放射性颌骨坏死的术式选择及疗效评价

目的：探讨经济有效的治疗放射性颌骨坏死（RONJ）的手术方式。方法77例RONJ根据颌骨坏死的范围、软组织条件选择不同治疗方式。方案1：骨坏死范围局限，牙龈及周围软组织无明显炎症的采用局部刮治或方块切除术；方案2：骨坏死范围较大、周围软组织炎症明显和（或）伴有明显纤维化的病例在控制炎症后，扩大切除同时行血管化游离复合组织瓣修复。结果21例采用方案1，其中15例一期愈合、6例行二次刮治或方块切除；56例采用方案2，其中软组织条件较好的30例，22例一期愈合，5例延期愈合，3例发生骨组织瓣血管危象，经探查和再吻合后1例正常愈合，2例仍发生组织瓣坏死；软组织炎症明显或伴有局部组织明显纤维化26例中，7例出现骨组织瓣血管危象，探查和再吻合后5例正常，2例出现骨坏死，9例一期愈合，15例局部出现不同程度软组织感染坏死，延期愈合。结论局限性放射性颌骨坏死可采用刮治或方块切除；骨坏死范围较大、软组织条件较好的采用血管化游离组织瓣进行修复；软组织纤维化明显的失败率较高，临床使用时应综合多方因素考虑。

Selection of operation and efficacy evaluation on radioactive osteomyelitis of jaws

Objective To explore the appropriate operation method of radioactive osteomyelitis of jaws （RONJ）. Method Seventy-seven cases were divided into 2 groups base on their extent of bone necrosis and condition of soft tissue , group 1 which is limited alveolar bone necrosis and limited soft tissue inflammation was treated with scaling or sequestrectomy; group 2 with extensive bone necrosis and severe inflammation or soft tissue fibrosis was treated with radical mandiblecotomy , and reconstruction with fibular myocutaneous flap. Results In group 1, 15 get primary healing, 6 need scaling or ostectomy twice or more; in group 2, 22 of 30 with comparatively favourable condition of soft tissue get primary healing, 5 get delay healing, 3 get vascular crisis, after exploration and anastomosis, 1 cases get primary healing, the other 2 get delay healing; while in the 26 case which soft tissue fibrosis, 9 get primary healing, 15 get delay healing, 2 graft get varying degrees necrosis. Conclusions RONJ with good condition of soft tissue could be treated with scaling or block resection; Extensive sequestrectomy in combination with immediate vascularized tissue grafts clearly improved the prognosis , however, it depends on the condition of the local soft and hard tissue .