双膦酸盐相关性颌骨坏死的研究进展

Progress of bisphosphonate related osteonecrosis of the jaws

双膦酸盐相关性颌骨坏死(bisphosphonate related osteonecrosis of the jaws,BRONJ)是一种罕见但严重的疾病,发生于接受双膦酸盐治疗的骨质疏松症、骨转移癌及其他骨破坏性疾病患者中。BRONJ发病机制尚不清楚,可能与骨重建失衡、血管生成抑制、炎性反应及感染、软组织毒性等相关。其防治措施尚无明确定论,目前大多数研究表明,治疗方案的选择须考虑疾病分期和患者的全身情况,对于不愿接受手术或全身条件不允许手术的患者,保守治疗包括近年来提出的辅助治疗是稳定病情的较好选择,外科手术干预应贯穿于疾病所有分期中。围手术期使用抗菌漱口液及全身性抗生素治疗是防止拔牙后颌骨坏死发生的有效措施,有创性牙科手术前预防性停用双膦酸盐是否能降低BRONJ的发生风险尚不明确。本文就近年来BRONJ的流行病学、发病机制、危险因素、预测指标、治疗及预防等最新研究进展作一综述。

Bisphosphonate related osteonecrosis of the jaws(BRONJ)is a rare but serious disease that occurs in patients with osteoporosis,metastatic bone cancer,and other bone destructive diseases treated with bisphosphonates.The pathogenesis of BRONJ remains unclear and may be related to imbalance of bone reconstruction,inhibition of angiogenesis,inflammation and infection,and soft tissue toxicity.The prevention and treatment of BRONJ is unclear,and most studies indicate that the treatment must take into account the stage of the disease and the patients’general condition.For patients who refuse surgery or whose systemic conditions do not permit surgery,conservative treatment including adjuvant therapy is a better choice to stabilize the condition.Surgical intervention should be carried out throughout all stages of the disease.Perioperative use of antimicrobial mouthwash and systemic antibiotic therapy are effective measures to prevent the occurrence of BRONJ after tooth extraction.Whether prophylactic discontinuation of bisphosphonates before invasive dental surgery reduces the risk of BRONJ is unclear.The recent progress of BRONJ in epidemiology,pathogenesis,risk factors,predictors,treatment,and prevention were reviewed.