关于接受地舒单抗治疗患者拔牙围手术期管理的专家共识

doi:10.7518/hxkq.2026.2025418

华西口腔医学杂志 ›› 2026, Vol. 44 ›› Issue (2): 153-172.doi: 10.7518/hxkq.2026.2025418

• 专家共识 •

关于接受地舒单抗治疗患者拔牙围手术期管理的专家共识

叶立¹(), 曹钰彬¹, 孙国文², 薛洋³, 崔念晖⁴, 蔡育⁵, 邹多宏⁶, 唐海阔⁷, 胡延佳⁸, 罗婷⁹, 孙蕾¹⁰, 龚忠诚¹¹, 朱赴东¹², 张富贵¹³, 游梦¹⁴, 郭玉兴⁴, 王予江¹⁵, 王了¹, 陈松龄¹⁶, 韩冰¹⁷, 张伟², 周青¹⁸, 何悦¹⁹, 赵吉宏⁵, 胡开进²⁰, 刘磊¹, 刘济远¹, 潘剑¹()

^1.口腔疾病防治全国重点实验室国家口腔医学中心口腔疾病国家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
^2.南京大学医学院附属口腔医院，南京市口腔医院，南京大学口腔医学研究所，南京 210008
^3.口颌系统重建与再生全国重点实验室，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，空军军医大学口腔医院口腔颌面外科，西安 710032
^4.北京大学口腔医学院·口腔医院口腔颌面外科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，口腔数字医学北京市重点实验室，北京 100081
^5.武汉大学附属口腔医院口腔颌面外科，武汉 430079
^6.上海交通大学医学院附属第九人民医院口腔外科，上海交通大学口腔医学院，国家口腔医学中心，口腔疾病国家临床医学研究中心，上海市口腔医学重点实验室，上海市口腔医学研究所，上海 200011
^7.中山大学附属口腔医院，广州 510055
^8.中南大学湘雅口腔医院，长沙 410000
^9.四川大学华西医院，成都 610041
^10.四川大学华西公共卫生学院/华西第四医院，成都 610041
^11.新疆医科大学第一附属医院，乌鲁木齐 830054
^12.浙江大学医学院附属口腔医院，浙江大学口腔医学院，浙江省口腔疾病临床医学研究中心，浙江省口腔生物医学研究重点实验室，浙江大学癌症研究院，口腔生物材料与器械浙江省工程研究中心，杭州 310000
^13.重庆医科大学附属口腔医院，重庆 401147
^14.口腔疾病防治全国重点实验室国家口腔医学中心口腔疾病国家临床医学研究中心四川大学华西口腔医院放射科，成都 610041
^15.南昌大学附属口腔医院，南昌 330006
^16.中山大学附属第一医院，广州 510080
^17.吉林大学口腔医院口腔颌面外科，长春 130021
^18.中国医科大学附属口腔医院，沈阳 110002
^19.上海交通大学医学院附属第九人民医院口腔颌面头颈肿瘤科，上海交通大学口腔医学院，国家口腔医学中心，口腔疾病国家临床医学研究中心，上海市口腔医学重点实验室，上海口腔医学研究所，上海 200011
^20.西安医学院口腔医学院，西安医学院第三附属医院，西安 710021

收稿日期:2025-10-23 出版日期:2026-04-01 发布日期:2026-03-31
通讯作者: 潘剑 E-mail:yeli-scu@qq.com;jianpancn@163.com
作者简介:叶立，主治医师，博士，E-mail：yeli-scu@qq.com|潘剑，医学博士，主任医师，博士研究生导师。四川大学华西口腔医院口腔外科门诊主任。中华口腔医学会牙及牙槽外科专业委员会第一、二届副主任委员，第三届候任主任委员，口腔颌面外科专业委员会第六、七、八届委员。四川省卫生健康委员会学术和技术带头人，临床技能名师，四川省海外高层次留学人才。四川省口腔医学会理事，四川省口腔医学会牙及牙槽外科专业委员会第一、二届主任委员，四川省口腔医学会口腔颌面外科专业委员会第二、三届副主任委员，四川省医师协会口腔医师分会常委，四川省口腔医疗科技创新促进会常务理事，四川省国际医学交流促进会口腔医学分会常委，四川省抗癌协会头颈肿瘤专业委员会第五、六、七届委员。国际牙医师学院Fellow，美国北卡大学教堂山分校（UNC-Chapel Hill）博士后。担任《华西口腔医学杂志》和《国际口腔医学杂志》常务编委，《中国口腔颌面外科学杂志》和《中国实用口腔科杂志》编委。从事口腔颌面外科临床、教学与科研工作30年。主持完成国家级和省部级基金15项，发表中英文论文110余篇，主编专著2部，参编专著16部，曾作为主研人获省部级科技进步奖2项。
基金资助:
四川大学华西口腔医院探索与研发项目(RD-03-2024-);四川大学华西口腔医院探索与研发项目(05)

