Some standard content:
National Standard of the People's Republic of China
Diagnostic criteria of Kashin Beck disease
Diagnostic criteria of Kashin Beck diseaseSubject content and scope of application
This standard specifies the diagnostic principles, clinical grading, technical indicators and usage requirements of Kashin Beck disease. This standard is applicable to the diagnosis of individual cases of Kashin Beck disease and the differentiation from other osteoarthritis. 2 Kashin Beck disease
GB16003-1995
This disease is an endemic deforming osteoarthritis that occurs in children. Its primary lesions are mainly multiple symmetrical degeneration and necrosis of articular cartilage during development, as well as extensive secondary degenerative osteoarthritis. Clinical manifestations include pain, thickening, deformation of the joints of the limbs, muscle atrophy, and in severe cases, short fingers, short limbs, and even dwarfism.
3 Diagnostic principles
This disease can be diagnosed based on the history of contact with the patient, symptoms and signs, as well as the changes in the finger and wrist joint articular surface, temporary calcification zone at the end of the shaft and the nucleus, such as multiple symmetrical depressions, sclerosis, destruction and deformation, etc., as seen in the hand bone X-ray. Multiple symmetrical changes in the distal end of the phalanx on X-ray are characteristic signs of this disease.
4 Diagnosis and grading standards
4.1 Severity diagnosis
4.1.1. Early stage
Children with incomplete healed shafts who have the following 4 items: a, c or b, c or b, d or only c, are diagnosed in the early stage. a.
Slightly limited and painful movement of the hand, wrist or ankle, knee joints. b. Multiple symmetrical flexion of the distal phalanges.
c. X-rays of the hand and wrist show depression, sclerosis, destruction and deformation of the bone articular surface or temporary calcification zone at the end or nucleus to varying degrees. d. Serum enzyme activity increased, urine creatine, hydroxyproline, and mucopolysaccharide content increased. 4.1.2 Grade 1
On the basis of early changes, multiple symmetrical fingers or other limbs joints are thickened, flexion and extension are limited, pain, mild muscle atrophy, and different degrees of X-ray changes in the trunk or bone ends. 4.1.3 Grade 1
On the basis of Grade I, symptoms and signs are aggravated, short fingers (toes) deformity occurs, and X-ray changes show premature epiphyseal closure. 4.1.4 Grade
On the basis of Grade I, symptoms, signs, and X-ray changes are aggravated, short limbs and dwarfism deformity occur. 4.2 Diagnosis of active and inactive types
Children with KBD whose trunks have not completely healed are diagnosed with active type if they have any of the following, otherwise they are diagnosed with inactive type. a X-ray films of the hands and wrists show widening, hardening, and deep depressions of the temporary calcification band at the ends of the trunk. Serum enzyme activity increases, urine creatine, hydroxyproline, and mucopolysaccharide content increases. b.
Approved by the State Administration of Technical Supervision on December 15, 1995 and implemented on July 1, 1996
A1 Preparation before examination
GB 16003--1995
Appendix A
Clinical examination methods and judgment criteria
(Supplement)
A1.1 The doctor should develop the habit of checking in order to avoid omissions. A1.2 Fully expose the parts to be checked. In winter, the patient should be checked 10 to 15 minutes after entering the room from the outdoors. A1.3 During the examination, the patient should be demonstrated and the key points should be pointed out. A2 Upper limb examination
A2.1 Phalangeal drooping
The examinee stretches both hands straight, parallel to the examiner's line of sight, and checks whether the 2nd, 3rd, and 4th phalanges are bent toward the palm side. Pay attention to the Heberden's tubercle on the dorsal side of the phalanges.
A2.2 Thickening of finger joints
When the fingers of a normal person are straightened and close together, there is no gap between the fingers. When the joints are thickened, the fingers are not close together, and there are gaps between the fingers. The thickened part is hard like a kidney when touched. The typical thickening is in the shape of an abacus plate.
A2.3 Brachydactyly
When a normal person puts his five fingers together and the fingers are long, the height of the fingers is in the order of middle finger, ring finger, index finger, little finger, and thumb. If the order is changed or the length of the middle finger/transverse palmar diameter is less than 1, it indicates brachydactyly.
A2.4 Tension of the magnus and hypothenar muscles
In a normal person, the magnus and hypothenar muscles are plump and tense to the touch. When the muscles are contracted, they are not plump, soft and have no tension to the touch. A2.5 Palm-joining test
In a normal person, the palms are put together and then the elbows are raised, so that the two forearms are at the same level. When the wrist joint is affected, the two forearms are placed at the same level and the palms are separated.
A2.6 Back of palm test
In a normal person, the backs of the hands are put together, so that the two forearms are placed at the same level. When the wrist joint is affected, the two forearms cannot be placed at the same level. A2.7 Forearm pronation and supination test
In a normal person, the elbows of both upper limbs are flexed to 90°, the upper arms are close to the chest and arms, the fingers are straightened, the thumbs are facing the sky, and then the palms are pronated or supinated, and the palm surface can be parallel to the horizon. When the radial head or ulna is affected, the palm surface is at an angle to the horizon when pronated or supinated. A2.8 Elbow bend
When a normal person's upper limbs are stretched forward, the angle between the forearm and the upper arm at the elbow joint is 180°. When the humerus is flexed and contracted, the angle becomes smaller. A2.9 Shortened humerus
When a normal person's two forearms are close to the sides of the chest wall, when the fingers touch the acromion, the wrist is below the acromion. When the humerus is shortened, the wrist is above the acromion. A2.10 Biceps tension
When a normal person flexes his arm, the biceps are plump, tough and strong to the touch. When the muscles are atrophied, they are not plump, soft and weak to the touch. A3 Lower limb examination
A3.1 Lower limb examination
When a normal person has a bowel movement disorder, the stool cannot be completely lowered. Although it can be completely lowered, the heel needs to leave the ground. A3.2 Calf length
GB16003—1995
For normal people, the ratio of the thigh length measured from the greater trochanter to the lower end of the femur below the lateral malleolus, the knee joint lateral space, to the calf length measured from the upper edge of the tibial plateau to the medial malleolus is 4/3. When the tibia and fibula become shorter, the ratio increases. A3.3 Half-leg raising test
For normal people, the knee joint is in semi-flexed position, the left and right legs are exchanged, and they can stand on one leg; when the knee joint is affected, they cannot stand on one leg. A3.4 Gastrocnemius tension
When normal people stand upright, the gastrocnemius muscles are plump and tense when touched. When the muscles are atrophied, they are not plump, soft and weak. A3.5 Ankle flexion and extension disorder
For normal people, the ankle joint can be flexed to 90° and extended to 180°; when the ankle joint is affected, the flexion and extension angles become smaller. At the same time, pay attention to whether the ankle joint is thickened and whether there is pain when flexing and extending.
