Pediatric bowed legs syndrome

Introduction to Children's Bow Leg Syndrome Skeletal leg syndrome is humeral deformity - osteochondrosis, also known as Blount-Barber syndrome, Blount's sacral syndrome, Blount's disease, Erlacher-Blount's syndrome, aseptic necrosis of the humerus, humeral varus - tibia deformity Cartilage, medial or lateral osteochondrosis, non-sick arched legs (Bowlegswithoutrickets), varus syndrome and so on. The medial epiphyseal plate of the proximal humerus was damaged by normal weight, which caused the proximal metaphysis of the humerus to bend inward. There was no avascular necrosis in this disease. There are two types of this disease, infant and juvenile. Infant deformity occurs within a few years after birth, and both sides are mostly. The juvenile type is usually deformed when it is 8 to 13 years old, mostly unilateral. basic knowledge The proportion of illness: 0.0003%-0.0007% Susceptible people: children Mode of infection: non-infectious complication:

Causes of pediatric arcuate leg syndrome

(1) Causes of the disease

This disease is an osteochondritis or osteophyte, the cause is unknown, may be related to trauma, allergies, including tuberculosis, syphilis, including cartilage growth defects, adjacent to the medial or lateral humeral temperament delay.

(two) pathogenesis

In the past, it was thought to be caused by local osteochondrosis of the medial part of the upper humerus. It is considered that the disease belongs to local dysplasia of the epiphysis. The inner part of the tarsal plate grows slowly and the lateral part continues to grow normally, resulting in progressive varus deformity. The medial part of the tarsal plate is closed in advance, and its pathological changes are very similar to those of the femoral epiphysis. It can be present at the same time. The pathology is found in the sinusoids. There are membranous cartilage islands under the epiphysis. The cells are irregularly distributed. Cylindrical.

There is no difference between infantile varus and physiologic knee varus in early stage. Both of them are caused by premature weight bearing. Premature weight bearing causes greater shear stress on the tarsal plate, which destroys the normal growth of medial tarsal plate and bone. Obesity can aggravate this damage, and the epiphyseal plate and the adjacent epiphysis and metaphysis can be compressed to produce secondary osteochondrosis.

Juvenile genital varus is not a continuation of infantile varus. The former may have no physiological knee varus during childhood, while the latter progresses to adolescent disease with severe changes, and the growth of the epiphysis is stagnant rather than stunted.

Pediatric arch leg syndrome prevention

The cause is unknown, prevention should be taken to prevent trauma, prevention and active treatment of tuberculosis, syphilis and other infectious diseases.

Complications of children with arcuate leg syndrome Complication

Due to lower limb deformity to lower limb motor dysfunction, the body is short.

Symptoms of Children's Bow Leg Syndrome Common Symptoms Body flapping "duck step" Gait knee pain Pain in the knee after kneeling, ... Two legs are not the same as long osteoporosis

Clinically, the symptoms can be divided into infants and adolescents.

1. Infants and young children develop symptoms when they are 1 to 2 years old. They are often overweight children. The legs are gradually curved without cause. They are often bilateral, even unilateral. One side is claudication, and the other side is duck. Walking, sometimes there is a foot injury due to strain, knee pain.

2. Adolescent symptoms appear at 6 to 12 years of age, often unilateral. Physical examination shows that the affected limb is 1 to 2 cm shorter. The lower side of the knee joint has pointed angular protrusions, spheroid swells, internal rotation of the humerus, and knees. There may be abnormal activities, and other general examinations are normal.

Examination of children's arcuate leg syndrome

General laboratory tests are more normal.

Infant type

The main findings of X-ray photographs are that the upper end of the humerus is turned into an angle, and the distal end of the femur is also varus deformed. There are a series of changes in the metaphysis and epiphysis of the upper part of the humerus. The specific changes depend on the development and maturity of the bone. The severity of the disease and the course of the disease are relatively large. Some children have completely disappeared from X-ray when they are 3 to 4 years old. However, when other children reach 10 to 13 years old, the changes still exist, according to the development of X-ray. It is divided into 6 stages.

