[双膦酸盐相关性颌骨骨坏死1例]。

Q3 Medicine
北京大学学报(医学版) Pub Date : 2025-04-18
Ju Yang, Yue Liu, Chunna Qu, Jianbin Sun, Tianying Li, Lianjie Shi
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引用次数: 0

摘要

下颌骨骨坏死也被称为下颌无血管性坏死,这是一种罕见的并发症的双磷酸盐。其特点是疼痛、肿胀、骨外露、局部感染和颌骨病理性骨折。随着双膦酸盐在恶性肿瘤骨转移和骨质疏松症中的广泛应用,这一罕见的并发症近年来受到越来越多的关注。在这里,我们报告了一例静脉注射唑来膦酸治疗骨质疏松症引起的双膦酸盐相关性颌骨骨坏死(BRONJ)。62岁女性患者,Sjögren综合征病史7年,骨质疏松病史3年,经唑来膦酸治疗3年后发生BRONJ。在去北京大学国际医院就诊前两个月,因牙周脓性分泌物就诊,并从右侧下颌骨拔出一颗牙齿。然而,病情没有改善,她感到右侧下颌骨持续疼痛和肿胀。因此,她接受了多次根治术,但没有改善。最后,根据数字体积断层扫描诊断为下颌骨骨坏死,显示右侧下颌骨骨坏死骨破坏。她在北京大学国际医院接受了坏死骨的手术清创和静脉注射抗生素。骨活检组织病理学分析进一步证实了BRONJ的诊断。在3年的随访中,她的病情得到了成功的改善。随着双膦酸盐使用的增加,下颌骨骨坏死变得更加常见。最近的研究报道,下颌骨骨坏死更容易发生在Sjögren综合征患者。此外,年龄、长期不规律使用糖皮质激素、不规律的口腔检查和治疗也可能是下颌骨坏死发病的危险因素。对于即将接受或已经接受双膦酸盐相关药物治疗的老年骨质疏松患者,应全程全面测量口腔健康状况及Sjögren’s综合征等与下颌骨坏死相关的疾病状态并进行充分评价。此外,为了更好地了解和预防或减少该并发症的发生,我们对BRONJ的发病机制、诊断、治疗和预防进行了综述。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Bisphosphonates-related osteonecrosis of the jaw: A case report].

Osteonecrosis of the mandible is also called avascular necrosis of the jaw, and it is a rare complication of bisphosphonates. It is characterized with pain, swelling, exposure of bone, local infection and pathologic fractures of the jaw. With the widespread usage of bisphosphonates in bone metastasis of malignant tumors and osteoporosis, this rare complication has received more attention in recent years. Here, we reported a case of bisphosphonates-related osteonecrosis of the jaw (BRONJ) caused by intravenous zoledronic acid for osteoporosis. A 62-year-old female patient with 7-year history of Sjögren's syndrome and 3-year history of osteoporosis developed BRONJ after 3-year treatment of zoledronic acid. Two months before she went to the Peking University International Hospital, she visited the dentist for periodontal purulent secretion and extracted one tooth from the right mandible. However, the condition was not improved and she felt persistent pain and swelling in the right mandible. Hence, she received repeated root curettage, but there was no improvement. Finally, she was diagnosed with osteonecrosis of the mandible based on the digital volume tomography scan, which showed right mandibular osteonecrosis bone destruction. She underwent surgical debridement of the necrotic bone and administered intravenous antibio-tics at the Peking University International Hospital. Histopathological analysis of the bone biopsy further confirmed the diagnosis of BRONJ. Her condition was improved successfully during a 3-year follow-up. Osteonecrosis of the mandible become more common with the increased use of bisphosphonates. Recent study has reported that osteonecrosis of the mandible is more likely to occur in patients with Sjögren's syndrome. In addition, age, long-term and irregular administration of glucocorticoids, irregular oral examination and treatment also might be the risk factors in the pathogenesis of osteonecrosis of the mandible. For the elder osteoporosis patients who would receive or had received bisphosphonate-related drugs, oral health status and the disease states associated with necrosis of the mandible such as Sjögren's syndrome should be comprehensively measured and fully evaluated during the whole process. Furthermore, to better understand and prevent or reduce the occurrence of this complication, we reviewed the patho-genesis, diagnosis, treatment, and prevention of BRONJ.

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来源期刊
北京大学学报(医学版)
北京大学学报(医学版) Medicine-Medicine (all)
CiteScore
0.80
自引率
0.00%
发文量
9815
期刊介绍: Beijing Da Xue Xue Bao Yi Xue Ban / Journal of Peking University (Health Sciences), established in 1959, is a national academic journal sponsored by Peking University, and its former name is Journal of Beijing Medical University. The coverage of the Journal includes basic medical sciences, clinical medicine, oral medicine, surgery, public health and epidemiology, pharmacology and pharmacy. Over the last few years, the Journal has published articles and reports covering major topics in the different special issues (e.g. research on disease genome, theory of drug withdrawal, mechanism and prevention of cardiovascular and cerebrovascular diseases, stomatology, orthopaedic, public health, urology and reproductive medicine). All the topics involve latest advances in medical sciences, hot topics in specific specialties, and prevention and treatment of major diseases. The Journal has been indexed and abstracted by PubMed Central (PMC), MEDLINE/PubMed, EBSCO, Embase, Scopus, Chemical Abstracts (CA), Western Pacific Region Index Medicus (WPR), JSTChina, and almost all the Chinese sciences and technical index systems, including Chinese Science and Technology Paper Citation Database (CSTPCD), Chinese Science Citation Database (CSCD), China BioMedical Bibliographic Database (CBM), CMCI, Chinese Biological Abstracts, China National Academic Magazine Data-Base (CNKI), Wanfang Data (ChinaInfo), etc.
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