Conservative surgical management of patients with bisphosphonate-related osteonecrosis of the jaws: a series of 120 patients
Conservative surgical management of patients with bisphosphonate-related osteonecrosis of the jaws: a series of 120 patients
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DOI：
10.1016/j.bjoms.2016.06.015
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发表时间：
2016-10-01
影响因子：
1.8
通讯作者：
Gabriele, M.
中科院分区：
文献类型：
--
作者：
Nisi, M.;La Ferla, F.;Gabriele, M.
我们回顾性评价了局部切除术对双膦酸盐相关性颌骨骨坏死（BRONJ）患者的疗效。我们研究了120名受试者，他们需要局部切除129个对药物治疗没有反应的BRONJ病变。主要结局是BRONJ临床分期的改善和疾病的消退，次要结局是外科医生的经验对病变愈合的影响。记录患者的年龄、性别、基础疾病、吸烟和共存疾病。Logistic回归分析用于分离可能影响结局的因素。大部分病变（n = 107，84%）术后改善，20例无变化，1例恶化。1例患者死亡。分层表明所有26处I期病变完全愈合和疾病完全消退，77处II期病变中的67处改善，25处III期病变中的14处改善。69例II期病变中有67例消退，14例III期病例消退。Logistic回归分析显示，吸烟和疾病分期对预后有影响。对外科医生学习曲线的分析表明，随着时间的推移，他们的表现得到了显著改善。局部切除后的完全愈合率在8年内从40%增加到80%（p < 0.001）。我们的结论是，局部切除可能是治疗的选择，在BRONJ阶段I和II。根据患者的病情，III期可能更好地通过切除或临床监测进行治疗。(C)2016年英国口腔颌面外科医师协会。由爱思唯尔有限公司出版。保留所有权利。
We evaluated retrospectively the efficacy of local resection for patients who presented with bisphosphonate-related osteonecrosis of the jaw (BRONJ). We studied 120 subjects with who required local resection of 129 BRONJ lesions that had not responded to medical treatment. The primary outcomes were improvement of the clinical stage of BRONJ and resolution of disease, and the secondary outcome was the influence of the surgeon's experience on the healing of the lesions. Age, sex, underlying diseases, smoking, and coexisting conditions were recorded. Logistic regression analysis was used to isolate factors that could potentially affect the outcome. Most of the lesions (n = 107, 84%) improved postoperatively, 20 showed no change, and one got worse. One patient died. Stratification indicated complete healing and total resolution of disease for all 26 stage I lesions, improvement for 67 of the 77 stage II lesions, and for 14 of the 25 stage III lesions. The disease resolved in 67 of the 69 stage II lesions, and 14 of the stage III cases. Logistic regression indicated that smoking and the stage of disease could affect the outcome. Analysis of the surgeons' learning curve showed that performance improved significantly over time. Complete healing after local resection increased from 40% to 80% over a period of eight years (p < 0.001). We conclude that local resection may be the treatment of choice in BRONJ stages I and II. Stage III might be better treated with either resection or clinical monitoring according to the condition of the patient. (C) 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.