Expert consensus on perioperative management of tooth extraction in patients receiving denosumab therapy

Ye Li¹(), Cao Yubin¹, Sun Guowen², Xue Yang³, Cui Nianhui⁴, Cai Yu⁵, Zou Duohong⁶, Tang Haikuo⁷, Hu Yanjia⁸, Luo Ting⁹, Sun Lei¹⁰, Gong Zhongcheng¹¹, Zhu Fudong¹², Zhang Fugui¹³, You Meng¹⁴, Guo Yuxing⁴, Wang Yujiang¹⁵, Wang Liao¹, Chen Songling¹⁶, Han Bing¹⁷, Zhang Wei², Zhou Qing¹⁸, He Yue¹⁹, Zhao Jihong⁵, Hu Kaijin²⁰, Liu Lei¹, Liu Jiyuan¹, Pan Jian¹()

^1.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
^2.Nanjing Stomatological Hospital, Affiliated Stomatological Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing 210008, China
^3.State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Dept. of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
^4.Dept. of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
^5.Dept. of Oral & Maxillofacial Surgery, Hospital of Stomatology, Wuhan University, Wuhan 430079, China
^6.Dept. of Oral Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine & College of Stomatology, Shanghai Jiao Tong University & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
^7.Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
^8.Xiangya Stomatological Hospital, Central South University, Changsha 410000, China
^9.West China Hospital, Sichuan University, Chengdu 610041, China
^10.West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
^11.The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
^12.Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center for Oral Biomaterials and Devices of Zhejiang Province, Hangzhou 310000, China
^13.The Affiliated Stomatological Hospital of Chongqing Medical University, Chongqing 401147, China
^14.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Oral Radiology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
^15.Affiliated Stomatological Hospital of Nanchang University, Nanchang 330006, China
^16.The First Affiliated Hospital, Sun Yet-sen University, Guangzhou 510080, China
^17.Dept. of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University, Changchun 130021, China
^18.Hospital of Stomatology, China Medical University, Shenyang 110002, China
^19.Dept. of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine & College of Stomatology, Shanghai Jiao Tong University & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
^20.School of Stomatology, Xi’an Medical University, The Third Affiliated Hospital of Xi’an Medical University, Xi’an 710021, China

Received:2025-10-23 Online:2026-04-01 Published:2026-03-31
Contact: Pan Jian E-mail:yeli-scu@qq.com;jianpancn@163.com
Supported by:
Research and Development Program of West China Hospital of Stomatology, Sichuan University(RD-03-202405)

摘要/Abstract

摘要：

地舒单抗是一种靶向核因子κB受体活化因子配体（RANKL）的人源化单克隆抗体，常用于治疗骨质疏松症和癌症相关骨转移。然而，随着地舒单抗在临床患者中应用越来越多，地舒单抗相关颌骨坏死（DRONJ）的病例也随之增加，尤其是在拔牙后。本专家共识旨在为正在或曾接受地舒单抗治疗的患者，制定拔牙围手术期的临床管理指南。共识内容涉及DRONJ的定义、病因、流行病学、分期、风险因素，并重点阐述了术前评估、基于风险的预防策略、微创手术技术及术后随访方案。DRONJ的核心管理策略强调基于术前全面评估用药史、局部感染及全身状况的个体化决策，DRONJ主要风险因素包括大剂量长疗程的地舒单抗治疗、牙周炎或根尖周炎等既存口腔感染、拔牙等口腔侵入性操作、糖尿病以及合并使用糖皮质激素或抗血管生成药物等。核心预防措施包括严格的围手术期口腔护理、基于风险评估的抗生素预防、以优先保障原发病治疗为前提的由口腔医生与内科医生共同制定的长期药物假期以及控制创伤、保障局部血供、彻底清除感染灶并实现创口严密闭合的微创外科技术。该共识强调了口腔和临床医学专家在处理DRONJ时进行多学科合作的重要性。未来有必要开展更多高质量研究，为优化DRONJ的防治策略提供循证依据。

