使用唑来膦酸骨质疏松患者拔牙窝愈合的前瞻性研究  

Prospective study of tooth extraction socket healing in osteoporosis patients treated with zoledronic acid

作　　者：张非煜[1] 刘林 董坚[1] 左健[1] 矫杰[2] 殷戬[1] 吕亚林[1] ZHANG Fei-yu;LIU Lin;DONG Jian;ZUO Jian;JIAO Jie;YIN Jian;LV Ya-lin(Stomatology Department,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院口腔科,北京100029 [2]首都医科大学附属北京安贞医院内分泌科,北京100029

出　　处：《中华老年口腔医学杂志》2020年第5期269-274,共6页Chinese Journal of Geriatric Dentistry

基　　金：2014年首都医科大学基础临床合作研究课题(项目编号:14JL63)。

摘　　要：目的:探讨使用唑来膦酸对骨质疏松患者拔牙窝愈合的影响。方法:收集5年间在首都医科大学附属北京安贞医院内分泌科就诊的骨质疏松患者79人,按照是否使用唑来膦酸进行分组,两组患者都进行拔牙操作,选定拔牙后1周,拔牙后10周和拔牙后6个月为观察时间点,观察双膦酸盐相关骨坏死发生情况;观察拔牙后拔牙窝的软组织愈合、拔牙窝的骨质影像和拔牙后疼痛指数,并对观察结果进行统计学分析。结果:试验组发生一例唑来膦酸相关的颌骨坏死。两组的拔牙后疼痛指数没有统计学差异(P>0.05);拔牙后1周和10周,使用唑来膦酸的骨质疏松患者拔牙窝软组织愈合比不使用者差,具有统计学差异(P<0.05);拔牙后10周和拔牙后6月,使用唑来膦酸的骨质疏松患者拔牙窝骨组织愈合比不使用者差,也具有统计学差异(P<0.05)。结论:使用唑来膦酸的老年骨质疏松患者拔牙后骨组织愈合差,软组织愈合慢。为减低骨坏死风险,建议使用唑来膦酸之前先行口腔预防性治疗;拔牙遵循微创的原则,使用抗生素控制感染。Objective:A prospective clinical study of zoledronic acid-related jaw necrosis in patients with osteoporosis to investigate tooth extraction therapy in osteoporosis patients treated with zoledronic acid.Methods:We had Collected 79 osteoporotic patients needed exodontia at the Department of Endocrinology,Beijing An Zhen Hospital,Capital Medical University,for 5 years.The healing situation after exodontia of 45 osteoporotic patients undergone the treatment of zoledronic acid were in experiment group,and the healing situation after exodontia of 34 osteoporotic patients without the treatment of zoledronic acid were in control group.After exodontia,the alveolar sockets of all patients were evaluated at the times of 1 week after exodontia,10 weeks after exodontia and 6 months after exodontia.The occurrence of bisphosphonate-related osteonecrosis was observed.The soft tissue healing of the tooth extraction socket after tooth extraction,the bone image of the tooth extraction socket and the pain index after tooth extraction were observed.The healing of the two groups of patients was compared,and the observation results were statistically analyzed by chi-square test.Results:Soft tissue healing of extraction socket in osteoporotic patients treated with zoledronic acid was slower than those in patients not treated with zoledronic acid.Bone healing in osteoporotic patients treated with zoledronic acid was worse than that in patients who do not use it.Only one case of bisphosphonates related osteonecrosis in osteoporotic patients was observed.Conclusions:Only one osteonecrosis emerged after forty five exodontia cases in osteoporotic patients treated with zoledronic acid,but cautious tooth extraction and antibiotic prescription are necessary for the poor healing of soft tissue and bone tissue were observed in patients.

关 键 词：唑来膦酸 骨质疏松 双膦酸盐相关骨坏死 

分 类 号：R782.1[医药卫生—口腔医学]