Za P, Papalia G F, Gregori P, Vasta S, Papalia R
Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
Musculoskelet Surg. 2025 Mar;109(1):1-7. doi: 10.1007/s12306-024-00854-w. Epub 2024 Aug 1.
Purpose SARS-CoV-2 is an RNA virus responsible for COVID-19 pandemic. Some authors described the set of persistent symptoms COVID-related as "Long-COVID Syndrome." Several cases of post-COVID-19 osteonecrosis (ON) are described. Our primary aim was to study the hypothetical correlation between SARS-CoV-2 infection and ON; our secondary aim was to understand if ON can be considered part of Long-COVID. Materials and methods We performed a systematic review following the Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) guidelines. Because COVID-19 is a recently described disease, we included all levels of evidence studies. We excluded studies lacking specification regarding the use of corticosteroids (CCS) and studies not related to COVID-19. The variables extracted were age, sex, risk factors, affected joints, signs and symptoms, magnetic resonance imaging (MRI) and X-ray features, histology, treatment of COVID-19, dose and duration of treatment with CCS, treatment of ON, follow-up, and treatment outcome. Results A total of 13 studies were included, involving 95 patients and 159 joints. Time between the diagnosis of COVID-19 and the onset of symptoms related to ON was 16 weeks on average. Time between the onset of symptoms and the MRI was 6 weeks. An average of 926.4 mg of prednisolone equivalent per patient were administered. On average, CCS were administered for 20.6 days. Conclusions Patients with a history of COVID-19 infection developed osteonecrosis prematurely and with a lower dose of CCS than usually reported in the literature. Symptoms of osteonecrosis occur within the interval of the period described as Long-COVID. Surgeons should not underestimate the persistence of arthralgia when a history of SARS-CoV-2 infection and use of CCS is reported.
目的 严重急性呼吸综合征冠状病毒2（SARS-CoV-2）是一种导致2019冠状病毒病大流行的RNA病毒。一些作者将与新冠相关的一系列持续症状描述为“长新冠综合征”。有几例新冠后骨坏死（ON）的病例被报道。我们的主要目的是研究SARS-CoV-2感染与ON之间的假设相关性；我们的次要目的是了解ON是否可被视为长新冠的一部分。材料和方法 我们按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行了系统评价。由于新冠是一种最近才被描述的疾病，我们纳入了所有证据水平的研究。我们排除了缺乏关于使用皮质类固醇（CCS）的具体说明的研究以及与新冠无关的研究。提取的变量包括年龄、性别、危险因素、受累关节、体征和症状、磁共振成像（MRI）和X线特征、组织学、新冠的治疗、CCS治疗的剂量和持续时间、ON的治疗、随访以及治疗结果。结果 共纳入13项研究，涉及95例患者和159个关节。新冠诊断与ON相关症状出现之间的平均时间为16周。症状出现与MRI检查之间的平均时间为6周。每位患者平均使用了926.4毫克泼尼松等效物。CCS平均使用20.6天。结论 有新冠感染史的患者过早发生骨坏死，且使用的CCS剂量低于文献中通常报道的剂量。骨坏死症状出现在被描述为长新冠的时间段内。当报告有SARS-CoV-2感染史和使用CCS时，外科医生不应低估关节痛的持续性。
