药物相关性颌骨坏死临床诊疗专家共识

doi:10.19438/j.cjoms.2023.04.001

中国口腔颌面外科杂志 ›› 2023, Vol. 21 ›› Issue (4): 313-325.doi: 10.19438/j.cjoms.2023.04.001

药物相关性颌骨坏死临床诊疗专家共识

何悦^1,*, 陈珩^1,*, 安金刚², 郭玉兴², 潘剑³, 田磊⁴, 刘冰⁵, 侯劲松⁶, 李劲松⁷, 蒋灿华⁸, 李萌宇⁹, 田臻¹⁰, 许洁¹¹, 朱凌¹², 孙长伏¹³, 郅克谦¹⁴, 瞿晴¹⁵, 宗春琳⁴, 孙晶晶¹⁰, 张志愿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,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,上海市口腔医学研究所,上海 200011;
2.北京大学口腔医院口腔颌面外科,北京 100081;
3.四川大学华西口腔医院口腔颌面外科,四川成都 610041;
4.空军军医大学口腔医院口腔颌面外科,陕西西安 710032;
5.武汉大学口腔医院口腔颌面外科,湖北武汉 430070;
6.中山大学光华口腔医学院附属口腔医院口腔颌面外科,广东广州 510055;
7.中山大学孙逸仙纪念医院口腔颌面外科,广东广州 510120;
8.中南大学湘雅医院口腔颌面外科,湖南长沙 410008;
9.复旦大学附属口腔医院口腔颌面外科,上海 200031;
10.上海交通大学医学院附属第九人民医院口腔病理科,11.感染科,12.影像科,上海 200011;
13.中国医科大学附属口腔医院口腔颌面-头颈外科,辽宁沈阳 110002;
14.青岛大学附属医院口腔颌面修复重建科,山东青岛 266003;
15.上海交通大学医学院附属瑞金医院肿瘤科,上海 200127

收稿日期:2023-03-28 修回日期:2023-04-20 出版日期:2023-07-20 发布日期:2023-08-16
通讯作者: 何悦,E-mail: william5218@126.com
作者简介:何悦（1973-）,男,教授,主任医师,博士研究生导师;陈珩（1995-）,女,博士研究生,E-mail: 739211733@qq.com。^*并列第一作者
基金资助:
国家自然科学基金（82173451）; 上海市科学技术委员会科研项目（21Y11903700）

Expert consensus on diagnosis and clinical management of medication-related osteonecrosis of the jaw

HE Yue¹, CHEN Heng¹, AN Jin-gang², GUO Yu-xing², PAN Jian³, TIAN Lei⁴, LIU Bing⁵, HOU Jin-song⁶, LI Jin-song⁷, JIANG Can-hua⁸, LI Meng-yu⁹, TIAN Zhen¹⁰, XU Jie¹¹, ZHU Ling¹², SUN Chang-fu¹³, ZHI Ke-qian¹⁴, QU Qing¹⁵, ZONG Chun-lin⁴, SUN Jing-jing¹⁰, ZHANG Zhi-yuan¹

1. Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology. Shanghai 200011;
2. Department of Oral and Maxillofacial Surgery, Peking University Hospital of Stomatology. Beijing 100081;
3. Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology. Chengdu 610041, Sichuan Province;
4. Department of Oral and Maxillofacial Surgery, School of Stomatology, Air Force Military Medical University. Xi'an 710032, Shaanxi Province;
5. Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Wuhan University. Wuhan 430070, Hubei Province;
6. Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University. Guangzhou 510055, Guangdong Province;
7. Department of Oral and Maxillofacial Surgery, Sun Yai-sen Memorial Hospital, Sun Yat-sen University. Guangzhou 510120, Guangdong Province;
8. Department of Oral and Maxillofacial Surgery, Xiangya Hospital,Central South University. Changsha 410078, Hunan Province;
9. Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Fudan University. Shanghai 200031;
10. Department of Oral Pathology, 11. Department of Infection, 12. Department of Imaging, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;
13. Department of Oromaxillofacial Head and Neck Surgery, School and Hospital of Stomatology, China Medical University. Shenyang 110001, Liaoning Province;
14. Department of Oral and Maxillofacial Repair and Reconstruction, Affiliated Hospital of Qingdao University. Qingdao 266003, Shandong Province;
15. Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200127, China

