吲哚菁绿近红外荧光成像技术在颌骨放射性骨坏死术中坏死骨质界定中的应用  

Application of indocyanine green in near-infrared fluorescence imaging to detect necrotic bone associated with osteoradionecrosis of the jaws

作　　者：康梓钦 王岳鹏 何奕霖 蔡永康 黄志权[1] KANG Ziqin;WANG Yuepeng;HE Yilin;CAI Yongkang;HUANG Zhiquan(De-partment of Oral and Maxillofacial Surgery,Sun Yat-sen Memorial Hospital,Sun Yatsen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院口腔颌面外科,广东广州510120

出　　处：《口腔疾病防治》2023年第6期408-413,共6页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：广东省自然科学基金面上项目(2019A1515011932);广州市科技计划项目(202103000093)。

摘　　要：目的 探讨吲哚菁绿近红外荧光成像技术在颌骨放射性骨坏死术中界定颌骨切除范围的可行性,为临床医生提供参考。方法 下颌骨放射性骨坏死患者8例,术中截骨前10 min经肘静脉注射吲哚菁绿,术中以影像学结果为主要依据对坏死骨病灶行保守性切除后,再以0.3 cm为初始距离逐步扩大低荧光强度区域的潜在死骨切除范围,扩大切除范围前后行骨截面近红外荧光成像和荧光强度测定,分析统计学差异。所有骨坏死患者术后均进行定期随访以评估疗效。结果 8例颌骨放射性骨坏死患者均获得清晰的吲哚菁绿近红外荧光图像,扩大下颌骨切除范围(0.95±0.14)cm的新鲜骨创面荧光强度为(226.2±15.8)au,高于基于术中肉眼观察和影像学结果的切除创面(108.8±3.4)au(t=20.718,P<0.001)。8例患者术后随访好转率达87.5%。结论 吲哚菁绿近红外荧光成像技术可辅助加强清除病变颌骨直到颌骨创面新鲜出血,对颌骨放射性骨坏死患者术中界定切除范围具有重要的临床价值。Objective To investigate the application of indocyanine green in near-infrared fluorescence imaging to determine the scope of necrotic bone resection in osteoradionecrosis of the jaw and to provide a reference for clinicians.Methods Eight patients with osteoradionecrosis of the jaws were enrolled.Indocyanine green was intravenously injected through the elbow vein 10 minutes before osteotomy.After conservative resection of necrotic bone lesions based on imaging results,the scope of potential dead bone resection in the area of low fluorescence intensity was gradually expanded at an initial distance of 0.3 cm.Near-infrared fluorescence imaging and fluorescence intensity determination of bone cross-section were performed before and after extended resection.Statistical differences were analyzed.All patients with osteonecrosis underwent regular follow-up to evaluate the postoperative efficacy.Results Indocyanine green was injected into all 8 patients with osteoradionecrosis for near-infrared fluorescence imaging and the scans were clear;the fluorescence intensity of fresh bone wounds with an expanded mandibular resection range of(0.95 ± 0.14) cm was(226.2 ± 15.8) au,which was higher than that based on intraoperative macroscopic observation and radiological results(108.8 ± 3.4) au,(t = 20.718,P<0.001).The postoperative follow-up improvement rate of 8 patients was 87.5%.Conclusion Near-infrared fluorescence imaging with indocyanine green can assist in the successful removal of necrotic bone until fresh bleeding of the jaw wound occurs,which has important clinical value in defining the resection range of osteoradionecrosis of the jaw.

关 键 词：放射性骨坏死 坏死骨 截骨术 吲哚菁绿 近红外荧光成像 荧光强度 新鲜骨创面 

分 类 号：R78[医药卫生—口腔医学]