中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2026, Vol. 24 ›› Issue (5): 494-500.doi: 10.19438/j.cjoms.2026.05.009

• 论著 • 上一篇    下一篇

74例晚期上颌骨药物相关性骨坏死治疗策略的回顾性分析

吴朱昊1, 孙亚威1, 何金媛1, 李馥焰1, 许慧霞1, 曹婷1, 江晨曦1, 赵旭龙2,*, 孙国文1,*   

  1. 1.南京大学医学院附属口腔医院,南京市口腔医院 口腔颌面外科,南京大学口腔医学研究所,江苏 南京 210008;
    2.北京大学肿瘤医院内蒙古医院 口腔科,内蒙古 呼和浩特 010020
  • 收稿日期:2026-02-13 修回日期:2026-03-11 出版日期:2026-09-20 发布日期:2026-10-10
  • 通讯作者: 孙国文,E-mail: 238957@sina.com;赵旭龙,E-mail: 80214286@qq.com。*共同通信作者
  • 作者简介:吴朱昊（1996—）,男,硕士,E-mail: wuzhuhao1996@163.com

Retrospective analysis of treatment strategies for advanced medication-related osteonecrosis of the maxilla

Wu Zhuhao1, Sun Yawei1, He Jinyuan1, Li Fuyan1, Xu Huixia1, Cao Ting1, Jiang Chenxi1, Zhao Xulong2, Sun Guowen1   

  1. 1. Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University. Nanjing 210008, Jiangsu Province;
    2. Department of Stomatology, Inner Mongolia Hospital of Peking University Cancer Hospital. Hohhot 010020, Inner Mongolia Autonomous Region, China
  • Received:2026-02-13 Revised:2026-03-11 Online:2026-09-20 Published:2026-10-10

PDF (PC)

20

摘要： 目的：探讨晚期上颌骨药物相关性骨坏死（medication-related osseous necrosis of the jaw,MRONJ）的有效治疗策略及预后,为临床规范化诊疗提供参考。方法：回顾性分析2022年1月—2025年12月南京大学医学院附属口腔医院收治的74例Ⅱ期及Ⅲ期上颌骨MRONJ患者的临床资料。所有患者术前均采用葡萄糖酸氯己定含漱液与1%过氧化氢溶液交替漱口、光谱热疗及抗生素预处理,根据分期选择手术方式—43例Ⅱ期患者行上颌骨牙槽突切除术,31例Ⅲ期患者行上颌骨部分切除术、次全切除术或局麻下死骨切除术联合上颌窦开窗术,其中23例采用带蒂颊脂垫瓣联合双层软组织封闭技术修复缺损。术后定期随访,观察愈合情况及并发症。结果：74例患者随访时间3~48个月,平均25.8个月。接受全麻手术的68例患者中,65例（95.6%）黏膜完全愈合,临床症状消失且无新发死骨。术后仅3例出现不良结局,1例为单纯MRONJ复发,2例为单纯并发口腔上颌窦瘘,无术后复发且合并上颌窦瘘的病例。6例局麻手术患者疼痛缓解、骨髓炎症状改善,23例采用颊脂垫瓣修复者均成功封闭口腔上颌窦交通。结论：针对Ⅱ期及Ⅲ期上颌骨MRONJ患者,根据分期选择个性化手术方案（如牙槽突切除术、部分/次全上颌骨切除术等）,并联合颊脂垫瓣转移修复及双层缝合技术,可有效促进创面愈合,减少复发及并发症发生。

关键词: 上颌骨药物相关性骨坏死, 个性化手术方案, 颊脂垫瓣修复, 双层软组织封闭, 预后分析

Abstract: PURPOSE: To explore effective therapeutic strategies and prognosis for advanced medication-related osteonecrosis of the jaw (MRONJ) in the maxilla, and to provide evidence for standardized clinical management. METHODS: A retrospective analysis was performed on 74 patients with stage Ⅱ and Ⅲ maxillary MRONJ treated in Affiliated Hospital of Medical School, Nanjing University from January 2022 to December 2025. All patients received preoperative preparation including alternating mouth rinses with chlorhexidine gluconate and 1% hydrogen peroxide, systemic hyperthermia, and antibiotic prophylaxis. Surgical methods were selected according to the staging: 43 patients with stage Ⅱ underwent maxillary alveolectomy; 31 patients with stage Ⅲ underwent partial maxillectomy, subtotal maxillectomy, or local anesthesia-guided sequestrectomy combined with maxillary sinus fenestration. Among them, 23 cases were repaired with pedicled buccal fat pad flap combined with double-layer soft tissue closure technique. Postoperative regular follow-up was performed to observe wound healing and complications. RESULTS: The 74 patients were followed up for 3 to 48 months, with an average of 25.8 months. Among 68 patients undergoing surgery under general anesthesia, 65 cases (95.6%) achieved complete mucosal healing with resolution of clinical symptoms and absence of new sequestrum formation. Postoperatively, adverse outcomes were observed in only 3 cases: 1 case involved a simple recurrence of MRONJ, and 2 cases involved simple concurrent oral-maxillary sinus fistulas. No instances of postoperative recurrence combined with maxillary sinus fistula were reported. The 6 patients who underwent local anesthesia surgery experienced pain relief and improved osteomyelitis symptoms; all 23 cases repaired with buccal fat pad flap successfully closed the oroantral communication. CONCLUSIONS: For patients with stage Ⅱ and Ⅲ maxillary MRONJ, stage tailored surgical procedures (alveolectomy, partial or subtotal maxillectomy, etc.) combined with pedicled buccal fat pad flap transfer and double-layer closure can effectively promote wound healing, reduce recurrence, and lower the incidence of complications.

Key words: Maxillary medication-related osteonecrosis, Personalized surgical plan, Buccal fat pad flap repair, Double-layer soft tissue closure, Prognosis analysis

中图分类号: