二膦酸盐相关性颌骨骨坏死的临床分析

Clinical analysis of bisphosphonate-related osteonecrosis of the jaw

目的：研究药物性颌骨骨髓炎的临床特点。方法分析2013年5月—2015年9月浙江大学附属第一医院口腔颌面外科收治的12例二膦酸盐相关性颌骨骨坏死患者的基本情况、长期用药史、出现颌骨骨髓炎时间、症状、诊治经过及疗效。结果9例患者为下颌骨骨髓炎，3例患者为上颌骨骨髓炎。10例患者用药时间10-80个月不等，平均用药（28.00±21.42）个月。手术治疗9例，保守治疗3例：经手术治疗后创面愈合8例，骨暴露处于稳定状态1例；保守治疗患者目前定期换药。结论静脉注射二膦酸盐类药物可导致药物性颌骨骨髓炎，下颌骨较多见，拔牙为一大诱因。目前的治疗手段多以缓解疼痛和提高生活治疗为目的，故该疾病的预防尤为重要。

Objective The study aims to analyze patients with bisphosphonate-related osteonecrosis of the jaw （BRONJ）. Methods Twelve patients treated in the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Me-dical School, Zhejiang University from May 2013 to September 2015 were included. Patients’ basic situation, medication, clinical symptoms, therapies, and effects were obtained and analyzed.Results The treatment of nine patients focused on the mandible, whereas that of three patients was on the maxilla. The clinical symptoms appeared from 10 to 80 months, with an average of about （28.00±21.42） months. Nine patients had tooth extraction history. After operation （nine patients）, eight were treated, one had stable in bone exposure and three patients received conservative treatment.Conclusion Intravenous infusion of bisphosphonates can induce BRONJ. The mandible is commonly involved and tooth extraction is a big inducement. Treatments nowadays seek to relieve clinical symptoms, but prevention is more important.