双膦酸盐相关性颌骨坏死9例临床分析

Bisphosphonate-related osteonecrosis of the jaw: report of 9 cases

目的 :探讨双膦酸盐相关性颌骨坏死(bisphosphonate-related osteonecrosis of the jaw,BRONJ)的临床特点及治疗效果。方法:分析2013年1月—2015年4月诊治的9例BRONJ患者的临床数据及影像学资料。结果:9例患者均为静脉给药,平均用药时间42.7个月。用药期间7例有拔牙史,2例有义齿局部刺激。除3例首次就诊即确诊外,其余6例经2家以上医疗机构方确诊。出现口腔症状至确诊时间间隔平均6.9个月。临床表现包括局部疼痛、间隙感染、拔牙创不愈合及死骨外露。影像学表现包括骨密度增高、骨膜反应、死骨形成及弥漫性骨质破坏。9例患者中,0期1例,Ⅱ期4例,Ⅲ期4例。保守治疗4例,手术治疗5例,平均随访10.3个月。3例临床Ⅲ期患者长期存在软组织慢性炎症并伴有感染急性发作,其余6例患者痊愈或病情稳定。结论:BRONJ的临床表现与影像学表现无特异性,询问双膦酸盐用药史是诊断的关键。BRONJ的疗效不佳,临床Ⅲ期患者倾向于难以治愈和病情易于反复。

PURPOSE： To summarize the clinical features and outcomes of bisphosphonate-related osteonecrosis of the .jaw （BRONJ）. METHODS： A total of 9 patients diagnosed and treated as BRONJ in our hospital from January 2013 to April 2015 were included. Their clinical data and imaging findings were analyzed. RESULTS： All patients received intravenous infusion of bisphosphonates with the average treatment duration of 42.7 months. During bispbosphonate treatment, seven patients had a history of tooth extraction, and the other 2 patients used removable dentures. Three patients were diagnosed as BRONJ at the first clinical visit; however, the other 6 patients got the confirmed diagnosis after visiting more than 2 medical institutions. The average time from the occurrence of oral symptoms to diagnosis was 6.9 months. The clinical manifestations of BRONJ included local pain, facial space infection, non-healing of extraction sockets, and exposure of sequestrum. The imaging findings of BRONJ included increased bone mineral density, periosteal reaction, sequestrum formation and diffused bone destruction. Of the 9 patients, one patient was classified into stage 0, 4 patients stage Ⅱ, and 4 patients stage Ⅲ. Five patients underwent surgery, four cases received conservative treatment. The average follow-up time was 10.3 months. Three patients in stage Ⅲ had long-standing chronic inflammation of soft tissue with acute attack of infection, while the remaining 6 patients were cured or in stable condition during the follow-up period. CONCLUSIONS： Due to lack of characteristic clinical manifestations and imaging findings, medical history of bisphosphonate treatment is the key to making a diagnosis of BRONJ. The outcome of BRONJ is generally poor, and patients in stage Ⅲ tend to be difficult to cure and easy to relapse.