背景:双膦酸盐能抑制破骨细胞介导的骨吸收,广泛用于预防和治疗由于破骨细胞活性增强所致的骨骼疾病.目的:探讨双膦酸盐类药物致颌骨坏死的临床诊断和治疗方法.方法:检索中国生物医学文献数据库和Medline 数据库2003/2011 收录的双膦酸盐类药物致颌骨坏死的相关综述和论文报告,并分析和探讨其发病机制、临床表现及其预防和治疗.同时根据患者的病史、辅助检查和专科查体确诊1 例乳腺癌骨转移患者应用双膦酸盐类药物致颌骨坏死的个案,采用手术为主的综合治疗手段对患者进行了治疗,临床治愈,疗效满意.结果与结论:共纳入双膦酸盐类药物致颌骨坏死的相关文献15 篇.双膦酸盐类药物可以抑制破骨细胞,降低肿瘤细胞引起的骨转移灶的溶骨性破坏.由于在正常骨组织中,成骨细胞和破骨细胞维持动态平衡,但在口腔治疗过程中,双膦酸盐抑制了颌骨在病损后的破骨细胞的活动,使骨改建的病理生理过程无法完成;造成颌骨尤其是牙槽骨在牙槽手术后骨的修复不能进行,引起经久不愈的感染.%BACKGROUND: Bisphosphonate is a potent osteoclast inhibitor that produces clinical therapeutic effect by inhibiting osteoclast-mediated bone resorption. Bisphosphonate is widely used in the prevention and treatment of osteoporosis, metabolic bone disease, multiple myeloma, hypercalcemia and cancer bone metastases-related bone disease. OBJECTIVE: To investigate the clinical diagnosis and treatment of bisphosphonate-induced osteonecrosis of the jaws. METHODS: The Chinese Biomedical Literature Database and Medline database 2003/2011 were searched to retrieve reviews and articles about bisphosphonate-induced osteonecrosis of the jaws to investigate and analyze its pathogenesis and clinical manifestation as well as its prevention and treatment. Based on patient's history, laboratory examinations and specialist examination, one breast cancer patient with bone metastases was confirmed as having bisphosphonate-induced osteonecrosis of the jaws. This patient was cured following surgical-based treatments, and clinical results were satisfactory. RESULTS AND CONCLUSION: A total of 15 articles related to bisphosphonate-induced osteonecrosis of the jaws were included. Bisphosphonates can inhibit osteoclasts, and reduce tumor cell-induced osteolytic bone metastases. In normal bone tissue, osteoblasts and osteoclasts maintain a homeostasis, but in the process of oral therapy, bisphosphonates inhibit the activity of osteoclasts in mandibular lesions, so that the pathophysiology process of bone remodeling cannot be completed. In addition, the repair for the jaw, especially the repair of alveolar bone in the alveolar surgery, cannot be done causing prolonged healing of the infection.
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