颌骨放射性骨坏死31例临床分析

Clinical Analysis of 31 Cases of Radiation Osteonecrosis of Jaw

目的探讨颌骨放射性骨坏死(ORNJ)的临床特点及治疗方法。方法回顾性分析近5 a本院ORNJ患者的临床资料,分析发病部位、潜伏期、照射剂量以及三种治疗方法的疗效差别。结果共有31例入组,其中口腔癌16例、鼻咽癌7例、口咽癌4例、其他4例。放疗联合化疗24例(77. 4%),平均照射剂量为67. 2 Gy,ORNJ发生距放疗后中位间隔时间7. 5 a。患者均无放疗后拔牙史,临床主要表现为死骨暴露。ORNJ中上颌2例,下颌29例。手术干预的治愈率高于保守治疗(χ2=6. 218,P=0. 013)。结论 ORNJ的发生与放疗后拔牙关系不大,死骨扩大切除术联合同期血管化组织瓣移植是一种有效的治疗方法。

Objective To investigate the clinical features and treatment pattern of osteonecrosis of the jaw （ORNJ）.Methods The clinical data of patients with ORNJ in our hospital during the past five years were retrospectively analyzed, which included the lesion location, latency, previous irradiation dose, and treatment patterns. Then, the difference of curative effect between three different treatment patterns, conservative treatment, extended bone debridement and extended bone resection combined with vascularized tissue flap transplantation to repair maxillofacial defects were analyzed.Results A total of 31 patients were enrolled, including 16 oral cancer cases, 7 nasopharyngeal cancer cases, 4 oropharyngeal cancer cases. The previous average irradiation dose was 67.2 Gy, and 24 cases （72.7%） received radiotherapy combined chemotherapy. The median latency of ORNJ after radiotherapy was 7.5 years. All patients had no history of tooth extraction after radiotherapy. The main clinical manifestations were local pain, discharge, limited mouth opening, and exposure to sequestrum. There were 2 cases of maxillary ORNJ, and 29 cases of mandible lesions. The curative rate of surgical intervention was higher than that of conservative therapy （χ 2=6.218, P =0.013）. Extended resection of the sequestrum combined with simultaneous vascularized tissue flap repair of maxillofacial defects can greatly improve the appearance.Conclusion The occurrence of ORNJ is not necessarily related to tooth extraction after radiotherapy. Extended resectectomy combined with vascularized tissue flap transplantation is an effective treatment for it.