放射性颌骨骨髓炎的临床特征与治疗

Clinical characteristics and treatment of radioactive osteomyelitis of jaws

目的探讨放射性颌骨骨髓炎的临床特征及治疗手段。方法对65例放射性颌骨骨髓炎患者的临床资料进行回顾性分析,评估其好发部位、发病时间、放疗剂量和治疗效果。结果放射性颌骨骨髓炎以下颌骨多见占72%;多发生于放疗后1～4年占86%;平均放疗剂量为70.2Gy。保守治疗只能缓解症状,控制病情。行死骨扩大切除术,放射性颌骨骨髓炎的治愈率可达92%。同期血管化组织瓣移植修复缺损,其成功率为95%。结论可将70Gy作为放射剂量的临床阈值,死骨扩大切除术同期血管化组织瓣移植修复缺损能获得较好疗效。

Objective To investigate the clinical characteristics and treatment of radiation osteomyelitis ofjaws（ROJ）. Methods The clinical records of 65 ROJ cases treated during the period from 1991 through 2003 were examined. Results The average dose of radiotherapy was 70.2 Gy. ROJ were more common in the mandible （72%） and in the first four years after radiotherapy （86%）. Conservative treatment relieved the symptoms and controlled the progress of the diseases. The cure rate of ROJ was 92% by extensive resection of sequestrum, The survival rate of transplant flap was 95 % with immediate vascularized tissue graft. Conclusion 70 Gy can be regarded as reference threshold for clinical irradiation. Extensive resection of sequestrum in combination with immediate vascularized tissue grafts clearly improved the prognosis of radiation osteomyelitis of jaws.