一种新的药物性颌骨坏死临床分期及治疗策略

目的: 通过分析药物性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)的病例资料,提出一种用于指导MRONJ临床诊疗的新分期方法。方法: 总结2008—2018年上海交通大学医学院附属第九人民医院收治的74例MRONJ患者的影像学资料及诊疗方式,将下牙槽神经管、下颌骨下缘及上颌窦底等作为划分骨质破坏严重程度的解剖学标志,再根据病损组织是否存在明确的界线,提出了一种新的MRONJ四分期二亚分类法及相应的治疗策略。结果: 根据骨坏死的不同程度将其分为4期,0期(7例),Ⅰa期(18例),Ⅰb期(14例),Ⅱa期(12例),Ⅱb期(15例),Ⅲ期(8例)。治疗后62例患者病情稳定,12例出现骨坏死进展。结论: 新的分期方法及相应治疗策略适用于MRONJ的临床诊疗。

A novel staging system and corresponding therapeutic strategies for medication-related osteonecrosis of the jaw

PURPOSE: To propose a new clinical staging method that can be performed to guide the diagnosis and treatment of MRONJ through a retrospective study of patients with medication-related osteonecrosis of the jaw (MRONJ). METHODS: The clinical data of 74 MRONJ patients admitted to Shanghai Ninth People's Hospital between 2008 and 2018 were enrolled. A novel staging method and corresponding treatments were proposed on the basis of anatomic structures (inferior alveolar canal and floor of maxillary sinus) and boundary of bone lesions. RESULTS: A new staging system with four different stages (stage 0: 7 cases; stageⅠa: 18 cases; stageⅠb: 14 cases; stage Ⅱa: 12 cases; stage Ⅱb: 15 cases; and stage Ⅲ: 8 cases) was proposed. Outcome of these samples demonstrated that only 12 cases hold progressed state. CONCLUSIONS: This new staging system is suitable for clinical diagnosis and therapeutic selection for MRONJ.