双膦酸盐类药物性颌骨坏死的发病机制、临床表现、特殊检查、预防及治疗方法分析

Analysis of Pathogenesis, Clinical Manifestations, Special Examination,Prevention and Treatment of Bisphosphonate-induced Osteonecrosis of the Jaw

目的探讨双膦酸盐类药物性颌骨坏死的发病机制、临床表现、特殊检查方法与防治对策。方法选择该院2010年1月—2018年12月收治的双膦酸盐类药物性颌骨坏死10例临床资料进行回顾性分析,入选病例为曾使用或正在使用双磷酸盐类药物,且颌骨骨质外露>8周、未接受颌骨放射线治疗者。结果 10例患者出现症状的累及服药时间为10~42个月。病变位置4例左侧上颌骨,4例右侧上颌骨,2例双侧下颌骨。死骨游离6例,死骨暴露4例。10例患者均合并感染。10例患者均有疼痛、牙龈肿胀、感觉异常、牙槽骨外露症状,部分患者有牙齿松动、脓性分泌物、瘘管形成表现。经颌骨X线检查进一步确诊为颌骨坏死,影像特征显著。10例患者中7例给予保守治疗,3例给予死骨摘除与病变位置刮治术治疗,其中2例治愈,余者病情稳定未进一步恶化。结论双膦酸盐类药物性颌骨坏死的发生与多因素有关,临床表现主要为颌骨疼痛、牙齿松动、颌骨外露等,部分患者合并感染,该病临床诊断并不难,但临床缺乏较理想的治疗方式,需加强预防,避免疾病发生。

Objective To investigate the pathogenesis, clinical manifestations, special examination methods and prevention and treatment strategies of bisphosphonate-induced osteonecrosis of the jaw. Methods The clinical data of 10 cases of bisphosphonate-induced osteonecrosis of the jaws admitted to the hospital from January 2010 to December 2018 were selected for retrospective analysis. The selected cases were used or are using bisphosphonates. And the bones of the jaws were exposed for more than 8 weeks, and the patients had not received radiotherapy of the jaws. Results The symptoms of10 patients involved taking medication for 10 to 42 months. The location of the lesion was 4 cases of left maxilla, 4 cases of right maxilla, and 2 cases of bilateral mandible. There were 6 cases of dead bones free and 4 cases of dead bones exposed.All 10 patients were co-infected. All 10 patients had symptoms of pain, gingival swelling, paresthesia, and alveolar bone exposure. Some patients had symptoms of loose teeth, purulent secretions, and fistula formation. The X-ray examination of the jaw was further diagnosed as osteonecrosis of the jaw, with significant imaging features. Seven of the 10 patients were treated conservatively, and 3 were treated with sequestrectomy and curettage of the diseased location. Of these, 2 were cured, and the rest were stable without further deterioration. Conclusion The occurrence of bisphosphonate-induced osteonecrosis of the jaw is related to multiple factors. The clinical manifestations are mainly jaw pain, tooth loosening, and jaw exposure. Some patients have co-infection. The clinical diagnosis of this disease is not difficult, but clinically lack of ideal treatment methods, and prevention needs to be strengthened to avoid the occurrence of diseases.