Beaded rib



Rickets is a chronic nutritional deficiency that is more common in children. It is commonly known as rickets, and occurs mostly in infants under 2 years of age. If not treated in time, skeletal symptoms gradually develop. For children aged 4-6 months, the skull grows fast, and the skull is softened due to less calcium deposition. When pressed by hand, it feels like pressing on table tennis. After 8-9 months, the head can be square or saddle-shaped deformed, the suture is widened, the bone edge is soft, and the cardia is large, and it is still not closed until 18 months. Teething is late and the order is irregular. There are successive "beaded ribs" (ie, at the junction of the ribs and costal cartilage, such as beads) and "chicken bracelets", which can also be accompanied by ribs of the lower edge of the ribs, and the bones of the wrists and ankles are swollen, shaped like hands and ankle bracelets. After the walk, "X" and "O" legs can appear. In addition, the child's abdomen is enlarged, the hair is sparse and dry, and the movement and mental development are slow.



The disease is caused by vitamin D deficiency, vitamin D has both endogenous and exogenous. Endogenous is the use of ultraviolet light in the sun to illuminate the skin, and then synthesized in the body; exogenous foods, such as fish, liver, eggs, milk, etc. contain vitamin D3, after the ergosterol in the plant is exposed to ultraviolet light, Form vitamin D2. They can promote the absorption of calcium and phosphorus in the small intestine mucosa, reduce the excretion of calcium and phosphorus from the urine, and promote the maturation of the bone-like tissue, so that the calcium and phosphorus in the blood sink to the bone growth site to form new bone.

The cause of rickets is insufficient sun exposure, especially in winter and spring, and because of the cold outdoor activities in winter, it is prone to rickets; another reason is improper feeding of children, less calcium or phosphorus in food, or improper proportion It also affects the absorption of calcium and phosphorus. In addition, when feeding with cereals alone. Because it contains a lot of phytic acid, it is easy to combine with calcium and phosphorus in the small intestine to become insoluble calcium phytate, which affects the absorption of calcium and phosphorus. In addition, excessive growth, premature birth, twins are also prone to rickets; chronic diarrhea, hepatobiliary diseases, chronic kidney disease affect the absorption and metabolism of vitamin D; long-term use of phenytoin, luminal and other drugs can accelerate the decomposition of vitamin D and Metabolism can cause rickets.


an examination

1. There are nightingale, sweating, irritability and loss of appetite in the early stage of the disease. Pillow baldness occurs due to shaking the head.

2, active signs can be seen in the softening of the skull (ping-pong head), square skull, anterior hysteresis late, delayed teeth, rib beading, rib valgus, rib groove, chicken breast, funnel chest, bracelet, bracelet winding, "O" shape Legs, "X" shaped legs, posterior or lateral curvature of the spine.

3, blood calcium is normal or slightly lower; blood phosphorus is reduced, often less than 1.29mmol / L. The calcium-phosphorus product is less than 30 and serum alkaline phosphatase is increased. The X-ray wrist film showed that the lower end of the ulna and ulna was widened, such as the cup mouth, and the calcification line was not uniform, and it was brush-like.


Differential diagnosis

Differential diagnosis of beaded ribs:

1, pleural effusion: pulmonary hydrops is usually called "pleural effusion", water is deposited outside the lungs, it can be caused by infection and inflammation (such as: pneumonia, tuberculosis, etc. can be combined with pleural effusion), also It can be caused by some autoimmune diseases (such as lupus erythematosus), and many lung diseases can be combined with pleural effusion.

2, ridge sulcus bulging: diagnosis of retroperitoneal abscess, physical examination found perirenal abscess, ridge bulge bulging tenderness, lumbar muscle spasm, lumbar skin with depression edema. Retroperitoneal abscess refers to a localized purulent infection that occurs in the retroperitoneal space. It occurs often in the abdominal organs, retroperitoneal organs, spinal or twelfth rib infection, pelvic retroperitoneal abscess, and bacteremia. Abscess can invade and mediastinum, flow down the femoral canal into the thigh, or penetrate into the abdominal cavity, gastrointestinal tract, pleura, bronchus, and even form a chronic persistent fistula. Retroperitoneal abscess is clinically far less common than abdominal abscess. If it cannot be diagnosed and treated effectively, it can often induce multiple organ dysfunction syndrome (MODS) and cause death.