Zhang N-F, Li Z R, Wei H-Y, Liu Z-H, Hernigou P
Department of Orthopaedic Surgery, Center of Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China.
J Bone Joint Surg Br. 2008 Sep;90(9):1239-43. doi: 10.1302/0301-620X.90B9.20056.
Severe acute respiratory syndrome (SARS) is a newly described infectious disease caused by the SARS coronavirus which attacks the immune system and pulmonary epithelium. It is treated with regular high doses of corticosteroids. Our aim was to determine the relationship between the dosage of steroids and the number and distribution of osteonecrotic lesions in patients treated with steroids during the SARS epidemic in Beijing, China in 2003. We identified 114 patients for inclusion in the study. Of these, 43 with osteonecrosis received a significantly higher cumulative and peak methylprednisolone-equivalent dose than 71 patients with no osteonecrosis identified by MRI. We confirmed that the number of osteonecrotic lesions was directly related to the dosage of steroids and that a very high dose, a peak dose of more than 200 mg or a cumulative methylprednisolone-equivalent dose of more than 4000 mg, is a significant risk factor for multifocal osteonecrosis with both epiphyseal and diaphyseal lesions. Patients with diaphyseal osteonecrosis received a significantly higher cumulative methylprednisolone-equivalent dose than those with epiphyseal osteonecrosis. Multifocal osteonecrosis should be suspected if a patient is diagnosed with osteonecrosis in the shaft of a long bone.
严重急性呼吸综合征（SARS）是一种新发现的由SARS冠状病毒引起的传染病，该病毒侵袭免疫系统和肺上皮。其治疗采用常规大剂量皮质类固醇。我们的目的是确定2003年中国北京SARS疫情期间接受类固醇治疗的患者中，类固醇剂量与骨坏死病变的数量和分布之间的关系。我们确定了114名患者纳入研究。其中，43例发生骨坏死的患者接受的甲基泼尼松龙等效累积剂量和峰值剂量显著高于71例经MRI检查未发现骨坏死的患者。我们证实骨坏死病变的数量与类固醇剂量直接相关，且非常高的剂量、超过200 mg的峰值剂量或超过4000 mg的甲基泼尼松龙等效累积剂量是发生骨骺和骨干均有病变的多灶性骨坏死的重要危险因素。骨干骨坏死患者接受的甲基泼尼松龙等效累积剂量显著高于骨骺骨坏死患者。如果患者被诊断为长骨干骨坏死，则应怀疑有多灶性骨坏死。
