中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2022, Vol. 20 ›› Issue (1): 72-76.doi: 10.19438/j.cjoms.2022.01.014

• 临床总结 • 上一篇    下一篇

127例药物性颌骨坏死患者回顾性分析：单中心10年经验总结

胡龙威1,*, 颜然2,*, 文晋2, 张陈平1, 赵小妹1#, 李思毅1#   

  1. 1.上海交通大学医学院附属第九人民医院 口腔颌面-头颈肿瘤科,上海交通大学口腔医学院,上海 200011;
    2.国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海 200011
  • 收稿日期:2021-05-06 修回日期:2021-09-18 出版日期:2022-01-20 发布日期:2022-01-20
  • 通讯作者: 李思毅,E-mail：dr.lisiyi@hotmail.com;赵小妹,E-mail: zhxm58327107@126.com。#共同通信作者
  • 作者简介:胡龙威（1991-）, 男, 博士研究生, E-mail：handsomelong@163.com;颜然(1995-),女, 硕士研究生,E-mail：462013842@qq.com。*并列第一作者
  • 基金资助:
    九院基础研究助推计划（JYZZ157）; 口腔颌面外科学系研究助力基金

Retrospective analysis of 127 cases of medication related osteonecrosis of the jaw: a summary of 10 years' experience in a single center

HU Long-wei1, YAN Ran2, WEN Jin2, ZHANG Chen-ping1, ZHAO Xiao-mei1, LI Si-yi1   

  1. 1. Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shangahi Jiao Tong University. Shanghai 200011;
    2. National Center of Stomatology, National Center for Clinical Research of Oral Diseases, Shanghai Key Laboratory of Stomatology. Shanghai 200011, China
  • Received:2021-05-06 Revised:2021-09-18 Online:2022-01-20 Published:2022-01-20

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摘要： 目的: 总结分析药物性颌骨坏死（MRONJ）的临床特征,为其诊治提供参考。方法: 回顾2008年1月—2018年6月上海交通大学医学院附属第九人民医院收治的MRONJ患者共127例,按照2014年美国口腔颌面外科医师协会制定的有关MRONJ的诊断标准及分类方法,分析MRONJ发生的诱因,危险因素与好发部位,患者手术情况、效果及预后。结果: 127例患者中,93例（73.23%）发生于下颌骨,30例（23.62%）发生于上颌骨,4例（3.15%）上、下颌骨同时发生。MRONJ诱因中,98例（77.17%）因颌骨局部创伤（拔牙、种植牙、牙自行脱落）导致。MRONJ分期中,0期6例（4.72%）,1期13例（10.24%）,2期80例（62.99%）,3期28例（22.05%）。MRONJ治疗方法,0期及1期患者均接受局部切除（骨髓炎刮治、死骨摘除、颌骨部分切除）;2期71例接受局部切除,8例行颌骨节段切除,1例行颌骨节段切除并同期游离皮瓣重建修复;3期17例接受局部切除,9例行颌骨节段切除,2例行颌骨节段切除并同期游离皮瓣修复。MRONJ预后,0期及1期各3例复发,2期24例复发,3期11例复发。结论: MRONJ好发于下颌骨,拔牙是MRONJ发生最常见的诱因。MRONJ病情复杂,局部刮除容易复发。

关键词: 药物性颌骨坏死, 唑来膦酸, 拔牙

Abstract: PURPOSE: This study aimed to provide better diagnosis and treatment of medication related osteonecrosis of the jaw (MRONJ) by analyzing the clinical data retrospectively. METHODS: A total of 127 MRONJ cases surgically treated from January 2008 to June 2018 at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were enrolled. According to the diagnostic criteria and classification proposed by American Association of Oral and Maxillofacial Surgeons in 2014, the cause, risk factors and predilection site of MRONJ were analyzed and the treatment methods, therapeutic effects and prognosis were evaluated. RESULTS: Ninety-three cases(73.23%) occurred in mandible, thirty cases (23.62%) occurred in maxilla, four cases (3.15%) occurred in both maxilla and mandible. Trauma was the main cause of MRONJ, ninety-eight cases (77.17%) of MRONJ occurred due to trauma including tooth extraction, dental implantation and tooth exfoliation. Six cases (4.72%) were classified as stage 0,thirteen cases (10.24%) as stage Ⅰ, eighty cases (62.99%) as stage Ⅱ, twenty-eight cases (22.05%) as stage Ⅲ. In both stage 0 and stage Ⅰ, all the cases received conservative surgical methods including curettage of osteomyelitis, partial mandibulectomy and debridement. In stage Ⅱ, seventy-one cases received conservative surgical methods, eight cases received segmental mandibulectomy, one case received simultaneously free flap reconstruction after mandibulectomy. In stage Ⅲ, seventeen cases received conservative surgical methods, nine cases received segmental mandibulectomy, two cases received simultaneously free flap reconstruction after mandibulectomy. Three cases had relapse in both stage 0 and stage Ⅰ. Twenty-four cases had relapse in stage Ⅱ. Eleven cases relapsed in stage Ⅲ. CONCLUSIONS: MRONJ has a predilection to occur in mandible. Jaw trauma is the main cause. MRONJ is complicated and prone to relapse after partial resection.

Key words: Medication related osteonecrosis of the jaw, Bisphosphonate, Tooth extraction

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