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二膦酸盐具有很强的抗骨质吸收的作用,20世纪70年代开始应用于临床,已被证实对于良、恶性骨病有效,包括骨质疏松症、Paget病,一些代谢性骨病以及因乳腺癌、肺癌、前列腺癌所致骨转移及多发性骨髓瘤。二膦酸盐的作用主要是抑制破骨细胞,引起破骨细胞的凋亡。用于癌症患者可以防止骨骼并发症,减少骨痛,并且提高生存质量。 相似文献
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二膦酸盐类药物是临床上治疗骨转移癌最为常用的药物。近年来发现,患者长期应用该类药物可产生二膦酸盐相关颌骨骨坏死(bisphosphonate-related osteonecrosis of the jaw, BRONJ)这一较为严重的并发症。患者一旦出现BRONJ的临床症状(如口腔瘘管、红肿、开口受限及骨折等),生活质量严重下降,常就诊于口腔科。因此,口腔科医生对于这种疾病治疗方法的了解非常重要。现将近年来针对这种疾病的常用治疗方法做一综述,以期对口腔临床工作起到帮助作用。 相似文献
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目的 研究药物性颌骨骨髓炎的临床特点。方法 分析2013年5月-2015年9月浙江大学附属第一医院口腔颌面外科收治的12例二膦酸盐相关性颌骨骨坏死患者的基本情况、长期用药史、出现颌骨骨髓炎时间、症状、诊治经过及疗效。结果 9例患者为下颌骨骨髓炎,3例患者为上颌骨骨髓炎。10例患者用药时间10~80个月不等,平均用药(28.00±21.42)个月。手术治疗9例,保守治疗3例:经手术治疗后创面愈合8例,骨暴露处于稳定状态1例;保守治疗患者目前定期换药。结论 静脉注射二膦酸盐类药物可导致药物性颌骨骨髓炎,下颌骨较多见,拔牙为一大诱因。目前的治疗手段多以缓解疼痛和提高生活治疗为目的,故该疾病的预防尤为重要。 相似文献
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报告2例二膦酸盐相关的颌骨骨坏死病例,1例发生在上颌,另1例发生在下颔。对患者进行了长疗程的抗生素治疗及最小量的外科清创.而未进行大型的切除性手术。概括当前的文献.对该类病损的预防与处置提出了一些临床建议。 相似文献
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双膦酸盐相关性颌骨坏死 总被引:2,自引:1,他引:1
双膦酸盐类(BPs)药物是一种强有力的骨吸收抑制剂,已广泛应用于临床治疗中。近年来,有关双膦酸盐相关性骨坏死(BRONJ)的报道日渐增多,该病临床上以骨面裸露、死骨形成、疼痛、口臭等为特征。由于目前发病机理不明确,临床上尚无完全有效的治疗方法,因此BRONJ的预防十分重要。本文就BRONJ的发病机制、危险因素、临床特征、治疗预后等方面的研究现状进行阐述,以期为临床提供帮助。 相似文献
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目的:了解双膦酸盐类药物相关性颌骨坏死(bisphosphonate?related osteonecrosis of the jaw ,BRONJ)的发病机制,探讨其诊断、临床表现、治疗和预防方法。方法对近两年收治的4例BRONJ患者资料进行回顾分析,结合国内外相关文献报道进行临床总结。结果报告的4例患者均有使用双膦酸盐类药物史,临床主要表现为患区反复疼痛、流脓,骨暴露及死骨形成。3例患者接受手术,同时抗生素对症治疗,其中1例术前病情最重的患者出院后半年内曾有小范围感染灶,口服抗生素控制,其余患者均无明显感染及复发。结论恰当的手术治疗对BRONJ可控制感染,缓解症状,使病情趋于静止。 相似文献
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目的总结双膦酸盐相关颌骨坏死(bisphosphonate-related osteonecrosis of the jaw,BRONJ)病例的临床及X线特点。方法对25例临床诊断为BRONJ患者的临床和X线资料进行回顾性分析。结果 25例患者中女性12例,男性13例,年龄35~81岁;其中23例曾患恶性肿瘤,另2例为骨质疏松症。临床表现多为患区反复肿痛、流脓和牙齿松动。25例共存在31个病灶。所有患者的X线表现均有颌骨密度改变。其中9处颌骨病变仅表现为骨密度改变而未形成死骨,为早期病变;其它X线表现包括死骨形成(22个)、牙槽窝不愈(17个)和骨膜反应(10个)。结论 BRONJ早期X线表现为颌骨密度改变和线状骨膜反应,晚期可形成死骨,常累及多个象限。 相似文献
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Niall M.H. McLeod Vinod PatelAtul Kusanale Simon N. RogersPeter A. Brennan 《The British journal of oral & maxillofacial surgery》2011,49(5):335-342
Despite the increasing number of cases of osteonecrosis of the jaws related to bisphosphonate therapy described in the literature there is a paucity of evidence-based treatment for the condition.In this second article on bisphosphonate-related jaw complications we discuss the different treatment strategies for the condition, review current literature, particularly in relation to the recommendations that have been published, and discuss the evidence behind them. 相似文献
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Parish P. Sedghizadeh Kyle Stanley Matthew Caligiuri Shawn Hofkes Brad Lowry Charles F. Shuler 《Journal of the American Dental Association (1939)》2009,140(1):61-66
BackgroundInitial reports of osteonecrosis of the jaw (ONJ) secondary to bisphosphonate (BP) therapy indicated that patients receiving BPs orally were at a negligible risk of developing ONJ compared with patients receiving BPs intravenously. The authors conducted a study to address a preliminary finding that ONJ secondary to oral BP therapy with alendronate sodium in a patient population at the University of Southern California was more common than previously suggested.MethodsThe authors queried an electronic medical record system to determine the number of patients with a history of alendronate use and all patients receiving alendronate who also were receiving treatment for ONJ.ResultsThe authors identified 208 patients with a history of alendronate use. They found that nine had active ONJ and were being treated in the school's clinics. These patients represented one in 23 of the patients receiving alendronate, or approximately 4 percent of the population.ConclusionsThis is the first large institutional study in the United States with respect to the epidemiology of ONJ and oral bisphosphonate use. Further studies along this line will help delineate more clearly the relationship between oral BP use and ONJ.Clinical ImplicationsThe findings from this study indicated that even short-term oral use of alendronate led to ONJ in a subset of patients after certain dental procedures were performed. These findings have important therapeutic and preventive implications. 相似文献
