| BackgroundSacral tumors are relatively rare in bone and soft-tissue tumors,including primary sacral tumors and secondary sacral tumors.Compared with the latter,primary sacral tumors are treated by surgical methods more frequently.Primary sacral tumors are often insidious,and some patients have large tumors at first visit.The disease not only seriously affects the quality of patients'daily life,but can even threaten the life safety of patients.Therefore,once the diagnosis is made,timely and standard treatment should be adopted as soon as possible to prevent and reverse the course of the disease.The sacrum has a special location and complex structure,adjacent to the pelvic organs,and closely related to the sacral nerves,so the operation is difficult and the operation methods are also diverse.The advancement of medical technology has promoted the continuous development of the treatment of primary sacral tumors.We are paying more and more attention to individualized surgical treatment plans in the clinic.An individualized surgical method need to strike a balance between the thoroughness of tumor resection,the preservation of sacral nerves,the amount of intraoperative blood loss and the local stability after reconstruction,which in turn will affect the occurrence of postoperative complications,the mental status and life quality of patients,disease recurrence rate and survival rate,etc.From the spiritualism medical model of primitive society,to the natural philosophy medical model of ancient Greece,to the modern biomedical model,human cognition of medicine has been in the process of development.In the 1970s,the American doctor Engel publicly criticized the limitations of the biomedical model and proposed the concept of "biological-psycho-social medical model".In this model,human beings are understood as the unity of the three attributes of biology,psychology and society Human health and disease are not just simple biological processes.For neoplastic diseases,physical and psychological health are equally important.Especially for postoperative patients with sacral tumors,they often face various troubles from the disease itself and dysfunction of sacral nerves,and sometimes serious negative life events occur.At present,clinicians pay more attention to the physical state of patients,and pay less attention to the deep feelings and spiritual needs of patients."To cure sometimes,to relieve often,to comfort always." As a clinician in the new era,one must not be afraid to face the danger of the disease,but also pay attention to the fragility of the patient's heart.We hope that through this study,we can understand the main related factors of postoperative neurological status and mental health in patients with primary sacral tumors,so as to provide references for future clinical workObjectiveTo retrospectively analyse and discuss the main factors affecting the postoperative neurological function and mental health in patients with primary sacral tumors.MethodsThe cases were from patients with primary sacral tumors who were admitted to the Department of Orthopedics,Qilu Hospital of Shandong University(January 2015-December 2019).All cases were confirmed by pathological examination.All those with the history of mental illness were excluded from this study.Collected clinical data,including:basic information(age,gender),main symptoms and signs before surgery,past medical history,pathological examination results(preoperative biopsy/postoperative routine pathological examination),operation time,intraoperative blood loss,operative methods,preservation levels of sacral nerves,postoperative complications,etc.At the last follow-up,the neurological function and mental health of patients were evaluated.Adopted the sacral nerve function scoring system for patients with sacral tumors proposed by People's Hospital of Peking University to evaluate the neurological function.Adopted the self-rating anxiety scale(SAS)and self-rating depression scale(SDS)compiled by Zung to evaluate the mental status.Made a statistical overview of the disease composition,age and gender characteristics,clinical characteristics,surgical methods and other aspects of patients with primary sacral tumors.The sacral nerve function scores of patients with different sacral nerve root retention were compared statistically.The SAS and SDS scores were used as dependent variables to adopt univariate and multivariate linear regression analysis for possible factors such as patient's age,gender,pathological type of tumor,operation time,intraoperative blood loss,operative methods,sacral nerve preservation,postoperative infection and follow-up duration.Obtained the_correlative factors affecting the postoperative anxiety and depression in patients with primary sacral tumors.Result1.53 patients were included in this study,including 29 males and 24 females,aged 14-77 years.The preoperative sacral nerve function scores were 18-27 points(23.81 ±2.193 points),the follow-up time was 8-66 months(31.83±19.17 months).There were 19 cases of chordoma,12 cases of giant cell tumor of bone,14 cases of neurogenic tumor,2 cases of chondrosarcoma,1 case of osteosarcoma,1 case of PNET/Ewing's sarcoma,3 cases of teratoma,and 1 case of osteochondroma.35 patients complained of sacrococcygeal pain before surgery,20 patients had symptoms of sciatica,17 patients had varying degrees of urinary and fecal dysfunction,and 4 patients had no symptoms.19 patients underwent simple posterior tumor resection,21 patients underwent posterior tumor resection and internal fixation,9 patients underwent posterior tumor resection and sacral prosthesis reconstruction,1 patient underwent posterior tumor resection and titanium mesh reconstruction,3 patients underwent simple anterior or combined anterior and posterior tumor resection.The operation time was 1.5-13h(5.71±3.014h),the intraoperative blood losses were 100-13000ml and the average intraoperative blood loss was 2177.36ml.There were 12 cases of poor surgical wound healing,infection and debridement after operation,2 of them had long-term sinus and exudate in the sacrococcygeal region.2.The average sacral nerve function score at the last follow-up of 53 patients in this study was 19.74 points,the highest score was 27 points and the lowest score was 3 points.Took the sacral nerve root retention levels and the sacral nerve function score segments as rows and columns to make a cross table,then used the Fisher's exact test to test the significance of the difference and got p=0.000.According to the table,the sacral nerve function scores of patients with all preserved sacral nerve roots were close to the normal level,the scores of patients with severed S4-S5 nerve roots were slightly reduced,the scores of patients with severed unilateral or bilateral S3 nerve roots were severely reduced,the scores of patients with severed bilateral S2 nerve roots and all severed sacral nerve roots were extremely low3.The average SDS standard score of 53 patients with primary sacral tumors in this study was 44.96±7.14 points,and the average SAS standard score was 40.62±7.30 points.Compared with the domestic norms,p=0.00(p<0.01).It showed that the postoperative depression and anxiety scores of patients with primary sacral tumors have significant statistical differences compared with the normal population.The results of univariate analysis showed that the significant_correlated factors associated with postoperative depression and anxiety included the following:age,sacral nerve root retention level,operation time,intraoperative blood loss,postoperative infection,whether the pathological type is chordoma,and whether the operation is sacral prosthesis reconstruction(p<0.05).Higher retention level of sacral nerve root,older age and more intraoperative blood loss were statistically significant in the multivariable model(p<0.01).Conclusions1.Primary sacral tumors are rare and have a variety of pathological types,the clinical symptoms are not the same,the surgical methods are diverse,the standard of diagnosis and treatment should be continuously normalized,and individualized treatment should be emphasized.2.There are significant differences in sacral nerve function scores between patients with different retention levels of sacral nerve root.In general,the higher the level of sacral nerve root retention,the worse the postoperative neurological function.The retention of the S3 nerve root has a more important impact on the postoperative neurological function.Clinicians need to take into account the safe surgical margin and the retention of important sacral nerve roots when making surgical plans3.Patients with primary sacral tumors are prone to psychological disorders such as depression and anxiety after surgery.The retention level of sacral nerve root,age and intraoperative blood loss are the main correlative factors that affect the postoperative depression and anxiety of patients.In clinical work,more attention should be paid to the mental health of patients with primary sacral tumors and timely intervention measures should be taken. |
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