A3.6 Toe examination
Normal people's toes are close together without gaps, the length sequence of the five toes is ladder-like or the second toe is slightly longer. When the toe joints are thickened, the toes are not close together or there are gaps. When the toes become shorter, the length sequence of the five toes changes. Appendix B
X-ray examination method and diagnostic criteria for Kaschin-Beck disease (supplement)
B1 X-ray examination method for Kaschin-Beck disease
B1.1 Preparation before examination
B1.1.1 Loading the film. For Kaschin-Beck disease hand photography, black paper bags should be used for loading the film. The film should be loaded and sealed at one time according to the number of people taking the film. B1.1.2 Explain the examination requirements and precautions to the examinee clearly to eliminate tension and facilitate a smooth examination. B1.2 Examination site
B1.2.1 Frontal image of the right hand (including the wrist bones). B1.2.2 Hand waving method: straighten fingers, palm down, flat on the X-ray film pocket, press and do not move, the lead number is placed on the little finger side. B1.3 X-ray machine model and projection conditions
Hand film projection conditions
X-ray machine
B1.4 Darkroom technology
Power supply voltage, V
High voltage, kv
B1.4.1 Development: liquid temperature 18℃, development time 4~5min. Distance, cm
B1.4.2 Water washing: After development, remove and rinse with clean water, then put into the fixing barrel. B1.4.3 Fixing: liquid temperature 18℃, fixing time 10min. Current, mA
B1.4.4 Water washing: Put the fixed X-ray film into the running water pool and rinse for 20~~30min, remove and dry. B2 X-ray diagnostic criteria
B2.1 X-ray signs of hand and foot bones
B2.1.1 Before the equal diameter stage, the early calcification band at the end of the shaft is interrupted, irregular and accompanied by local bone lesions. Light time, s
GB16003—1995
B2.1.2 Various forms of depressions in the early calcification band at the end of the epiphysis and accompanied by sclerosis. B2.1.3 Depression and sclerosis at the end of the first metacarpal bone. Note: Changes in the metacarpal and phalangeal shafts do not include the middle segment of the little finger and the distal segment of the thumb. B2.1.4 The bony articular surface of the end of the phalanx is rough, irregular, depressed and sclerotic. B2.1.5 The edge of the bone end is defective or there are calcification and ossification foci nearby, bone hyperplasia at the joint edge of the bone end, disordered trabecular structure, cystic changes and coarse deformation.
B2.1.6 The epiphyseal joint surface is sunken, sclerotic, or the joint surface is straight or the nucleus is skewed, the line is narrowed, and the line is localized and prematurely fused with local sclerosis.
Bone deformation, defect and fragmentation of the same degree of tendon and nucleus. B2.1.8 The edge of the carpal bone is interrupted, sunken, and sclerotic. B2.1:9 Localized defect, destruction or cystic changes and deformation, crowding, or absence of carpal bones. B2.1.10 The edges of the heel and talus of infants are rough, and the trabecular structure is disordered and irregular. B2.1.11 Defect, sclerosis, irregularity of the articular surface of the talus, collapse of the talus, sclerosis of the edges, or shortening and deformation of the calcaneus. B2.1.12 Changes in the toes are the same as those in the phalanges.
Note: There are many normal variations in the renal trunks of the 2nd, 3rd, and 4th toes. When making a diagnosis, it should be determined in combination with changes in the hand bones or clinical manifestations. B2.1.13 Changes such as depression, irregularity, and sclerosis at the epiphysis of the base of the big toe are more characteristic. Note: When making a diagnosis, combined with the medical history and clinical manifestations, patients with any of the following X-rays on the hand can be diagnosed with KBD. Patients with any X-ray sign of the bone end (symmetry). a.
Patients with other X-ray signs and multiple sites of disease. b.
For single site or unclear X-ray signs, it is necessary to combine clinical and whether there are changes in the first metacarpal shaft to make a diagnosis. X-ray diagnosis of KBD should first be done with hand films, and if necessary, lateral ankle and anteroposterior foot films. The site of disease and the degree and nature of the lesion should be recorded during diagnosis.
B3 Criteria for judging the degree of abnormal X-ray changes
B3.1 Metacarpophalangeal shaft
B3.1.1 If the initial calcification band is interrupted and irregular with local trabecular disorder, it can be classified as (+). B3.1.2 If the initial calcification band is concave in various forms and accompanied by sclerosis, the depth of the concave and the thickness of the sclerosis widening shall not exceed 2.0mm and shall be classified as (+). If it exceeds 2.0mm, it shall be classified as (+).
