Parratt M T R, Donaldson J R, Flanagan A M, Saifuddin A, Pollock R C, Skinner J A, Cannon S R, Briggs T W R
The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
J Bone Joint Surg Br. 2010 Feb;92(2):262-6. doi: 10.1302/0301-620X.92B2.22927.
Elastofibroma dorsi is an uncommon, benign, slow-growing soft-tissue tumour of uncertain aetiology. It classically presents as an ill-defined mass at the inferior pole of the scapula with symptoms which include swelling, discomfort, snapping, stiffness and occasionally pain. We report the symptoms, function and outcome after treatment of 21 elastofibromas in 15 patients. All were diagnosed by MRI and early in the series four also underwent CT-guided biopsy to confirm the diagnosis. In all, 18 tumours were excised and three were observed. After excision, the mean visual analogue score for pain decreased from 4.6 (0 to 10) pre-operatively to 2.4 (0 to 8) post-operatively (p = 0.04). The mean shoulder function, at a mean follow-up of 4.2 years (3 months to 16 years), was 78.1% (30 to 100) using the Stanmore percentage of normal shoulder assessment scoring system. The mean range of forward flexion improved from 135 degrees (70 degrees to 180 degrees ) to 166 degrees (100 degrees to 180 degrees ) after excision (p = 0.005). In four patients a post-operative haematoma formed; one required evacuation. Three patients developed a post-operative seroma requiring needle aspiration and one developed a superficial infection which was treated with antibiotics. Our findings support previous reports suggesting that a pre-operative tissue diagnosis is not necessary in most cases since the lesion can be confidently diagnosed by MRI, when interpreted in the light of appropriate clinical findings. Surgical excision in symptomatic patients, is helpful. It has been suggested that elastofibroma is caused by a local tissue reaction and is not a true neoplastic process. A strong association has been noted between elastofibroma and repetitive use of the shoulder, which is supported by our findings.
背侧弹力纤维瘤是一种病因不明的罕见良性软组织肿瘤，生长缓慢。其典型表现为肩胛骨下角处边界不清的肿块，症状包括肿胀、不适、弹响、僵硬，偶尔还有疼痛。我们报告了15例患者21个弹力纤维瘤的治疗后症状、功能及结果。所有病例均经磁共振成像（MRI）诊断，系列病例早期有4例还接受了CT引导下活检以确诊。总共切除了18个肿瘤，3个进行了观察。切除术后，疼痛的视觉模拟评分平均从术前的4.6（0至10）降至术后的2.4（0至8）（p = 0.04）。采用斯坦莫尔正常肩部评估评分系统，在平均随访4.2年（3个月至16年）时，肩部功能平均为78.1%（30至100）。切除术后前屈平均活动范围从135度（70度至180度）改善至166度（100度至180度）（p = 0.005）。4例患者术后形成血肿，1例需要引流。3例患者出现术后血清肿需要穿刺抽吸，1例发生浅表感染，用抗生素治疗。我们的研究结果支持先前的报告，表明在大多数情况下术前组织诊断并非必要，因为结合适当的临床发现进行MRI解读时，可明确诊断该病变。对有症状的患者进行手术切除是有益的。有人提出弹力纤维瘤是由局部组织反应引起的，并非真正的肿瘤性病变。弹力纤维瘤与肩部反复使用之间存在密切关联，我们的研究结果支持这一点。
