The value of reconstructive surgery in the management of refractory jaw osteoradionecrosis: a single-center 10-year experience
The value of reconstructive surgery in the management of refractory jaw osteoradionecrosis: a single-center 10-year experience
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DOI：
10.1016/j.ijom.2019.06.007
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发表时间：
2019-11-01
影响因子：
2.4
通讯作者：
Devauchelle, B.
中科院分区：
文献类型：
--
作者：
Bettoni, J.;Olivetto, M.;Devauchelle, B.
下颌骨放射性骨坏死是头颈部放射治疗的严重并发症。目前，国际社会对MORN的管理缺乏共识。本研究旨在评价早期重建手术（切除病变骨并立即用游离皮瓣重建）治疗难治性MORN的有效性和益处。对2003年至2013年期间在法国大学医学中心进行的手术进行了单中心回顾性研究。记录每例患者的手术方式和术后结局。共施行手术55例（边缘切除19例，节段切除36例），总成功率为92.3%。相对于边缘切除术，节段切除术的手术时间较长（分别为440 +/- 62 min vs. 531 +/- 72 min; Student t检验中P < 0.05），住院时间较长（分别为16.5 ± 6.5天vs. 25.6 ± 11.3天; P < 0.05），并发症发生率较高（分别为26.3% vs. 63.9%; Fisher检验P < 0.05）。鉴于难治性MORN的进展不可预测，以及本文观察到的风险-获益比，应重新评估早期重建手术的价值。
Mandibular osteoradionecrosis (mORN) is a severe complication of head and neck irradiation. International consensus on the management of mORN is currently lacking. The present study sought to evaluate the effectiveness and benefits of early reconstructive surgery (resection of the diseased bone and immediate reconstruction with a free flap) in treatment-refractory mORN. A single-center retrospective study was carried out of operations performed in a French university medical center between 2003 and 2013 inclusive. For each patient, the surgical modalities and postoperative outcomes were recorded. A total of 55 operations (19 marginal resections and 36 segmental resections) were performed, and the overall success rate was 92.3%. Relative to marginal resections, segmental resections were associated with longer operating times (440 +/- 62 min vs. 531 +/- 72 min, respectively; P < 0.05 in Student's t-test), a longer length of hospital stay (16.5 +/- 6.5 days vs. 25.6 +/- 11.3 days, respectively; P < 0.05), and a higher complication rate (26.3% vs. 63.9%, respectively; P < 0.05 in Fisher's test). Given the unpredictable progression of treatment-refractory mORN and the risk-benefit ratio observed here, the value of early reconstructive surgery with curative intent should be reassessed.