关键词: 拔牙, 地舒单抗, 地舒单抗相关颌骨坏死, 药物相关性颌骨坏死, 牙周炎, 肿瘤骨转移, 骨质疏松症

Abstract:

Denosumab is a humanized monoclonal antibody targeting receptor activator of nuclear factor-κB ligand (RANKL) and is commonly used in the treatment of osteoporosis and cancer-related bone metastases. However, the persistent use of denosumab has been associated with an increasing incidence of denosumab-related osteonecrosis of the jaw (DRONJ), particularly following tooth extraction. This expert consensus aims to develop clinical management guidelines for the perioperative period of tooth extraction in patients who are currently receiving or have previously received denosumab therapy. The consensus covers the definition, etiology, epidemiology, staging, and risk factors of DRONJ, focusing on preoperative assessment, risk-based prevention strategies, minimally invasive surgical techniques, and postoperative follow-up protocols. The core management strategy for DRONJ emphasizes individualized decision-making based on a comprehensive preoperative assessment of medication history, local infection, and systemic conditions. The main risk factors for DRONJ include high-dose and long-term denosumab therapy, preexisting oral infections, such as periodontitis and periapical periodontitis, and invasive dental procedures, including tooth extraction, diabetes, and concomitant use of glucocorticoids or antiangiogenic agents. Core preventive measures include strict perioperative oral care, risk assessment-based antibiotic prophylaxis, long-term drug holidays, which were developed by dentists and physicians prio-ritizing the primary disease, and minimally invasive surgical techniques for managing trauma, preserving local blood supply, thoroughly removing infected tissues, and ensuring tight wound closure. This consensus highlights the importance of multidisciplinary collaboration between dental and clinical medicine experts in managing DRONJ. High-quality research is necessary to provide an evidence-based foundation for optimizing DRONJ prevention and treatment strategies.

Key words: tooth extraction, denosumab, denosumab-related osteonecrosis of the jaw, medication-related osteonecrosis of the jaw, periodontitis, neoplasm bone metastasis, osteoporosis

中图分类号:

R782.1

叶立, 曹钰彬, 孙国文, 薛洋, 崔念晖, 蔡育, 邹多宏, 唐海阔, 胡延佳, 罗婷, 孙蕾, 龚忠诚, 朱赴东, 张富贵, 游梦, 郭玉兴, 王予江, 王了, 陈松龄, 韩冰, 张伟, 周青, 何悦, 赵吉宏, 胡开进, 刘磊, 刘济远, 潘剑. 关于接受地舒单抗治疗患者拔牙围手术期管理的专家共识[J]. 华西口腔医学杂志, 2026, 44(2): 153-172.

Ye Li, Cao Yubin, Sun Guowen, Xue Yang, Cui Nianhui, Cai Yu, Zou Duohong, Tang Haikuo, Hu Yanjia, Luo Ting, Sun Lei, Gong Zhongcheng, Zhu Fudong, Zhang Fugui, You Meng, Guo Yuxing, Wang Yujiang, Wang Liao, Chen Songling, Han Bing, Zhang Wei, Zhou Qing, He Yue, Zhao Jihong, Hu Kaijin, Liu Lei, Liu Jiyuan, Pan Jian. Expert consensus on perioperative management of tooth extraction in patients receiving denosumab therapy[J]. West China Journal of Stomatology, 2026, 44(2): 153-172.

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Expert consensus on perioperative management of tooth extraction in patients receiving denosumab therapy

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