药物相关性颌骨骨髓炎和放射性骨坏死所致病理性下颌骨骨折中骨痂形成受损。
Impaired Callus Formation in Pathological Mandibular Fractures in Medication-Related Osteonecrosis of the Jaw and Osteoradionecrosis.
机构信息
Resident, Oral and Maxillofacial Surgery - Imaging and Pathology Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral & Maxillofacial Surgery, University of Leuven, Leuven, Belgium.
Resident, Oral and Maxillofacial Surgery - Imaging and Pathology Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral & Maxillofacial Surgery, University of Leuven, Leuven, Belgium.
出版信息
J Oral Maxillofac Surg. 2021 Sep;79(9):1892-1901. doi: 10.1016/j.joms.2021.04.024. Epub 2021 Apr 28.
PURPOSE
Nonsurgical treatment of mandibular fractures secondary to medication-related osteonecrosis of the jaw (MRONJ) or osteoradionecrosis (ORN) mostly results in nonunion, whereas nonsurgical fracture treatment of atrophic fractures can achieve favorable results in selected cases. The aim of this study was to compare callus formation in pathological mandibular fractures due to MRONJ, ORN, or extreme mandibular atrophy.
METHODS
A retrospective cohort study reviewing the medical records of all MRONJ-, ORN-, or atrophy-related fractures treated at the departments of maxillofacial surgery in the Leuven or Lille university hospitals between 2010 and 2019 was undertaken. The primary predictor variable in this study was disease state (MRONJ, ORN, or extreme mandibular atrophy). The primary outcome variable was callus formation after 1 month of follow-up (present, absent). Additional study variables measured included patient age and gender. T-tests, Fisher exact tests, and multiple logistic regression were used for statistical analysis. The significance level was set at P < .05.
RESULTS
Seventy patients were analyzed (12 MRONJ cases, 54 ORN fractures, 4 atrophic fractures). The callus formation prevalence in nonsurgically approached fractures secondary to ORN and MRONJ after 1 month of follow-up was 3.03% (2/66 cases). In contrast, callus was detected in all patients in the mandibular atrophy-related fracture group. Osteonecrosis was statistically correlated with impaired callus formation (P = .0121).
CONCLUSION
Whereas one would expect indirect fracture healing and thus callus formation to occur in all non-surgically treated fractures, our data demonstrate its absence in the majority of MRONJ- and ORN-related fractures. Multiple plausible explanations for this phenomenon were identified: periosteal damage with loss of callus-forming cells, compromised vasculature, and bacterial colonization.
目的
对于因药物相关性颌骨坏死（MRONJ）或放射性骨坏死（ORN）引起的下颌骨骨折，非手术治疗通常导致骨折不愈合，而对于萎缩性骨折的非手术治疗，在选择的病例中可以获得良好的效果。本研究的目的是比较 MRONJ、ORN 或极度下颌骨萎缩引起的病理性下颌骨骨折的骨痂形成情况。
方法
回顾性队列研究，对 2010 年至 2019 年期间在鲁汶或里尔大学附属医院颌面外科治疗的所有 MRONJ、ORN 或萎缩相关骨折的病历进行了回顾。本研究的主要预测变量是疾病状态（MRONJ、ORN 或极度下颌骨萎缩）。主要观察指标是 1 个月随访时的骨痂形成情况（存在、不存在）。此外，还测量了患者年龄和性别等研究变量。使用 t 检验、Fisher 确切检验和多因素逻辑回归进行统计学分析。显著性水平设为 P <.05。
结果
共分析了 70 例患者（12 例 MRONJ 病例、54 例 ORN 骨折、4 例萎缩性骨折）。1 个月随访时，继发于 ORN 和 MRONJ 的非手术治疗骨折中骨痂形成的发生率为 3.03%（66 例中的 2 例）。相比之下，在所有下颌骨萎缩性骨折组的患者中都检测到了骨痂。骨坏死与骨痂形成不良呈统计学相关（P =.0121）。
结论
虽然人们预计所有非手术治疗的骨折都会发生间接骨折愈合，从而形成骨痂，但我们的数据显示，MRONJ 和 ORN 相关骨折中大多数都没有形成骨痂。对于这种现象有多种可能的解释：骨膜损伤导致成骨细胞丧失、血管受损和细菌定植。
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