B3.1.3 If the shaft and bone are partially or mostly penetrated, it shall be classified as (++). B3.2 Metacarpal and phalangeal bone ends
B3.2.1 If the bone joint surface is rough, irregular, concave, or sclerotic, it shall be determined as (+). B3.2.2 If the edge of the bone end is defective or there are calcified ossification foci nearby and bone hyperplasia at the joint edge of the bone end, and the trabecular structure is disordered, it shall be determined as (+10+10). B3.2.3 If the bone end is coarse and deformed, it shall be determined as (+10+10). B3.3 Bones
B3.3.1 If the bone joint surface is sclerotic, irregular, and straight, it shall be determined as (+). B3.3.2 If the bone is crooked, the epiphyseal line is narrowed, or the line is fused prematurely with local sclerosis, it shall be determined as (++). B3.3.3 If the bone is deformed, the nucleus is defective, broken, or absent to varying degrees, it shall be determined as (+++10). B3.4 Carpal bones
B3.4.1 If the edge of the carpal bone is interrupted, concave, or sclerotic, it shall be determined as (+). B3.4.2 If the carpal bone is defective, destroyed, or cystic, it shall be determined as (+10+10). B3.4.3 Wrist bones that are deformed, crowded, or absent are defined as (+++). B3.5 Talar and calcaneal bones
B3.5.1 In infants, the marginal hair medullary and trabecular structures of the talar and talus are defined as (+). 488
GB16003-1995
B3.5.2 The articular surface of the talus is irregular, sclerotic, sunken, and accompanied by trabecular structure disorder. It is defined as (++). B3.5.3 The talus is collapsed, the margin is defective, or the calcaneal is shortened and deformed. It is defined as (+10). B3.6 Metatarsal and phalanges
B3.6.1 The changes in the phalanges are the same as B3.1.
Note: The degree of X-ray changes is indicated by the symbol (+). One (+) indicates a mild lesion, two (+) indicates a severe lesion, and three (+) indicates a serious lesion. B4 X-ray signs of active KBD
B4.1 Before the super-diameter stage, the early calcification band of the metaphysis is slightly depressed, and the epiphysis is skewed, the line becomes narrower, or accompanied by disordered trabecular structure. B4.2 Before the equal-diameter stage, the early calcification band of the metaphysis is obviously depressed, presenting a "clear" shape without structure, and the depression exceeds 2.0mm. B4.3 Various forms of depression and sclerosis of the early calcification band of the metaphysis, accompanied by changes in the bone end or the epiphysis and carpal bones, and disordered trabecular structure.
B5 X-ray signs of inactive KBD
B5.1 Before the equal-diameter stage of the epiphysis, the early calcification band of the metaphysis is depressed, presenting a double-layer image of the repair period or a medium and uneven X-ray sign of sclerosis density.
B5.2 In the isodiametric stage, the early calcification zone of the shaft is concave and sclerotic, both less than 2.0 mm. B5.3 Various X-ray signs of the bone ends without changes in the epiphyseal ends before the isodiametric stage. B5.4 Various X-ray signs of the carpal bones without changes in the shaft ends before the isodiametric stage. B5.5 Various X-ray signs of the bone ends after the shaft is completely healed. Note: ① The X-ray signs of active and inactive KBD are mainly applicable to children and adolescents whose epiphyses have not yet healed. ② For the judgment of the double-layer images in the repair stage in B5. 1, see the judgment criteria for the prevention and treatment effects of KBD. Appendix C
Hematuria detection indicators, detection methods and judgment criteria (supplement)
C1 Hematuria detection indicators
C1. 1 Blood detection indicators
Six enzyme activities of GOT, GPT, LDH, HBDH, -GT and CPK in serum. The activity of enzymes is expressed in international units of μkat/L. C1.2 Urine test indicators
Excretion of creatine, hydroxyproline and mucopolysaccharide in urine. The units are expressed in μmol/L, μmol/L and μmol/L, respectively. C2 Subjects
Children aged 7 to 14 years.
C3 Test methods
C3.1 Determination of serum enzyme activity
Automatic biochemical analyzer.
C3.2 Determination of urinary creatine excretion
Piric acid colorimetric method.
C3.3 Determination of urinary hydroxyproline excretion
Chloramine T oxidation colorimetric method.
C3.4 Determination of urinary mucopolysaccharide excretion
Sulfuric acid-imidazole colorimetric method.
C4 Judgment criteria
GB16003-1995
C4.1 Reference values of biochemical indices of blood and urine in children with Kaschin-Beck disease are shown in Table C1. Table C1 Reference values of biochemical indices of blood and urine in children with Kaschin-Beck disease refer to
α-HBDH
Urine creatine
Urine hydroxyproline
Urine mucopolysaccharide
μkat/L
μukat/L
μkat/L
μkat/L
μkat/L
μkat/L
μmol/L
μmol /L
C4.2 Criteria for determining biochemical changes in KBDa.
Active severe disease area
Non-disease point in disease area
Non-disease point
The blood and urine biochemical index values measured are less than or equal to the reference values of non-disease points, which is a negative biochemical change, recorded as (-); greater than or equal to the reference values of active severe disease areas, which is a positive biochemical change, recorded as (+); between the reference values of non-disease points and active severe disease areas, which is a suspected biochemical change, recorded as (+).
Children under examination with more than 4 of the 6 serum enzyme activities changed to (+) or more than 2 of the 3 urine index excretions changed to (+)b.
Can be determined to have blood or urine biochemical changes in KBD. Appendix D
Instructions for the correct use of the standard
(reference)
D1 This standard is applicable to the diagnosis of KBD cases in known KBD disease areas. D2 In unknown KBD disease areas, this standard also applies to children whose trunks have not completely healed and whose hands have multiple, symmetrical bone end changes on X-ray examination, and there are typical cases of degree 1 or above in the same residential area. D3 In known non-disease areas, this standard only applies to those with a history of contact with the disease area. D4 This disease should be differentiated from osteoarthritis, rheumatoid arthritis, osteoarthritis (OA), gout, scrotal disease, cretinism, familial short stature, primary dwarfism, metaphyseal bone development disorder, achondroplasia, pseudoosteogenesis imperfecta, multiple bone dysplasia and other short stature diseases without intellectual or sexual development disorders. 4701
Additional Notes:
GB16003-1995
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the KBD Research Institute of the China Endemic Disease Prevention and Control Research Center. The main drafters of this standard are Yang Jianbo, Wang Zhiwu, Liu Tangxian, and He Fenglan. The Ministry of Health has entrusted the China Endemic Disease Control and Prevention Research Center, a technical unit, to interpret this standard.
