Department of Surgical Sciences, "Sapienza" University, Viale Regina Elena 324, Rome 00185, Italy.
World J Surg Oncol. 2013 Sep 17;11:233. doi: 10.1186/1477-7819-11-233.
Synovial osteochondromatosis is a benign metaplastic proliferative disorder of the synovium characterised by the formation of multiple cartilaginous nodules in the synovium, many of which detach and become loose bodies. The disease is characteristically monoarticular, most commonly involving the knee. A site in the elbow was first reported in 1918 by Henderson, but any joint may be involved. Very few cases of synovial osteochondromatosis of the elbow have been reported in the literature. The presenting symptoms are usually diffuse discomfort in the affected joint and decreased range of motion with an accompanying gritty or locking sensation. The treatment of choice is excision of the synovium and removal of the loose bodies.
We report a rare neglected case covering a 32-year period of a locally aggressive synovial osteochondromatosis of the elbow in a 47-year-old man. Clinical examination revealed a significant increase in size of the left elbow compared to the contralateral one. The simple radiographs and the computed tomography showed multiple rounded, calcified bodies widespread throughout the elbow joint. At surgery we removed and counted a total of 312 loose bodies, varying in size from a few millimeters to 3 cm. The evaluation at 6 months postoperatively showed marked reduction in the volume of the elbow, improvement of extension and flexion and an increase of the Mayo elbow performance score from 50 points before surgery to 80 points at 6 months postoperative.
Synovial osteochondromatosis is an uncommon condition characterized by the formation of multiple nodules of hyaline cartilage within the sub-synovial connective tissue. The differential diagnosis includes chronic articular infection, osteoarthritis, pigmented villonodular synovitis, mono-articular inflammatory arthritis and periarticular neoplasms like synovial sarcoma. The treatment of choice is excision of the synovium and removal of the loose bodies. The prognosis is good, but recurrences may occur if the removal is incomplete.
滑膜骨软骨瘤病是一种良性的滑膜化生性增生性疾病，其特征为滑膜内形成多个软骨性小结节，其中许多小结节会脱落并成为游离体。该疾病通常为单关节病变，最常累及膝关节。1918 年，Henderson 首次报道了肘关节部位的病变，但任何关节都可能受累。文献中仅报道了少数几例肘关节滑膜骨软骨瘤病。其主要表现为受累关节弥漫性不适，活动范围减小，伴有沙沙声或锁定感。治疗方法是切除滑膜和游离体。
我们报告了一例罕见的、被忽视了 32 年的肘关节局部侵袭性滑膜骨软骨瘤病。患者为 47 岁男性，左侧肘部明显大于右侧。临床检查发现。简单的 X 线和 CT 显示，肘部关节内广泛分布着多个圆形、钙化的游离体。手术中我们共切除并计数了 312 个游离体，大小从几毫米到 3 厘米不等。术后 6 个月评估显示，肘部体积明显缩小，屈伸度改善，Mayo 肘关节功能评分从术前的 50 分提高到术后 6 个月的 80 分。
滑膜骨软骨瘤病是一种罕见的疾病，其特征为在滑膜下结缔组织内形成多个透明软骨小结节。鉴别诊断包括慢性关节感染、骨关节炎、色素绒毛结节性滑膜炎、单关节炎炎症性关节炎和关节周围肿瘤，如滑膜肉瘤。治疗方法是切除滑膜和游离体。如果切除不完全，可能会复发，但预后良好。
