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张玉珠,女,10岁5个月,住院号1149,因生长迟缓八年,脊柱变形一年入院。患儿系第一胎,足月顺产,出生体重3000克,生后母乳喂养,11个月出牙,2岁会走,生长发育明显落后于同龄儿,5岁开始乳牙脱落(齿早脱),曾在当地医院诊断为维生素D缺乏性佝偻病,系统治疗半年,病情无好转。入院前五年,因咳嗽拍胸片发现骨质疏松,故进一步拍全身骨片,显示全身骨质明显疏松。近一年,出现脊柱变形(驼背),行走困难,双腿呈“X形”生长停滞。父母非近亲结婚,母孕期身体健康,否认服药史,其第5岁,生长发育正常。 查体:体温36.5℃,脉搏102次/分,呼吸26次/分,体重18公斤,身高114厘米,头围50厘米,神志清,精神弱,反应略迟钝,前及颅缝均未闭合,颈短、胸廓呈鸡胸,哈氏沟(+),两肺呼吸音清,心前区无隆起,心尖部未闻及杂音,心律整,心率102次/分,腹平软,肝脾均未艘及,肠鸣音正常,四肢关节松弛,肌张力减弱,脊柱呈后突畸形,上肢肘外翻,下肢呈“X”形腿,踝间距8厘米,四肢末端短小,生理反射均引出,未引出病理反射。
Zhang Yuzhu, female, 10 years old 5 months, hospital number 1149, due to growth retardation eight years, spinal deformity one year admission. Pediatric first-line, term full-term, birth weight 3000 grams, after birth, breastfeeding, 11 months teeth, 2 years old will go, growth and development significantly behind their children, 5 years old began deciduous teeth (teeth off early) , Had a local hospital diagnosed with vitamin D deficiency rickets, systemic treatment for six months, the condition did not improve. Five years before admission, cough chest X-ray film found that osteoporosis, so further shot the whole body bone chips, showing that the whole body was obviously loose bone. In the recent year, there was spine deformation (humpback), difficulty walking and legs with “X-shaped” growth arrest. Parents non-relatives get married, pregnant women during pregnancy, denied medication history, its 5-year-old, normal growth and development. Physical examination: body temperature 36.5 ℃, pulse 102 beats / min, breathing 26 beats / min, weight 18 kg, height 114 cm, head circumference 50 cm, clear consciousness, weak spirit, reaction dull, Short neck, thorax showed chicken breast, Hastelloy groove (+), lung breath sounds clear, precordial no uplift, apical unobstructed and murmurs, rhythm, heart rate 102 beats / min, abdominal soft, liver and spleen are not Bowel sounds, normal bowel sounds, limbs and joints relaxation, muscle tension weakened, spinal posterior deformity, upper extremity elbow valgus, lower extremities were “X” -shaped legs, ankle spacing of 8 cm, extremities distal short, physiologic reflex leads, not Lead to pathological reflex.