Bisphosphonate-related osteonecrosis: laser-assisted surgical treatment or conventional surgery?
Bisphosphonate-related osteonecrosis: laser-assisted surgical treatment or conventional surgery?
复制标题
DOI：
10.1007/s10103-011-0974-2
复制
发表时间：
2011-11-01
影响因子：
2.1
通讯作者：
Oncu, Bora
中科院分区：
文献类型：
--
作者：
Atalay, Belir;Yalcin, Serhat;Oncu, Bora
双膦酸盐（BSP）用于治疗多发性骨髓瘤、转移性乳腺癌和肺癌、佩吉特氏病、骨质疏松症、恶性肿瘤引起的高钙血症以及许多其他骨骼疾病。 BSP 会降低破骨细胞功能，从而导致骨吸收。双磷酸盐相关颌骨坏死（BRONJ）是一个新开发的术语，用于描述接受双磷酸盐治疗的患者出现的严重并发症。已知 BSP 具有抗血管生成作用，可引发硬组织坏死。目前对于解决这个问题的正确方法尚未达成共识。这项回顾性研究的目的是比较激光手术联合生物刺激与传统手术治疗 BSP 引起的股骨头缺血性坏死的效果，该手术对我们诊所接受过治疗的 20 名患者进行。 BRONJ 在接受静脉 BSP 治疗的肺癌、前列腺癌和乳腺癌患者中进行了评估。本研究中的 20 名患者在小型拔牙手术后或自发发生下颌骨或上颌骨缺血性坏死。使用电化学发光免疫分析技术通过血清末端C-端肽（CTX）水平评估骨转换率，并对患者进行激光或常规手术治疗和药物治疗。十名患者接受了激光手术和生物刺激治疗。使用 Er:YAG 激光器（Fotona Fidelis Plus II (R) 组合激光设备，斯洛文尼亚）超长脉冲 (VLP) 模式（200 mJ，20 Hz），使用直径 1.3 mm、长度 12 mm 的光纤尖端，用于去除缺血性坏死区域的坏死和肉芽组织。术后使用 Nd:YAG 激光进行生物刺激。使用 Nd: YAG 激光器 (Fotona-Slovenia)，采用 R24 950-μ m 光纤手机长脉冲 (LP) 模式，0.25-W，10 Hz 功率/cm(2)，从 4 cm 距离对组织进行低强度激光治疗 (LLLT) 1 分钟，光斑尺寸为 0.4 cm(2)，功率输出为 2.5 J。计算上述距离的能量密度为 6.25 J/cm(2)。其余十名患者均接受常规手术治疗。治疗结果被记录为完全愈合或不完全愈合。激光手术与传统手术的差异无统计学意义（p>0.05）。 CTX值也不影响患者的预后。 II期骨坏死患者的治疗结果明显好于I期骨坏死患者。我们的研究结果表明，在用药前对患者进行牙科评估是预防 BRONJ 的重要因素。激光手术是治疗这种情况患者的一种有益的选择。对更多患者进行进一步的随机研究也可能会提高我们对这种情况的治疗方案的理解。
Bisphosphonates (BSPs) are used for the treatment of multiple myeloma, metastatic breast and lung cancer, Paget's disease, osteoporosis, hypercalcemia due to malignancy, and many other skeletal diseases. BSPs reduce osteoclastic functions, which result in bone resorption. Bisphosphonates-related osteonecrosis of jaws (BRONJ) is a newly developed term that is used to describe the significant complication in patients receiving bisphosphonates. BSPs are known to exhibit an anti-angiogenetic effect that initiates tissue necrosis of the hard tissue. There is currently no consensus on the correct approach to this issue. The aim of this retrospective study is to compare the effects of laser surgery with biostimulation to conventional surgery in the treatment of BSP-induced avascular bone necrosis on 20 patients who have been treated in our clinic. BRONJ was evaluated in patients with lung, prostate, and breast cancer under intravenous BSP treatment. Twenty patients in this study developed mandibular or maxillary avascular necrosis after a minor tooth extraction surgery or spontaneously. Bone turnover rates were evaluated by serum terminal C-telopeptide levels (CTX) using the electrochemiluminescence immunoassay technique and patients were treated with laser or conventional surgical treatments and medical therapy. Ten patients were treated with laser surgery and biostimulation. An Er:YAG laser (Fotona Fidelis Plus II (R) Combine laser equipment, Slovenia) very long pulse (VLP) mode (200 mJ, 20 Hz) using a fiber tip 1.3 mm in diameter and 12 mm in length was used to remove the necrotic and granulation tissues from the area of avascular necrosis. Biostimulation was applied postoperatively using an Nd:YAG laser. Low-level laser therapy (LLLT) was applied to the tissues for 1 min from 4 cm distance using an Nd: YAG laser (Fotona-Slovenia) with a R24 950-mu m fiber handpiece long-pulse (LP) mode, 0.25-W, 10 Hz power/cm(2) from the mentioned distance the spot size was 0.4 cm(2), and power output was 2.5 J. Energy density from the mentioned distance was calculated to be 6.25 J/cm(2). The other ten patients were treated with conventional surgery. Treatment outcomes were noted as either complete healing or incomplete healing. There were no statistically significant differences between laser surgery and conventional surgery (p>0.05). CTX values also did not affect the prognosis of the patients. Treatment outcomes were significantly better in patients with stage II osteonecrosis than in patients with stage I osteonecrosis. Our findings suggest that dental evaluation of the patients prior to medication is an important factor in the prevention of BRONJ. Laser surgery is a beneficial alternative in the treatment of patients with this situation. Further randomized studies with larger patient numbers may also improve our understanding of treatment protocols for this situation.