寰枕、寰枢关节滑膜皱襞解剖观测及临床意义

目的：观察寰枕、寰枢关节中各关节有无滑膜皱襞存在，皱襞的形态、位置和组织学，探讨其临床意义。方法：对16例12岁以下小儿和8例成人防腐尸体的寰枕、寰枢关节中的各关节进行解剖观测。结果：无论成人或小儿，除了寰枢后正中关节外，其它关节均有滑膜皱襞存在，滑膜皱襞总出现率66．7％。寰枢前正中关节中皱襞位于上关节间隙，寰枕关节、寰枢外侧关节的皱襞主要分布于前外侧，多数皱襞呈月牙形。与成人相比，小儿组皱襞数量多，总出现率达72．34％(成人组仅58．3％)，小儿以大中型皱襞为主(58．35％)，成人以小型皱襞为主(62．5％)且无大皱襞。镜下观察儿童有三种不同的组织学类型，其中以脂肪型和纤维脂肪型为主(88．9％)。结论：推测在儿童寰枕、寰枢关节中有更多更大的滑膜皱襞，在受到外伤或炎症作用下，皱襞肿胀变大，位置改变，发生嵌顿，这很可能是小儿好发某些上颈椎疾病，如寰枢椎旋转畸形的解剖学基础。

Anatomical observation and clinical significance of synovial folds in occipitoatlantoaxial joints

Objective: This study was performed to determine the occurrence of synovial folds in the occipital-atlanto-axial joints and to explore the locations, gross morphology, histology and the function of the synovial folds. Methods: Occipital-atlanto-axial joints from sixteen embalmed cadavers of children and eight of adults were dissected and observed. Results: There were synovial folds in most joints in both adult and child group except the posterior atlantoaxial joints. The total occurrence rate is 66.7%. Most of synovial folds were crescent, distributed in the lateral occipitalatlantal joints and lateral atlantoaxial joints. Comparing with the adult group, the child group had a bigger occurrence rate: 72.34% (58.3% in adult only). 58.35% of the synovial folds in child were medium or large size, however 62.5% of the synovial folds in adult were small size and no large one was found. Under the microscope, there were three histologic types in child synovial folds and most of them belonged to adipose type or fibro-adipose type. Conclusions: It is suggested that there would be more and bigger synovial folds in the occipitalatlantal joints and atlantoaxial joints in childen than in adults. Under the effection of trauma or inflammation, synovial folds in children will be more easy to swell, displace or entrap. This may be the cause why some cervical spine diseases like to take place in children rather than in adults, such as atlantoaxial rotatory deformity.