放射性颌骨坏死的术式选择及疗效评价  

Selection of operation and efficacy evaluation on radioactive osteomyelitis of jaws

作　　者：袁柱炫[1] 胡逢春[2] 王成[2] 侯劲松[2] 陶谦[2] 唐海阔[2] 

机构地区：[1]东莞市人民医院口腔科,523000 [2]中山大学光华口腔医学院·附属口腔医院,广东省口腔医学重点实验室

出　　处：《中华口腔医学研究杂志（电子版）》2014年第2期51-53,共3页Chinese Journal of Stomatological Research(Electronic Edition)

基　　金：广东省自然科学基金(S2012010008665)

摘　　要：目的探讨经济有效的治疗放射性颌骨坏死(RONJ)的手术方式。方法 77例RONJ根据颌骨坏死的范围、软组织条件选择不同治疗方式。方案1:骨坏死范围局限,牙龈及周围软组织无明显炎症的采用局部刮治或方块切除术;方案2:骨坏死范围较大、周围软组织炎症明显和(或)伴有明显纤维化的病例在控制炎症后,扩大切除同时行血管化游离复合组织瓣修复。结果 21例采用方案1,其中15例一期愈合、6例行二次刮治或方块切除;56例采用方案2,其中软组织条件较好的30例,22例一期愈合,5例延期愈合,3例发生骨组织瓣血管危象,经探查和再吻合后1例正常愈合,2例仍发生组织瓣坏死;软组织炎症明显或伴有局部组织明显纤维化26例中,7例出现骨组织瓣血管危象,探查和再吻合后5例正常,2例出现骨坏死,9例一期愈合,15例局部出现不同程度软组织感染坏死,延期愈合。结论局限性放射性颌骨坏死可采用刮治或方块切除;骨坏死范围较大、软组织条件较好的采用血管化游离组织瓣进行修复;软组织纤维化明显的失败率较高,临床使用时应综合多方因素考虑。Objective To explore the appropriate operation method of radioactive osteomyelitis of jaws （RONJ）. Method Seventy-seven cases were divided into 2 groups base on their extent of bone necrosis and condition of soft tissue , group 1 which is limited alveolar bone necrosis and limited soft tissue inflammation was treated with scaling or sequestrectomy; group 2 with extensive bone necrosis and severe inflammation or soft tissue fibrosis was treated with radical mandiblecotomy , and reconstruction with fibular myocutaneous flap. Results In group 1, 15 get primary healing, 6 need scaling or ostectomy twice or more; in group 2, 22 of 30 with comparatively favourable condition of soft tissue get primary healing, 5 get delay healing, 3 get vascular crisis, after exploration and anastomosis, 1 cases get primary healing, the other 2 get delay healing; while in the 26 case which soft tissue fibrosis, 9 get primary healing, 15 get delay healing, 2 graft get varying degrees necrosis. Conclusions RONJ with good condition of soft tissue could be treated with scaling or block resection; Extensive sequestrectomy in combination with immediate vascularized tissue grafts clearly improved the prognosis , however, it depends on the condition of the local soft and hard tissue .

关 键 词：放射性颌骨坏死 刮治术 复合组织瓣游离移植修复术 疗效评价 

分 类 号：R730.5[医药卫生—肿瘤]