For single site or unclear X-ray signs, it is necessary to combine clinical and whether there are changes in the first metacarpal shaft to make a diagnosis. X-ray diagnosis of KBD should first be done with hand films, and if necessary, lateral ankle and anteroposterior foot films. The site of disease and the degree and nature of the lesion should be recorded during diagnosis.
B3 Criteria for judging the degree of abnormal X-ray changes
B3.1 Metacarpophalangeal shaft
B3.1.1 If the initial calcification band is interrupted and irregular and accompanied by local trabecular disorder, it can be classified as (+). B3.1.2 If the initial calcification band is depressed in various forms and accompanied by sclerosis, the depression depth and the thickness of the sclerosis widening shall not exceed 2.0mm and shall be classified as (+). If it exceeds 2.0mm, it shall be classified as (+).
B3.1.3 If the shaft and bone are partially or mostly penetrated, it shall be classified as (++). B3.2 Metacarpal and phalangeal bone ends
B3.2.1 If the bone joint surface is rough, irregular, concave, or sclerotic, it shall be determined as (+). B3.2.2 If the edge of the bone end is defective or there are calcified ossification foci nearby and bone hyperplasia at the joint edge of the bone end, and the trabecular structure is disordered, it shall be determined as (+10+10). B3.2.3 If the bone end is coarse and deformed, it shall be determined as (+10+10). B3.3 Bones
B3.3.1 If the bone joint surface is sclerotic, irregular, and straight, it shall be determined as (+). B3.3.2 If the bone is crooked, the epiphyseal line is narrowed, or the line is fused prematurely with local sclerosis, it shall be determined as (++). B3.3.3 If the bone is deformed, the nucleus is defective, broken, or absent to varying degrees, it shall be determined as (+++10). B3.4 Carpal bones
B3.4.1 If the edge of the carpal bone is interrupted, concave, or sclerotic, it shall be determined as (+). B3.4.2 If the carpal bone is defective, destroyed, or cystic, it shall be determined as (+10+10). B3.4.3 Wrist bones that are deformed, crowded, or absent are defined as (+++). B3.5 Talar and calcaneal bones
B3.5.1 In infants, the marginal hair medullary and trabecular structures of the talar and talus are defined as (+). 488
GB16003-1995
B3.5.2 The articular surface of the talus is irregular, sclerotic, sunken, and accompanied by trabecular structure disorder. It is defined as (++). B3.5.3 The talus is collapsed, the margin is defective, or the calcaneal is shortened and deformed. It is defined as (+10). B3.6 Metatarsal and phalanges
B3.6.1 The changes in the phalanges are the same as B3.1.
Note: The degree of X-ray changes is indicated by the symbol (+). One (+) indicates a mild lesion, two (+) indicates a severe lesion, and three (+) indicates a serious lesion. B4 X-ray signs of active KBD
B4.1 Before the super-diameter stage, the early calcification band of the metaphysis is slightly depressed, and the epiphysis is skewed, the line becomes narrower, or accompanied by disordered trabecular structure. B4.2 Before the equal-diameter stage, the early calcification band of the metaphysis is obviously depressed, presenting a "clear" shape without structure, and the depression exceeds 2.0mm. B4.3 Various forms of depression and sclerosis of the early calcification band of the metaphysis, accompanied by changes in the bone end or the epiphysis and carpal bones, and disordered trabecular structure.
B5 X-ray signs of inactive KBD
B5.1 Before the equal-diameter stage of the epiphysis, the early calcification band of the metaphysis is depressed, presenting a double-layer image of the repair period or a medium and uneven X-ray sign of sclerosis density.
B5.2 In the isodiametric stage, the early calcification zone of the shaft is concave and sclerotic, both less than 2.0 mm. B5.3 Various X-ray signs of the bone ends without changes in the epiphyseal ends before the isodiametric stage. B5.4 Various X-ray signs of the carpal bones without changes in the shaft ends before the isodiametric stage. B5.5 Various X-ray signs of the bone ends after the shaft is completely healed. Note: ① The X-ray signs of active and inactive KBD are mainly applicable to children and adolescents whose epiphyses have not yet healed. ② For the judgment of the double-layer images in the repair stage in B5. 1, see the judgment criteria for the prevention and treatment effects of KBD. Appendix C
Hematuria detection indicators, detection methods and judgment criteria (supplement)
C1 Hematuria detection indicators
C1. 1 Blood detection indicators
Six enzyme activities of GOT, GPT, LDH, HBDH, -GT and CPK in serum. The activity of enzymes is expressed in international units of μkat/L. C1.2 Urine test indicators
Excretion of creatine, hydroxyproline and mucopolysaccharide in urine. The units are expressed in μmol/L, μmol/L and μmol/L, respectively. C2 Subjects
Children aged 7 to 14 years.
C3 Test methods
C3.1 Determination of serum enzyme activity
Automatic biochemical analyzer.
C3.2 Determination of urinary creatine excretion
Piric acid colorimetric method.
C3.3 Determination of urinary hydroxyproline excretion
Chloramine T oxidation colorimetric method.
C3.4 Determination of urinary mucopolysaccharide excretion
Sulfuric acid-imidazole colorimetric method.
C4 Judgment criteria
GB16003-1995
C4.1 Reference values of biochemical indices of blood and urine in children with Kaschin-Beck disease are shown in Table C1. Table C1 Reference values of biochemical indices of blood and urine in children with Kaschin-Beck disease refer to
α-HBDH
Urine creatine
Urine hydroxyproline
Urine mucopolysaccharide
μkat/L
μukat/L
μkat/L
μkat/L
μkat/L
μkat/L
μmol/L
μmol /L
C4.2 Criteria for determining biochemical changes in KBDa.
Active severe disease area
Non-disease point in disease area
Non-disease point
The blood and urine biochemical index values measured are less than or equal to the reference values of non-disease points, which is a negative biochemical change, recorded as (-); greater than or equal to the reference values of active severe disease areas, which is a positive biochemical change, recorded as (+); between the reference values of non-disease points and active severe disease areas, which is a suspected biochemical change, recorded as (+).
Children under examination with more than 4 of the 6 serum enzyme activities changed to (+) or more than 2 of the 3 urine index excretions changed to (+)b.
Can be determined to have blood or urine biochemical changes in KBD. Appendix D
Instructions for the correct use of the standard
(reference)
D1 This standard is applicable to the diagnosis of KBD cases in known KBD disease areas. D2 In unknown KBD disease areas, this standard also applies to children whose trunks have not completely healed and whose hands have multiple, symmetrical bone end changes on X-ray examination, and there are typical cases of degree 1 or above in the same residential area. D3 In known non-disease areas, this standard only applies to those with a history of contact with the disease area. D4 This disease should be differentiated from osteoarthritis, rheumatoid arthritis, osteoarthritis (OA), gout, scrotal disease, cretinism, familial short stature, primary dwarfism, metaphyseal bone development disorder, achondroplasia, pseudoosteogenesis imperfecta, multiple bone dysplasia and other short stature diseases without intellectual or sexual development disorders. 4701
Additional Notes:
GB16003-1995
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the KBD Research Institute of the China Endemic Disease Prevention and Control Research Center. The main drafters of this standard are Yang Jianbo, Wang Zhiwu, Liu Tangxian, and He Fenglan. The Ministry of Health has entrusted the China Endemic Disease Control and Prevention Research Center, a technical unit, to interpret this standard.
For single site or unclear X-ray signs, it is necessary to combine clinical and whether there are changes in the first metacarpal shaft to make a diagnosis. X-ray diagnosis of KBD should first be done with hand films, and if necessary, lateral ankle and anteroposterior foot films. The site of disease and the degree and nature of the lesion should be recorded during diagnosis.
B3 Criteria for judging the degree of abnormal X-ray changes
B3.1 Metacarpophalangeal shaft
B3.1.1 If the initial calcification band is interrupted and irregular and accompanied by local trabecular disorder, it can be classified as (+). B3.1.2 If the initial calcification band is depressed in various forms and accompanied by sclerosis, the depression depth and the thickness of the sclerosis widening shall not exceed 2.0mm and shall be classified as (+). If it exceeds 2.0mm, it shall be classified as (+).
B3.1.3 If the shaft and bone are partially or mostly penetrated, it shall be classified as (++). B3.2 Metacarpal and phalangeal bone ends
B3.2.1 If the bone joint surface is rough, irregular, concave, or sclerotic, it shall be determined as (+). B3.2.2 If the edge of the bone end is defective or there are calcified ossification foci nearby and bone hyperplasia at the joint edge of the bone end, and the trabecular structure is disordered, it shall be determined as (+10+10). B3.2.3 If the bone end is coarse and deformed, it shall be determined as (+10+10). B3.3 Bones
B3.3.1 If the bone joint surface is sclerotic, irregular, and straight, it shall be determined as (+). B3.3.2 If the bone is crooked, the epiphyseal line is narrowed, or the line is fused prematurely with local sclerosis, it shall be determined as (++). B3.3.3 If the bone is deformed, the nucleus is defective, broken, or absent to varying degrees, it shall be determined as (+++10). B3.4 Carpal bones
B3.4.1 If the edge of the carpal bone is interrupted, concave, or sclerotic, it shall be determined as (+). B3.4.2 If the carpal bone is defective, destroyed, or cystic, it shall be determined as (+10+10). B3.4.3 Wrist bones that are deformed, crowded, or absent are defined as (+++). B3.5 Talar and calcaneal bones
B3.5.1 In infants, the marginal hair medullary and trabecular structures of the talar and talus are defined as (+). 488
GB16003-1995
B3.5.2 The articular surface of the talus is irregular, sclerotic, sunken, and accompanied by trabecular structure disorder. It is defined as (++). B3.5.3 The talus is collapsed, the margin is defective, or the calcaneal is shortened and deformed. It is defined as (+10). B3.6 Metatarsal and phalanges
B3.6.1 The changes in the phalanges are the same as B3.1.
Note: The degree of X-ray changes is indicated by the symbol (+). One (+) indicates a mild lesion, two (+) indicates a severe lesion, and three (+) indicates a serious lesion. B4 X-ray signs of active KBD
B4.1 Before the super-diameter stage, the early calcification band of the metaphysis is slightly depressed, and the epiphysis is skewed, the line becomes narrower, or accompanied by disordered trabecular structure. B4.2 Before the equal-diameter stage, the early calcification band of the metaphysis is obviously depressed, presenting a "clear" shape without structure, and the depression exceeds 2.0mm. B4.3 Various forms of depression and sclerosis of the early calcification band of the metaphysis, accompanied by changes in the bone end or the epiphysis and carpal bones, and disordered trabecular structure.
B5 X-ray signs of inactive KBD
B5.1 Before the equal-diameter stage of the epiphysis, the early calcification band of the metaphysis is depressed, presenting a double-layer image of the repair period or a medium and uneven X-ray sign of sclerosis density.