Received:2023-03-28 Revised:2023-04-20 Online:2023-07-20 Published:2023-08-16

摘要/Abstract

摘要： 药物相关性颌骨坏死（medication-related osteonecrosis of the jaw, MRONJ）是一种因治疗全身其他疾病需要使用抗骨吸收药物（双膦酸盐类药物等）、抗血管生成类药物、激素类药物等发生的颌骨坏死并发症,临床主要表现为局部红肿、疼痛、咀嚼障碍、面部软组织瘘管经久不愈、骨外露等,严重者可伴病理性骨折,严重影响患者生活质量及身心健康。迄今为止,国内对于MRONJ缺乏统一的分类、分期及相关治疗共识或指南,不同单位对于MRONJ的诊治水平参差不齐,缺乏统一、科学的诊疗标准及客观的疗效评价体系。为统一和规范MRONJ的诊疗标准,减少医疗资源浪费,提高治疗效果,国内MRONJ研究领域的专家经反复讨论,汇集全国12家著名医学院校及附属医院专家的诊治意见,同时借鉴和参考国内外近年来对MRONJ的研究成果与诊治经验,制订本专家共识,供相关临床医师参考。

关键词: 药物相关性颌骨坏死, 治疗指南, 专家共识

Abstract: Medication-related osteonecrosis of the jaw(MRONJ) is a complication caused by the application of anti-resorptive medications, angiogenesis inhibitors, hormones and other medications for the treatment of some systemic diseases. The clinical symptoms include swelling, pain, masticatory disorders, persistent fistula, bone exposure and even pathological fracture, which seriously affect the patients' quality of life. Domestically, there is a lack of consensus or guidelines on classification, staging and treatment of MRONJ, and different institutions make diagnosis and treatment plans empirically. In order to unify and standardize the diagnosis and treatment of MRONJ and improve the prognosis, an expert panel of MRONJ research from 12 famous domestic medical colleges and affiliated hospitals convened a meeting to discuss the diagnosis and treatment opinions of MRONJ. Meanwhile, consensus recommendations were also revised with a comprehensive literature review of the previous treatment experiences and research findings. Finally, this expert consensus was finished for clinical references.

Key words: Medication-related osteonecrosis of the jaw, Treatment guideline, Expert consensus

中图分类号:

R782

何悦, 陈珩, 安金刚, 郭玉兴, 潘剑, 田磊, 刘冰, 侯劲松, 李劲松, 蒋灿华, 李萌宇, 田臻, 许洁, 朱凌, 孙长伏, 郅克谦, 瞿晴, 宗春琳, 孙晶晶, 张志愿. 药物相关性颌骨坏死临床诊疗专家共识[J]. 中国口腔颌面外科杂志, 2023, 21(4): 313-325.

HE Yue, CHEN Heng, AN Jin-gang, GUO Yu-xing, PAN Jian, TIAN Lei, LIU Bing, HOU Jin-song, LI Jin-song, JIANG Can-hua, LI Meng-yu, TIAN Zhen, XU Jie, ZHU Ling, SUN Chang-fu, ZHI Ke-qian, QU Qing, ZONG Chun-lin, SUN Jing-jing, ZHANG Zhi-yuan. Expert consensus on diagnosis and clinical management of medication-related osteonecrosis of the jaw[J]. China J Oral Maxillofac Surg, 2023, 21(4): 313-325.

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药物相关性颌骨坏死临床诊疗专家共识

Expert consensus on diagnosis and clinical management of medication-related osteonecrosis of the jaw

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