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14.\u9752\u5c9b\u5927\u5b66\u9644\u5c5e\u533b\u9662&nbsp; &nbsp;\u53e3\u8154\u988c\u9762\u4fee\u590d\u91cd\u5efa\u79d1\uff0c\u5c71\u4e1c&nbsp; &nbsp;\u9752\u5c9b&nbsp; &nbsp;266003\uff1b<\/p>\n<p>&nbsp;&nbsp;15.\u4e0a\u6d77\u4ea4\u901a\u5927\u5b66\u533b\u5b66\u9662\u9644\u5c5e\u745e\u91d1\u533b\u9662&nbsp; &nbsp;\u80bf\u7624\u79d1\uff0c\u4e0a\u6d77&nbsp; &nbsp;200127\uff09<\/p>\n<p>\u63d0&nbsp; &nbsp;\u8981<\/p>\n<p>&nbsp; &nbsp; \u836f\u7269\u76f8\u5173\u6027\u988c\u9aa8\u574f\u6b7b\uff08medication-related osteonecrosis of the jaw, MRONJ\uff09\u662f\u4e00\u79cd\u56e0\u6cbb\u7597\u5168\u8eab\u5176\u4ed6\u75be\u75c5\u9700\u8981\u4f7f\u7528\u6297\u9aa8\u5438\u6536\u836f\u7269\uff08\u53cc\u81a6\u9178\u76d0\u7c7b\u836f\u7269\u7b49\uff09\u3001\u6297\u8840\u7ba1\u751f\u6210\u7c7b\u836f\u7269\u3001\u6fc0\u7d20\u7c7b\u836f\u7269\u7b49\u53d1\u751f\u7684\u988c\u9aa8\u574f\u6b7b\u5e76\u53d1\u75c7\uff0c\u4e34\u5e8a\u4e3b\u8981\u8868\u73b0\u4e3a\u5c40\u90e8\u7ea2\u80bf\u3001\u75bc\u75db\u3001\u5480\u56bc\u969c\u788d\u3001\u9762\u90e8\u8f6f\u7ec4\u7ec7\u7618\u7ba1\u7ecf\u4e45\u4e0d\u6108\u3001\u9aa8\u5916\u9732\u7b49\uff0c\u4e25\u91cd\u8005\u53ef\u4f34\u75c5\u7406\u6027\u9aa8\u6298\uff0c\u4e25\u91cd\u5f71\u54cd\u60a3\u8005\u751f\u6d3b\u8d28\u91cf\u53ca\u8eab\u5fc3\u5065\u5eb7\u3002\u8fc4\u4eca\u4e3a\u6b62\uff0c\u56fd\u5185\u5bf9\u4e8eMRONJ\u7f3a\u4e4f\u7edf\u4e00\u7684\u5206\u7c7b\u3001\u5206\u671f\u53ca\u76f8\u5173\u6cbb\u7597\u5171\u8bc6\u6216\u6307\u5357\uff0c\u4e0d\u540c\u5355\u4f4d\u5bf9\u4e8eMRONJ\u7684\u8bca\u6cbb\u6c34\u5e73\u53c2\u5dee\u4e0d\u9f50\uff0c\u7f3a\u4e4f\u7edf\u4e00\u3001\u79d1\u5b66\u7684\u8bca\u7597\u6807\u51c6\u53ca\u5ba2\u89c2\u7684\u7597\u6548\u8bc4\u4ef7\u4f53\u7cfb\u3002\u4e3a\u7edf\u4e00\u548c\u89c4\u8303MRONJ\u7684\u8bca\u7597\u6807\u51c6\uff0c\u51cf\u5c11\u533b\u7597\u8d44\u6e90\u6d6a\u8d39\uff0c\u63d0\u9ad8\u6cbb\u7597\u6548\u679c\uff0c\u56fd\u5185MRONJ\u7814\u7a76\u9886\u57df\u7684\u4e13\u5bb6\u7ecf\u53cd\u590d\u8ba8\u8bba\uff0c\u6c47\u96c6\u5168\u56fd12\u5bb6\u8457\u540d\u533b\u5b66\u9662\u6821\u53ca\u9644\u5c5e\u533b\u9662\u4e13\u5bb6\u7684\u8bca\