头颈部放射治疗后拔牙与放射性颌骨骨髓炎关系的临床分析

目的探讨牙拔除术对头颈部放射治疗后患者发生放射性颌骨骨髓炎（osteoradionecrosis，ORN）的影响。方法收集83例头颈部恶性肿瘤放疗后经x线诊断ORN的需拔牙患者，拔牙前给予口服抗生素2d，微创拔牙，术后继续口服抗生素5d，3个月拔牙创不愈合者诊断为ORN。结果83例患者放疗后因智齿冠周炎、急性牙髓炎、残根残冠、根尖周炎等，共拔除182颗患牙，其中8例出现ORN。放疗剂量不同导致放疗后拔牙发生ORN的差异有统计学意义（x^2=5．004，P=0．025），高剂量患者（70～80Gy）拔牙后ORN炎发生率25．00％，明显高于低剂量患者（50—70Gy）的发生率4．76％。放疗后拔牙时间（X2=0，P=I．000）、一次性拔牙总数目（x2=0，P=1．000）对放疗后拔牙发生ORN的差异无统计学意义。结论放射剂量是诱发ORN的主要原因，放疗前拔除患牙、放疗后定期检查口腔，防治牙周、牙体疾病是预防ORN的主要手段。

Clinical analysis of and dental extraction in irradiated patients

Objective To investigate the relationship between osteoradionecrosis and dental extraction in irradiated patients. Methods Eighty-three cases of head and neck cancer patients without osteomyelitis after radiotherapy were col- lected by X-ray examination, which were regularly treated with antibiotics 2 d before dental extraetinn. Minimally invasive surgery was used during operation. And they were treated with antibiotics for 5 d after dental extraction. Osteomyelitis were diagnosed if wound would not healing after 3 months. Results A total of 182 teeth were extracted from eighty-three patients after radiotherapy due to pericoronitis, acute pulpitis, residual crown and root, periapical diseases. Eight cases of osteomyelitis were found. Statistical analysis showed that the relationship of different radiation doses and the incidence of radioactive osteomyelitis were statistically significant （ X2 = 5. 004, P = 0.025 ）. High-dose patients （70 - 80 Gy） had a significant higher incidence of 25% than the low-dose patients （50 -70 Gy） whose incidence was 4.76%. However, there was no significant correlation with the time interval （ X2 = 0,P = 1. 000） and the number of teeth extracted one time （ X2 = O, P ： 1. 000）. Conclusion Radiation dose is the main reason for the induction of radioactive osteomyelitis. Ex- traction of wisdom teeth before radiotherapy, regular dental examination after radiotherapy, prevention and treatment of periodontal and dental diseases is the primary means of prevention for post-radiotherapy.