Objective: To investigate the clinical application effect of double-layer soft tissue (DLST) suture closure technique in patients with mandible medication-related osteonecrosis of the jaw (MRONJ) of early and medium stages resulted in application of anti-bone-resorptive drugs.
Methods: Early to medium stage mandible MRONJ patients who underwent surgical treatment in the fourth ward of Peking University School and Hospital of Stomatology from October 2021 to September 2022 were included. Clinical information of the patients were collected, including primary disease, concomitant disease, medication regimen (drug type, duration of medication), MRONJ stage, clinical symptoms, imaging manifestations, etc. During surgery, after using marginal mandibulae resection to remove the necrotic bone, the wound was closed using DLST closure technique. Regular post-operative follow-up was performed to evaluate the therapeutic effect and complications of the DLST technique, the pain score and functional status of the patiens were evaluated.
Results: This study totally included 13 patients, 12 women and 1 man, aged (66.69±13.14) years. Seven patients had osteoporosis, 2 had lung cancer, 3 had breast cancer and 1 had prostate cancer among their primary diseases; 7 had no concomitant diseases, 2 had diabetes mellitus, 2 had cardiovascular disease and 1 had dry syndrome. Intravenous zoledronic acid were used in 9 patients, the average duration was (37.7±20.0) months, and other drugs, such as letrozole tablets were taken in 7 patients at the same time; Denosumab injection was used in 3 patients for an average of (10.3±11.9) months; Alendronate sodium tablets were taken in 5 patients for an average of (55.20±27.20) months, and prednisone acetate tablets or acarbose tablets were taken to varying degrees in 2 patients. The average post-operative follow-up was 11.9 months (9 to 17 months), and all the 13 patients were cured without complications, such as pus overflow and so forth. The pre-operative score of Karnofsky performance status (KPS) in the patients was 68.46±14.05, and the post-operative score was 82.31±15.36, and the difference was statistically significant (P < 0.05). The pre-operative score of visual analogue scale (VAS) in the patients was 5.77±0.73 and the post-operative score was 0.38±0.51, and the difference had statistical significance (P < 0.001).
Conclusion: The double-layer soft tissue suture closure technique can achieve good clinical results in patients with MRONJ of the mandible using anti-bone-resorptive drugs alone, and can provide clinical treatment ideas for MRONJ patients with more complicated drug use.
目的: 探究双层软组织缝合封闭技术在单纯应用抗骨吸收药物引起的发生在下颌骨的中早期药物相关性颌骨骨坏死(medication-related osteonecrosis of the jaw, MRONJ)患者手术治疗中的临床应用效果。
方法: 选择2021年10月至2022年9月于北京大学口腔医院四病区经手术治疗的中早期下颌骨MRONJ患者的病历资料进行回顾性分析，收集患者术前基线临床资料，包括原发疾病、伴发疾病、用药方案(药物种类、用药时长)、MRONJ分期、临床症状、影像学表现等，所有患者在手术中行下颌骨边缘切除术去除坏死骨，运用双层软组织缝合封闭技术关闭伤口，术后定期复查随访，评价双层软组织缝合封闭技术的治疗效果及并发症，并对患者进行疼痛评分和功能状态评价。
结果: 研究共纳入13例患者(女12例，男1例)，年龄(66.69±13.14)岁。原发疾病包括骨质疏松7例，肺癌2例，乳腺癌3例，前列腺癌1例；2例伴发糖尿病，2例伴发心血管疾病，1例伴发干燥综合征。9例患者静脉注射唑来膦酸，平均用药时间(37.7±20.0)个月，7例患者同时服用了来曲唑片等其他药物；3例患者应用地舒单抗注射液，平均用药时间(10.3±11.9)个月；5例患者服用阿仑膦酸钠片，平均用药时间(55.20±27.20)个月，2例患者不同程度地服用醋酸泼尼松片或阿卡波糖片。MRONJ 1期4例，2期9例。13例患者均采用双层软组织缝合封闭技术关闭伤口，术后平均随访11.9个月(9~17个月)，13例患者皆治愈，无溢脓等并发症发生。患者术前Karnofsky功能状态评分量表(Karnofsky performance status, KPS)评分为(68.46±14.05)分，术后评分为(82.31±15.36)分，差异有统计学意义(P < 0.05)。患者术前疼痛评估视觉模拟评分量表(visual analogue scale，VAS)评分为(5.77±0.73)分，术后评分为(0.38±0.51)分，差异有统计学意义(P < 0.001)。
结论: 双层软组织缝合封闭技术在中早期单纯使用抗骨吸收类药物的下颌骨MRONJ患者中可以取得良好的临床治疗效果，可为用药情况更加复杂的MRONJ患者提供临床治疗思路。
Keywords: Anti-bone-resorptive drugs; Double-layer soft tissue suture closure technique; Marginal mandibulectomy; Medication-related osteonecrosis of the jaw; Surgical treatment.