放射性及双膦酸盐相关性颌骨坏死的发病机制及治疗进展

Osteoradionecrosis and bisphosphonate-related osteonecrosis of the jaw:a review of the pathogenesis and treatment

放射治疗及双膦酸盐类药物的应用可导致颌骨坏死及骨缺损,严重影响患者颌面部的形态与功能。近年,放射性及双膦酸盐相关性颌骨坏死的发病机制研究及临床治疗取得了一系列进展。研究发现,放疗15 d内颌骨中仍有骨改建活动,但由于内皮细胞及微血管损伤,放疗15 d后微血管闭锁,骨改建停止,颌骨内开始出现纤维化。基于干细胞的生物性治疗可使颌骨内微循环得到恢复并修复骨质,为重度放射性颌骨坏死的治疗提供了新方法、新思路。双膦酸盐除了可沉积于颌骨使破骨细胞大量凋亡外,还可抑制骨髓间充质干细胞功能,并引起机体的免疫失衡。异体骨髓间充质干细胞能修复颌骨损伤并调节免疫,对双膦酸盐相关性颌骨坏死有良好的治疗作用,具有较好的潜在应用前景。随着生物工程技术的发展及间充质干细胞的逐步应用,有望在放射性及双膦酸盐相关性颌骨坏死等颌骨疾病的诊疗中发挥重要作用。

Osteoradionecrosis of the jaw(ORNJ)and bisphosphonate-related osteonecrosis of the jaw(BRONJ)are usually caused by head and neck radio-therapy and by the usage of bisphosphonate,respectively.These diseases can lead to facial deformity and dysfunction of the mandible,and may cause severe chronic facial pain.The pathogenesis of ORNJ and BRONJ are complex,and the therapy of which is still challenged.The present article reviewed the latest literature about the pathogenesis and treatment of ORNJ and BRONJ for update.The irradiation may damage the endothelia cells and microvessels in jaw bone,which leads to the termination of the bone remodeling 15 days after irradiation.Mesenchymal stem cells based bio-therapy can assist the recovery of mandibular circulation and the reconstruction of the bone,showing therapeutic potential for ORNJ clinical treatment.Bisphosphonate can induce the dysfunction of bone marrow mesenchymal stem cells and the immune imbalance of the body.Allogeneic mesenchymal stem cells transplantation can rebuild the jaw bone and rebalance the immune of the recipient,demonstrating the ideally potential for the treatment of BRONJ.Taking together,although it would be complicated and winding,the improvement of biotech and the usage of mesenchymal stem cells shed a light on the way of ORNJ and BRONJ treatments.