u6cbb\u610f\u89c1\uff0c\u540c\u65f6\u501f\u9274\u548c\u53c2\u8003\u56fd\u5185\u5916\u8fd1\u5e74\u6765\u5bf9MRONJ\u7684\u7814\u7a76\u6210\u679c\u4e0e\u8bca\u6cbb\u7ecf\u9a8c\uff0c\u5236\u8ba2\u672c\u4e13\u5bb6\u5171\u8bc6\uff0c\u4f9b\u76f8\u5173\u4e34\u5e8a\u533b\u5e08\u53c2\u8003\u3002<\/p>\n<p>\u5173\u952e\u8bcd<\/p>\n<p>\u836f\u7269\u76f8\u5173\u6027\u988c\u9aa8\u574f\u6b7b\uff1b\u6cbb\u7597\u6307\u5357\uff1b\u4e13\u5bb6\u5171\u8bc6<\/p>\n<p>&nbsp; &nbsp;&nbsp;\u836f\u7269\u76f8\u5173\u6027\u988c\u9aa8\u574f\u6b7b\uff08medication-related osteonecrosis of the jaw\uff0cMRONJ\uff09\u662f\u6307\u56e0\u6076\u6027\u80bf\u7624\u9aa8\u8f6c\u79fb\u3001\u9aa8\u8d28\u758f\u677e\u7b49\u75be\u75c5\u4f7f\u7528\u53cc\u81a6\u9178\u76d0\u7c7b\u836f\u7269\uff08bisphosphonates, BPs\uff09\u3001\u6297\u8840\u7ba1\u751f\u6210\u7c7b\u836f\u7269\u6216\u7c7b\u56fa\u9187\u7c7b\u836f\u7269\u7b49\u6240\u81f4\u7684\u988c\u9aa8\u4ee3\u8c22\u7d0a\u4e71\u53ca\u9aa8\u574f\u6b7b\u7c7b\u75be\u75c5\u3002\u5728\u53e3\u670d\u836f\u7269\u6cbb\u7597\u9aa8\u8d28\u758f\u677e\u75c7\u7684\u60a3\u8005\u4e2d\uff0cMRONJ\u7684\u53d1\u75c5\u7387\u7ea6\u4e3a0.02%\uff5e0.04%\uff1b\u800c\u901a\u8fc7\u9759\u8109\u6ce8\u5c04\u6cbb\u7597\u80bf\u7624\u9aa8\u8f6c\u79fb\u7684\u764c\u75c7\u60a3\u8005\u4e2d\uff0cMRONJ\u7684\u53d1\u75c5\u7387\u663e\u8457\u5347\u9ad8\uff0c\u53ef\u8fbe0.7%\uff5e9%<sup>[1]<\/sup>\u3002\u8be5\u75c5\u4e34\u5e8a\u8868\u73b0\u4e3a\u5c40\u90e8\u7ea2\u80bf\u3001\u75bc\u75db\u3001\u7618\u7ba1\u5f62\u6210\u3001\u988c\u9aa8\u574f\u6b7b\u53ca\u6b7b\u9aa8\u66b4\u9732\u7b49\uff0c\u4e25\u91cd\u65f6\u53ef\u5bfc\u81f4\u75c5\u7406\u6027\u9aa8\u6298\uff0c\u4e25\u91cd\u5f71\u54cd\u60a3\u8005\u7684\u996e\u98df\u7b49\u529f\u80fd<sup>[2]<\/sup>\u3002\u8fd1\u5e74\u6765\uff0c\u968f\u7740\u764c\u75c7\u6cbb\u7597\u8fc7\u7a0b\u4e2d\u6297\u9aa8\u5438\u6536\u836f\u7269\u4f7f\u7528\u7684\u589e\u52a0\uff0cMRONJ\u7684\u53d1\u751f\u7387\u8d8a\u6765\u8d8a\u9ad8\uff0c\u4e34\u5e8a\u533b\u5e08\u5bf9\u8be5\u75c5\u7684\u75c5\u7406\u751f\u7406\u5b66\u3001\u98ce\u9669\u56e0\u7d20\u53ca\u6cbb\u7597\u65b9\u5f0f\u7684\u8ba4\u8bc6\u4e5f\u4e0d\u65ad\u52a0\u6df1<sup>[3]<\/sup>\u3002\u7f8e\u56fd\u53e3\u8154\u988c\u9762\u5916\u79d1\u533b\u5e08\u534f\u4f1a\uff08American