下颌骨放射性骨坏死的临床治疗

目的 探讨下颌骨放射性骨坏死（Osteoradionecrosis of jaws,ORNJ）治疗和外形重建的方案。方法23例因鼻咽癌放疗后引发的下颌骨放射性骨坏死采用局部刮治加高压氧治疗和下颌骨切除后钛板加皮瓣修复两种方法治疗。结果 局部刮治加高压氧对ORNJ治疗无效,有9例症状复发;而切除下颌坏死骨用钛板做支架利用胸大肌皮瓣修复治疗16例,全部有效,随访时间3个月～1年,除1例因排斥反应伤口未愈外,其余15例皆有效。结论 钛板和局部皮瓣或胸大肌皮瓣修复是治疗ORNJ的有效方法。

CLINICAL TREATMENT OF OSTEORADIONECROSIS OF JAWS

ve To investigate the methods of treatment and appearance reconstruction of ORNJ. Methods We collected the cases about 23 patients with ORNJ who accepted radiatios. Local scarping and high-pressure oxygen treatment used in 9 of them and the other patients were excised the necrosis mandibulae and repaired by titanium plate and transfer of skin flap, we analysised the results. Results Local scarping and high-pressure oxygen treatment is no use in treating ORNJ. The 9 cases are all recrudescene. But mandibulectomy and using titanium plate as brace and repairing by pectoralis major my-ocutaneous flap in the treatment of ORNJ is effective 16 patients accepted the operation are all cure in one-stage. Following from smooth to one year post operatively, 15 cases recovered well. The effect of the operation is obvious, except for one patient was uncure because of rejection. Conclusion Using titamiun plate as brace and repairing by transfer of local flap or pectoralis major myocutancous flap in the treatment of ORNJ is effective and satisfying.