B5.2 In the isodiametric stage, the early calcification zone of the shaft is concave and sclerotic, both less than 2.0 mm. B5.3 Various X-ray signs of the bone ends without changes in the epiphyseal ends before the isodiametric stage. B5.4 Various X-ray signs of the carpal bones without changes in the shaft ends before the isodiametric stage. B5.5 Various X-ray signs of the bone ends after the shaft is completely healed. Note: ① The X-ray signs of active and inactive KBD are mainly applicable to children and adolescents whose epiphyses have not yet healed. ② For the judgment of the double-layer images in the repair stage in B5. 1, see the judgment criteria for the prevention and treatment effects of KBD. Appendix C
Hematuria detection indicators, detection methods and judgment criteria (supplement)
C1 Hematuria detection indicators
C1. 1 Blood detection indicators
Six enzyme activities of GOT, GPT, LDH, HBDH, -GT and CPK in serum. The activity of enzymes is expressed in international units of μkat/L. C1.2 Urine test indicators
Excretion of creatine, hydroxyproline and mucopolysaccharide in urine. The units are expressed in μmol/L, μmol/L and μmol/L, respectively. C2 Subjects
Children aged 7 to 14 years.
C3 Test methods
C3.1 Determination of serum enzyme activity
Automatic biochemical analyzer.
C3.2 Determination of urinary creatine excretion
Piric acid colorimetric method.
C3.3 Determination of urinary hydroxyproline excretion
Chloramine T oxidation colorimetric method.
C3.4 Determination of urinary mucopolysaccharide excretion
Sulfuric acid-imidazole colorimetric method.
C4 Judgment criteria
GB16003-1995
C4.1 Reference values of biochemical indices of blood and urine in children with Kaschin-Beck disease are shown in Table C1. Table C1 Reference values of biochemical indices of blood and urine in children with Kaschin-Beck disease refer to
α-HBDH
Urine creatine
Urine hydroxyproline
Urine mucopolysaccharide
μkat/Lbzxz.net
μukat/L
μkat/L
μkat/L
μkat/L
μkat/L
μmol/L
μmol /L
C4.2 Criteria for determining biochemical changes in KBDa.
Active severe disease area
Non-disease point in disease area
Non-disease point
The blood and urine biochemical index values measured are less than or equal to the reference values of non-disease points, which is a negative biochemical change, recorded as (-); greater than or equal to the reference values of active severe disease areas, which is a positive biochemical change, recorded as (+); between the reference values of non-disease points and active severe disease areas, which is a suspected biochemical change, recorded as (+).
Children under examination with more than 4 of the 6 serum enzyme activities changed to (+) or more than 2 of the 3 urine index excretions changed to (+)b.
Can be determined to have blood or urine biochemical changes in KBD. Appendix D
Instructions for the correct use of the standard
(reference)
D1 This standard is applicable to the diagnosis of KBD cases in known KBD disease areas. D2 In unknown KBD disease areas, this standard also applies to children whose trunks have not completely healed and whose hands have multiple, symmetrical bone end changes on X-ray examination, and there are typical cases of degree 1 or above in the same residential area. D3 In known non-disease areas, this standard only applies to those with a history of contact with the disease area. D4 This disease should be differentiated from osteoarthritis, rheumatoid arthritis, osteoarthritis (OA), gout, scrotal disease, cretinism, familial short stature, primary dwarfism, metaphyseal bone development disorder, achondroplasia, pseudoosteogenesis imperfecta, multiple bone dysplasia and other short stature diseases without intellectual or sexual development disorders. 4701
Additional Notes:
GB16003-1995
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the KBD Research Institute of the China Endemic Disease Prevention and Control Research Center. The main drafters of this standard are Yang Jianbo, Wang Zhiwu, Liu Tangxian, and He Fenglan. The Ministry of Health has entrusted the China Endemic Disease Control and Prevention Research Center, a technical unit, to interpret this standard.2. The talus articular surface is irregular, sclerotic, depressed, and accompanied by trabecular structural disorder. B3.5.3. The talus is collapsed, the edge is defective, or the calcaneus is shortened and deformed. B3.6. Metatarsus and phalanges
B3.6.1. The changes of phalanges are the same as B3.1.
Note: The degree of X-ray changes is indicated by the symbol (+). One (+) indicates a mild lesion, two (+) indicates a severe lesion, and three (+) indicates a severe lesion. B4. X-ray signs of active KBD
B4.1. Before the super-equal diameter stage, the metaphyseal early calcification band is slightly depressed, and the epiphyseal nucleus is skewed, the line is narrowed, or accompanied by trabecular structural disorder. B4.2. Before the equal diameter stage, the metaphyseal early calcification band is obviously depressed, presenting a "clear" shape without structure, and the depression exceeds 2.0mm. B4.3 Preliminary calcification of the stem with various forms of depression, sclerosis, accompanied by bone ends or changes in the epiphysis and carpal bones, and disordered trabecular structure.
B5 X-ray signs of inactive KBD
B5.1 Before the epiphysis isodiametric stage, the early calcification of the stem is depressed, showing a double-layer image in the repair period or a medium and uneven X-ray sign of sclerosis density.
B5.2 During the isodiametric stage, the depression and sclerosis of the early calcification of the stem are both less than 2.0mm. B5.3 Various X-ray signs of the bone ends without changes in the epiphysis before the isodiametric stage. B5.4 Various X-ray signs of the carpal bones without changes in the stem before the isodiametric stage. B5.5 Various X-ray signs of the bone ends after the stem is completely healed. Note: ① X-ray signs of active and inactive KBD are mainly applicable to children and adolescents whose epiphysis has not yet healed. ② For the judgment of the double-layer image in the repair period in B5.1, see the judgment standard for the prevention and treatment effect of Kaschin-Beck disease. Appendix C
Hematuria detection indicators, detection methods and judgment criteria (supplementary)
C1 Hematuria detection indicators
C1. 1 Blood detection indicators
Six enzyme activities of GOT, GPT, LDH, HBDH, -GT and CPK in serum. The activity unit of enzyme is expressed in international unit μkat/L. C1.2 Urine detection indicators
Excretion of creatine, hydroxyproline and mucopolysaccharide in urine. The units are expressed in μmol/L, μmol/L and μmol/L respectively. C2 Subjects
Children aged 7 to 14 years old.
