双膦酸盐类药物相关性颌骨坏死临床研究

Clinical study of bisphosphonate-related osteonecrosis of the jaws

目的了解双膦酸盐类药物相关性颌骨坏死(bisphosphonate-related osteonecrosis of the jaw,BRONJ)的发病机制,探讨其诊断、临床表现、治疗和预防方法。方法对近两年收治的4例BRONJ患者资料进行回顾分析,结合国内外相关文献报道进行临床总结。结果报告的4例患者均有使用双膦酸盐类药物史,临床主要表现为患区反复疼痛、流脓,骨暴露及死骨形成。3例患者接受手术,同时抗生素对症治疗,其中1例术前病情最重的患者出院后半年内曾有小范围感染灶,口服抗生素控制,其余患者均无明显感染及复发。结论恰当的手术治疗对BRONJ可控制感染,缓解症状,使病情趋于静止。

Objective To understand the pathogenesis of bisphosphonate-related osteonecrosis of the jaws（BRONJ）and to investigate its differential diagnosis, clinical manifestations, treatment and prevention. Methods By analyzing the clinical data of 4 patients with BRONJ in the retrospective study with reviewing related literatures in the world to make a summary of it. Results Cases of 4 patients mainly presented recurring pain, discharging of pus and disposure and necrosis of the bone. 3 patients received surgical and antibiotics treatments, one of them had local infection which was under control by oral antibiotic. The other 2 patients had no infection and recurrence. Conclusion BRONJ is caused by jaw necrosis due to bisphosphonate inhibition of osteoclast function. For the reason that none of the treatments is unified and satisfied, we should focus on the risk factors in prevention. Appropriate surgery treatment could be well controlled the process of the BRONJ which should be popularization in our study.