Dürr H R, Klein A
Schwerpunkt Tumororthopädie, Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
Orthopade. 2017 Jun;46(6):498-504. doi: 10.1007/s00132-017-3427-1.
Intraarticular benign tumors are rare lesions in many cases seen as incidental findings. One of the typical lesions is the diffuse or nodular form of pigmented villonodular synovitis, which needs a complete surgical removal. Magnetic Resonance Imaging (MRI) is diagnostic in most of the cases because of the intracellular iron content which shows an at least in some parts dark T2-sequence. Adjuvant therapies as radiosynoviorthesis should be considered in diffuse or recurrent lesions. Synovial Chondromatosis represents a metaplastic disorder of the synovial membrane resulting in the production of loose cartilage bodies. Also in this dissease synovectomy or, in late cases, removal of the loose bodies only, is recommended. Synovial hemangiomas are hamartomas which may lead to pain or restriction of movement. In these cases total or partial resection is justified. Alternative treatment options such as laserablation may be possible. Lipoma arborescens represents a proliferative lipoid lesion of the subsynovial region leading to villonodular synovial proliferation. If clinically symptomatic, resection by arthroscopic or open synovectomy is recommented.
关节内良性肿瘤在很多情况下是罕见病变，多为偶然发现。典型病变之一是色素沉着绒毛结节性滑膜炎的弥漫性或结节性形式，需要完整手术切除。磁共振成像（MRI）在大多数病例中具有诊断价值，因为细胞内铁含量在至少部分区域表现为T2序列低信号。对于弥漫性或复发性病变，应考虑放射性滑膜切除等辅助治疗。滑膜软骨瘤病是滑膜的一种化生紊乱，导致产生游离软骨体。对于这种疾病，同样建议进行滑膜切除术，或在晚期仅切除游离体。滑膜血管瘤是错构瘤，可能导致疼痛或活动受限。在这些情况下，进行全部或部分切除是合理的。也可能有激光消融等替代治疗选择。树状脂肪瘤是滑膜下区域的一种增殖性类脂病变，导致绒毛结节性滑膜增生。如果有临床症状，建议通过关节镜或开放性滑膜切除术进行切除。
