上颌药物相关性颌骨坏死的不同分期手术治疗效果

doi:10.19723/j.issn.1671-167X.2026.01.014

摘要/Abstract

摘要：

目的: 总结上颌药物相关性颌骨坏死(medication-related osteonecrosis of the jaw, MRONJ)的手术治疗效果, 比较不同手术方式治疗Ⅲ期病变患者预后的差异。方法: 回顾性分析2014年4月至2024年2月于北京大学口腔医院颌面外科接受手术治疗的136例上颌MRONJ患者的临床资料。根据美国口腔颌面外科医师协会(American Association of Oral and Maxillofacial Surgeons, AAOMS)2022年发布的分期标准, 将患者分为Ⅰ期(8例)、Ⅱ期(30例)和Ⅲ期(98例)三组。手术方式包括局部病变切除直接缝合、颊脂垫填塞及碘条填塞。患者术后随访1年, 评估黏膜愈合、疼痛、感染控制及上颌窦炎症改善情况。采用SPSS 20.0软件进行统计学分析。结果: 全部患者短期(3个月)总治愈率为91.2%(124/136), 长期(1年)总治愈率为94.9%(129/136)。Ⅲ期患者中, 颊脂垫填塞组在短期和长期随访中的口腔上颌窦瘘消除率均显著高于碘条填塞组(79.4% vs. 23.4%, P < 0.001;85.3% vs. 54.7%, P=0.002)。然而, 碘条填塞组在上颌窦炎症改善方面的表现更优, 其短期和长期炎症评分改善程度均显著高于颊脂垫填塞组(P=0.029, P=0.014)。结论: 手术治疗适宜于Ⅰ~Ⅲ期的上颌MRONJ患者, 对于Ⅲ期上颌MRONJ, 颊脂垫填塞更有利于口腔上颌窦瘘的闭合, 而碘条填塞在上颌窦炎症控制方面更具优势, 临床应根据患者具体情况选择个体化手术方案。

关键词: 骨坏死, 上颌骨, 外科手术, 治疗结果, 疾病恶化

Abstract:

Objective: To evaluate the surgical outcomes of maxillary medication-related osteonecrosis of the jaw (MRONJ) at different disease stages and to analyze the comparative efficacy of different surgical techniques on the prognosis of stage Ⅲ patients. Methods: A detailed retrospective analysis was conducted on the clinical data of 136 patients with maxillary MRONJ who underwent surgical treatment in the Department of Oral and Maxillofacial Surgery of Peking University School and Hospital of Stomatology from April 2014 to February 2024. All patients were rigorously classified according to the 2022 American Association of Oral and Maxillofacial Surgeons (AAOMS) staging criteria: Stage Ⅰ (n=8), stage Ⅱ (n=30), and stage Ⅲ (n=98). The surgical interventions included local lesion resection with primary direct closure, buccal fat pad packing, and iodoform gauze packing. The patients were systematically followed up for a period of 1 year postoperatively to comprehensively assess several key outcome measures: Complete mucosal healing, resolution of pain, effective infection control, and radiological improvement of maxillary sinus inflammation based on serial computed tomography scans. Statistical analysis was performed using SPSS version 20.0. Continuous variables were expressed as mean±standard deviation and compared using the t-test, while categorical variables were expressed as numbers and percentages and compared using the χ² test or Fisher' s exact test as appropriate. A P-value < 0.05 was considered statistically significant for all analyses. Results: The overall short-term (3 months) cure rate was 91.2% (124/136), which improved to a long-term (1 year) cure rate of 94.9% (129/136). A stage-stratified analysis revealed excellent long-term cure rates: 100.0% (8/8) for stage Ⅰ, 96.7% (29/30) for stage Ⅱ, and 93.9% (92/98) for stage Ⅲ, with no statistically significant difference in outcomes across the different stages (P=0.611). Among the 98 stage Ⅲ patients, 34 were treated with buccal fat pad transfer (BFPT group) and 64 with iodine strip packing (ISP group), with no significant differences in baseline demographic or clinical characteristics between the two groups, ensuring comparability. The BFPT group demonstrated a statistically significant superior performance in achieving oroantral fistula closure both at the short-term (79.4% vs. 23.4%, P < 0.001) and long-term (85.3% vs. 54.7%, P=0.002) follow-up assessments. In contrast, the ISP group showed a markedly greater degree of improvement in maxillary sinus inflammation, as quantified by a standardized radiographic scoring system, with significantly greater reductions in inflammation scores at both the 3-month (P=0.029) and 12-month (P=0.014) follow-up intervals. Conclusion: Surgical management of maxillary MRONJ results in high rates of success with a favorable complication profile. For advanced (stage Ⅲ) disease, the choice of surgical technique entails a strategic trade-off: The buccal fat pad procedure is more conducive to achieving reliable soft tissue closure and oroantral fistula resolution, whereas iodoform gauze packing provides superior management and resolution of concomitant maxillary sinusitis. Consequently, the selection of surgical technique should be individualized, based on a careful consideration of the patient's specific anatomical defect, the extent of sinus involvement, and their overall clinical condition.

