Bernardi S, Di Girolamo M, Necozione S, Continenza M A, Cutilli T
Anatomy Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio, Coppito 2, 67100, L'Aquila, Italy.
Maxillo-Facial Surgery Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Lorenzo Natali 1: Località Coppito, 67100, L'Aquila, Italy.
Musculoskelet Surg. 2019 Apr;103(1):47-53. doi: 10.1007/s12306-018-0548-6. Epub 2018 Jun 14.
Bisphosphonate drug therapy provides benefits in the case of osteoporosis and carcinomas metastasizing to the bones, but it exposes patients to important side effects. The aim of this study was to investigate the incidence and the appropriate surgical treatment of bone lesions and fractures due to antiresorptive drug-related osteonecrosis of the jaws (ARONJ).
Patients presenting with osteonecrosis lesions of the jaw, who were referred to the Maxillo-Facial unit of the University of L'Aquila, were considered for inclusion. Grade of the lesion and treatment choice was recorded for each patient. Descriptive statistics were calculated and the data were analysed with Chi-squared tests. A representative case of a fracture reduction with a supra-periostal approach is reported.
Among the 165 patients with ARONJ lesions, 112 were female and 53 were male. In total, 115 patients received intra-venous bisphosphonate therapy and 50 received oral bisphosphonate therapy. Five stage 2 lesions, three stage 2 lesions and two stage 3 lesions were not a consequence of dental procedures. Eighteen surgical bone excisions were performed and four pathological fractures were reduced. In one case (the reported one), the combined use of platelet-rich plasma and the supra-periostal approach leads to a successful 1-year follow-up.
ARONJ lesions are a type of pathological bone disease affecting the jawbones. The pathology pathway remains a controversial and frequently discussed topic. A surgically conservative strategy seems to be the best way to assure a comfortable quality of life to those patients negatively affected by this condition.
双膦酸盐药物治疗在骨质疏松症及骨转移癌病例中具有益处，但会使患者面临重要的副作用。本研究的目的是调查抗吸收药物相关性颌骨坏死（ARONJ）所致骨病变和骨折的发生率及合适的外科治疗方法。
纳入转诊至拉奎拉大学颌面科的颌骨坏死病变患者。记录每位患者的病变分级及治疗选择。计算描述性统计量，并采用卡方检验分析数据。报告1例采用骨膜上入路进行骨折复位的代表性病例。
在165例ARONJ病变患者中，女性112例，男性53例。总计115例患者接受静脉双膦酸盐治疗，50例接受口服双膦酸盐治疗。5例2期病变、3例2期病变和2例3期病变并非牙科手术所致。实施了18例手术骨切除，复位了4例病理性骨折。在1例（报告的病例）中，富血小板血浆与骨膜上入路联合应用使随访1年成功。
ARONJ病变是一种影响颌骨的病理性骨病。病理途径仍是一个有争议且经常讨论的话题。手术保守策略似乎是确保受该疾病负面影响的患者获得舒适生活质量的最佳方法。
