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目的:探讨颌骨放射性骨坏死的临床特征、治疗方法、分类及分期。方法:采用BS分类及分期,对我院口腔颌面-头颈肿瘤科2003年1月—2013年1月10a间收治的120例放射性颌骨坏死患者临床资料进行回顾分析。结果:下颌骨发生骨坏死的病例明显多于上颌骨及上、下颌骨,分别为99例、14例及7例。累计放疗剂量区间为35~148Gy,中位剂量为68.1Gy,69(57.5%)例患者剂量大于60Gy。大多数患者骨坏死发生在放疗后1~2a内(64.2%),少数发生在放疗5a以后(20.0%)。按BS分类,StageⅠ期患者为0例;StageⅡ期患者16(13.3%)例,主要采用单纯死骨刮治及单纯死骨扩大切除术(14例);StageⅢ期患者92(76.7%)例,71例患者采用死骨扩大切除术,其中47例同期行血管化组织瓣修复;StageⅣ期患者12(10.0%)例,主要采用死骨扩大切除联合同期血管化组织瓣修复(10例)。结论:放射性颌骨坏死以单侧下颌骨最多见,并以体部及部分下颌支最为好发,大多数患者骨坏死发生在放疗后1~2a。死骨扩大切除联合同期血管化组织瓣修复是目前最好的治疗方法。
Objective: To investigate the clinical features, treatment, classification and staging of osteonecrosis of the jaw. Methods: The clinical data of 120 patients with radioactive jaw osteonecrosis admitted to our hospital from January 2003 to January 2013 were analyzed retrospectively by BS classification and staging. Results: The incidence of osteonecrosis in the mandible was significantly higher than that in the maxilla, upper and mandible, 99, 14 and 7 cases, respectively. The cumulative dose ranged from 35 to 148 Gy, with a median dose of 68.1 Gy. 69 (57.5%) patients had a dose greater than 60 Gy. The majority of patients with osteonecrosis occurred within 1 ~ 2 years after radiotherapy (64.2%), and a few occurred after radiotherapy (5a, 20.0%). According to the classification of BS, there were 0 cases in StageⅠperiod and 16 cases (13.3%) in Stage Ⅱ, which were treated by simple sequestrum and simple resection of sequestrum (14 cases) .92 cases (76.7% Seventy-one patients underwent resection of sequestrum with resection of vascularized tissue flap in 47 patients. Twelve patients (10.0%) in StageⅣ stage were treated with sequestrum expansion combined with vascularized flap replacement (10 patients). CONCLUSION: Radiographic maxillary necrosis is most common in unilateral mandible, with the most prominent part of the body and part of the mandibular branch, most of the patients with osteonecrosis occurred after radiotherapy 1 ~ 2a. Expansion of the sequestrum combined with vascularized tissue flap repair is the best treatment.