双膦酸盐相关性颌骨坏死16例临床分析

Clinical analysis of bisphosphonate-related osteonecrosis of the jaw

目的探讨双膦酸盐相关性颌骨坏死的临床特点及治疗效果。方法选取2018年6月至2019年3月于中国医科大学附属口腔医院口腔颌面外科就诊的双膦酸盐相关性颌骨坏死患者16例,回顾性分析所有患者的临床和影像学资料。结果所有患者早期仅表现为牙龈不适,后期表现为颌骨疼痛、牙龈组织肿胀溢脓,其中有6例患者颊部肿胀并有瘘管形成,10例患者死骨裸露,4例患者张口受限,3例患者下唇麻木,1例患者发生颌面部多间隙蜂窝织炎。CT显示11例患者发生溶骨性骨质破坏,5例患者出现骨小梁增粗、结构紊乱,5例患者有死骨形成并与周围骨组织分离。患者进行手术综合治疗6例,保守治疗10例。治疗3个月后,手术综合治疗患者疗效评分明显高于保守治疗患者。结论双膦酸盐相关性颌骨坏死主要临床特点为颌骨疼痛,多数病例可见死骨裸露,CT显示很可能发生溶骨性骨质破坏,手术综合治疗能够取得良好效果。

Objective To analyze the clinical characteristics of bisphosphonate-related osteonecrosis of the jaw and the treatment effect. Methods The clinical and imaging data of 16 patients with bisphosphonate-related osteonecrosis of jaw who were treated at the Oral and Maxillofacial Surgery Department of the School and Hospital of Stomatology Affiliated to China Medical University from June 2018 to March 2019 were retrospectively analyzed. Results All patients showed gingival discomfort in the early stage and jaw pain and gingival tissue swelling in the later stage. Six patients had swelling on the cheek and fistula formation,10 patients had necrosis of the jaw with bare dead bone,and 4 patients had open mouth limitation;numbness of the lower lip was found in 3 cases,and multiple maxillofacial cellulitis occurred in 1 case. CT showed that 11 patients had osteolytic bone destruction,5 patients had thickened trabeculae and structural disorders,and 5 patients had dead bone formation which was separated from surrounding bone tissue. Six patients underwent comprehensive surgical treatment and 10 patients underwent conservative treatment. The 3-month follow-up effect score was significantly higher in comprehensive treatment patients than in conservatively treated patients. Conclusion The main clinical characteristics of the bisphosphonate-related osteonecrosis of the jaw was pain,and most cases had bare dead bone. CT shows that osteolytic bone destruction is verly likely to occure. Comprehensive surgical treatment can achieve good results.