Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics170710.17816/2311-2905-1707ReviewsОбзорыReviewsReview ArticleOsteonecrosis in Patients Recovering from COVID-19: Mechanisms, Diagnosis, and Treatment at Early-Stage Disease (Review)Остеонекроз у пациентов, перенесших COVID-19: механизмы развития, диагностика, лечение на ранних стадиях (обзор литературы)https://orcid.org/0000-0002-2789-6172TorgashinAlexander N.ТоргашинАлександр Николаевич
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук, старший научный сотрудник, врач травматолог-ортопед

dr.torgashin@gmail.comhttps://orcid.org/0000-0002-2726-8758RodionovaSvetlana S.РодионоваСветлана Семеновна
Russian Federation

Dr. Sci. (Med.), Professor, Scientific and Clinical Center for Osteoporosis

профессор, доктор медицинских наук, руководитель научно-клинического центра остеопороза, врач травматолог-ортопед

rod06@inbox.ruNational Medical Research Center for Traumatology and Orthopedics named after N.N. PriorovФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии им. Н.Н. Приорова» Минздрава России22022022150120222811281372311202115022022Copyright ©; 2022, Torgashin A.N., Rodionova S.S.Copyright ©; 2022, Торгашин А.Н., Родионова С.С.Copyright ©; 2022,2022Torgashin A.N., Rodionova S.S.Торгашин А.Н., Родионова С.С.https://creativecommons.org/licenses/by/4.0https://journal.rniito.org/jour/article/view/1707

Background. Aseptic bone necrosis (osteonecrosis), as a consequence of the ongoing coronavirus disease-2019 (COVID-19) pandemic, is increasingly becoming the cause of severe pain syndrome in the hip, knee, and shoulder joints with disruption of their function. The discussion of the pathogenesis of post-COVID-19 osteonecrosis, possibility of its diagnosis, and treatment at early stages continue. As COVID-19 affects young and able-bodied people, the diagnosis and treatment of this form of aseptic necrosis at early stages have great social and economic importance.

Methods. The literature search was conducted in the databases of eLIBRARY, PubMed, and Scopus. The search depth was 10 years. Selected publications were related to the early diagnosis and treatment of aseptic necrosis following COVID-19.

Results. The form of osteonecrosis that developed after COVID-19 should now be classified according to ICD-10 as M87.3 (another secondary osteonecrosis). The review provides data on the possible mechanisms of osteonecrosis development in patients who had COVID-19, explains the role of MRI for the early detection of the pathology, provides the results of treatment that can influence both pathogenesis mechanisms, and leads to disease regression if treatment was initiated at an early stage.

Conclusions. Improving the doctors’ awareness about the pathogenesis, diagnostic methods, and treatment of early disease stages will reduce the risk of developing an advanced stage of aseptic necrosis post-COVID-19, slow down the progression of the pathology, and delay or even prevent the need for joint replacement. Our concern is based on the continuation of the pandemic, the observed fact of the dramatic increase in the frequency of aseptic necrosis post-COVID-19, and the number of total arthroplasties in young and middle-aged people for aseptic necrosis of the femoral head.

Актуальность. Асептический некроз костей (остеонекроз) как следствие перенесенного COVID-19 в условиях продолжающейся пандемии все чаще становится причиной выраженного болевого синдрома в области крупных суставов с нарушением их функции. Продолжается обсуждение патогенеза постковидного остеонекроза, возможности его выявления и лечения на ранних стадиях. Учитывая масштаб распространенности инфекции COVID-19 среди лиц молодого и трудоспособного возраста, выявление и лечение этой формы асептического некроза на ранних стадиях имеет важное социальное и экономическое значение.

Материал и методы. Поиск литературы проведен в базах данных eLIBRARY, PubMed, Scopus. Глубина поиска — 10 лет. Отобраны публикации, касающиеся ранней диагностики и лечения асептического некроза после перенесенного COVID-19.

Результаты. Форму остеонекроза, развившегося после перенесенного COVID-19, в настоящее время следует классифицировать по МКБ-10 как M87.3 – другой вторичный остеонекроз. В обзоре приводятся данные о возможных механизмах развития остеонекроза у пациентов, перенесших СОVID-19, обосновывается необходимость выполнения МРТ для раннего выявления патологии, приводятся результаты лечения, способного оказывать влияние на оба механизма патогенеза и привести к обратному развитию процесса при условии начала лечения на ранней стадии заболевания.

Заключение. Повышение осведомленности врачей о патогенезе, методах диагностики и лечения ранних стадий позволит снизить риск развития запущенной стадии асептического некроза после перенесенного COVID-19, замедлит прогрессирование патологического процесса, отсрочит или даже предотвратит необходимость эндопротезирования суставов. Наша озабоченность основывается на продолжении пандемии и резко возросшей частоте асептического некроза после COVID-19, с одной стороны, и операций эндопротезирования у лиц молодого и среднего возраста по поводу асептического некроза головки бедренной кости, с другой стороны.

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