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Our aim was to assess the feasibility of using leucocyte-rich and platelet-rich fibrin (L-PRF) for the treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in a single group study. After treatment with L-PRF, the response of each patient was recorded 1 month and 4 months postoperatively. Further assessments were made of the site, stage, concentration of c-terminal crosslinked telopepide of type 1 collagen, and actinomycosis. Among the total of 34 patients, 26 (77%) showed complete resolution, 6 (18%) had delayed resolution, and 2 (6%) showed no resolution. There was a significant association between the response to treatment and the stage of BRONJ (p = 0.002) but no other significant associations were detected. This study has shown that it is feasible to use L-PRF for the treatment of BRONJ, but the effectiveness cannot be judged with this study design. Randomised prospective trials are needed to confirm this. 相似文献
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George Markose Fiona R. Mackenzie W.J.R. Currie W.S. Hislop 《The British journal of oral & maxillofacial surgery》2009
We present a protocol for the management of a subgroup of patients with bisphosphonate osteonecrosis who presented with painful, exposed, necrotic, alveolar bone. It is simple and can easily be adapted to suit anatomical variations of the oral cavity. Current guidelines based on consensus for the management of bisphosphonate-induced osteonecrosis fail to provide mucosal coverage, which is a primary requirement in managing the condition. We have evaluated the results of a group of 15 patients and analysed their postoperative progress for 24 months. 相似文献
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Alberto Bedogni Stefano Fedele Giorgio Bedogni Matteo Scoletta Gianfranco Favia Giuseppe Colella Alessandro Agrillo Giordana Bettini Olga Di Fede Giacomo Oteri Vittorio Fusco Mario Gabriele Livia Ottolenghi Stefano Valsecchi Stephen Porter Massimo Petruzzi Paolo Arduino Salvatore D’Amato Claudio Ungari Pok-Lam Fung Polly Giorgia Saia Giuseppina Campisi 《The British journal of oral & maxillofacial surgery》2014
Management of osteonecrosis of the jaw associated with antiresorptive agents is challenging, and outcomes are unpredictable. The severity of disease is the main guide to management, and can help to predict prognosis. Most available staging systems for osteonecrosis, including the widely-used American Association of Oral and Maxillofacial Surgeons (AAOMS) system, classify severity on the basis of clinical and radiographic findings. However, clinical inspection and radiography are limited in their ability to identify the extent of necrotic bone disease compared with computed tomography (CT). We have organised a large multicentre retrospective study (known as MISSION) to investigate the agreement between the AAOMS staging system and the extent of osteonecrosis of the jaw (focal compared with diffuse involvement of bone) as detected on CT. We studied 799 patients with detailed clinical phenotyping who had CT images taken. Features of diffuse bone disease were identified on CT within all AAOMS stages (20%, 8%, 48%, and 24% of patients in stages 0, 1, 2, and 3, respectively). Of the patients classified as stage 0, 110/192 (57%) had diffuse disease on CT, and about 1 in 3 with CT evidence of diffuse bone disease was misclassified by the AAOMS system as having stages 0 and 1 osteonecrosis. In addition, more than a third of patients with AAOMS stage 2 (142/405, 35%) had focal bone disease on CT. We conclude that the AAOMS staging system does not correctly identify the extent of bony disease in patients with osteonecrosis of the jaw. 相似文献
