目的 通过总结韧带样型纤维瘤病（DF）的超声图像表现和病理学结构，以提高对DF的认识和诊断水平。 方法 回顾性分析2005年1月－2011年12月70例经手术和病理组织学证实为DF患者的超声图像和病理组织学结果。 结果 DF肿块的超声表现与病理结构密切相关。70例DF中腹部外型41例（58.6%）、腹壁型18例（25.7%）、腹内型11例（15.7%）。DF的典型超声图像表现为沿肌纤维浸润性生长的低回声肿块,累及多块肌肉；肿块无包膜,多数形态不规则、边界不清；其中8例包绕和侵犯相邻骨质, 12例肿瘤压迫或侵犯邻近血管、神经、肠管等组织；40例瘤体内探及Ⅰ级血流信号，4例探及Ⅲ级血流信号；所有病变均未见坏死出血和囊变，病变周围无淋巴结肿大。 结论 DF的声像图表现有较强的特征性，超声能较为准确判断肿块累及范围、是否侵犯相邻骨质、与毗邻血管、神经的关系，有助于制定手术计划。
ObjectiveTo evaluate the long-term effectiveness of patients received surgical treatment under the guidance of “West China Classification” of desmoid-type fibromatosis (DTF) in the shoulder girdle.MethodsThe clinical data of 32 patients with DTF in the shoulder girdle admitted between June 2003 and December 2016 were retrospectively analyzed, including 14 males and 18 females, aged 14-56 years with an average age of 36.8 years. The maximum diameter of the tumor was 7-19 cm, with an average of 11.1 cm. According to the “West China Classification” of DTF in the shoulder girdle, there were 4 cases of region Ⅰ, 3 cases of region Ⅱ, 6 cases of region Ⅲ, 3 cases of region Ⅳ, 5 cases of regions Ⅰ+Ⅱ, 5 cases of regions Ⅱ+Ⅲ, and 6 cases of regions Ⅰ+Ⅱ+Ⅲ. In addition, the involvement of blood vessels and nerves was also taken into consideration for choosing a surgical approach. Finally, 12 cases were operated via anteroposterior approach (group A), 14 via posterior approach (group B), and 6 via combined anterior-posterior approach (group C). The 1993 Musculoskeletal Tumor Society (MSTS93) score (including pain, limb function, satisfaction, hand position, hand flexibility, and lifting ability), Japanese Orthopedic Association (JOA) score, range of motion (ROM) of shoulder joint (including flexion, extension, abduction, and adduction), and complications of patients in the 3 groups were recorded and compared.ResultsAll the 32 patients were followed up 30-190 months, with an average of 94.6 months. At last follow-up, complications occurred in 5 cases (15.6%), including 2 cases (16.6%) in group A, 2 (14.3%) in group B, and 1 (16.6%) in group C. There was no significant difference in the incidence of complications among the 3 groups (P=1.000). Tumor recurrence occurred in 5 (15.6%) cases, including 1 (8.3%) case in group A, 2 (14.3%) in group B, and 1 (16.6%) in group C. No significant difference was found in the recurrence rate among the 3 groups (P=1.000). At last follow-up, MSTS93 score of pain, limb function, satisfaction, hand flexibility, and hand position in groups A and B were significantly better than those in group C (P<0.05), even though no significant difference existed between group A and group B (P>0.05). The lifting ability score in group C was significantly lower than in group A (P<0.05), and no significant difference was found between other groups (P>0.05). The JOA score and flexion, extension, abduction, and adduction activities of shoulder in groups A and B were significantly better than those in group C (P<0.05). The extension activity in group A was significantly better than that in group B (P<0.05), the flexion activity in group B was significantly better than that in group A (P<0.05). There was no significant difference in other indexes between groups A and B (P>0.05).ConclusionTaking a rational approach to fully expose and completely remove the tumor is the key point of surgical treatment for patients with DTF in the shoulder girdle. At the same time, preservation of vital structures and reconstruction of soft tissues should also be taken into consideration. Overall, surgical treatment under the guidance of “West China Classification” of DTF in the shoulder girdle has achieved satisfactory long-term effectiveness.