一种新的药物性颌骨坏死临床分期及治疗策略

A novel staging system and corresponding therapeutic strategies for medication-related osteonecrosis of the jaw

目的:通过分析药物性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)的病例资料,提出一种用于指导MRONJ临床诊疗的新分期方法。方法:总结2008—2018年上海交通大学医学院附属第九人民医院收治的74例MRONJ患者的影像学资料及诊疗方式,将下牙槽神经管、下颌骨下缘及上颌窦底等作为划分骨质破坏严重程度的解剖学标志,再根据病损组织是否存在明确的界线,提出了一种新的MRONJ四分期二亚分类法及相应的治疗策略。结果:根据骨坏死的不同程度将其分为4期,0期(7例),Ⅰa期(18例),Ⅰb期(14例),Ⅱa期(12例),Ⅱb期(15例),Ⅲ期(8例)。治疗后62例患者病情稳定,12例出现骨坏死进展。结论:新的分期方法及相应治疗策略适用于MRONJ的临床诊疗。

PURPOSE:To propose a new clinical staging method that can be performed to guide the diagnosis and treatment of MRONJ through a retrospective study of patients with medication-related osteonecrosis of the jaw(MRONJ).METHODS:The clinical data of 74 MRONJ patients admitted to Shanghai Ninth People’s Hospital between 2008 and2018 were enrolled.A novel staging method and corresponding treatments were proposed on the basis of anatomic structures(inferior alveolar canal and floor of maxillary sinus)and boundary of bone lesions.RESULTS:A new staging system with four different stages(stage 0:7 cases;stageⅠa:18 cases;stageⅠb:14 cases;stageⅡa:12 cases;stageⅡb:15 cases;and stageⅢ:8 cases)was proposed.Outcome of these samples demonstrated that only 12 cases hold progressed state.CONCLUSIONS:This new staging system is suitable for clinical diagnosis and therapeutic selection for MRONJ.