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药物相关性颌骨坏死是患者使用抗骨吸收或抗血管生成药物导致的并发症,破坏了口腔卫生,影响患者饮食、语音功能,降低生活质量。对MRONJ患者最恰当的治疗策略还未达成共识。本文就近年来药物相关性颌骨坏死的分期及辅助治疗方法的研究进展作一综述。 相似文献
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Zeynep Burçin Gönen 《Cranio : the journal of craniomandibular practice》2017,35(5):332-336
Background: Bisphosphonates are commonly prescribed antiresorptive agents for the management of patients with osteoporosis, Paget’s disease, multiple myeloma, and metastatic tumors. Platelet-rich fibrin (PRF) is a second generation platelet concentrate, and has the ability of regulating the inflammation and stimulation of chemotactic agents. The aim of this report is to present the treatment of Stage-3 bisphosphonate-related osteonecrosis of the jaw (BRONJ) by PRF.
Clinical Presentation: A 77-year-old male patient with Stage-3 BRONJ was treated with minimal surgical operations and PRF membrane. The patient was followed up for 18 months, and there was no recurrence or exposure.
Conclusion: PRF may promote the healing of both bone and soft tissues even in Stage-3 patients. This technique is an alternative treatment modality for the closure of bone exposure and tissue healing in BRONJ patients. 相似文献
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Vinod PatelNiall M.H. McLeod Simon N. RogersPeter A. Brennan 《The British journal of oral & maxillofacial surgery》2011,49(4):251-257
There has been an exponential rise in the literature of osteonecrosis and its complications in patients taking bisphosphonate drugs. Despite this increase, there is little evidence-based publications on how best to manage this complication. In this article (the first of two on bisphosphonate related jaw complications), we compare the guidelines produced by national specialist medical associations and expert panels on the prevention of bisphosphonate osteonecrosis of the jaws and review the evidence behind these guidelines. 相似文献
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《Journal of cranio-maxillo-facial surgery》2014,42(7):1203-1206
ContextBisphosphonates are common drugs used in the management of bone metabolic diseases. Because of their recently increased use, their adverse effects, especially bisphosphonate-related osteonecrosis of the jaw (BRONJ), are monitored more frequently. BRONJ is a critical challenge in craniofacial surgery and is difficult to treat. Its occurrence is either spontaneous or follows dentoalveolar surgery. Typical complications of BRONJ are painful exposed bone, pathological fractures, extra-oral fistula, and local infections.ObjectiveThe aim of this paper is to report a rare case of bacterial embolism in the internal jugular vein after a BRONJ-induced submandibular abscess resulting in bacterial sepsis, multi-organ failure syndrome, and death.Case illustrationA 59-year-old female patient developed severe BRONJ (stage II) with recurrent abscesses after oral osteoporosis therapy with alendronic acid. A subsequent submandibular abscess led to bacterial embolism of the left internal jugular vein, causing sepsis and death.DiscussionPrevention, early detection and management of BRONJ remain a crucial challenge in craniofacial clinical practice. Despite several therapeutic approaches described in the current literature, none have undergone bedside application.ConclusionConsidering this report of death after recurrent abscesses following BRONJ, the use of bisphosphonates should be carefully monitored in order to prevent such severe complications. 相似文献