Stage 1 (2 to 3 years old): The humeral deformity of the humerus is constantly developing. It is characterized by irregular ossification of the temporal humerus. There are scattered calcified masses in the transparent zone. The medial epiphysis is backward, and the medial side of the metaphysis protrudes inward. .

Stage 2 (2.5 to 4 years old): There is a tendency to heal significantly. The inner 1/3 of the epiphysis line has a sharp oblique depression, forming a bird's beak. The upper part of the beak has higher transparency than the other parts of the cocoon. The inside of the epiphysis is wedge-shaped, the boundary is unclear, and the development is worse than the lateral side.

Stage 3 (4-6 years old): It is characterized by the deepening of the depression at the tip of the epiphysis of the epiphysis, which is filled with cartilage, forming a stepped shape at the metaphyseal end, and the inside of the epiphysis is wedge-shaped and the boundary is unclear. Occasionally there is a small calcification zone below the edge.

Stage 4 (5-10 years old): The bones are becoming more and more mature, the jaws are becoming narrower, the bones become larger, and the steps on the inner side of the metaphysis are enlarged. The bones are in the stepped depression and the inner side of the metaphysis At this time, the inner edge of the epiphysis is very irregular, and a bone bridge is often found. The fourth stage of partial healing of the infant is similar to the late stage of the juvenile type.

Stage 5 (9-11 years old): There is a translucent band on the side of the tarsal plate to the articular cartilage surface. The bone sputum is divided into two pieces. It looks like a double scorpion. There are triangular lumps near the articular cartilage. The edges are irregular and the cartilage covers the inside. The edge of the medial articular surface at the upper end of the humerus is abnormal, and it has a slanting block shape from the crotch to the inside.

Stage 6 (10-13 years old): The medial tarsal plate of the bifurcation is ossified, and the lateral growth is normal. The 5th and 6th stages mean that the deformity can not be repaired. After the age of 13 years, the infantile patella varus cannot be seen.

2. Juvenile type

The X-ray findings of this type have many differences from the infant type, because the secondary ossification center has been formed at this time, the lesion is more limited, the middle of the 1/2 of the tarsal plate is narrowed, and the contralateral bone density is increased. The shape of the epiphysis is normal, the tarsal plate is not stepped, and the distal femur is also varus deformed, and the distal end of the humerus is valgus deformed. Unlike the infant type that naturally develops into adolescence, the juvenile humeral medial tarsal plate appears as Early closure, while the former has a bone bridge.

Diagnosis and diagnosis of children's arcuate leg syndrome

diagnosis

According to the clinical features and X-ray film, it can be seen that the outline of the proximal humerus line is irregular, and the enlarged sacral end can be seen in the osteoporosis area, which can help diagnosis.

Differential diagnosis

1. Rickets Infant type should be distinguished from vitamin D deficiency rickets, which helps identify points as follows:

(1) Bone fracture: The congenital humerus is curved and the bend is located at the distal end of the humerus.

(2) Clinical manifestations: Untreated active rickets, the diagnosis is not too difficult, but the lightly cured rickets with residual O-legs are more difficult to distinguish from the second stage of infantile varus, rickets have whole body Sexual signs, local changes in symmetry, and no typical valgus varus changes at the upper end of the humerus help to confirm the diagnosis, and the necessary laboratory tests are also useful for identification.

2. Multiple endogenous chondromatosis and exocrine osteophytes Multiple endogenous chondromatosis and upper humeral epiphysis are also considered to be varus in the clinic, but X-ray photographs are easy to identify.

3. The proximal humeral fracture of the humerus The proximal humerus fracture of the humerus can also be misdiagnosed as palpebral varus, especially the old inwardly displaced tarsal fracture, which can be confirmed in the future.

4. The upper end of the humerus osteomyelitis The upper end of the humerus osteomyelitis affects local development, and can also cause varus varus, pay attention to identification.

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