29例Ⅱ期和Ⅲ期双膦酸盐相关颌骨坏死的手术疗效

Outcomes of surgical treatment of 29 patients with stagesⅡ⁃Ⅲbisphosphonate⁃related osteonecrosis of the jaw

目的探讨Ⅱ~Ⅲ期双膦酸盐相关颌骨坏死的手术治疗经验。方法Ⅱ~Ⅲ期双膦酸盐相关颌骨坏死患者29例,随访6个月以上,观察手术效果。结果 21例患者接受局部病灶刮除术后,有19例痊愈,2例缓解;6例患者接受了上颌骨次全切除术,术后症状完全消失;2例患者接受了下颌骨部分切除术,术后痊愈。结论外科清创是治疗Ⅱ~Ⅲ期双膦酸盐相关颌骨坏死的有效措施,多数通过口内入路行局部病灶刮除术可彻底清除死骨和炎性肉芽组织,当死骨累及上颌窦底水平或下颌骨连续性时,则行上颌骨次全切除术或下颌骨部分切除术,通过及时外科干预去除病变骨质,以保持局部有活力骨微环境的无菌状态。

Objective To examine the outcome of surgical treatment in patients with stagesⅡ⁃Ⅲbisphosphonate⁃related osteonecrosis of the jaw.Methods Twenty⁃nine patients with bisphosphonate⁃related osteonecrosis of the jaw were examined.The patients were followed up for more than 6 months,and the treatment outcome was reviewed.Re⁃sults After curettage of local lesions,19 out of the 21 patients were cured,and 2 were relieved of symptoms.Six pa⁃tients underwent subtotal resection of the maxilla,and the symptoms disappeared completely after the surgery.Two pa⁃tients underwent partial resection of the mandible and recovered.Conclusion Surgical debridement is an effective measure for the treatment of patients with bisphosphonate⁃related osteonecrosis of the jaw in stagesⅡ⁃Ⅲ.In most cas⁃es,curettage of local lesions via the intraoral approach can completely remove sequestrum and inflammatory granuloma⁃tous tissue.Subtotal maxillary resection or partial mandible resection is performed when the bone death reaches the lev⁃el of the maxillary sinus floor or continues to the mandible.By timely surgical intervention,the bone lesion is removed to maintain the sterile,active bone microenvironment locally.