药物相关性颌骨坏死的病因特点和临床治疗初探  

Preliminary study on the etiological characteristics and clinical treatment of medication-related osteonecrosis of the jaws

作　　者：侯伟 董肖婷 吴婷婷[1] 马雪芳 张新华[1] 侯春林 柳新华 Hou Wei;Dong Xiaoting;Wu Tingting;Ma Xuefang;Zhang Xinhua;Hou Chunlin;Liu Xinhua(Department of Oral and Maxillofacial Surgery,the First People′s Hospital of Jinzhong,Jinzhong Hospital Affiliated to Shanxi Medical University,Jinzhong 030600,China)

机构地区：[1]晋中市第一人民医院口腔颌面外科,山西医科大学附属晋中医院,030600

出　　处：《中华口腔医学杂志》2021年第7期659-664,共6页Chinese Journal of Stomatology

摘　　要：目的对17例药物相关性颌骨坏死患者的发病因素特点和临床治疗效果进行初步总结和分析。方法回顾2016年7月至2019年12月晋中市第一人民医院口腔颌面外科收治的17例药物相关性颌骨坏死患者临床资料,其中男性9例,女性8例,年龄(63.6±9.6)岁(43~82岁)。对其原发疾病、发病因素、发病部位、临床表现、治疗方法及效果进行随访至少1年,并进行描述性分析。结果原发疾病为恶性肿瘤者12例,骨质疏松5例;诱因为拔牙者11例,自发4例,不良可摘义齿2例;发病部位位于上颌骨6例,下颌骨10例,上、下颌骨同时累及1例。17例患者均使用抗坏死类药物,其中单独皮下注射地舒单抗1例,静脉使用双膦酸盐16例,其中5例患者同时口服抑制血管生成药物;给药时间为(10.1±3.9)个月(3~18个月)。手术治疗17例,15例患者的创口一期愈合,2例患者于术后8个月再次出现颌骨暴露,行第二次手术治疗后创口愈合。结论拔牙为药物相关性颌骨坏死的最常见诱因,下颌骨多于上颌骨,采取合适的手术治疗可达到较好的临床治疗效果。Objective To summarize the etiological characteristics and clinical treatment effects of 17 patients with medication-related osteonecrosis of the jaw(MRONJ).Methods The clinical data of 17 patients with MRONJ admitted to the Department of Oral and Maxillofacial Surgery,the First People′s Hospital of Jinzhong,Shanxi Province,from July 2016 to December 2019 were retrospectively analyzed,including 9 males and 8 females,aged(63.6±9.6)years old(43-82 years old).Descriptive analysis of the primary disease,onset factors,site of disease,clinical manifestations,treatment methods,and treatment effects was conducted through follow-up for at least 1 year.Results Among the primary diseases of the 17 cases,12 were malignant tumors,and 5 were osteoporosis.There were 13 cases with a history of a trigger event(tooth extraction or unsuited removable denture).Six cases occurred in the maxilla,10 cases occurred in the mandible,and 1 case involved both the upper and lower jaws.For the most common medication used,bisphosphonate was used in 16 cases including 5 cases with concomitant use of angiogenesis-inhibiting drugs.There was 1 case resulted from receptor activator of NF-κB ligand(RANKL)monoclonal antibody application.The duration of medication application was(10.1±3.9)months(3-18 months).All 17 cases were treated surgically.Totally 15 patients healed well after surgical treatment and the other 2 patients,who had poor soft tissue healing after surgery,healed well after a second operation.Conclusions Tooth extraction might be a major trigger factor for the onset of MRONJ in the mandible.The disease was more possibly occured in the mandible than in the maxilla.Appropriate surgical treatment could achieve a good clinical outcome.

关 键 词：骨坏死 药物相关性颌骨坏死 发病因素 临床表现 手术治疗 

分 类 号：R782.4[医药卫生—口腔医学]