Osteomalacia major occurs in children and is an endemic bone disease with degenerative necrosis of articular cartilage, epiphyseal cartilage and epiphyseal cartilage plates as the basic lesion. It is also known as willow abductor disease. In China, it is mainly distributed in a narrow alpine zone from northeast to Tibet (Aba Prefecture). The cause of the disease is still incompletely understood. In the endemic area of the disease, the low selenium content in soil, grain and human hair has a very obvious negative phase husband system with the disease. Total humic acid and humic acid (I OH) in water had a very obvious positive relationship with the disease. Insufficient, excess and imbalance of micronutrients in the drinking water in large bone disease areas may be a factor causing malnutrition changes. In addition, the use of “food, water and sanitation” to prevent osteoarthritis has achieved good results. The onset of the disease is relatively young, generally for children aged 3 to 15 years old, with a high incidence in the hands, feet and ankles.
1.Clinical manifestations
The typical manifestations are dwarfism, enlarged bone ends, joint movement limitation and pain. The earlier the age of onset, the more pronounced the joint deformation and dwarfism, while the symptoms in adult patients are generally mild and often limited to the joints.
2.Differential diagnosis
The occurrence and development of x-ray signs of osteoarthrosis are specifically related to the age and location of onset. Therefore, the differential diagnosis should be differentiated from cartilage dysplasia, rheumatoid arthritis, traumatic or degenerative arthritis and other diseases according to different situations. Combined with epidemiology, clinical manifestations, the diagnosis of the disease is not difficult
3, large osteoarthrosis treatment measures large osteoarthrosis can not be cured, and can not inhibit the development of the lesion. Symptomatic treatment can reduce pain.
3.1 Drugs for possible etiology and pathogenesis
These drugs are suitable for early stage patients and aim to interrupt the progression of the disease and promote lesion repair. The following are commonly used.
(1) Sodium selenite and vitamin E are used for patients with alterations of low selenium in the body and manifestations of membrane damage. Generally, sodium selenite tablets are used orally, each tablet contains lmg of sodium selenite, the dosage is usually l tablet per week for children under 10 years old and 2 tablets per week for children over lO years old, for at least 6 months. At the same time take vitamin E, 10-20mg per day, can enhance the effect, Yongshou big bone joint disease examination shows that, judging by the change of epiphysis under X-ray, the efficacy reaches 81,9% when taking the medicine for 1 year, similar to the lesion repair process after the patient leaves the disease area to the non-disease area. The physiologically appropriate dosage range of ten selenium is narrow, so the dosage should be strictly controlled and not abused.
(2) Chondroitin sulfate tablets (Kantorin): for patients with chondroitin sulfate metabolism disorder and used. Tablets 0,129 per tablet, 5 tablets each time, 2 times a day, 3 months as a course of treatment.
(3) Sulfate: also for disorders of sulfur metabolism. Commonly used compound sodium sulfate tablets, each tablet contains anhydrous sodium sulfate 0, 369, citric acid 0, 099, there are appropriate amounts of starch, magnesium stearate and other excipients. Dosage under 10 years of age 4 tablets per day, 10-15 years of age 5 tablets each, 15 years of age and above 6 tablets per day. Each 2 times after meals to take. 6-8 months for a course of treatment. Also available magnesium sulfate tablets, under 10 years of age 29 per day, 10-15 years of age per R 39, 15 years of age and above per R 49. 2 times daily after meals. 6 to 8 months for a course of treatment. Also can take 1% dilute sulfuric acid orally once a day, each time 5 ~ lOmg, add warm boiled water 200raL, take after meals.
3.2 Drugs for joint pain and movement disorders
There are many allopathic drugs in this category, which can be used for patients in all periods. The following two kinds of drugs are commonly used.
(1) Salicylic acid: Enteric aspirin tablets or other salicylic acid preparations are available. It is reported that it not only has pain-relieving effect, but also inhibits protein hydrolase and promotes cartilage lesion repair. However, long-term use should be noted for its side effects.
(2) Chinese herbal medicine: commonly used are Wu Wu Wan (composed of Chuan Wu, Cao Wu, etc.), Strychnine Pills, Upper Pain and Blood Activation San, and Xiao Wu Luo Dan, etc.
3.3 Acupuncture, physiotherapy
Acupuncture and physiotherapy are also allopathic treatments to relieve pain, relieve spasm and improve joint function. In addition to traditional acupuncture, cupping and massage, mud therapy, wax therapy, mineral baths and other therapies can be used according to local conditions, and thermoelectric stimulation therapy and ion introduction therapy can also be used. The solution of ion introduction can be used 5% sodium thiosulfate.
3.4 Surgical treatment
For patients with severe joint deformity, joint contracture or sometimes joint interlocking of degree II and III, orthopedic surgery can be performed to remove joint free bodies, clean up the interior of the joint and correct the deformity. Good results can often be received.
4.Prevention
4.1 Improve water quality
In view of the low mineralization and heavy natural pollution of the drinking water for residents in the disease area, efforts should be made to improve water quality. Conditional places can be based on local hydrogeological conditions to drill deep wells, or lead the water quality of good springs into the village. Should strengthen the protection of drinking water sources to prevent pollution. Poor water quality, high organic content can be localized to build water filtration facilities, centralized filtration, unified water supply.
4.2 Improve the quality of food
In view of the monotonous and partial food situation of the residents in the disease area, it should be advocated that a variety of crops should be planted by and food diversification. Disease areas in the north with water conservancy conditions can be changed from dry fields to paddy fields, and the staple food of mainly corn or wheat to mainly rice. People grain harvesting, transportation to storage storage, are to be fully dried or dried in a timely manner to prevent grain mold. Grain milling before and after, should also be maintained fully dried to curb the reproduction of mold and produce toxins.
4, 3 selenium supplementation
This is for the disease area soil, crops divided selenium and measures taken. As a large area cast selenium prevention, consider crop spraying selenium. For example, before and after the flowering period of wheat or corn, to the foliage spraying sodium selenite aqueous solution 2 to 3 times, each time each mu of land spray water 10-25mg, containing sodium selenite lg. Can also give the pot of selenium soil nitrogen, phosphorus, alum compound fertilizer, quite per container of farmland application of selenium fertilizer containing about 159 sodium selenite. Preliminary tests have shown that 1 application of selenium can improve the selenium content in grain within 3 years, without the need to apply fertilizer year after year. Of course this needs to monitor the selenium content in soil and grain to ensure the reasonable use of selenium fertilizer. Large-scale selenium supplementation party and government forces can add selenium to salt. Selenium salt preparation method is to add sodium selenite 159 per ton of salt, stirring cupped evenly. This is a simple and easy method as iodized salt to prevent iodine deficiency disease.