Expert consensus on prevention and treatment strategies for osteonecrosis of femoral head during the prevention and control of novel coronavirus pneumonia (2020)_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

Bone Circulation and Osteonecrosis Professional Committee, Shockwave Medical Specialty Committee of Chinese Research Hospital Association

Corresponding author：

Bone Circulation and Osteonecrosis Professional Committee, Shockwave Medical Specialty Committee of Chinese Research Hospital Association, Email:

Keywords：

Novel coronavirus pneumonia; osteonecrosis of femoral head; disease prevention and control; expert consensus

DOI：

10.7507/1002-1892.202003068

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Novel coronavirus pneumonia is a new type of respiratory infectious disease that has rapidly spread in many countries or regions around the world. The World Health Organization (WHO) named it “coronavirus disease 2019 (COVID-19)”. Glucocorticoids (GC) have certain application value in patients with COVID-19, but they need to be used with caution and strict indications and dosage. Application of large doses of GC can also cause osteonecrosis of femoral head (ONFH). On the basis of the latest literature and evidence-based medical evidence on the fight against COVID-19 epidemic and steroid ONFH diagnosis and treatment, the Bone Circulation and Osteonecrosis Professional Committee, Shockwave Medical Specialty Committee of Chinese Research Hospital Association organized Chinese bone necrosis related experts to jointly write this consensus, focusing on the prevention strategy and the protective management measures in the ONFH diagnosis and treatment process during the prevention and control of COVID-19, which can provide reference for hospitals at all levels to carry out early prevention and treatment of ONFH.

Citation： Bone Circulation and Osteonecrosis Professional Committee, Shockwave Medical Specialty Committee of Chinese Research Hospital Association. Expert consensus on prevention and treatment strategies for osteonecrosis of femoral head during the prevention and control of novel coronavirus pneumonia (2020). Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(8): 1031-1035. doi: 10.7507/1002-1892.202003068 Copy

