目的:探讨双层软组织(DLST)缝合技术在早中期下颌骨药物相关性颌骨坏死(MRONJ)患者应用抗骨吸收药物的临床应用效果。
方法:纳入2021年10月至2022年9月在北京大学医学院第四病区和口腔医院接受手术治疗的早中期下颌骨MRONJ患者。收集患者的临床资料,包括原发性疾病,伴随疾病,药物治疗方案(药物类型,药物持续时间),MRONJ舞台,临床症状,影像学表现,等。手术期间,在使用边缘下颌骨切除术去除坏死骨之后,使用DLST闭合技术闭合伤口。术后定期随访,评价DLST技术的治疗效果和并发症,评估患者的疼痛评分和功能状态.
结果:本研究共纳入13例患者,12个女人和1个男人,年龄(66.69±13.14)岁。七个病人有骨质疏松,2得了肺癌,3例患有乳腺癌,1例患有前列腺癌,7例没有伴随疾病,2患有糖尿病,2人患有心血管疾病,1人患有干燥综合征。9例患者使用唑来膦酸静脉注射,平均持续时间为(37.7±20.0)个月,和其他药物,7例患者同时服用来曲唑片;3例患者平均服用(10.3±11.9)个月,阿仑膦酸钠片5例患者平均服用(55.20±27.20)个月,2例患者不同程度服用醋酸泼尼松片或阿卡波糖片。术后随访9~17个月,平均11.9个月,13例患者全部治愈,无并发症,如脓液溢出等。患者术前Karnofsky表现状态(KPS)评分为68.46±14.05,术后评分为82.31±15.36,差异有统计学意义(P<0.05)。患者术前视觉模拟评分(VAS)评分为5.77±0.73,术后评分为0.38±0.51,差异有统计学意义(P<0.001)。
结论:在单用抗骨吸收药物的下颌骨MRONJ患者中,双层软组织缝合技术能取得良好的临床效果,为用药较为复杂的MRONJ患者提供临床治疗思路。
OBJECTIVE: To investigate the clinical application effect of double-layer soft tissue (DLST) suture closure technique in patients with mandible medication-related osteonecrosis of the jaw (MRONJ) of early and medium stages resulted in application of anti-bone-resorptive drugs.
METHODS: Early to medium stage mandible MRONJ patients who underwent surgical treatment in the fourth ward of Peking University School and Hospital of Stomatology from October 2021 to September 2022 were included. Clinical information of the patients were collected, including primary disease, concomitant disease, medication regimen (drug type, duration of medication), MRONJ stage, clinical symptoms, imaging manifestations, etc. During surgery, after using marginal mandibulae resection to remove the necrotic bone, the wound was closed using DLST closure technique. Regular post-operative follow-up was performed to evaluate the therapeutic effect and complications of the DLST technique, the pain score and functional status of the patiens were evaluated.
RESULTS: This study totally included 13 patients, 12 women and 1 man, aged (66.69±13.14) years. Seven patients had osteoporosis, 2 had lung cancer, 3 had breast cancer and 1 had prostate cancer among their primary diseases; 7 had no concomitant diseases, 2 had diabetes mellitus, 2 had cardiovascular disease and 1 had dry syndrome. Intravenous zoledronic acid were used in 9 patients, the average duration was (37.7±20.0) months, and other drugs, such as letrozole tablets were taken in 7 patients at the same time; Denosumab injection was used in 3 patients for an average of (10.3±11.9) months; Alendronate sodium tablets were taken in 5 patients for an average of (55.20±27.20) months, and prednisone acetate tablets or acarbose tablets were taken to varying degrees in 2 patients. The average post-operative follow-up was 11.9 months (9 to 17 months), and all the 13 patients were cured without complications, such as pus overflow and so forth. The pre-operative score of Karnofsky performance status (KPS) in the patients was 68.46±14.05, and the post-operative score was 82.31±15.36, and the difference was statistically significant (P < 0.05). The pre-operative score of visual analogue scale (VAS) in the patients was 5.77±0.73 and the post-operative score was 0.38±0.51, and the difference had statistical significance (P < 0.001).
CONCLUSIONS: The double-layer soft tissue suture closure technique can achieve good clinical results in patients with MRONJ of the mandible using anti-bone-resorptive drugs alone, and can provide clinical treatment ideas for MRONJ patients with more complicated drug use.