Association of Oral and Maxillofacial Surgeons, AAOMS\uff09\u57282007\u30012009\u548c2014\u5e74\u610f\u89c1\u4e66\u4e2d\u63d0\u51fa\u4e86\u9488\u5bf9MRONJ\u60a3\u8005\u6216\u5177\u6709MRONJ\u53d1\u751f\u98ce\u9669\u60a3\u8005\u7684\u6cbb\u7597\u7b56\u7565<sup>[4-6]<\/sup>\uff0c\u5e76\u4e8e2022\u5e74\u66f4\u65b0\u4e86\u5173\u4e8eMRONJ\u53d1\u75c5\u673a\u5236\u3001\u75be\u75c5\u6cbb\u7597\u7b49\u65b9\u9762\u7684\u8fdb\u5c55<sup>[7]<\/sup>\u3002\u76ee\u524d\uff0c\u56fd\u5185\u5bf9\u4e8eMRONJ\u7684\u5206\u7c7b\u3001\u5206\u671f\u3001\u8bca\u65ad\u53ca\u6cbb\u7597\u4e3b\u8981\u53c2\u8003AAOMS\u6807\u51c6\u3002\u7136\u800c\uff0c\u4e34\u5e8a\u5b9e\u8df5\u53d1\u73b0\uff0cAAOMS\u610f\u89c1\u4e66\u4e2d\u5bf9MRONJ\u7684\u5206\u7c7b\u548c\u5206\u671f\u4f9d\u8d56\u4e8e\u4e34\u5e8a\u8868\u73b0\uff0c\u800c\u5ffd\u7565\u4e86\u5f71\u50cf\u5b66\u8868\u73b0\u5728\u8bca\u7597\u4e2d\u7684\u91cd\u8981\u6027\u3002\u6b64\u5916\uff0c\u4e9a\u6d32\u4eba\u79cd\u4e0e\u6b27\u7f8e\u4eba\u79cd\u5b58\u5728\u5dee\u5f02\uff0c\u56fd\u5185\u5404\u5730\u7684\u533b\u7597\u6761\u4ef6\u53ca\u8bca\u7597\u6c34\u5e73\u4ea6\u53c2\u5dee\u4e0d\u9f50\uff0c\u8fd9\u4f7f\u5f97\u610f\u89c1\u4e66\u4e2d\u7684\u6cbb\u7597\u539f\u5219\u4e0d\u5b8c\u5168\u9002\u7528\u4e8e\u6211\u56fd\u7684\u533b\u7597\u73b0\u72b6\u3002\u4e3a\u8fdb\u4e00\u6b65\u89c4\u8303\u56fd\u5185MRONJ\u7684\u8bca\u7597\uff0c\u51cf\u5c11\u533b\u7597\u8d44\u6e90\u6d6a\u8d39\uff0c\u56fd\u5185\u836f\u7269\u76f8\u5173\u6027\u988c\u9aa8\u574f\u6b7b\u7814\u7a76\u9886\u57df\u7684\u4e13\u5bb6\u7ecf\u8fc7\u5145\u5206\u8ba8\u8bba\u540e\uff0c\u6c47\u96c6\u5168\u56fd12\u5bb6\u8457\u540d\u533b\u5b66\u9662\u6821\u53ca\u9644\u5c5e\u533b\u9662\u4e13\u5bb6\u7684\u8bca\u6cbb\u610f\u89c1\uff0c\u540c\u65f6\u501f\u9274\u548c\u53c2\u8003\u56fd\u5185\u5916\u8fd1\u5e74\u6765\u5bf9MRONJ\u7684\u7814\u7a76\u6210\u679c\u4e0e\u8bca\u6cbb\u7ecf\u9a8c\uff0c\u5236\u8ba2\u672c\u4e13\u5bb6\u5171\u8bc6\uff0c\u4ee5\u89c4\u8303\u8be5\u75c5\u7684\u4e34\u5e8a\u8bca\u65ad\u4e0e\u6cbb\u7597\u6d41\u7a0b\uff0c\u4fc3\u8fdb\u5176\u63a8\u5e7f\u5e94\u7528\u3002<\/p>\n<p>1&nbsp; &nbsp;\u5b9a\u4e49<\/p>\n<p>&nbsp; &nbsp; &nbsp; &nbsp;2003\u5e74\uff0cMarx\u9996\u6b21\u62a5\u905336\u4f8b\u56e0\u5e94\u7528BPs\u5bfc\u81f4\u988c\u9aa8\u574f\u6b7b\u66b4\u9732\u7684\u60a3\u8005\uff0c\u4e3a\u533a\u522b\u4e8e\u653e\u5c04\u6027\u988c\u9aa8\u574f\u6b7b\uff08osteoradionecrosis