Department of Oral and Maxillofacilal Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China.
Department of Oral and Maxillofacilal Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China.
Int J Oral Maxillofac Surg. 2021 Jun;50(6):740-745. doi: 10.1016/j.ijom.2020.07.036. Epub 2020 Oct 3.
Medication-related osteonecrosis of the jaw (MRONJ) is generally difficult to treat. So far, no optimal strategy for MRONJ has been established. The aim of this study was to determine whether a new surgical technique, i.e. curettage with cortical perforations of healthy adjacent bone that enhances bone perfusion would be more effective than standard curettage in treating patients with MRONJ. Twenty-eight MRONJ patients who underwent curettage treatment with or without cortical perforation technique at our institution between June 2014 and May 2016 were included in this retrospective study. Ten cases treated using cortical perforation technique were completely cured after primary wound closure with mucoperiosteal flap. During a long-term follow-up, two cases from the cortical perforation group relapsed at the mandibular sites 6 and 40 months post-operation, respectively, while in the control group, 77.8% (14/18) cases relapsed due to infected mucosa fistula or bone exposure 1-3 months after treatment. It was concluded that the new treatment approach might be more effective in treating patients with MRONJ caused by antiresorptive drugs. However, more extensive randomized trials are needed to further evaluate its efficacy in clinic.
药物相关性颌骨坏死（MRONJ）通常难以治疗。到目前为止，尚未确定治疗 MRONJ 的最佳策略。本研究旨在确定一种新的手术技术，即对健康相邻骨进行皮质穿孔刮除以增强骨灌注，是否比标准刮除术更有效治疗 MRONJ 患者。本回顾性研究纳入了 2014 年 6 月至 2016 年 5 月在我院接受刮除术治疗且有或无皮质穿孔技术的 28 例 MRONJ 患者。10 例采用皮质穿孔技术治疗的患者在初次闭合后完全治愈黏膜皮瓣。在长期随访中，皮质穿孔组的 2 例分别在术后 6 个月和 40 个月时在下颌部位复发，而对照组的 18 例中有 77.8%（14 例）由于感染的黏膜瘘或骨暴露在治疗后 1-3 个月复发。结论：新的治疗方法可能对治疗抗吸收药物引起的 MRONJ 患者更有效。然而，需要进行更广泛的随机试验来进一步评估其在临床上的疗效。
