Ploegmakers Danique J M, Zielman-Blokhuis Anna M, van Duijnhoven Hanneke J R, de Rooy Jacky W J, Geurts Alexander C H, Nonnekes Jorik
Radboudumc, Nijmegen: Afd. Revalidatie.
Contact: Anna M. Zielman-Blokhuis (
Ned Tijdschr Geneeskd. 2020 Sep 24;164:D5357.
COVID-19 patients admitted to the Intensive Care Unit may develop painful range of motion restrictions of the large joints due to heterotopic ossifications. Here we describe two patients who developed restricted and painful passive and active mobility of the hips, shoulders and elbows after mechanical ventilation because of respiratory failure due to COVID-19 pneumonia. Conventional radiography showed extensive heterotopic ossifications. Retrospectively, alkaline phosphatase levels were elevated. It is likely that local and systemic factors contribute to the development of heterotopic ossifications. Early diagnosis is important to provide complementary non-pharmacological interventions (gentle passive mobilization) and medication (non-steroidal anti-inflammatory drugs, such as indomethacin). If pain and limited joint mobility remain present, surgical removal of ectopic bone could be considered. Future trials are needed to systematically map the prevalence of heterotopic ossifications in COVID-19 patients who were admitted to the Intensive Care Unit, andto evaluate whether prophylactic treatment with non-steroidal anti-inflammatory drug is of relevance.
入住重症监护病房的新冠肺炎患者可能会因异位骨化而出现大关节活动范围疼痛受限。在此，我们描述两名患者，他们因新冠肺炎肺炎导致呼吸衰竭接受机械通气后，出现了髋部、肩部和肘部被动和主动活动受限及疼痛。传统X线摄影显示广泛的异位骨化。回顾性分析发现碱性磷酸酶水平升高。局部和全身因素可能促成异位骨化的发生。早期诊断对于提供补充性非药物干预（轻柔的被动活动）和药物治疗（非甾体类抗炎药，如吲哚美辛）很重要。如果疼痛和关节活动受限仍然存在，可以考虑手术切除异位骨。未来需要进行试验，以系统地查明入住重症监护病房的新冠肺炎患者异位骨化的发生率，并评估非甾体类抗炎药预防性治疗是否有意义。