of the jaw\uff0cORNJ\uff09\uff0c\u5c06\u5176\u5b9a\u4e49\u4e3a\u201c\u53cc\u81a6\u9178\u76d0\u76f8\u5173\u988c\u9aa8\u574f\u6b7b\u201d\uff08bisphosphonate-related osteonecrosis of the jaw\uff0cBRONJ\uff09<sup>[8]<\/sup>\u30022007\u5e74\uff0cAAOMS\u786e\u7acbBRONJ\u8bca\u65ad\u6807\u51c6\u4e3a\uff1a\u53e3\u8154\u988c\u9762\u90e8\u5b58\u57288\u5468\u672a\u6108\u5408\u7684\u6b7b\u9aa8\u9aa8\u9762\u66b4\u9732\uff0c\u4e14\u60a3\u8005\u6b63\u5728\u63a5\u53d7\u6216\u63a5\u53d7\u8fc7BPs\u836f\u7269\u6cbb\u7597\uff0c\u4f46\u65e0\u5934\u9888\u90e8\u653e\u7597\u53f2\u3002\u52a0\u62ff\u5927\u7684\u4e00\u9879\u4e13\u5bb6\u5171\u8bc6\u6307\u5357\u8ba4\u4e3a\uff0c\u5c068\u5468\u4f5c\u4e3a\u4e34\u5e8a\u89c2\u5bdf\u671f\uff0c\u662f\u56e0\u4e3a\u9aa8\u66b4\u9732\u540e\u8f6f\u7ec4\u7ec7\u7684\u4fee\u590d\u9700\u89818\u5468\u624d\u80fd\u5b8c\u5168\u6108\u5408<sup>[9]<\/sup>\u30022009\u5e74\uff0cAAOMS\u5bf9BRONJ\u7684\u5b9a\u4e49\u4f5c\u4e86\u8c03\u6574\uff1a\u53bb\u9664\u201c\u6b7b\u9aa8\u201d\u4e00\u8bcd\uff0c\u5e76\u589e\u52a0\u8be5\u75c5\u5206\u7c7b\u4e2d\u76840\u671f\uff0c\u5176\u4f59\u5b9a\u4e49\u65e0\u660e\u663e\u53d8\u52a8\u3002\u7136\u800c\uff0c\u6b64\u5b9a\u4e49\u4ec5\u4f9d\u9760\u75be\u75c5\u7684\u4e34\u5e8a\u8868\u73b0\uff0c\u6ca1\u6709\u7ec4\u7ec7\u5b66\u4f9d\u636e\uff0c\u5177\u6709\u4e00\u5b9a\u5c40\u9650\u6027\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp;&nbsp;\u8fd1\u5e74\u6765\uff0c\u4e0d\u65ad\u6709\u6297\u9aa8\u5438\u6536\u836f\u7269\u3001\u6297\u8840\u7ba1\u751f\u6210\u836f\u7269\u7b49\u975eBPs\u5bfc\u81f4\u988c\u9aa8\u574f\u6b7b\u7684\u62a5\u9053\u30022014\u5e74\uff0cAAOMS\u5c06BRONJ\u66f4\u540d\u4e3aMRONJ\uff0c\u5e76\u5bf9\u5176\u91cd\u65b0\u8fdb\u884c\u5b9a\u4e49<sup>[6]<\/sup>\uff1a\u6b63\u5728\u6216\u66fe\u7ecf\u63a5\u53d7\u6297\u9aa8\u5438\u6536\u6216\u6297\u8840\u7ba1\u751f\u6210\u836f\u7269\u6cbb\u7597\uff0c\u4e34\