薬剤関連顎骨壊死 (MRONJ) の治療法と予後に関する臨床的研究：保存療法と外科療法の比較検討

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  • A clinical study of treatment methods for and outcomes of medication-related osteonecrosis of the jaw (MRONJ) : Comparison between surgical and conservative treatments
  • ヤクザイ カンレン ガッコツ エシ(MRONJ)ノ チリョウホウ ト ヨゴ ニ カンスル リンショウテキ ケンキュウ : ホゾン リョウホウ ト ゲカ リョウホウ ノ ヒカク ケントウ

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<p>　Objectives: Although conservative therapy has usually been performed in patients with medication-related osteonecrosis of the jaw (MRONJ) , studies reporting the superiority of surgical therapy have increased in recent years. Since the establishment of our Department in September 2013, patients with MRONJ have received conservative therapy, but since April 2016 surgical therapy is the rule in our department. We reviewed the treatment methods and outcomes of patients with MRONJ in our department.</p><p>　Methods : For 36 patients with MRONJ who were treated in our department, age, gender, affected jaw, stage, trigger, primary disease, type of bone-modifying agent, administration period, diabetes, steroid administration, leukocyte count, serum albumin, drug holiday, treatment method, and outcome were surveyed by reviewing the medical records. Multivariate logistic regression analysis was performed to study the relation between each factor and outcomes.</p><p>　Results: Among the 36 patients, conservative therapy was performed in 15 patients and surgical therapy in 21. Complete cure was obtained in one patient (6.7%) who received conservative therapy and 15 (76.2%) who received surgical therapy. In the surgical therapy group, the cure rate was higher in patients who underwent extensive surgery, which removes the surrounding bone as well as necrotic bone, than in patients who underwent conservative surgery, which removes only the necrotic bone. Multivariate analysis showed that the triggering factor (other than tooth extraction) , primary disease (osteoporosis) , and treatment method (surgical therapy) significantly correlated with a higher cure rate.</p><p>　Conclusions: Extensive surgery is the best treatment for MRONJ.</p>

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