华西口腔医学杂志 ›› 2021, Vol. 39 ›› Issue (3): 245-254.doi: 10.7518/hxkq.2021.03.001

• 专家论坛 •    下一篇

药物相关性颌骨坏死的发病机制及其防治

潘剑(), 刘济远   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院口腔颌面外科,成都 610041
  • 收稿日期:2020-09-02 修回日期:2021-04-08 出版日期:2021-06-01 发布日期:2021-05-26
  • 通讯作者: 潘剑 E-mail:jianpancn@163.com
  • 作者简介:潘剑,教授,博士研究生导师,医学博士,四川大学华西口腔医院口腔外科主任。国际牙医师学院委员(FICD)、中华口腔医学会牙及牙槽外科专委会副主任委员,口腔颌面外科专委会委员,四川省卫生健康委员会学术和技术带头人,四川省口腔医学会牙及牙槽外科专委会主任委员,口腔颌面外科专委会副主任委员,口腔全科专委会及口腔装备委员会常委,四川省医学会口腔专委会委员,四川省抗癌协会头颈肿瘤专委会委员。担任《华西口腔医学杂志》和《国际口腔医学杂志》常务编委,《中国口腔颌面外科杂志》编委。主持国家自然基金和省部级基金12项,发表学术论文80余篇,参编专著16部。从事口腔颌面外科临床、科研、教学与管理工作20余年。
  • 基金资助:
    四川省科技计划项目(2020YFS0182);四川大学华西口腔医院临床研究项目(LCYJ2019-1)

Mechanism, prevention, and treatment for medication-related osteonecrosis of the jaws

Pan Jian(), Liu Jiyuan   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2020-09-02 Revised:2021-04-08 Online:2021-06-01 Published:2021-05-26
  • Contact: Pan Jian E-mail:jianpancn@163.com
  • Supported by:
    Science and Technology Program of Sichuan Province(2020YFS0182);Clinical Research Program of West China Hospital of Stomatology, Sichuan University(LCYJ2019-1)

摘要:

药物相关性颌骨坏死(MRONJ)近年来发病率不断增高,目前认为其机制可能为骨重建抑制学说、血管生成抑制学说、口腔微生物感染学说、免疫抑制学说、细胞毒性、颌骨微裂纹形成及单核苷酸多态性等,但基于单机制进行防治效果均不理想。药物治疗前规范的口腔检查及相关疾病预处理,药物治疗期间定期口腔随访对MRONJ的预防具有重要意义。在MRONJ治疗过程中,准确判断其分期,根据指南进行标准化治疗的同时,也需考虑患者具体情况,进行个性化调整。本文将国内外最新相关研究及指南和四川大学华西口腔医院口腔颌面外科近年来对MRONJ诊治经验相结合,对其发病机制及防治策略展开阐述和讨论,供同行参考。

关键词: 药物相关性颌骨坏死, 机制, 预防, 诊断, 治疗

Abstract:

The morbidity rate of medication-related osteonecrosis of the jaws (MRONJ) increased rapidly in recent years. Thusfar, the mechanism of MRONJ has no consensus. The possible mechanisms may include bone remodeling inhibition theory, angiogenesis inhibition theory, oral microorganism infection theory, immunosuppression theory, cytotoxicity-targeted oral epithelial cells, microcrack formation of maxillary or mandibular bone, and single nucleotide polymorphism. However, the efficacy of prevention and treatment based on a single mechanism is not ideal. Routine oral examination before MRONJ-related drug treatment, treatment of related dental diseases, and regular oral follow-up during drug treatment are of great significance for the prevention of MRONJ. During the treatment of MRONJ, the stage of MRONJ must be determined accurately, treatment must be standardized in accordance with the guidelines, and personalized adjustments must be made considering the specific conditions of patients. This review aimed to combine the latest research and guidelines for MRONJ and the experiences on the treatment of MRONJ in the Maxillofacial Surgery Department of West China Hospital of Stomatology, Sichuan University, and discuss the strategies to improve the clinical process.

Key words: medication-related osteonecrosis of the jaws, mechanism, prevention, diagnosis, treatment

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