肘関節滑膜ヒダの解剖学的検討―関節症性変化との関連

An Anatomic Study of the Synovial Folds in the Elbow Joint. Relationship to Osteoarthritic Change

　解剖学実習用遺体42体84肘を用いて，肘関節内滑膜ヒダの局在と性状を観察し，関節症性変化や臨床症状の発現に関与する病的な滑膜ヒダの特徴を明らかにした．肘関節内滑膜ヒダは，腕橈関節ヒダ，後方ヒダ，内側ヒダの3部位に分類した．腕橈関節ヒダは前方部，外側部，後方部の3部位に，後方ヒダは外側部，後外側部，後方部，後内側部の4部位に細分した．滑膜ヒダの肉眼的，組織学的評価とともに，滑膜ヒダと関節症性変化の関連について検討した．腕橈関節ヒダは，前方部と後方部は全例に，外側部は43肘(51％)に存在した．後方ヒダは，各部位とも全例に存在した．後方部は，27肘(32％)が後外側ヒダや後内側ヒダと連続する形状を呈していた．内側ヒダも全例に存在した．腕橈関節ヒダと腕橈関節の関節症性変化との間に，後方ヒダと腕尺関節の関節症性変化との間に有意な相関が認められた．全例において各部位に滑膜ヒダが確認されたことから，滑膜ヒダは先天性に存在する正常組織である可能性が示唆された．また，滑膜ヒダの性状と関節症性変化に相関が認められたことから，滑膜ヒダの性状の変化と関節症性変化が，滑膜ヒダ由来の症状発現に関与している可能性が示唆された．

　This is a report of the results of a study of the anatomy of the synovial folds in the elbow joint and an assessment of their clinical significance.　The 84 elbow joints of 42 cadavers were examined for morphological changes and the features, size, and fibrillations of the radiohumeral, posterior, and medial synovial folds were investigated.　The relationship between morphological changes in the synovial folds and osteoarthritic changes in the elbow joint were also investigated.　Synovial folds were observed in all of the specimens, however, the lateral portion of the radiohumeral fold was observed in only 51% of the elbow joints.　A significant relationship was observed not only between the degenerateve change in the radiohumeral synovial folds and arithritic change in the radiohumeral joint, but between the degenerative change in the posterior folds and arthritic change in the ulnohumeral joint.　This study revealed the presence of posterior and medial synovial folds as wellas radiohumeral synovial folds in the normal elbow joint and that degenerative change in these folds is corelated with the development of osteoarthritis.