C3 Detection method
C3.1 Determination of serum enzyme activity
Automatic biochemical analyzer determination.
C3.2 Determination of urinary creatine excretion
Piric acid colorimetric method.
C3.3 Determination of urinary hydroxyproline excretion
Chloramine T oxidation colorimetric method.
C3.4 Determination of urinary mucopolysaccharide excretion
Sulfuric acid-imidazole colorimetric method.
C4 Judgment criteria
GB16003-1995
C4.1 Reference values of blood and urine biochemical indicators in children with Kaschin-Beck disease are shown in Table C1. Table C1 Reference values of biochemical indices of blood and urine in children with Kaschin-Beck disease
α-HBDH
Urine creatine
Urine hydroxyproline
Urine mucopolysaccharide
μkat/L
μkat/L
μkat/L
μkat/L
μkat/L
μkat/L
μmol/L
μmol /L
C4.2 Criteria for determining biochemical changes in KBDa.
Active severe disease area
Non-disease point in disease area
Non-disease point
The blood and urine biochemical index values measured are less than or equal to the reference values of non-disease points, which is a negative biochemical change, recorded as (-); greater than or equal to the reference values of active severe disease areas, which is a positive biochemical change, recorded as (+); between the reference values of non-disease points and active severe disease areas, which is a suspected biochemical change, recorded as (+).
Children under examination with more than 4 of the 6 serum enzyme activities changed to (+) or more than 2 of the 3 urine index excretions changed to (+)b.
Can be determined to have blood or urine biochemical changes in KBD. Appendix D
Instructions for the correct use of the standard
(reference)
D1 This standard is applicable to the diagnosis of KBD cases in known KBD disease areas. D2 In unknown KBD disease areas, this standard also applies to children whose trunks have not completely healed and whose hands have multiple, symmetrical bone end changes on X-ray examination, and there are typical cases of degree 1 or above in the same residential area. D3 In known non-disease areas, this standard only applies to those with a history of contact with the disease area. D4 This disease should be differentiated from osteoarthritis, rheumatoid arthritis, osteoarthritis (OA), gout, scrotal disease, cretinism, familial short stature, primary dwarfism, metaphyseal bone development disorder, achondroplasia, pseudoosteogenesis imperfecta, multiple bone dysplasia and other short stature diseases without intellectual or sexual development disorders. 4701
Additional Notes:
GB16003-1995
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the KBD Research Institute of the China Endemic Disease Prevention and Control Research Center. The main drafters of this standard are Yang Jianbo, Wang Zhiwu, Liu Tangxian, and He Fenglan. The Ministry of Health has entrusted the China Endemic Disease Control and Prevention Research Center, a technical unit, to interpret this standard.2. The talus articular surface is irregular, sclerotic, depressed, and accompanied by trabecular structural disorder. B3.5.3. The talus is collapsed, the edge is defective, or the calcaneus is shortened and deformed. B3.6. Metatarsus and phalanges
B3.6.1. The changes of phalanges are the same as B3.1.
Note: The degree of X-ray changes is indicated by the symbol (+). One (+) indicates a mild lesion, two (+) indicates a severe lesion, and three (+) indicates a severe lesion. B4. X-ray signs of active KBD
B4.1. Before the super-equal diameter stage, the metaphyseal early calcification band is slightly depressed, and the epiphyseal nucleus is skewed, the line is narrowed, or accompanied by trabecular structural disorder. B4.2. Before the equal diameter stage, the metaphyseal early calcification band is obviously depressed, presenting a "clear" shape without structure, and the depression exceeds 2.0mm. B4.3 Preliminary calcification of the stem with various forms of depression, sclerosis, accompanied by bone ends or changes in the epiphysis and carpal bones, and disordered trabecular structure.
B5 X-ray signs of inactive KBD
B5.1 Before the epiphysis isodiametric stage, the early calcification of the stem is depressed, showing a double-layer image in the repair period or a medium and uneven X-ray sign of sclerosis density.
B5.2 During the isodiametric stage, the depression and sclerosis of the early calcification of the stem are both less than 2.0mm. B5.3 Various X-ray signs of the bone ends without changes in the epiphysis before the isodiametric stage. B5.4 Various X-ray signs of the carpal bones without changes in the stem before the isodiametric stage. B5.5 Various X-ray signs of the bone ends after the stem is completely healed. Note: ① X-ray signs of active and inactive KBD are mainly applicable to children and adolescents whose epiphysis has not yet healed. ② For the judgment of the double-layer image in the repair period in B5.1, see the judgment standard for the prevention and treatment effect of Kaschin-Beck disease. Appendix C
Hematuria detection indicators, detection methods and judgment criteria (supplementary)
C1 Hematuria detection indicators
C1. 1 Blood detection indicators
Six enzyme activities of GOT, GPT, LDH, HBDH, -GT and CPK in serum. The activity unit of enzyme is expressed in international unit μkat/L. C1.2 Urine detection indicators
Excretion of creatine, hydroxyproline and mucopolysaccharide in urine. The units are expressed in μmol/L, μmol/L and μmol/L respectively. C2 Subjects
Children aged 7 to 14 years old.
C3 Detection method
C3.1 Determination of serum enzyme activity
Automatic biochemical analyzer determination.
C3.2 Determination of urinary creatine excretion
Piric acid colorimetric method.
C3.3 Determination of urinary hydroxyproline excretion
Chloramine T oxidation colorimetric method.
