Mayerson Joel L, Scharschmidt Thomas J, Lewis Valerae O, Morris Carol D
J Am Acad Orthop Surg. 2014 Nov;22(11):742-50. doi: 10.5435/JAAOS-22-11-742.
Soft-tissue masses of the extremities are common entities encountered by nearly all providers of musculoskeletal patient care. Proper management of these lesions requires a specific process of evaluation. A detailed history and physical examination must be performed. Appropriate imaging studies must be obtained based on clinical indications. MRI is the imaging modality of choice for diagnosis of soft-tissue masses, with CT and ultrasonography used as secondary options. These modalities aid the clinician in developing an appropriate differential diagnosis and treatment plan. When the initial evaluation is inconclusive, biopsy must be performed. A diagnosis must be established before definitive treatment with surgical excision or, in rare cases, radiation therapy is performed. Clinicians without significant experience in treating soft-tissue masses should consider referral to a musculoskeletal oncologist for specialized care when a definitive diagnosis of a benign lesion cannot be made. Several studies have shown that multidisciplinary care in specialized referral centers optimizes outcomes and diminishes comorbid complications.
肢体软组织肿块是几乎所有肌肉骨骼疾病患者护理人员都会遇到的常见病症。对这些病变进行恰当管理需要特定的评估流程。必须进行详细的病史询问和体格检查。应根据临床指征进行适当的影像学检查。MRI是诊断软组织肿块的首选影像学检查方法，CT和超声检查作为次要选择。这些检查方法有助于临床医生制定合适的鉴别诊断和治疗方案。当初始评估结果不明确时，必须进行活检。在进行手术切除或在极少数情况下进行放射治疗等确定性治疗之前，必须先明确诊断。对于无法明确诊断为良性病变且在治疗软组织肿块方面经验不足的临床医生，在无法做出明确诊断时，应考虑将患者转诊至肌肉骨骼肿瘤专科医生处接受专科护理。多项研究表明，在专科转诊中心进行多学科护理可优化治疗效果并减少合并症。
