿瘤 - 一种新的技术

由于可及性和观察窗有限，涉及骶髂关节的恶性肿瘤在技术上难以获得足够的边缘。为了解决髂骶部肿瘤切除术面临的技术难题，我们提出了一种精确截骨技术，该技术涉及使用空心螺钉和 Gigli 锯 (CSGS)，以促进方向控制、切除点的前后连接和足够的手术切缘。本研究的目的是评估 CSGS 技术是否有利于骶骨矢状截骨术，以及是否获得了足够的手术切缘？还确定了功能和肿瘤学结果以及值得注意的并发症。2018年4月至2019年11月，我们回顾性地审查了 15 名因骨盆或骶骨原发性肿瘤而需要使用建议的 CSGS 技术切除髂骶关节的患者。软骨肉瘤是最常见的诊断。骶骨内截骨部位在同侧骶骨腹侧8例，骶骨中线5例，对侧骶骨腹侧和骶翼各1例。平均术中失血量为 3640 mL（范围，1200 和 6000 mL），平均手术时间为 7.4 小时（范围，5 至 12 小时）。存活患者的平均随访时间为 23.0 个月（范围为 18 个月和 39 个月）。12 名患者 (80%) 的手术切缘宽，1 名患者 (6.7%) 的广泛污染，2 名患者 (13.3%) 边缘。12 名（80%）患者实现了 R0 切除，3 名患者实现了 R1 切除。术后平均 11 个月内发生了 3 次局部复发（20%）。骶骨截骨术未见局部复发。总的1年和3年生存率分别为86.7%和72.7%。3例患者出现并发症。目前的研究表明，CSGS技术在骶骨和骨盆内切除肿瘤是可行的，可以达到理想的切除精度。在当前系列中，CSGS 的使用与阴性切缘切除的高可能性相关。术中使用 CSGS 在技术上似乎很简单，可以实现计划的手术切缘。值得考虑使用CSGS技术切除伴骶部侵犯的盆腔肿瘤和髂骶部肿瘤，