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4.	Griffith JF, Antonio GE, Kumta SM, et al. Osteonecrosis of hip and knee in patients with severe acute respiratory syndrome treated with steroids. Radiology, 2005, 235(1): 168-175.
5.	陈卫衡, 张强, 刘道兵, 等. SARS 并发股骨头坏死的发病特点分析及临床意义. 中国骨伤, 2004, 17(7): 388-390.
6.	Fink B, Degenhardt S, Paselk C, et al. Early detection of avascular necrosis of the femoral head following renal transplantation. Arch Orthop Trauma Surg, 1997, 116(3): 151-156.
7.	Shigemura T, Nakamura J, Kishida S, et al. Incidence of osteonecrosis associated with corticosteroid therapy among different underlying diseases: prospective MRI study. Rheumatology (Oxford), 2011, 50(11): 2023-2028.
8.	Auyeung TW, Lee JSW, Lai WK, et al. The use of corticosteroid as treatment in SARS was associated with adverse outcomes: a retrospective cohort study. J Infect, 2005, 51(2): 98-102.
9.	Lee N, Allen Chan KC, Hui DS, et al. Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients. J Clin Virol, 2004, 31(4): 304-309.
10.	Arabi YM, Mandourah Y, Al-Hameed F, et al. Corticosteroid therapy for critically Ill patients with middle east respiratory syndrome. Am J Resp Crit Care Med, 2018, 197(6): 757-767.
11.	Alfaraj SH, Al-Tawfiq JA, Assiri AY, et al. Clinical predictors of mortality of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: a cohort study. Travel Med Infect Dis, 2019, 29: 48-50.
12.	Moreno G, Rodríguez A, Reyes LF, et al. Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study. Inte Care Med, 2018, 44(9): 1470-1482.
13.	Cao B, Gao H, Zhou B, et al. Adjuvant corticosteroid treatment in adults with influenza a (H7N9) viral pneumonia. Crit Care Med, 2016, 44(6): e318-328.
14.	Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet, 2020. doi: 10.1016/S0140-6736(20)30317-2.
15.	倪忠, 罗凤鸣, 王吉梅, 等. 针对新型冠状病毒感染患者的雾化吸入治疗的建议. 中国呼吸与危重监护杂志, 2020, 19(2): 120-124.
16.	刘朝晖, 李子荣, 张念非, 等. SARS 后双侧股骨头坏死进展前瞻性分析. 中国骨与关节损伤杂志, 2010, 25(10): 889-893.
17.	李子荣, 孙伟, 屈辉, 等. 皮质类固醇与骨坏死关系的临床研究. 中华外科杂志, 2005, 43(16): 1048-1053.
18.	Oinuma K, Harada Y, Nawata Y, et al. Osteonecrosis in patients with systemic lupus erythematosus develops very early after starting high dose corticosteroid treatment. Ann Rheum Dis, 2001, 60(12): 1145-1148.
19.	李子荣. 股骨头坏死: 早期诊断与个体化治疗. 中国矫形外科杂志, 2013, 21(19): 1909-1911.
20.	李子荣. 股骨头坏死临床诊疗规范 (2015 年版). 中华关节外科杂志 (电子版), 2015, 9(1): 133-138.
21.	Mont MA, Cherian JJ, Sierra RJ, et al. Nontraumatic osteonecrosis of the femoral head: Where do we stand today? A ten-year update. J Bone Joint Surg (Am), 2015, 97(19): 1604-1627.
22.	何伟. 精确诊断前提下股骨头坏死非手术治疗实践. 临床外科杂志, 2017, 25(8): 580-582.
23.	吴巍, 关邯峰, 方忠, 等. 新型冠状病毒肺炎疫情期骨科诊疗的规范化流程建议. 骨科, 2020, 11(2): 93-99.
24.	Zhao D, Zhang F, Wang B, et al. Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version). Journal of Orthopaedic Translation, 2020. doi: org/10.1016/j.jot.2020.01.009.
25.	李子荣. 2015 年股骨头坏死中国分期与分型解读. 临床外科杂志, 2017, 25(8): 565-568.
26.	李子荣, 刘朝晖, 孙伟, 等. 基于三柱结构的股骨头坏死分型——中日友好医院分型. 中华骨科杂志, 2012, 32(6): 515-520.
27.	中华中医药学会. 股骨头坏死中医辨证标准 (2019 年版). 中医正骨, 2019, 31(6): 1-2.

