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中华口腔医学研究杂志(电子版) ›› 2016, Vol. 10 ›› Issue (05) : 337 -342. doi: 10.3877/cma.j.issn.1674-1366.2016.05.007

所属专题: 文献

临床研究

507例放射性颌骨坏死回顾性分析及临床新分期的建立:单一中心20年经验
刘舒畅1, 胡静2, 侯劲松2, 王成2, 刘习强2,(), 黄洪章2   
  1. 1. 510055 广州,中山大学光华口腔医院·附属口腔医院,广东省口腔医学重点实验室(现在广东省口腔医院·南方医科大学附属口腔医院口腔颌面外科)
    2. 510055 广州,中山大学光华口腔医院·附属口腔医院,广东省口腔医学重点实验室
  • 收稿日期:2016-04-06 出版日期:2016-10-01
  • 通信作者: 刘习强
  • 基金资助:
    国家自然科学基金(81372885、81172567); 广州市产学研协同创新重大专项(201604020160)

Retrospective analysis of 507 osteoradionecrosis of the jaws and proposed new classification: a single institution′s 20-year experience

Shuchang Liu1, Jing Hu2, Jinsong Hou2, Cheng Wang2, Xiqiang Liu2,(), Hongzhang Huang2   

  1. 1. Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
  • Received:2016-04-06 Published:2016-10-01
  • Corresponding author: Xiqiang Liu
  • About author:
    Corresponding author: Liu Xiqiang, Email:
引用本文:

刘舒畅, 胡静, 侯劲松, 王成, 刘习强, 黄洪章. 507例放射性颌骨坏死回顾性分析及临床新分期的建立:单一中心20年经验[J]. 中华口腔医学研究杂志(电子版), 2016, 10(05): 337-342.

Shuchang Liu, Jing Hu, Jinsong Hou, Cheng Wang, Xiqiang Liu, Hongzhang Huang. Retrospective analysis of 507 osteoradionecrosis of the jaws and proposed new classification: a single institution′s 20-year experience[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2016, 10(05): 337-342.

目的

通过回顾性分析放射性颌骨坏死(ORNJ)的临床表现,探讨建立一种可更好地指导临床治疗和预后风险评估的新分期。

方法

选择中山大学附属口腔医院1993年3月至2014年10月ORNJ手术病例共507例,根据软组织和骨组织破坏程度,结合长期的临床经验以及对国内外ORNJ分期的总结,提出基于软组织(T)和骨组织(B)破坏程度的"TB"临床新分期,进一步分析不同新分期病损与患者手术情况、手术效果及预后的关系。

结果

按"TB"新分期,Ⅰ期55例(10.85%)、Ⅱ期174例(34.32%)、Ⅲ期180例(35.50%)、Ⅳ期98例(19.33%)。Ⅰ、Ⅱ期病例主要采取死骨刮治术、扩大摘除或颌骨方块切除术,Ⅲ、Ⅳ期患者主要采用颌骨节段性切除,部分病例予同期组织瓣包括游离血管化腓骨肌皮瓣转移修复术。不同分期患者手术治疗后均获得较好效果。术后最常见的并发症为手术部位感染(19.92%)和伤口裂开(13.41%)。极少数出现皮瓣坏死、吸入性肺炎甚至死亡等严重并发症。按新分期划分,越严重的患者预后越差,围手术期并发症发生率越高,Ⅰ~Ⅳ期病例围手术期并发症的发生率分别为9.09%、25.86%、30.00%和53.06%。

结论

成功建立了一种基于软硬组织破坏程度的"TB"新分期,该分期可更好地用于指导ORNJ临床治疗和预后风险评估。

Objective

To retrospectively analyze of the clinical characteristics and propose and categorise a new classification for osteoradionecrosis of the jaws (ORNJ) .

Methods

A total of 507 ORNJ cases surgically treated from March 1993 to October 2014 at the Affiliated Hospital of Stomatology, Sun Yat-sen University were enrolled. Using the proposed "TB" classification based on the damage degree of the soft tissue and jaws, the lesions were defined and categorized. The groups of "TB" definition based on their clinical characteristics were analyzed and correlated to treatments, therapeutic effects and prognosis.

Results

According to "TB" classification, 55 (10.85%) cases were in stageⅠ, 174 (34.32%) , 180 (35.50%) , and 98 (19.33%) cases were in stageⅡ, Ⅲ, and Ⅳ, respectively. Sequestrum scaling, extensive sequestrum resection, or partial ostectomy was performed for patients with stageⅠand stageⅡlesions. For stageⅢand Ⅳ lesions, segmental ostectomy with or without simultaneous vascularized tissue flap, was adopted. In follow-up period, satisfied results have been achieved. The most frequent complications were surgical site infection (19.92%) and wound dehiscence (13.41%) . Severe complications including flap necrosis, aspiration pneumonia and death. The incidences of complications in patients with stageⅠ, Ⅱ, Ⅲ, and Ⅳ were 9.09%, 25.86%, 30.00% and 53.06%, respectively.

Conclusion

We established a "TB" classification based on damage degree of the soft tissue and jaw, and this classification was helpful for making treatment strategy and prognosis evaluation of ORNJ.

表1 放射性颌骨坏死的"TB"新分期
图1 放射性颌骨坏死"TB"不同分期骨破坏图(红色标记为骨破坏区域)
表2 不同分期放射性颌骨坏死采用的手术治疗方法比较(例)
表3 不同分期放射性颌骨坏死患者的手术效果评估(例)
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