药物相关性颌骨坏死患者的手术治疗与疾病缓解和生活质量改善相关：一项前瞻性队列研究。
Surgical Therapy in Patients With Medication-Related Osteonecrosis of the Jaw Is Associated With Disease Resolution and Improved Quality of Life: A Prospective Cohort Study.
机构信息
Fellow in Cleft and Craniofacial Surgery, Florida Craniofacial Institute, Tampa, FL.
Chief, Department of Dentistry, Sunnybrook Hospital; Assistant Professor in Oral and Maxillofacial Surgery, Department of Dentistry, University of Toronto, Toronto, ON, Canada.
出版信息
J Oral Maxillofac Surg. 2022 Jun;80(6):1084-1093. doi: 10.1016/j.joms.2022.01.012. Epub 2022 Jan 22.
PURPOSE
Although recent evidence has suggested the value of operative therapy for the management of medication-related osteonecrosis of the jaw (MRONJ), its effectiveness remains controversial. The purpose of this study was to measure and compare MRONJ disease resolution and changes to the quality of life (QoL) between operative and nonoperative management of MRONJ.
METHODS
This is a prospective cohort study. Consecutive MRONJ patients presenting to Mount Sinai Hospital and Sunnybrook Health Sciences Center (September 2016 to August 2020) were recruited and divided by the treatments provided into operative and nonoperative groups. The primary and secondary outcome variables were disease resolution and QoL at 6 months, respectively. Disease resolution was defined as mucosal coverage with an absence of pain, and QoL was measured via the MRONJ-QoL questionnaire. The primary and secondary outcomes, after adjusting for potential confounders, were assessed via multivariate logistic regression and multivariate linear regression analyses, respectively, with significance set to P < .05.
RESULTS
Sixty patients were included in this study. Of these, 40 patients received operative treatment, and 20 received nonoperative treatment. In the unadjusted analyses, operative therapy was found to be significantly associated with both disease resolution and improvement in QoL (relative risk 6.75, 95% confidence interval [CI] 1.78 to 25.6, P < .001; and MRONJ-QoL score improvement of 3.35, 95% CI 0.16 to 6.54, P = .04). When controlling for potential confounders, operative therapy was found to be significantly associated with disease resolution when compared with nonoperative therapy (adjusted odds ratio 46.2, 95% CI 5.57 to 383.9, P < .001). Linear regression analysis also showed operative therapy to be significantly associated with improved QoL compared with nonoperative therapy (adjusted MRONJ-QoL score improvement of 3.72, 95% CI 0.34 to 7.11, P = .03).
CONCLUSIONS
Our study demonstrated operative therapy to be significantly associated with disease resolution and improvement in QoL.
目的
尽管最近有证据表明手术治疗对于药物相关性下颌骨坏死（MRONJ）的管理具有价值，但它的疗效仍存在争议。本研究旨在测量和比较手术与非手术治疗 MRONJ 之间的 MRONJ 疾病缓解和生活质量（QoL）变化。
方法
这是一项前瞻性队列研究。连续招募了 2016 年 9 月至 2020 年 8 月期间在西奈山医院和桑尼布鲁克健康科学中心就诊的 MRONJ 患者，并根据提供的治疗方法将其分为手术组和非手术组。主要和次要结局变量分别为 6 个月时的疾病缓解和 QoL。疾病缓解定义为黏膜覆盖且无疼痛，QoL 通过 MRONJ-QoL 问卷进行测量。主要和次要结局在调整潜在混杂因素后，分别通过多变量逻辑回归和多变量线性回归分析进行评估，显著性水平设为 P<.05。
结果
本研究共纳入 60 例患者，其中 40 例接受手术治疗，20 例接受非手术治疗。在未调整的分析中，手术治疗与疾病缓解和 QoL 改善均显著相关（相对风险 6.75，95%置信区间 [CI] 1.78 至 25.6，P<.001；MRONJ-QoL 评分改善 3.35，95%CI 0.16 至 6.54，P=.04）。当控制潜在混杂因素后，与非手术治疗相比，手术治疗与疾病缓解显著相关（调整后的优势比 46.2，95%CI 5.57 至 383.9，P<.001）。线性回归分析也表明，与非手术治疗相比，手术治疗与 QoL 改善显著相关（调整后的 MRONJ-QoL 评分改善 3.72，95%CI 0.34 至 7.11，P=.03）。
结论
本研究表明，手术治疗与疾病缓解和 QoL 改善显著相关。
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