u5e8a\u8868\u73b0\u4e3a\u6301\u7eed8\u5468\u4ee5\u4e0a\u7684\u988c\u9aa8\u9aa8\u8d28\u66b4\u9732\u6216\u75c5\u53d8\u533a\u7618\u7ba1\uff0c\u65e0\u5934\u9888\u90e8\u653e\u5c04\u6cbb\u7597\u53f2\u6216\u988c\u9aa8\u8f6c\u79fb\u764c\u75c5\u53f2\u3002\u8f832009\u5e74\u610f\u89c1\u4e66\u4e2d\u7684\u5b9a\u4e49\uff0c2014\u5e74\u610f\u89c1\u4e66\u4e2d\u53d6\u6d88\u4e86\u201c\u6b7b\u9aa8\u5916\u9732\u201d\u7684\u63cf\u8ff0\uff0c\u6539\u4e3a\u201c\u9aa8\u5916\u9732\u6216\u53e3\u5185\u3001\u53e3\u5185\u5916\u7618\u53e3\u201d\uff0c\u5e76\u6392\u9664\u5176\u4ed6\u764c\u75c7\u988c\u9aa8\u8f6c\u79fb\u7684\u60a3\u8005\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u7ed3\u54082022\u5e74\u6700\u65b0\u7248AAOMS\u610f\u89c1\u4e66\u548c\u56fd\u5185\u76f8\u5173\u9886\u57df\u4e13\u5bb6\u610f\u89c1\uff0c\u672c\u5171\u8bc6\u5bf9MRONJ\u7684\u5b9a\u4e49\u4e3a\uff1a\u2460\u6b63\u5728\u6216\u66fe\u7ecf\u63a5\u53d7\u8fc7\u6297\u9aa8\u5438\u6536\u836f\u7269\u6cbb\u7597\uff0c\u4ee5\u53ca\u5355\u72ec\u6216\u5408\u5e76\u4f7f\u7528\u8fc7\u514d\u75ab\u8c03\u8282\u5242\u6216\u6297\u8840\u7ba1\u751f\u6210\u836f\u7269\uff1b\u2461\u988c\u9762\u90e8\u5b58\u5728\u6b7b\u9aa8\u66b4\u9732\uff0c\u6216\u53ef\u901a\u8fc7\u53e3\u5185\/\u5916\u7618\u63a2\u53ca\u9aa8\u9762\u6301\u7eed8\u5468\u4ee5\u4e0a\uff1b\u2462\u65e0\u988c\u9aa8\u653e\u5c04\u6cbb\u7597\u53f2\u6216\u988c\u9aa8\u8f6c\u79fb\u6027\u80bf\u7624\u75be\u75c5\u3002\u5f15\u8d77MRONJ\u7684\u5e38\u89c1\u836f\u7269\u8be6\u89c1\u88681\u3002<\/p>\n<p>2&nbsp; \u75c5\u56e0\u5b66\u4e0e\u9ad8\u5371\u56e0\u7d20<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u6297\u9aa8\u5438\u6536\u3001\u6297\u8840\u7ba1\u751f\u6210\u836f\u7269\u5bf9\u9aa8\u8d28\u758f\u677e\u3001\u6076\u6027\u80bf\u7624\u9aa8\u8f6c\u79fb\u7b49\u75be\u75c5\u5177\u6709\u826f\u597d\u7684\u63a7\u5236\u4f5c\u7528\uff0c\u7136\u800c\u4f1a\u5f15\u8d77MRONJ\u7b49\u5e76\u53d1\u75c7<sup>[10-11]<\/sup>\u3002\u76f8\u6bd4\u4e8e\u8eab\u4f53\u5176\u4ed6\u90e8\u4f4d\u7684\u9aa8\u7ec4\u7ec7\uff0c\u988c\u9aa8\u66f4\u6613\u53d1\u751fMRONJ\uff0c\u8fd9\u662f\u7531\u988c\u9aa8\u7684\u89e3\u5256\u7ed3\u6784\u3001\u751f\u7406\u529f\u80fd\u53ca\u53e3\u8154\u5fae\u751