放射性下颌骨坏死的BS临床分类及治疗策略

摘要

Objective:To introduce a novel clinical classification that can be applied to osteoradionecrosis treatment in an easy and considerably acceptable manner through a retrospective analysis of patients with osteoradionecrosis of the mandible (ORNM). Methods:The clinical data of 99 ORNM patients admitted to shanghai Ninth People's Hospital between 2000 and 2013 were summa-rized. A novel classification was established based on bone necrosis and soft tissue lesions. The new staging system was developed based on"B"and"S"classifications. Corresponding strategies and methods of ORNM treatment at different stages were also proposed. Results:A new staging system with four different stages (i.e., stage 0:8 cases;stageⅠ:14 cases;stageⅡ:65 cases;and stageⅢ:12 cases) was proposed. Conservative treatment was applied to stage 0 patients, whereas sequestrectomy was performed in stageⅠcases. Marginal or segmental resection of the mandible was selected for stageⅡpatients;osteocutaneous flap or just soft tissue flap was also reconstructed. Conclusion:This new classification and staging system is easier to use and more acceptable for clinical evaluation than other systems.%目的:本研究旨在通过对下颌骨放射性骨坏死(osteoradionecrosis of mandible,ORNM)病例的回顾性分析,提出一种用于指导放射性骨坏死治疗的新的分类及分期系统.方法:总结上海交通大学医学院附属第九人民医院2000年1月至2013年12月99例ORNM病例资料,并以此为基础将病损中骨组织(bone tissue)及软组织(soft tissue)病损分别进行分类.再将骨、软组织病损的分类"合并",同时结合国外关于ORNM的分期研究,提出了最新的"BS"分类及分期系统,在此基础上提出ORNM标准化治疗的构思.结果:根据骨坏死的不同严重程度将其分为4期:0期(8例),Ⅰ期(14例),Ⅱ期(65例),Ⅲ期(12例).0期患者给予保守性治疗;Ⅰ期患者实施死骨摘除术;Ⅱ期患者行下颌骨边缘性切除或是节段性切除,血管化骨肌瓣或单纯软组织瓣修复;Ⅲ期患者则行下颌骨方块切除,血管化骨肌瓣或单纯软组织瓣修复.4个不同分期患者接受相对应治疗后均获得较好效果.结论:"BS"分类及分期系统能够更容易且更为恰当地运用于ORNM的临床治疗指导.