Kim Tae-Hwan, Seo Won-Gyo, Koo Chul-Hong, Lee Jae-Hoon
Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea.
J Korean Assoc Oral Maxillofac Surg. 2016 Aug;42(4):193-204. doi: 10.5125/jkaoms.2016.42.4.193. Epub 2016 Aug 24.
This study examined the statistical relevance of whether the systemic predisposing factors affect the prognosis of surgical treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ). All cases had undergone bone biopsies to determine the characteristics of the mechanisms of BRONJ by optical microscopy.
The data included 54 BRONJ cases who underwent surgery and in whom bone biopsies were performed. The results of surgery were evaluated and the results were classified into 3 categories: normal recovery, delayed recovery, and recurrence after surgery. The medical history, such as diabetes mellitus, medication of steroids, malignancies on other sites was investigated for an evaluation of the systemic predisposing factors in relation to the prognosis. The three factors involved with the medication of bisphosphonate (BP) were the medication route, medication period, and drug holiday of BP before surgery. The serum C-terminal cross-linking telopeptide (CTX) value and presence of microorganism colony in bone biopsy specimens were also checked. Statistical analysis was then carried out to determine the relationship between these factors and the results of surgery.
The group of patients suffering from diabetes and on steroids tended to show poorer results after surgery. Parenteral medication of BP made the patients have a poorer prognosis after surgery than oral medication. In contrast, the medication period and drug holiday of BP before surgery did not have significance with the results of surgery nor did the serum CTX value and presence of microorganism colony. Necrotic bone specimens in this study typically showed disappearing new bone formation around the osteocytic lacunae and destroyed Howship's lacunae.
Although many variables exist, this study could in part, predict the prognosis of surgical treatment of BRONJ by taking the patient's medical history.
本研究探讨全身易感因素是否影响双膦酸盐相关颌骨骨坏死（BRONJ）手术治疗预后的统计学相关性。所有病例均进行了骨活检，以通过光学显微镜确定BRONJ的机制特征。
数据包括54例接受手术并进行了骨活检的BRONJ病例。评估手术结果并将结果分为3类：正常恢复、恢复延迟和术后复发。调查病史，如糖尿病、类固醇药物使用情况、其他部位的恶性肿瘤，以评估与预后相关的全身易感因素。与双膦酸盐（BP）用药相关的三个因素是BP的用药途径、用药时间和术前停药期。还检查了血清C端交联端肽（CTX）值和骨活检标本中微生物菌落的存在情况。然后进行统计分析以确定这些因素与手术结果之间的关系。
患有糖尿病且使用类固醇的患者组术后结果往往较差。BP的胃肠外给药使患者术后预后比口服给药差。相比之下，术前BP的用药时间和停药期与手术结果无关，血清CTX值和微生物菌落的存在情况也无关。本研究中的坏死骨标本通常显示骨陷窝周围新骨形成消失，Howship陷窝破坏。
尽管存在许多变量，但本研究可以通过了解患者病史部分预测BRONJ手术治疗的预后。