C3.4 Determination of urinary mucopolysaccharide excretion
Sulfuric acid-imidazole colorimetric method.
C4 Judgment criteria
GB16003-1995
C4.1 Reference values of blood and urine biochemical indicators in children with Kaschin-Beck disease are shown in Table C1. Table C1 Reference values of biochemical indices of blood and urine in children with Kaschin-Beck disease
α-HBDH
Urine creatine
Urine hydroxyproline
Urine mucopolysaccharide
μkat/L
μkat/L
μkat/L
μkat/L
μkat/L
μkat/L
μmol/L
μmol /L
C4.2 Criteria for determining biochemical changes in KBDa.
Active severe disease area
Non-disease point in disease area
Non-disease point
The blood and urine biochemical index values measured are less than or equal to the reference values of non-disease points, which is a negative biochemical change, recorded as (-); greater than or equal to the reference values of active severe disease areas, which is a positive biochemical change, recorded as (+); between the reference values of non-disease points and active severe disease areas, which is a suspected biochemical change, recorded as (+).
Children under examination with more than 4 of the 6 serum enzyme activities changed to (+) or more than 2 of the 3 urine index excretions changed to (+)b.
Can be determined to have blood or urine biochemical changes in KBD. Appendix D
Instructions for the correct use of the standard
(reference)
D1 This standard is applicable to the diagnosis of KBD cases in known KBD disease areas. D2 In unknown KBD disease areas, this standard also applies to children whose trunks have not completely healed and whose hands have multiple, symmetrical bone end changes on X-ray examination, and there are typical cases of degree 1 or above in the same residential area. D3 In known non-disease areas, this standard only applies to those with a history of contact with the disease area. D4 This disease should be differentiated from osteoarthritis, rheumatoid arthritis, osteoarthritis (OA), gout, scrotal disease, cretinism, familial short stature, primary dwarfism, metaphyseal bone development disorder, achondroplasia, pseudoosteogenesis imperfecta, multiple bone dysplasia and other short stature diseases without intellectual or sexual development disorders. 4701
Additional Notes:
GB16003-1995
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the KBD Research Institute of the China Endemic Disease Prevention and Control Research Center. The main drafters of this standard are Yang Jianbo, Wang Zhiwu, Liu Tangxian, and He Fenglan. The Ministry of Health has entrusted the China Endemic Disease Control and Prevention Research Center, a technical unit, to interpret this standard.
Active critically ill area
Non-disease point in the disease area
Non-disease point
The blood and urine biochemical index values measured are less than or equal to the reference value of the non-disease point, which is a negative biochemical change, recorded as (-); greater than or equal to the reference value of the active critically ill area, which is a positive biochemical change, recorded as (+); between the reference value of the non-disease point and the active critically ill area, which is a suspicious biochemical change, recorded as (+).
Children who have more than 4 of the 6 serum enzyme activities changed to (+) or more than 2 of the 3 urine index excretions changed to b.
(+) can be judged to have blood or urine biochemical changes of KBD. Appendix D
Instructions for the correct use of the standard
(reference)
D1 This standard is applicable to the diagnosis of KBD cases in known KBD areas. D2 In unknown KBD disease areas, this standard also applies to children whose trunks have not completely healed and whose hands have multiple, symmetrical bone end changes on X-ray examination, and there are typical cases of degree 1 or above in the same residential area. D3 In known non-disease areas, this standard only applies to those with a history of contact with the disease area. D4 This disease should be differentiated from osteoarthritis, rheumatoid arthritis, osteoarthritis (OA), gout, scrotal disease, cretinism, familial short stature, primary dwarfism, metaphyseal bone development disorder, achondroplasia, pseudoosteogenesis imperfecta, multiple bone dysplasia and other short stature diseases without intellectual or sexual development disorders. 4701
Additional Notes:
GB16003-1995
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the KBD Research Institute of the China Endemic Disease Prevention and Control Research Center. The main drafters of this standard are Yang Jianbo, Wang Zhiwu, Liu Tangxian, and He Fenglan. The Ministry of Health has entrusted the China Endemic Disease Control and Prevention Research Center, a technical unit, to interpret this standard.
Active critically ill area
Non-disease point in the disease area
Non-disease point
The blood and urine biochemical index values measured are less than or equal to the reference value of the non-disease point, which is a negative biochemical change, recorded as (-); greater than or equal to the reference value of the active critically ill area, which is a positive biochemical change, recorded as (+); between the reference value of the non-disease point and the active critically ill area, which is a suspicious biochemical change, recorded as (+).
Children who have more than 4 of the 6 serum enzyme activities changed to (+) or more than 2 of the 3 urine index excretions changed to b.
(+) can be judged to have blood or urine biochemical changes of KBD. Appendix D
Instructions for the correct use of the standard
(reference)
D1 This standard is applicable to the diagnosis of KBD cases in known KBD areas. D2 In unknown KBD disease areas, this standard also applies to children whose trunks have not completely healed and whose hands have multiple, symmetrical bone end changes on X-ray examination, and there are typical cases of degree 1 or above in the same residential area. D3 In known non-disease areas, this standard only applies to those with a history of contact with the disease area. D4 This disease should be differentiated from osteoarthritis, rheumatoid arthritis, osteoarthritis (OA), gout, scrotal disease, cretinism, familial short stature, primary dwarfism, metaphyseal bone development disorder, achondroplasia, pseudoosteogenesis imperfecta, multiple bone dysplasia and other short stature diseases without intellectual or sexual development disorders. 4701
Additional Notes:
GB16003-1995
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the KBD Research Institute of the China Endemic Disease Prevention and Control Research Center. The main drafters of this standard are Yang Jianbo, Wang Zhiwu, Liu Tangxian, and He Fenglan. The Ministry of Health has entrusted the China Endemic Disease Control and Prevention Research Center, a technical unit, to interpret this standard.
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