血管化腓骨瓣修复二膦酸盐颌骨骨坏死导致的下颌骨缺损：病例报告及文献复习

上海口腔医学 ›› 2015, Vol. 24 ›› Issue (5): 474-477.

血管化腓骨瓣修复二膦酸盐颌骨骨坏死导致的下颌骨缺损：病例报告及文献复习

郭玉兴，王佃灿，王洋，彭歆，郭传瑸，毛驰

北京大学口腔医学院·口腔医院口腔颌面外科，北京 100081

收稿日期:2014-12-30 修回日期:2015-02-20 出版日期:2015-10-20 发布日期:2015-11-03
通讯作者: 毛驰，E-mail: maochicn@gmail.com
作者简介:郭玉兴（1984-），男，博士，E-mail:gladiater1984@163.com

Vascularized fibula flap reconstruction of the mandible defect resulting from bisphosphonate-related osteonecrosis of the jaws: case report and literature

review GUO Yu-xing, WANG Dian-can, WANG Yang, PENG Xin, GUO Chuan-bin, MAO Chi.

Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology. Beijing 100081, China

Received:2014-12-30 Revised:2015-02-20 Online:2015-10-20 Published:2015-11-03
Supported by:
Supported by Scientific Research Fund for Youth of Peking University School and Hospital of Stomatology(PKUSS20140103).

摘要/Abstract

摘要： 二膦酸盐（Bisphosphonates, BPs）作为一种强效骨吸收作用抑制剂已经用于临床30多年，广泛用于控制与骨更新改变相关的疾病。近年来发现，临床长期应用二膦酸盐类药物可导致颌骨骨坏死。对于二膦酸盐颌骨骨坏死的治疗，学术界观点不一，包括保守治疗、手术刮治、颌骨切除（重建或不重建）。本文介绍1例采用血管化腓骨瓣修复二膦酸盐颌骨骨坏死造成的下颌骨缺损，效果满意。

关键词: 二膦酸盐, 颌骨, 骨坏死

Abstract: Bisphosphonates have been used in clinic for over 30 years as a potent of bone resorption inhibitors, which are widely prescribed in diseases related to bone turnover change. In recent years, many authors found that long-term application of bisphosphonates can lead to osteonecrosis of the jaws. The treatment proposal has not reached consensus, including conservative treatment, surgical curettage and bone resection (reconstruction or without reconstruction). This paper reported a case with mandibular defect resulting from bisphosphonate related osteonecrosis of the jaws, repaired with vascularized fibular flap subsequently. The final functional and aesthetic outcomes were satisfied.

Key words: Bisphosphonates, Jaws, Osteonecrosis

郭玉兴，王佃灿，王洋，彭歆，郭传瑸，毛驰. 血管化腓骨瓣修复二膦酸盐颌骨骨坏死导致的下颌骨缺损：病例报告及文献复习[J]. 上海口腔医学, 2015, 24(5): 474-477.

review GUO Yu-xing, WANG Dian-can, WANG Yang, PENG Xin, GUO Chuan-bin, MAO Chi. Vascularized fibula flap reconstruction of the mandible defect resulting from bisphosphonate-related osteonecrosis of the jaws: case report and literature[J]. Shanghai Journal of Stomatology, 2015, 24(5): 474-477.

参考文献

[1] Ruggiero SL, Dodson TB, Assael LA, et al. American association of oral and maxillofacial surgeons position paper on bisphosphonate-related osteonecrosis of the jaws-2009 update [J]. J Oral Maxillofac Surg, 2009, 67(5 Suppl): 2-12.
[2] Ruggiero SL, Mehrotra B, Rosenberg TJ, et al. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases [J]. J Oral Maxillofac Surg, 2004, 62(5): 527-534.
[3] Sacco R, Sacco G, Acocella A, et al. A systematic review of microsurgical reconstruction of the jaws using vascularized fibula flap technique in patients with bisphosphonate-related osteonecrosis [J]. J Appl Oral Sci, 2011, 19(4): 293-300.
[4] Engroff S L, Kim DD. Treating bisphosphonate osteonecrosis of the jaws: is there a role for resection and vascularized reconstruction? [J]. J Oral Maxillofac Surg, 2007, 65(11): 2374-2385.
[5] Ferrari S, Bianchi B, Savi A, et al. Fibula free flap with endosseous implants for reconstructing a resected mandible in bisphosphonate osteonecrosis [J]. J Oral Maxillofac Surg, 2008, 66(5): 999-1003.
[6] Mücke T, Haarmann S, Wolff KD, et al. Bisphosphonate related osteonecrosis of the jaws treated by surgical resection and immediate osseous microvascular reconstruction[J]. J Craniomaxillofac Surg, 2009, 37(5): 291-297.
[7] Nocini PF, Saia G, Bettini G, et al. Vascularized fibula flap reconstruction of the mandible in bisphosphonate-related osteonecrosis [J]. Eur J Surg Oncol, 2009, 35(4): 373-379.
[8] Seth R, Futran ND, Alam DS, et al. Outcomes of vascularized bone graft reconstruction of the mandible in bisphosphonate-related osteonecrosis of the jaws[J]. Laryngoscope, 2010, 120(11): 2165-2171.
[9] Ghazali N, Collyer JC, Tighe JV. Hemimandibulectomy and vascularized fibula flap in bisphosphonate-induced mandibular osteonecrosis with polycythaemia rubra vera [J]. Int J Oral Maxillofac Surg, 2013, 42(1): 120-123.
[10] Hanasono MM, Militsakh ON, Richmon JD, et al. Mandibulectomy and free flap reconstruction for bisphosphonate-related osteonecrosis of the jaws [J]. JAMA Otolaryngol Head Neck Surg, 2013, 139(11): 1135-1142.
[11] Ruggiero S, Gralow J, Marx RE, et al. Practical guidelines for the prevention, diagnosis, and treatment of osteonecrosis of the jaw in patients with cancer [J]. J Oncol Pract, 2006, 2(1): 7-14.
[12] 郭玉兴, 王佃灿, 安金刚, 等. 二膦酸盐颌骨骨髓炎24例临床特点分析 [J]. 中华口腔医学杂志, 2014, 49(9): 517-520.
[13] Harvey HA, Cream L. Biology of bone metastases: causes and consequences [J]. Clin Breast Cancer, 2007, 7(Suppl 1): S7-13. [14] Yoneda T. Mechanism and treatment of cancer metastasis to bone[J]. Clin Calcium, 2005, 15(7): 29-37.

