药物相关性颌骨坏死术后软组织创口闭合技术的临床研究进展  

Progress in clinical research on soft tissue wound closure after surgical treatment of medication-related osteonecrosis of the jaw

作　　者：李梦媛 郭玉兴[2] 张新华 Li Mengyuan;Guo Yuxing;Zhang Xinhua(School of Stomatology,Shanxi Medical University,Taiyuan 030001,China;Dept.of Oral and Maxillofacial Surgery,Peking University School and Hospital of Stomatology,Beijing 100081,China;Dept.of Stomatology,Jinzhong First People’s Hospital,Jinzhong 030600,China)

机构地区：[1]山西医科大学口腔医学院,太原030001 [2]北京大学口腔医学院·口腔医院口腔颌面外科,北京100081 [3]晋中市第一人民医院口腔科,晋中030600

出　　处：《国际口腔医学杂志》2025年第2期263-271,共9页International Journal of Stomatology

摘　　要：药物相关性颌骨坏死(MRONJ)是因治疗癌症和骨质疏松症等疾病使用抗骨吸收、抗血管生成等药物所致的一种严重的颌骨感染坏死性疾病,临床症状较重,发病率逐年增加,严重影响患者的生活质量。MRONJ的治疗原则尚未取得统一意见,目前多建议进行积极的手术治疗。目前临床手术重点主要集中在坏死骨的去除上,软组织创口的有效闭合尚未引起足够重视,术后口腔黏膜愈合不良、创口裂开、骨面暴露、反复感染等并发症较多,治疗效果较差。病变切除后软组织创口的有效处理是影响预后的关键步骤,已成为临床上的热点问题。本文总结了多种MRONJ术后软组织创口闭合技术,包括双层软组织缝合封闭技术、带蒂颊脂垫瓣、鼻唇瓣、下颌舌骨肌瓣和下颌下腺转位、颏下岛状瓣、游离皮瓣移植以及手术联合辅助治疗,就这些技术适用情况和优缺点的临床研究进展进行综述,以便为提高临床治疗效果提供参考。Medication-related osteonecrosis of the jaw(MRONJ)is a serious infection and necrotizing disease of the jaw.It is caused by the use of antiresorptive and anti-angiogenic drugs in the treatment of cancer,osteoporosis,and other diseases.MRONJ has serious clinical symptoms and an increasing yearly incidence,seriously affecting the quality of life of patients.No consensus regarding the treatment principle of MRONJ has not been reached.To date,active surgical treatment is recommended,but the surgical focus is mainly on the removal of necrotic bone.The effective closure of soft tissue wounds has not attracted enough attention,resulting in poor postoperative oral mucosal healing,wound dehiscence,bone surface exposure,repeated infection,and other complications,and the treatment effect is poor.Therefore,the effective management of soft tissue wounds after lesion resection is another key step affecting prognosis and has become a to-pic of great interest in clinical practice.This article summarizes various soft tissue wound closure techniques after MRONJ surgery,including double-layer soft tissue suture closure,pedicle buccal fat pad flap,nasolabial flap,mylohyoid flap and submandibular gland transposition,submental island flap,free skin flap transplantation,and surgical combined adjuvant therapy.This study discussed progress in clinical research on the applicability and advantages and disadvantages of these techniques to provide reference for improving the clinical treatment of MRONJ.

关 键 词：药物相关性颌骨坏死 双膦酸盐 颊脂垫 颏下动脉瓣 

分 类 号：R782[医药卫生—口腔医学]