f\u7269\u73af\u5883\u6240\u51b3\u5b9a\u3002\u988c\u9aa8\u7684\u9aa8\u6539\u5efa\u901f\u5ea6\u8f83\u5176\u4ed6\u90e8\u4f4d\u7684\u9aa8\u7ec4\u7ec7\u5feb\uff0c\u7ea6\u4e3a\u9ac2\u9aa8\u768420\u500d\uff0c\u56e0\u6b64\u836f\u7269\u66f4\u591a\u5728\u6b64\u5904\u6c89\u79ef\uff1b\u988c\u9aa8\u8840\u8fd0\u4e30\u5bcc\uff0cBPs\u53ca\u5176\u4ed6\u6297\u8840\u7ba1\u751f\u6210\u836f\u7269\u7b49\u53ef\u6291\u5236\u9aa8\u9abc\u8840\u6d41\u548c\u8840\u7ba1\u751f\u957f\uff0c\u6613\u9020\u6210\u5c40\u90e8\u7f3a\u8840\uff0c\u8fdb\u800c\u589e\u52a0\u9aa8\u574f\u6b7b\u98ce\u9669<sup>[12]<\/sup>\u3002\u6b64\u5916\uff0c\u53e3\u8154\u4e0e\u5916\u754c\u76f8\u901a\uff0c\u5177\u6709\u590d\u6742\u7684\u5fae\u751f\u6001\u7cfb\u7edf\uff0c\u53e3\u8154\u5185\u5e38\u53d1\u751f\u7259\u6e90\u6027\u611f\u67d3\uff0c\u5982\u7259\u5468\u708e\u3001\u7259\u9ad3\u708e\u548c\u6839\u5c16\u5468\u708e\u3002\u5f53\u53d7\u5230\u62d4\u7259\u7b49\u521b\u4f24\u65f6\uff0c\u53e3\u8154\u5185\u83cc\u7fa4\u6613\u5f15\u8d77\u5c40\u90e8\u611f\u67d3\uff0c\u8fdb\u800c\u53ef\u80fd\u8bf1\u53d1MRONJ\u3002MRONJ\u7684\u53d1\u75c5\u7387\u5728\u4e0d\u540c\u56fd\u5bb6\u4e4b\u95f4\u6709\u6240\u4e0d\u540c\uff0c\u4f46\u8fd1\u5e74\u6765\u968f\u7740\u5f15\u8d77MRONJ\u76f8\u5173\u836f\u7269\u5728\u4e34\u5e8a\u4e0a\u7684\u5e7f\u6cdb\u5e94\u7528\uff0c\u5404\u56fdMRONJ\u53d1\u75c5\u7387\u603b\u4f53\u5448\u4e0a\u5347\u8d8b\u52bf\u3002MRONJ\u6cbb\u7597\u96be\u5ea6\u5927\uff0c\u5e76\u53ef\u4e25\u91cd\u5f71\u54cd\u60a3\u8005\u751f\u6d3b\u8d28\u91cf\uff0c\u9700\u5f15\u8d77\u91cd\u89c6\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u76ee\u524d\u5173\u4e8eMRONJ\u7684\u53d1\u75c5\u673a\u5236\u6709\u591a\u79cd\u5047\u8bf4\uff0c\u5305\u62ec\u9aa8\u91cd\u5efa\u6291\u5236\u5b66\u8bf4\u3001\u8840\u7ba1\u751f\u6210\u6291\u5236\u5b66\u8bf4\u3001\u53e3\u8154\u5fae\u751f\u7269\u611f\u67d3\u5b66\u8bf4\u3001\u514d\u75ab\u6291\u5236\u5b66\u8bf4\u7b49<sup>[13]<\/sup>\u3002\u9aa8\u91cd\u5efa\u6291\u5236\u5b66\u8bf4\u8ba4\u4e3a\uff0c\u988c\u9aa8\u6539\u5efa\u57fa\u4e8e\u6210\u9aa8\u7ec6\u80de\u4e0e\u7834\u9aa8\u7ec6\u80de\u7684\u529f\u80fd\u8026\u8fde\u3002BPs\u53ca\u5730\u8212\u5355\u6297\u5747\u6291\u5236\u7834