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药物相关性颌骨坏死:富白细胞血小板纤维蛋白在治疗中的辅助应用

Medication-Related Osteonecrosis of the Jaw: The Use of Leukocyte-Platelet-Rich Fibrin as an Adjunct in the Treatment.

作者信息

Valente Nicola Alberto, Chatelain Sibylle, Alfonsi Fortunato, Mortellaro Carmen, Barone Antonio

机构信息

Unit of Oral Surgery and Implantology, Service of Maxillofacial and Buccal Surgery, Department of Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.

Department of Medical Science, University of Eastern Piedmont, Novara, Italy.

出版信息

J Craniofac Surg. 2019 Jun;30(4):1095-1101. doi: 10.1097/SCS.0000000000005475.

Abstract

Medication-related osteonecrosis of the jaw are bone exposures in the maxillofacial region that does not heal after 8 weeks from the observation of a health care provider in patients with history of the intake of antiresorptive agents and no previous irradiation of the craniofacial region. Initially attributed only to the intake of bisphosphonates they have later been associated also with the intake of other classes of antiresorptive medications.This retrospective study analyzed records from patients with documented medication-related osteonecrosis of the jaws treated in our unit. Clinical data, comorbidities and concurrent medications, treatment outcome information such us number of repeated treatments needed, antibiotic used, type of treatment adopted were recorded. Baseline demographics for the included records of 15 patients (mean age: 64 years) revealed a treatment success rate of 73.3% (mean observation period: 42.2 months), failure rate of 26.6%, dental extraction trigger rate of 33.3%, and a spontaneous trigger rate of 40%.Zolendronate and denosumav were the medications most frequently associated with the upset of medication-related osteonecrosis of the jaw (60% of the sample). In 8 cases out of the 11 that were successful, the surgical treatment had to be repeated more than once. Leukocyte-platelet-rich fibrin led to the resolution of 11 of the 14 cases in which it was used.

摘要

药物相关性颌骨坏死是指在有抗吸收剂摄入史且既往无颅面部放疗史的患者中,自医疗保健人员观察起8周后仍未愈合的颌面部骨暴露。最初仅归因于双膦酸盐的摄入,后来也与其他类抗吸收药物的摄入有关。这项回顾性研究分析了在我们科室接受治疗的有记录的药物相关性颌骨坏死患者的病历。记录了临床数据、合并症和同时使用的药物、治疗结果信息,如所需重复治疗的次数、使用的抗生素、采用的治疗类型。纳入的15例患者(平均年龄:64岁)的基线人口统计学数据显示,治疗成功率为73.3%(平均观察期:42.2个月),失败率为26.6%,拔牙触发率为33.3%,自发触发率为40%。唑来膦酸和地诺单抗是与药物相关性颌骨坏死发生最常相关的药物(占样本的60%)。在11例成功的病例中,有8例手术治疗不得不重复不止一次。富白细胞血小板纤维蛋白使14例使用该材料的病例中的11例病情得到缓解。

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