PDF(Pubmed)
Abstract：
UNASSIGNED: The aim of this study was to investigate the effect of antiresorptive agents on the ossification of reconstructed mandibles by free bone grafts for the first time.
UNASSIGNED: A total of 38 reconstructions of the jaw were retrospectively evaluated for ossification between bone segments by two raters based on postoperative panoramic radiographs. The study group (n = 13) had segmental resection of the mandible and free bone flap reconstruction due to medication-related osteonecrosis of the jaw (MRONJ). The control group (noMRONJ, n = 25) comprised segmental mandibular resections and free bone flap reconstructions due to tumors, chronic osteomyelitis, or trauma without any radiation. Ossification time and influencing factors were evaluated.
UNASSIGNED: Both duration of surgery (346 ± 90 min. vs. 498 ± 124 min.; p < 0.001) and hospitalization (8.7 ± 2.8 days vs. 13.4 ± 5.3 days, p = 0.006) were shorter in the MRONJ group compared to the noMRONJ group. Ossification after mandibular reconstruction was significantly faster in the MRONJ study group [224 days, interquartile range (IQR) 175-287] compared to the control group (288 days, IQR 194-445; p < 0.001). Moreover, good initial contact between the segments resulted in faster ossification (p < 0.001) in the MRONJ group. Ossification rate between original and grafted bone or between grafted bone segments only did not differ in both the study and control groups (MRONJ, p = 0.705 vs. control, p = 0.292). The type of antiresorptive agent did not show any significance for ossification. The rate of wound healing disturbances did also not differ between the study and control groups (p = 0.69).
UNASSIGNED: Advanced MRONJ (stage 3) can be resected and reconstructed safely with free microvascular bone flaps. Antiresorptive agents enhance the ossification of the bone segments. Optimal initial contact of the bone segments accelerates bone healing. Surgery and hospitalization are markedly shortened in this vulnerable group of MRONJ patients compared to oncologic patients.
UNASSIGNED: A total of 38 reconstructions of the jaw were retrospectively evaluated for ossification between bone segments by two raters based on postoperative panoramic radiographs. The study group (n = 13) had segmental resection of the mandible and free bone flap reconstruction due to medication-related osteonecrosis of the jaw (MRONJ). The control group (noMRONJ, n = 25) comprised segmental mandibular resections and free bone flap reconstructions due to tumors, chronic osteomyelitis, or trauma without any radiation. Ossification time and influencing factors were evaluated.
UNASSIGNED: Both duration of surgery (346 ± 90 min. vs. 498 ± 124 min.; p < 0.001) and hospitalization (8.7 ± 2.8 days vs. 13.4 ± 5.3 days, p = 0.006) were shorter in the MRONJ group compared to the noMRONJ group. Ossification after mandibular reconstruction was significantly faster in the MRONJ study group [224 days, interquartile range (IQR) 175-287] compared to the control group (288 days, IQR 194-445; p < 0.001). Moreover, good initial contact between the segments resulted in faster ossification (p < 0.001) in the MRONJ group. Ossification rate between original and grafted bone or between grafted bone segments only did not differ in both the study and control groups (MRONJ, p = 0.705 vs. control, p = 0.292). The type of antiresorptive agent did not show any significance for ossification. The rate of wound healing disturbances did also not differ between the study and control groups (p = 0.69).
UNASSIGNED: Advanced MRONJ (stage 3) can be resected and reconstructed safely with free microvascular bone flaps. Antiresorptive agents enhance the ossification of the bone segments. Optimal initial contact of the bone segments accelerates bone healing. Surgery and hospitalization are markedly shortened in this vulnerable group of MRONJ patients compared to oncologic patients.
摘要：
■这项研究的目的是首次研究抗再吸收剂对游离骨移植物重建下颌骨骨化的影响。
■根据术后全景X线照片，由两名评估者回顾性评估了38例颌骨重建的骨化情况。研究组（n=13）因药物相关的颌骨坏死（MRONJ）进行下颌骨节段切除和游离骨瓣重建。对照组(noMRONJ，n=25）包括由于肿瘤引起的节段性下颌骨切除和游离骨瓣重建，慢性骨髓炎,或者没有任何辐射的创伤。评估骨化时间和影响因素。
■两次手术的持续时间（346±90分钟。vs.498±124分钟。；p<0.001）和住院（8.7±2.8天vs.13.4±5.3天，与noMRONJ组相比，MRONJ组的p=0.006）较短。MRONJ研究组下颌骨重建后骨化明显更快[224天，四分位距（IQR）175-287]与对照组（288天，IQR194-445；p<0.001)。此外，节段之间良好的初始接触导致MRONJ组骨化更快(p<0.001)。在研究组和对照组中，原始骨和移植骨之间或移植骨段之间的骨化率没有差异（MRONJ，p=0.705vs.control,p=0.292）。抗吸收剂的类型对骨化没有任何意义。创伤愈合障碍的发生率在研究组和对照组之间也没有差异(p=0.69)。
■可以使用游离的微血管骨瓣安全地切除和重建高级MRONJ（第3阶段）。抗吸收剂增强骨段的骨化。骨段的最佳初始接触加速骨愈合。与肿瘤患者相比，MRONJ患者的这一脆弱群体的手术和住院时间明显缩短。
■根据术后全景X线照片，由两名评估者回顾性评估了38例颌骨重建的骨化情况。研究组（n=13）因药物相关的颌骨坏死（MRONJ）进行下颌骨节段切除和游离骨瓣重建。对照组(noMRONJ，n=25）包括由于肿瘤引起的节段性下颌骨切除和游离骨瓣重建，慢性骨髓炎,或者没有任何辐射的创伤。评估骨化时间和影响因素。
■两次手术的持续时间（346±90分钟。vs.498±124分钟。；p<0.001）和住院（8.7±2.8天vs.13.4±5.3天，与noMRONJ组相比，MRONJ组的p=0.006）较短。MRONJ研究组下颌骨重建后骨化明显更快[224天，四分位距（IQR）175-287]与对照组（288天，IQR194-445；p<0.001)。此外，节段之间良好的初始接触导致MRONJ组骨化更快(p<0.001)。在研究组和对照组中，原始骨和移植骨之间或移植骨段之间的骨化率没有差异（MRONJ，p=0.705vs.control,p=0.292）。抗吸收剂的类型对骨化没有任何意义。创伤愈合障碍的发生率在研究组和对照组之间也没有差异(p=0.69)。
■可以使用游离的微血管骨瓣安全地切除和重建高级MRONJ（第3阶段）。抗吸收剂增强骨段的骨化。骨段的最佳初始接触加速骨愈合。与肿瘤患者相比，MRONJ患者的这一脆弱群体的手术和住院时间明显缩短。
