【文章內(nèi)容簡介】 rmanent teeth’s being affected boxlike appearance Progressing stage osseous change ＊ Chest (about 1yr) beading of the ribs (rachitic rosary佝僂病串珠 ) (Fig) Harrison groove (赫氏溝 ) (Fig) funnellike chest (漏斗胸 ) (Fig) pigeon breast deformity (雞胸 ) (Fig) rachitic rosary Harrison groove Funnellike chest L: pigeon breast Progressing stage osseous change ＊ Extremities *thickening of the wrists and ankles(Fig ) (Rachitic bracelets佝僂病手鐲、腳鐲 ) *bowlegs or knockknees(Fig) （ O型腿、 X型腿） R. thickening of the wrists L. thickening of the ankles Thickening of the wrist Thickening of the ankles R. bowlegs L. knockknees Progressing stage osseous change ＊ others spinal column (kyphosis脊柱后突， s scoliosis脊柱側(cè)彎 ) conitant deformity of the pelvis, ec flat pelvis kyphosis amp。 scoliosis Progressing stage muscle and ligament ? poorly developed and lack tone (late in sitting, standing and walking) ? overextension of the great joint Clinical manifestations summarized as following table Histological osteomalacia osteoid Pathology （骨質(zhì)軟化） deposition Head Craniotabes Caput quadratum chest Harrison groove,funnel Rachitic like chest,Pigeon breast rosary Spinal Kyphosis, Scoliosis column pelvis Flat pelvis extremities Bowlegs, Knockknees Rachitic bracelets Progressing stage Biochemical changes serum Ca↓, P↓, serum ALP (Alkaline phosphatase)↑↑ serum 25(OH)D↓ 1,25(OH)2D3↓ urine cyclic AMP↑ Progressing stage Roentgenographic examination (Fig) ＊ rachitic metaphysis (deposition of nonrigid tissue) * at the end of the shaft (widdened, cupping, fraying) ** ZPC bees unclear even disappear ＊ rarefied cortical bone (↓density ) Normal X rays Rachitic metaphysis Upper limp Normal X rays Rachitic metaphysis Lower limp Convalescent stage (after adequate antirachitic treatment) ＊ Clinical manifestation improved soon regain muscle tone, mentally improved several days serum Ca, P ↑ →N 46w ALP ↓→ N ＊ roentgenographicly improved 23w ZPC reappears, bone density↑ 4w ZPC, rachitic metaphysis and shafts bees united Sequelae stage 2 yr Severe rachitic child leave osseous deformities — bowleg or knockknee, pigeon chest, funnellike chest, kyphosis, scoliosis, head deformity, etc. Biochemical change and Roentgenographic examination normal Sequelae stage amp。 Rickets of Vitamin D Deficiency Introduction Physiological function and regulation of VitD Etiology Pathology Pathogenesis Clinical manifestations Diagnosis Differential diagnosis Prevention Treatment amp。 Tetany of VitD Deficiency based on ? a history of inadequate gain of VitD ? Clinical observation ? Confirmed by biochemical test 25－ (OH)D↓(11~60μg/ml) serum Ca↓, P↓, serum AKP ↑↑ (500μ/L) roentgenograghic examination Diagnosis amp。 Rickets of Vitamin D Deficiency Introduction Physiological function and regulation of VitD Etiology Pathology Pathogenesis Clinical manifestations Diagnosis Differential di