1. 国家卫生健康委员会.《新型冠状病毒肺炎诊疗方案(试行第七版)》. http://www.nhc.gov.cn/yzygj/s7652m/202003/a31191442e29474b98bfed5579d5af95.shtml.
2. 赵建平, 胡轶, 杜荣辉, 等. 新型冠状病毒肺炎糖皮质激素使用的建议. 中华结核和呼吸杂志, 2020, 43. doi: 10.3760/cma.j.issn.1001-0939.2020.0007.
3. Chen R, Tang X, Tan Y, et al. Treatment of severe acute respiratory syndrome with glucosteroids: the Guangzhou experience. Chest, 2006, 129(6): 1441-1452.
4. Griffith JF, Antonio GE, Kumta SM, et al. Osteonecrosis of hip and knee in patients with severe acute respiratory syndrome treated with steroids. Radiology, 2005, 235(1): 168-175.
5. 陈卫衡, 张强, 刘道兵, 等. SARS 并发股骨头坏死的发病特点分析及临床意义. 中国骨伤, 2004, 17(7): 388-390.
6. Fink B, Degenhardt S, Paselk C, et al. Early detection of avascular necrosis of the femoral head following renal transplantation. Arch Orthop Trauma Surg, 1997, 116(3): 151-156.
7. Shigemura T, Nakamura J, Kishida S, et al. Incidence of osteonecrosis associated with corticosteroid therapy among different underlying diseases: prospective MRI study. Rheumatology (Oxford), 2011, 50(11): 2023-2028.
8. Auyeung TW, Lee JSW, Lai WK, et al. The use of corticosteroid as treatment in SARS was associated with adverse outcomes: a retrospective cohort study. J Infect, 2005, 51(2): 98-102.
9. Lee N, Allen Chan KC, Hui DS, et al. Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients. J Clin Virol, 2004, 31(4): 304-309.
10. Arabi YM, Mandourah Y, Al-Hameed F, et al. Corticosteroid therapy for critically Ill patients with middle east respiratory syndrome. Am J Resp Crit Care Med, 2018, 197(6): 757-767.
11. Alfaraj SH, Al-Tawfiq JA, Assiri AY, et al. Clinical predictors of mortality of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: a cohort study. Travel Med Infect Dis, 2019, 29: 48-50.
12. Moreno G, Rodríguez A, Reyes LF, et al. Corticosteroid treatment in critically ill patients with severe influenza pneumonia: a propensity score matching study. Inte Care Med, 2018, 44(9): 1470-1482.
13. Cao B, Gao H, Zhou B, et al. Adjuvant corticosteroid treatment in adults with influenza a (H7N9) viral pneumonia. Crit Care Med, 2016, 44(6): e318-328.
14. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet, 2020. doi: 10.1016/S0140-6736(20)30317-2.
15. 倪忠, 罗凤鸣, 王吉梅, 等. 针对新型冠状病毒感染患者的雾化吸入治疗的建议. 中国呼吸与危重监护杂志, 2020, 19(2): 120-124.
16. 刘朝晖, 李子荣, 张念非, 等. SARS 后双侧股骨头坏死进展前瞻性分析. 中国骨与关节损伤杂志, 2010, 25(10): 889-893.
17. 李子荣, 孙伟, 屈辉, 等. 皮质类固醇与骨坏死关系的临床研究. 中华外科杂志, 2005, 43(16): 1048-1053.
18. Oinuma K, Harada Y, Nawata Y, et al. Osteonecrosis in patients with systemic lupus erythematosus develops very early after starting high dose corticosteroid treatment. Ann Rheum Dis, 2001, 60(12): 1145-1148.
19. 李子荣. 股骨头坏死: 早期诊断与个体化治疗. 中国矫形外科杂志, 2013, 21(19): 1909-1911.
20. 李子荣. 股骨头坏死临床诊疗规范 (2015 年版). 中华关节外科杂志 (电子版), 2015, 9(1): 133-138.
21. Mont MA, Cherian JJ, Sierra RJ, et al. Nontraumatic osteonecrosis of the femoral head: Where do we stand today? A ten-year update. J Bone Joint Surg (Am), 2015, 97(19): 1604-1627.
22. 何伟. 精确诊断前提下股骨头坏死非手术治疗实践. 临床外科杂志, 2017, 25(8): 580-582.
23. 吴巍, 关邯峰, 方忠, 等. 新型冠状病毒肺炎疫情期骨科诊疗的规范化流程建议. 骨科, 2020, 11(2): 93-99.
24. Zhao D, Zhang F, Wang B, et al. Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version). Journal of Orthopaedic Translation, 2020. doi: org/10.1016/j.jot.2020.01.009.
25. 李子荣. 2015 年股骨头坏死中国分期与分型解读. 临床外科杂志, 2017, 25(8): 565-568.
26. 李子荣, 刘朝晖, 孙伟, 等. 基于三柱结构的股骨头坏死分型——中日友好医院分型. 中华骨科杂志, 2012, 32(6): 515-520.
27. 中华中医药学会. 股骨头坏死中医辨证标准 (2019 年版). 中医正骨, 2019, 31(6): 1-2.

Chinese Journal of Reparative and Reconstructive Surgery

Expert consensus on prevention and treatment strategies for osteonecrosis of femoral head during the prevention and control of novel coronavirus pneumonia (2020)

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