[1]	魏子程, 周晨, 季炼, 侯德强, 董煜. 海奥口腔生物膜单独或联合同种异骨体对颌骨囊肿术后骨缺损修复效果比较[J]. 上海口腔医学, 2024, 33(3): 285-289.
[2]	赵燕, 张颖, 陈茜, 侯黎莉. 下颌骨缺损患者对咬合功能锻炼需求的质性研究[J]. 上海口腔医学, 2024, 33(1): 106-112.
[3]	张扬, 祝庆海, 张永杰, 王晨星, 叶金海. 血管化髂骨肌瓣的应用解剖学特点及其在颌骨缺损修复中的临床应用[J]. 上海口腔医学, 2023, 32(6): 603-608.
[4]	王萌, 陶李明, 胡亚男. Twin-block联合上颌扩弓器矫治下颌后缩儿童前后舌位的改变及上气道的三维变化[J]. 上海口腔医学, 2023, 32(6): 635-639.
[5]	陈双喜, 高美琴. 隐形矫治与SGTB治疗下颌骨后退的效果比较[J]. 上海口腔医学, 2023, 32(5): 513-518.
[6]	刘畅, 吴琼, 陈少华, 徐涛, 刘亮, 张凯. 数字化精准骨穿刺指导颌骨切除范围的可行性研究[J]. 上海口腔医学, 2023, 32(5): 519-524.
[7]	张赟, 李小兵. 下颌骨后缩伴上颌牙弓狭窄的骨性Ⅱ类错𬌗双期矫治1例报告[J]. 上海口腔医学, 2023, 32(5): 555-560.
[8]	马晓晴, 陆雯, 叶茂, 邢允波, 钱文昊, 张玲. 下颌骨后缩伴前牙正常覆盖青少年患者Twin-block治疗效果分析[J]. 上海口腔医学, 2023, 32(4): 422-427.
[9]	寇鹏, 李迎梅, 李志萍, 孟箭. 3D打印改良牙支持式塞治器在下颌骨囊性病变开窗引流中的应用[J]. 上海口腔医学, 2023, 32(2): 203-208.
[10]	史敬存, 吴梓谦, 张于涵, 肖孟, 张士剑, 章臻, 张冰清, 王磊. 同期神经化髂骨瓣在下颌骨重建中保存下唇及颏部感觉的效果评价[J]. 上海口腔医学, 2023, 32(1): 52-57.
[11]	唐汝萍, 刘帅, 赵震锦, 汪俊妍. 骨性Ⅲ类下颌偏斜患者颞下颌关节形态位置及上颌骨特征的三维评估[J]. 上海口腔医学, 2023, 32(1): 91-96.
[12]	潘巧婷, 臧晓龙, 孙照薇, 潘梦琪, 朱鑫美, 李志勇. 信号素4D在大鼠双膦酸盐相关颌骨坏死发生中的作用探讨[J]. 上海口腔医学, 2022, 31(6): 625-631.
[13]	许来俊, 袁鹤, 叶青, 李继遥. 负载纳米羟磷灰石的结冷胶修复大鼠下颌骨缺损的效果评价[J]. 上海口腔医学, 2022, 31(5): 449-453.
[14]	江润洋, 康非吾. 唑来膦酸对小鼠下颌拔牙创早期修复过程的影响[J]. 上海口腔医学, 2022, 31(4): 349-353.
[15]	周明智, 王林, 王亮, 吴可, 秦燕军, 赵春洋. 青少年安氏Ⅱ²类错畸形矫治后下颌骨的变化[J]. 上海口腔医学, 2022, 31(4): 389-394.