Vertebral hemangiomas are typically asymptomatic; however, they can also be a source of severe axial back pain. In this report, the authors describe the case of an unusually large sacral hemangioma that was effectively treated with staged cement augmentation. A 57-year-old man presented with chronic mid-sacral pain that was episodically severe. Magnetic resonance imaging revealed a massive lytic defect involving a majority of the body of S1 with features consistent with a hemangioma. It was theorized that the patient's pain could be attributed to the compromised structural integrity of the proximal sacrum with associated microfractures. Extensive conservative treatment failed to ameliorate the pain. A cement augmentation procedure was therefore recommended to stabilize the proximal sacrum. Due to concern about the potential for cement embolic complications, a staged bilateral approach was chosen. In the first procedure, 12 mL of bone cement was injected into the right proximal sacrum. The pain was partially improved by this injection. A 2-month interval was observed before the second cement injection in order to give time for pulmonary recovery from any potential microscopic emboli. In the second stage, 8 mL of bone cement was injected into the left proximal sacrum with excellent pain relief. There were no complications from either injection. At the 5-year follow-up, the patient reported no recurrence of mid-sacral pain. To the authors' knowledge, this is the first case reporting the effective treatment of a sacral hemangioma with staged cement injections. [Orthopedics. 20XX;XX(X):xx–xx.]

椎体血管瘤通常无症状；然而，它们也可能是严重的轴性背痛的根源。在这份报告中，作者描述了一个异常大的骶骨血管瘤的病例，该病例通过分阶段骨水泥强化得到有效治疗。一名 57 岁男性因慢性骶中段疼痛就诊，且发作性严重。磁共振成像显示 S1 主体存在大量溶解性缺损，其特征与血管瘤一致。据推测，患者的疼痛可能是由于近端骶骨的结构完整性受损以及相关的微骨折所致。广泛的保守治疗未能减轻疼痛。因此，建议采用骨水泥增强手术来稳定近端骶骨。由于担心水泥栓塞并发症的可能性，选择了分阶段的双侧方法。在第一个手术中，将 12 mL 骨水泥注入右侧近端骶骨。通过这次注射，疼痛得到了部分改善。在第二次注射水泥之前观察了 2 个月的间隔，以便为肺部从任何潜在的微小栓塞中恢复提供时间。第二阶段，将8mL骨水泥注入左侧近端骶骨，疼痛缓解效果良好。两种注射均未出现并发症。在 5 年随访中，患者报告骶中部疼痛没有复发。据作者所知，这是第一例报告采用分阶段骨水泥注射有效治疗骶骨血管瘤的病例。[骨科。20XX;XX(X):xx–xx。]