Temple H T, Kuklo T R, Sweet D E, Gibbons C L, Murphey M D
Walter Reed Army Medical Center, Washington, DC, USA.
Am J Sports Med. 1998 Jul-Aug;26(4):544-8. doi: 10.1177/03635465980260041301.
Quadriceps muscle strains are common sporting injuries, but occasionally a tear of the rectus femoris muscle can appear as a soft tissue mass of the anterior thigh with or without a significant history of trauma. Between 1992 and 1996, seven patients were referred to the Orthopaedic Oncology Unit at Walter Reed Army Medical Center with an unexplained soft tissue mass of the thigh. Three were active duty soldiers, three were military dependents, and one was a retired serviceman. All patients were men, and the mean age was 32 years (range, 15 to 73). A palpable, mildly tender mass was confirmed on clinical examination. Laboratory studies and plain radiographs were normal. Magnetic resonance imaging showed an obvious, but often ill-defined, lesion at the musculotendinous junction of the rectus femoris muscle. Four patients subsequently underwent a tissue biopsy to rule out a soft tissue sarcoma. Histologic studies showed fibrosis, degeneration of muscle fibers, and chronic inflammatory cells with no evidence of malignancy. A chronic rectus femoris muscle tear can mimic a soft tissue tumor or sarcoma and needs to be excluded in the differential diagnosis. These tears may occur acutely or may represent an overuse injury caused by repeated microtrauma. Careful history taking, physical examination, and selective radiographic studies, specifically magnetic resonance imaging, can confirm the diagnosis of muscle tear and full functional recovery can be anticipated.
股四头肌拉伤是常见的运动损伤，但偶尔股直肌撕裂可表现为大腿前部的软组织肿块，有无明显外伤史均可出现。1992年至1996年期间，7例患者因不明原因的大腿软组织肿块被转诊至沃尔特里德陆军医疗中心的骨科肿瘤病房。其中3例是现役军人，3例是军属，1例是退役军人。所有患者均为男性，平均年龄32岁（范围15至73岁）。临床检查证实可触及轻度压痛肿块。实验室检查和X线平片均正常。磁共振成像显示股直肌肌腱结合处有明显但边界不清的病变。4例患者随后接受了组织活检以排除软组织肉瘤。组织学研究显示有纤维化、肌纤维变性和慢性炎症细胞，无恶性证据。股直肌慢性撕裂可类似软组织肿瘤或肉瘤，在鉴别诊断中需要排除。这些撕裂可能急性发生，也可能是反复微创伤导致的过度使用损伤。仔细询问病史、体格检查和选择性影像学检查，特别是磁共振成像，可确诊肌肉撕裂，预期可实现完全功能恢复。
