摘要
目的分析颌骨放射性骨坏死的临床特点及治疗方法，为临床诊治该疾病提供参考。方法对2000-2010年北京大学口腔医院口腔颌面外科收治的93例颌骨放射性骨坏死患者病历资料进行回顾性分析。66例患者接受1个疗程放疗，放疗剂量34-90Gy，平均64．6Gy，其中22例在骨坏死症状暴露前有拔牙或牙槽外科手术等创伤刺激。末次放疗与症状暴露间隔时间为放疗后2周至33年，平均间隔54个月。病变发生于下颌骨79例，上颌骨13例，上下颌骨均有累及1例。结果56例患者行颌骨切除术并行游离组织瓣修复，49例手术成功，7例术后出现血管危象，其中3例进行血管危象探查，并重新吻合血管皮瓣成活，2例去除皮岛及血管蒂改行游离骨移植并成活，2例行皮瓣摘除直接拉拢缝合。56例患者术后1例坏死复发，53例术后咀嚼、吞咽等功能恢复良好，2例颌骨切除患者仅行钛板修复，术后均出现钛板外露。20例行刮治术，9例术后坏死复发。15例行颌骨切除术后未作修复，2例坏死复发，余术后咀嚼、吞咽等功能均较差。结论颌骨放射性骨坏死一般发生于下颌骨，手术治疗主张颌骨切除并行游离组织瓣修复，应慎行刮治术及单纯钛板修复。
Objective To investigate the clinical feature, treatment, and prognosis of hospitalized patients with jaw osteoradioneerosis. Methods A total of 93 cases with jaw osteoradionecrosis treated between 2000 and 2010 was reviewed. Of the 93 cases, 79 cases were with mandible lesions, 13 cases with maxillary lesions, and 1 case with both mandible and maxillary lesions. Sixty-six cases received one course of radiotherapy, with the radiation doses of 34 - 90 Gy （ mean 64.6 Gy）. Twenty-two eases experienced tooth extraction or other operative procedures before exhibition of the clinical symptoms for osteoradionecrosis. The interval time between radiotherapy and the onset of osteoradionecrosis varied from 2 weeks to 32 years （mean 54 months）. Results Of 93 eases, 56 patients underwent radical resection of the pathologic bone and reconstruction with free tissue flaps, in whom 7 cases received the second surgery due to microvascular thrombosis in flap vessels, and flaps were survival by new vascular anastomosis in 3 eases, thefailed flaps were removed and replaeed successfully by non vascnlafized bone grat^s in 2 cases, and the failed flaps removed and the defects were repaired with adjacent skin in other 2 eases. In the 56 eases, only one case was with disease recurrence and 53 eases with significant improvement in chewing and swallowing functions. Only 2 of 93 eases underwent resection of the pathologic bone and reconstruction with titanium plates, and thereafter they encountered titanium exposure. Sealing of osteoradionecrosis lesions was applied to 20 of 93 patients and 9 cases of them were with disease recmTence. Fifteen eases had resection of the effeeted mandible without reconstruction. Disease relapse was encountered in 2 of them, others had poor chewing and swallowing. Conclusions The mandible is more susceptible to osteoradionecrosis than maxilla. Radical resection with reconstruction by free tissue flap is recommended for the treatment of jaw osteoradionecrosis, and scaling and reconstruction only with tit
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2012年第6期458-461,共4页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