\u9aa8\u7ec6\u80de\u7684\u529f\u80fd\uff0c\u8fdb\u800c\u4f7f\u6210\u9aa8\u7ec6\u80de\u529f\u80fd\u4ea6\u53d7\u635f\u3001\u9aa8\u4ee3\u8c22\u7d0a\u4e71\uff0c\u6700\u7ec8\u8bf1\u53d1MRONJ\u3002\u8840\u7ba1\u751f\u6210\u6291\u5236\u5b66\u8bf4\u8ba4\u4e3a\uff0cBPs\u53ef\u6291\u5236\u988c\u9aa8\u5185\u8840\u7ba1\u751f\u6210\uff0c\u9020\u6210\u5c40\u90e8\u9aa8\u8d28\u7f3a\u8840\uff0c\u7ecf\u62d4\u7259\u6216\u5176\u4ed6\u7259\u79d1\u6cbb\u7597\u7b49\u9020\u6210\u7684\u521b\u4f24\u540e\u6700\u7ec8\u8bf1\u53d1MRONJ\u3002\u6b64\u5916\uff0c\u4e00\u4e9b\u9488\u5bf9VEGF\u53ca\u76f8\u5173\u901a\u8def\u7684\u836f\u7269\uff0c\u5982\u8d1d\u4f10\u73e0\u5355\u6297\u7b49\u4ea6\u53ef\u8bf1\u53d1\u9aa8\u574f\u6b7b\uff0c\u5728\u4e00\u5b9a\u7a0b\u5ea6\u4e0a\u652f\u6301\u8be5\u5b66\u8bf4\u3002\u53e3\u8154\u5fae\u751f\u7269\u611f\u67d3\u5b66\u8bf4\u8ba4\u4e3a\uff0c\u988c\u9aa8\u4ec5\u9760\u4e00\u8584\u5c42\u9ecf\u9aa8\u819c\u4e0e\u53e3\u8154\u4e2d\u5404\u79cd\u5fae\u751f\u7269\u76f8\u9694\uff0c\u6781\u6613\u7531\u4e8e\u8f7b\u5fae\u521b\u4f24\u800c\u66b4\u9732\u4e8e\u7259\u6e90\u6027\u611f\u67d3\u7684\u73af\u5883\u4e2d\uff0c\u8fdb\u800c\u5f15\u8d77MRONJ\u3002\u4f46\u8be5\u5b66\u8bf4\u76ee\u524d\u5b58\u5728\u4e89\u8bae<sup>[14-15]<\/sup>\u3002\u514d\u75ab\u6291\u5236\u5b66\u8bf4\u8ba4\u4e3a\uff0cMRONJ\u60a3\u8005\u5927\u591a\u6709\u957f\u671f\u7cd6\u76ae\u8d28\u6fc0\u7d20\u4f7f\u7528\u53f2\u3001\u6076\u6027\u80bf\u7624\u53f2\u6216\u5316\u7597\u53f2\uff0c\u5904\u4e8e\u514d\u75ab\u6291\u5236\u72b6\u6001\u3002\u8fd9\u79cd\u72b6\u6001\u4e00\u65b9\u9762\u53ef\u80fd\u662f\u539f\u53d1\u75be\u75c5\u53ca\u76f8\u5e94\u6cbb\u7597\u5bfc\u81f4\u7684\uff0c\u53e6\u4e00\u65b9\u9762\u4e5f\u53ef\u80fd\u53d7BPs\u7b49\u836f\u7269\u7684\u5f71\u54cd\u3002\u4f8b\u5982\uff0cBPs\u53ef\u80fd\u901a\u8fc7\u5f71\u54cdNK\u7ec6\u80de\u53caT\u7ec6\u80de\u5bf9\u673a\u4f53\u514d\u75ab\u4ea7\u751f\u5f71\u54cd\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u4e0e\u4ee5\u4e0a\u5047\u8bf4\u76f8\u5173\u7684\u9ad8\u5371\u56e0\u7d20\u5305\u62ec\u836f\u7269\u76f8\u5173\u6027\u56e0\u7d20\u3001\u53e3\u8154\u5c40\u90e8\u56e0\u7d20\u53ca\u5168\u8eab\u56e0\u7d20\u7b49\uff0c\u8fd9\u4e9b