一种新的放射性颌骨坏死的临床分类分期—120例临床分析

A new clinical classification and stage for osteoradionecrosis of the jaws: clinical analysis of 120 cases

目的：探讨颌骨放射性骨坏死的临床特征、治疗方法、分类及分期。方法：采用BS分类及分期,对我院口腔颌面-头颈肿瘤科2003年1月—2013年1月10 a间收治的120例放射性颌骨坏死患者临床资料进行回顾分析。结果：下颌骨发生骨坏死的病例明显多于上颌骨及上、下颌骨,分别为99例、14例及7例。累计放疗剂量区间为35～148 Gy,中位剂量为68.1 Gy, 69（57.5%）例患者剂量大于60 Gy。大多数患者骨坏死发生在放疗后1～2 a内（64.2%）,少数发生在放疗5 a以后（20.0%）。按BS分类,Stage Ⅰ期患者为0例;Stage Ⅱ期患者16（13.3%）例,主要采用单纯死骨刮治及单纯死骨扩大切除术（14例）;Stage Ⅲ期患者92（76.7%）例,71例患者采用死骨扩大切除术,其中47例同期行血管化组织瓣修复;Stage Ⅳ期患者12（10.0%）例,主要采用死骨扩大切除联合同期血管化组织瓣修复（10例）。结论：放射性颌骨坏死以单侧下颌骨最多见,并以体部及部分下颌支最为好发,大多数患者骨坏死发生在放疗后1～2 a。死骨扩大切除联合同期血管化组织瓣修复是目前最好的治疗方法。

PURPOSE： To investigate the clinical characteristics, treatment, classification and stage of osteoradionecrosis of the jaws. METHODS： Using BS classification and Stage, we retrospectively studied the clinical data of 120 ORNJ cases treated from Jan. 2003 to Jan. 2013. RESULTS： Mandibular necrosis was significantly more than maxilla and upper-lower jaws, account for 99, 14 and 7, respectively. Cumulative radiation dose ranged from 35 to 148Gy, with a median dose of 68.1Gy, and 69（57.5%） cases received more than 60Gy. In majority of patients （64.2%）, osteonecrosis occurred first to two years after radiotherapy, however, also 20.0% patients osteonecrosis occurred more than five years after radiotherapy. According to BS classification, none of patient belonged to StageⅠ; Stage Ⅱ patients accounted for 13.3% （n=16）, and 14 cases were treated by sequestrum scaling and simple sequestrum extensive resection; Stage Ⅲ patients accounted for 76.7% （n=92）, and 71 cases were treated by sequestrum extensive resection, and 47 cases treated with simultaneous vascularized flap; Stage Ⅳ patients accounted for 10.0% （n=12）, 10 cases were treated by sequestrum extensive resection and immediately vascularized flap transplantation. CONCLUSIONS： Osteoradionecrosis occurs more easily in unilateral mandible, especially the body and partial ramus. In majority of patients, osteoradionecrosis occurred first to two years after radiotherapy. The currently best treatment methods for ORNJ are extensive sequestrum resection combined immediately vascularized flap transplantation.Supported by National Natural Science Foundation of China （81271112, 30973341）, Development Foundation of Shanghai Municipal Human Resources and Social Security Bureau （201312） and SMC Rising Star-A Scholar of Shanghai Jiao Tong University （201312）.