二膦酸盐颌骨骨髓炎24例临床特点分析

Clinical analysis of 24 cases of bisphosphonate-related osteonecrosis of the jaw

目的 分析二膦酸盐颌骨骨髓炎的临床特点.方法 分析自2009年3月至2013年12月诊治的24例二膦酸盐颌骨骨髓炎的用药种类、方式及时间,患者原发疾病及出现颌骨骨髓炎症状时间、处理方法及预后.24例二膦酸盐颌骨骨髓炎患者中,20例患者为恶性肿瘤,应用二膦酸盐药物的平均时间为36.4个月,均为静脉给药;另4例为骨质疏松患者,其中3例伴类风湿关节炎（有激素治疗史）.结果 所有患者出现口腔临床症状的时间平均为11.6个月,19例有拔牙史.累及下颌骨11例、上颌骨10例,同时累及上下颌骨3例.保守治疗3例、手术21例.经手术治疗后创面愈合10例,骨面暴露症状稳定6例,4例死骨进一步加大再次手术.随访期内1例因原发疾病（肾癌）死亡.结论 静脉及口服二膦酸盐药物均可出现颌骨骨髓炎症状;牙槽骨创伤后易引发临床症状,上下颌骨分布无特异;治疗以缓解临床症状为主.

Objective To retrospectively analyze the data of the patients with Bisphosphonate-related osteonecrosis of the jaw over the past five years in our hospital.Methods Twenty-four patients with bisphosphonate-related osteonecrosis of the jaw treated in our hospital from 2009 to 2013 were included.The medication,bisphosphonate types,clinical signs and symptom,treatment methods and results were also analyzed.Results Of the 24 cases,20 cases suffered from malignant tumors and received intravenous infusion of bisphosphonates and 4 cases took oral bisphosphonates.Three of the 4 cases with osteoporosis had history of glucocorticoid （rheumatoid arthritis）.All patients had oral clinical symptoms for an average of 11.6 months,and 19 patients had the history of tooth extraction.There were 11 cases with mandible involved,10 cases with maxilla involved,and 3 cases with both mandible and maxilla involved.After conservative treatment（3 cases） or operation（21 cases）,10 cases had wound healing,6 cases were stable with bone exposure,and 4 cases with died bone needed reoperation.During the follow-up period,there was one patient died of primary disease（renal carcinoma）.Conclusions Both intravenous and oral application routes of bisphosphonates can induce osteonecrosis of the jaw.Bisphosphonate-related osteonecrosis of the jaw can be caused by alveolar trauma.The treatment modality is to relieve the clinical symptoms of bisphosphonate-related osteonecrosis of the jaw.