骨管技术在Ⅱ期下颌骨药物相关性颌骨坏死手术中的应用初探

doi:10.7518/hxkq.2024.2024133

摘要/Abstract

摘要：

目的探讨手术联合骨管技术在Ⅱ期下颌骨药物相关性颌骨坏死（MRONJ）治疗中的效果。方法纳入2020年6月—2023年6月期间21例行手术治疗的Ⅱ期下颌骨MRONJ患者，回顾分析患者的临床资料（性别、年龄、原发疾病、药物名称及给药方式、术前是否停药和预后）。其中男性14例，女性7例，发病时平均年龄为（68.33±10.74）岁。根据美国口腔颌面外科医师协会的指南对患者进行分期，纳入患者为Ⅱ期下颌骨MRONJ，治疗方式为颌骨部分切除术联合骨管技术，术中软组织无张力严密缝合。术后定期随访，并根据患者的临床表现及影像学检查等评价手术疗效。采用简版SF-12量表对所有患者进行术前和术后生活质量评价。结果本组患者共21例，术后随访8~38个月，17例患者黏膜愈合良好（80.95%），临床伴随症状消失，无新的死骨形成。患者术后生活质量评分［（83.62±5.90）分］显著高于术前［（63.67±4.70）分］（P<0.05）。结论手术联合骨管技术在较为难治的Ⅱ期MRONJ患者中是一种有效的治疗方法，成功率高。

关键词: 下颌骨, 药物相关性颌骨坏死, 手术治疗, 颌骨部分切除术

Abstract:

Objective This study aimed to explore the effect of surgery combined with bone perforation for treating stage Ⅱ medication-related osteonecrosis of the jaw (MRONJ). Methods A total of 21 patients with stage Ⅱ mandibular MRONJ who underwent surgical treatment from June 2020 to June 2023 were included in this study. Retrospective analysis was conducted on their clinical data, including gender, age, primary disease, drug name and administration method, pre-surgery drug cessation, and prognosis. The cohort comprised 14 males and 7 females, with an average age at onset of 68.33±10.74 years. According to the guidelines of the American Association of Oral and Maxillofacial Surgeons, the included patients had stage Ⅱ mandibular MRONJ. The treatment approach consisted of partial mandibulectomy combined with bone perforation techniques, ensuring tension-free suturing of soft tissues. Follow-up was performed regularly, and the curative effect was evaluated. The SF-12 health survey was used to assess the quality of life for all patients before and after surgery. Results A total of 21 patients were followed up for 8-38 months after surgery, and the mucosal healing of 17 patients was good (80.95%). The postoperative quality of life score (83.62±5.90) was significantly higher than that before operation (63.67±4.70, P<0.05). Conclusion Surgery combined with bone perforation technique is an effective treatment method with high success rate in refractory stage Ⅱ MRONT patients.

Key words: mandible, medication-related osteonecrosis of the jaw, surgical treatment, partial mandibulectomy

中图分类号:

R782.05

高娜, 田美, 孙亚威, 王丹妮, 孙国文. 骨管技术在Ⅱ期下颌骨药物相关性颌骨坏死手术中的应用初探[J]. 华西口腔医学杂志, 2024, 42(5): 629-635.

Gao Na, Tian Mei, Sun Yawei, Wang Danni, Sun Guowen. Application of bone perforation in the surgery of medication-related osteonecrosis of the jaw in stage Ⅱ[J]. West China Journal of Stomatology, 2024, 42(5): 629-635.

图/表 4

表 1

21例MRONJ患者的临床资料

序号	性别	年龄/ 岁	诱发因素	原发疾病	药物名称及给药方式	术前是否停药	随访时间/月	随访结果
1	女	82	拔牙史	骨质疏松	口服阿仑膦酸钠	未停药	35	黏膜完全愈合，伴随症状消失
2	男	63	拔牙史	膀胱癌	静脉注射唑来膦酸	未停药	38	术后2月左下后牙区反复肿痛， 33、34区骨质暴露
3	男	72	拔牙史	前列腺癌	静脉注射双膦酸盐类（具体不祥）	未停药	36	黏膜完全愈合，伴随症状消失
4	女	81	牙自行脱落史	乳腺癌	静脉注射唑来膦酸	停药	30	黏膜完全愈合，伴随症状消失
5	男	64	拔牙史	右肺癌	静脉注射唑来膦酸	未停药	28	黏膜完全愈合，伴随症状消失
6	男	73	拔牙史	肾恶性肿瘤	静脉注射唑来膦酸	未停药	26	黏膜完全愈合，伴随症状消失
7	男	65	无明显诱因	前列腺癌	静脉注射唑来膦酸	停药	20	黏膜完全愈合，伴随症状消失
8	男	36	无明显诱因	胸腺癌	静脉注射唑来膦酸	未停药	22	术后10月左下后牙区肿痛溢脓，死骨暴露
9	男	62	拔牙史	肺癌	静脉注射唑来膦酸、帕博利珠单抗和贝伐单抗	未停药	20	黏膜完全愈合，伴随症状消失
10	男	76	无明显诱因	肾恶性肿瘤	口服培唑帕尼片	未停药	18	黏膜完全愈合，伴随症状消失
11	男	73	拔牙史	前列腺癌	皮下注射醋酸戈舍瑞林	未停药	14	黏膜完全愈合，伴随症状消失
12	男	78	拔牙史	前列腺癌	皮下注射醋酸戈舍瑞林	停药	15	黏膜完全愈合，伴随症状消失
13	女	64	无明显诱因	肺癌	静脉注射唑来膦酸	未停药	12	术后半年左下后牙区肿痛，死骨暴露
14	男	79	拔牙史	前列腺癌	静脉注射唑来膦酸	未停药	13	术后8月左下后牙区肿痛明显，大面积死骨暴露
15	男	59	45、46残根	肺癌	静脉注射唑来膦酸	未停药	10	黏膜完全愈合，伴随症状消失
16	女	69	拔牙史	乳腺癌	静脉注射唑来膦酸	停药	10	黏膜完全愈合，伴随症状消失
17	女	82	拔牙史	骨质疏松	静脉注射双膦酸盐类（具体不祥）	停药	11	黏膜完全愈合，伴随症状消失
18	男	70	无明显诱因	恶性淋巴瘤	静脉注射唑来膦酸	未停药	10	黏膜完全愈合，伴随症状消失
19	男	70	拔牙史	肺癌	静脉注射唑来膦酸	未停药	9	黏膜完全愈合，伴随症状消失
20	女	58	拔牙史	乳腺癌	口服三苯氯胺	未停药	8	黏膜完全愈合，伴随症状消失
21	女	59	拔牙史	乳腺癌	静脉注射双膦酸盐类（具体不祥）	未停药	8	黏膜完全愈合，伴随症状消失

表 1

图 1

图 2

表 2

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