目的

探讨经济有效的治疗放射性颌骨坏死（RONJ）的手术方式。

方法

77 例RONJ根据颌骨坏死的范围、软组织条件选择不同治疗方式。 方案1：骨坏死范围局限，牙龈及周围软组织无明显炎症的采用局部刮治或方块切除术；方案2：骨坏死范围较大、周围软组织炎症明显和（或）伴有明显纤维化的病例在控制炎症后，扩大切除同时行血管化游离复合组织瓣修复。

结果

21 例采用方案1，其中15 例一期愈合、6 例行二次刮治或方块切除；56 例采用方案2，其中软组织条件较好的30 例，22 例一期愈合，5 例延期愈合，3 例发生骨组织瓣血管危象，经探查和再吻合后1 例正常愈合，2 例仍发生组织瓣坏死；软组织炎症明显或伴有局部组织明显纤维化26 例中，7 例出现骨组织瓣血管危象，探查和再吻合后5 例正常，2 例出现骨坏死，9 例一期愈合，15 例局部出现不同程度软组织感染坏死，延期愈合。

结论

局限性放射性颌骨坏死可采用刮治或方块切除；骨坏死范围较大、软组织条件较好的采用血管化游离组织瓣进行修复；软组织纤维化明显的失败率较高，临床使用时应综合多方因素考虑。

Objective

To explore the appropriate operation method of radioactive osteomyelitis of jaws （RONJ）.

Method

Seventy-seven cases were divided into 2 groups base on their extent of bone necrosis and condition of soft tissue， group 1 which is limited alveolar bone necrosis and limited soft tissue inflammation was treated with scaling or sequestrectomy； group 2 with extensive bone necrosis and severe inflammation or soft tissue fibrosis was treated with radical mandiblecotomy， and reconstruction with fibular myocutaneous flap.

Results

In group 1， 15 get primary healing， 6 need scaling or ostectomy twice or more； in group 2， 22 of 30 with comparatively favourable condition of soft tissue get primary healing， 5 get delay healing， 3 get vascular crisis， after exploration and anastomosis， 1 cases get primary healing， the other 2 get delay healing； while in the 26 case which soft tissue fibrosis， 9 get primary healing， 15 get delay healing， 2 graft get varying degrees necrosis.

Conclusions

RONJ with good condition of soft tissue could be treated with scaling or block resection； Extensive sequestrectomy in combination with immediate vascularized tissue grafts clearly improved the prognosis， however， it depends on the condition of the local soft and hard tissue.