下颌骨3期药物相关性颌骨坏死手术治疗的回顾性研究  

A retrospective study of surgical treatment of mandibular stage 3 medication-related osteonecrosis of the jaw

作　　者：宗春琳 陆金标 丁明超 刘义闻 田磊 ZONG Chunlin;LU Jinbiao;DING Mingchao;LIU Yiwen;TIAN Lei(State Key Laboratory of Military Stomatology&National Clinical Research Center for Oral Diseases&Shaanxi Clinical Research Center for Oral Diseases,Department of Oral and Maxillofacial Trauma and Orthognathic Surgery,The Third Hospital Affiliated of Air Force Military Medical University,710032 Xi'an,China)

机构地区：[1]军事口腔医学国家重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔疾病临床医学研究中心,空军军医大学学第三附属医院颌面创伤与正颌外科,西安710032

出　　处：《实用口腔医学杂志》2023年第3期329-334,共6页Journal of Practical Stomatology

基　　金：国家自然科学基金青年项目(编号:81903249);陕西省自然科学基础研究计划重点项目(编号:2022JZ-50)。

摘　　要：目的:探讨下颌骨3期药物相关性颌骨坏死(MRONJ)的手术治疗方式及疗效。方法:纳入手术治疗的下颌骨3期MRONJ患者54例,对其一般情况、手术情况等进行统计分析。结果:截骨方式包括节段性截骨术23例(42.59%)及边缘性截骨术31例(57.41%),术后随访0.5~2年。术后复发分别为2例(8.70%)和7例(22.58%)。对需行同期骨缺损重建的37例患者中,30例(81.08%)行重建板植入术、4例(10.81%)行血管化游离骨瓣移植术,3例未重建。重建板植入术伤口初期愈合率为80%,血管化游离骨瓣移植术远期骨愈合率为100%。结论:下颌骨3期MRONJ行节段性截骨术后复发率较低,同期行重建板植入术及血管化游离骨瓣移植术重建效果均可靠。Objective:To evaluate the surgical treatment effects of mandibular stage 3 medication-related osteonecrosis of the jaw(MRONJ).Methods:54 patients with stage 3 MRONJ underwent surgical treatment were included.The clinical information of the patients and surgical treatment results were retrospectively reviewed and analyzed.Results:23 patients(42.59%)were treated by mandibular segmental resection and 31 patients(57.41%)by marginal resection,the patients were followed up for 0.5-2 years,the postoperative recurrence was found in 2(8.70%)and 7(22.58%)patients of the cases respectively.Among the 37 cases who required simultaneous bone defect reconstruction,30 cases(81.08%)underwent reconstruction plate implantation,4 cases(10.81%)underwent vascularized free bone flap transplantation,and 3 cases did not undergo reconstruction.The initial wound healing rate of reconstruction plate implantation was 80%,and long-term mandibular bone healing was observed in all patients of vascularized free bone flap transplantation.Conclusion:The recurrence rate of mandibular stage 3 MRONJ using segmental resection is lower than that of marginal resection.Simultaneous reconstruction with reconstruction plate and vascularized free bone flap transplantation can achieve reliable results.

关 键 词：药物相关性颌骨坏死 血管化游离骨瓣移植术 重建板植入术 下颌骨节段性截骨术 下颌骨边缘性截骨术 

分 类 号：R782.2[医药卫生—口腔医学]