Key words: Osteonecrosis, Maxilla, Surgical procedures, operative, Treatment outcome, Disease progression

中图分类号:

R782

FarinEbrahimi, 冯志强, FarazEbrahimi, 韩玮华, 于子杨, 贾宽宽, 安金刚. 上颌药物相关性颌骨坏死的不同分期手术治疗效果[J]. 北京大学学报（医学版）, 2026, 58(1): 107-114.

Ebrahimi Farin, Zhiqiang FENG, Ebrahimi Faraz, Weihua HAN, Ziyang YU, Kuankuan JIA, Jingang AN. Surgical treatment outcomes of different stages of maxillary medication-related osteonecrosis of the jaw[J]. Journal of Peking University (Health Sciences), 2026, 58(1): 107-114.

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参考文献 24

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Outcome	Wound condition	Pain	Infection	Image findings
Healing	Healed, no bone exposure	No pain	No signs of inflammation or infection	Normal trabeculation, no sequestrum, clear maxillary sinus
Recurrence	No improvement or worsened	No improvement or worsened	No improvement	Presence of sequestrum or osteolytic changes, signs of maxillary sinusitis

Maxillary sinusitis	Stage Ⅰ (n=8)			Stage Ⅱ (n=30)			Stage Ⅲ (n=98)
Maxillary sinusitis	Pre-surgery	3 moths post-surgery	1 year post-surgery	Pre-surgery	3 months post-surgery	1 year post-surgery	Pre-surgery	3 months post-surgery	1 year post-surgery
Normal	8	8	8	27	29	29	4	17	38
Mild				3	1		2	34	41
Moderate						1	13	42	16
Severe							79	5	3

Items	Short term (3 months)			Long term (1 year)
Items	ISP (n=64)	BFPT (n=34)	P value	ISP (n=64)	BFPT (n=34)	P value
Clinical efficacy, n (%)			0.656			0.415
Recovery	60 (93.8)	32 (94.1)		61 (95.3)	31 (91.2)
Recurrence	4 (6.2)	2 (5.9)		3 (4.7)	3 (8.8)
Pain, n (%)			0.656			0.415
No	60 (93.8)	32 (94.1)		61 (95.3)	31 (91.2)
Yes	4 (6.3)	2 (5.9)		3 (4.7)	3 (8.8)
Soft tissue swelling, n (%)			0.570			0.415
No	61 (95.3)	32 (94.1)		61 (95.3)	31 (91.2)
Yes	3 (4.7)	2 (5.9)		3 (4.7)	3 (8.8)
Sequestrum, n (%)			0.576			0.415
No	63 (98.4)	33 (97.1)		61 (95.3)	31 (91.2)
Yes	1 (1.6)	1 (2.9)		3 (4.7)	3 (8.8)
Oral antral fistula, n (%)			< 0.001^***			0.002^**
No	15 (23.4)	27 (79.4)		35 (54.7)	29 (85.3)
Yes	49 (76.6)	7 (20.6)		29 (45.3)	5 (14.7)
Maxillary sinusitis score, ${\bar x}$±s			0.029^*			0.014^*
Pre-surgery	2.80±0.59	2.53±0.85		2.80±0.59	2.53±0.85
Post-surgery	1.33±0.77	1.41±0.91		0.78±0.78	0.94±0.84
Degree of improvement	1.47±0.81	1.12±0.83		2.02±0.86	1.59±1.00