127例药物性颌骨坏死患者回顾性分析：单中心10年经验总结

目的: 总结分析药物性颌骨坏死（MRONJ）的临床特征,为其诊治提供参考。方法: 回顾2008年1月—2018年6月上海交通大学医学院附属第九人民医院收治的MRONJ患者共127例,按照2014年美国口腔颌面外科医师协会制定的有关MRONJ的诊断标准及分类方法,分析MRONJ发生的诱因,危险因素与好发部位,患者手术情况、效果及预后。结果: 127例患者中,93例（73.23%）发生于下颌骨,30例（23.62%）发生于上颌骨,4例（3.15%）上、下颌骨同时发生。MRONJ诱因中,98例（77.17%）因颌骨局部创伤（拔牙、种植牙、牙自行脱落）导致。MRONJ分期中,0期6例（4.72%）,1期13例（10.24%）,2期80例（62.99%）,3期28例（22.05%）。MRONJ治疗方法,0期及1期患者均接受局部切除（骨髓炎刮治、死骨摘除、颌骨部分切除）;2期71例接受局部切除,8例行颌骨节段切除,1例行颌骨节段切除并同期游离皮瓣重建修复;3期17例接受局部切除,9例行颌骨节段切除,2例行颌骨节段切除并同期游离皮瓣修复。MRONJ预后,0期及1期各3例复发,2期24例复发,3期11例复发。结论: MRONJ好发于下颌骨,拔牙是MRONJ发生最常见的诱因。MRONJ病情复杂,局部刮除容易复发。

Retrospective analysis of 127 cases of medication related osteonecrosis of the jaw:a summary of 10 years'experience in a single center

PURPOSE:This study aimed to provide better diagnosis and treatment of medication related osteonecrosis of the jaw(MRONJ)by analyzing the clinical data retrospectively.METHODS:A total of 127 MRONJ cases surgically treated from January 2008 to June 2018 at Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine were enrolled.According to the diagnostic criteria and classification proposed by American Association of Oral and Maxillofacial Surgeons in 2014,the cause,risk factors and predilection site of MRONJ were analyzed and the treatment methods,therapeutic effects and prognosis were evaluated.RESULTS:Ninety-three cases(73.23%)occurred in mandible,thirty cases(23.62%)occurred in maxilla,four cases(3.15%)occurred in both maxilla and mandible.Trauma was the main cause of MRONJ,ninety-eight cases(77.17%)of MRONJ occurred due to trauma including tooth extraction,dental implantation and tooth exfoliation.Six cases(4.72%)were classified as stage 0,thirteen cases(10.24%)as stageⅠ,eighty cases(62.99%)as stageⅡ,twenty-eight cases(22.05%)as stageⅢ.In both stage 0 and stageⅠ,all the cases received conservative surgical methods including curettage of osteomyelitis,partial mandibulectomy and debridement.In stageⅡ,seventy-one cases received conservative surgical methods,eight cases received segmental mandibulectomy,one case received simultaneously free flap reconstruction after mandibulectomy.In stageⅢ,seventeen cases received conservative surgical methods,nine cases received segmental mandibulectomy,two cases received simultaneously free flap reconstruction after mandibulectomy.Three cases had relapse in both stage 0 and stageⅠ.Twenty-four cases had relapse in stageⅡ.Eleven cases relapsed in stageⅢ.CONCLUSIONS:MRONJ has a predilection to occur in mandible.Jaw trauma is the main cause.MRONJ is complicated and prone to relapse after partial resection.