\u56e0\u7d20\u53ef\u80fd\u5355\u4e00\u4f5c\u7528\uff0c\u4e5f\u53ef\u80fd\u534f\u540c\u4f5c\u7528<sup>[7]<\/sup>\u3002\u76ee\u524d\u63a8\u65ad\u53ef\u80fd\u7684\u9ad8\u5371\u56e0\u7d20\u603b\u7ed3\u89c1\u88682\u3002<\/p>\n<p>2.1<\/p>\n<p>\u836f\u7269\u76f8\u5173\u56e0\u7d20<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u6297\u9aa8\u5438\u6536\u53ca\u6291\u5236\u6076\u6027\u80bf\u7624\u9aa8\u8f6c\u79fb\u7684\u836f\u7269\u79cd\u7c7b\u4e0eMRONJ\u75be\u75c5\u8fdb\u5c55\u5bc6\u5207\u76f8\u5173\u3002\u5728\u5b9e\u4f53\u80bf\u7624\u53d1\u751f\u8fdc\u5904\u8f6c\u79fb\u7684\u75c5\u4f8b\u4e2d\uff0c\u524d\u5217\u817a\u764c\u7684\u9aa8\u8f6c\u79fb\u7387\u4e3a70%\uff5e88.74%\uff0c\u4e73\u817a\u764c\u4e3a50%\uff5e70%\uff0c\u80ba\u764c\u4e3a34.56%\uff5e40%<sup>[16-19]<\/sup>\u3002\u4e0d\u540c\u79cd\u7c7b\u7684\u6cbb\u7597\u7528\u836f\u4f5c\u7528\u673a\u5236\u4e0d\u540c\uff0c\u5176\u53d1\u75c5\u7387\u53ca\u53d1\u75c5\u65f6\u95f4\u4ea6\u4e0d\u540c\u3002\u4ee5BPs\u4e3a\u4f8b\uff0c\u4f7f\u7528\u542b\u6c2eBPs\u6bd4\u4e0d\u542b\u6c2eBPs\u53d1\u75c5\u7387\u9ad8\uff0c\u5176\u4e2d\uff0c\u5511\u6765\u81a6\u9178\u76d0\u7c7b\u836f\u7269\u81f4\u75c5\u6548\u529b\u6700\u5f3a\uff0c\u53d1\u75c5\u7387\u7ea6\u4e3a\u5e15\u7c73\u81a6\u9178\u4e8c\u94a0\u6216\u4f0a\u73ed\u81a6\u9178\u94a0\u76845\u500d<sup>[20-21]<\/sup>\u3002\u4f7f\u7528\u6297\u9aa8\u5438\u6536\u836f\u7269\u5730\u8212\u5355\u6297\u540e\uff0cMRONJ\u53d1\u75c5\u7387\u4e0eBPs\u76f8\u8fd1\uff0c\u4f46\u53d1\u75c5\u8f83\u65e9\u3002\u836f\u7269\u8054\u5408\u5e94\u7528\u4e5f\u53ef\u63d0\u9ad8\u53d1\u75c5\u98ce\u9669\uff0c\u7814\u7a76\u62a5\u9053BPs\u4e0e\u5730\u8212\u5355\u6297\u7684\u53e0\u52a0\u4f5c\u7528\u53ef\u5bfc\u81f4\u53d1\u75c5\u7387\u63d0\u5347\u7ea60.7%\uff5e1.9%<sup>[22-23]<\/sup>\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u4e0d\u540c\u7ed9\u836f\u65b9\u5f0f\u4ea6\u53ef\u5bfc\u81f4MRONJ\u7684\u53d1\u75c5\u7387\u4e0d\u540c\uff0c\u9759\u8109\u6ce8\u5c04BPs\u7684\u60a3\u8005\u53d1\u75c5\u7387\u660e\u663e\u9ad8\u4e8e\u53e3\u670d\u7ed9\u836f\u60a3\u8005\u3002\u9759\u8109\u6ce8\u5c04\u5511\u6765\u81a6\u9178\u7684\u60a3\u8005\uff0cMRONJ\u53d1\u75c5\u7387\u57280.3%\uff5e5%<sup>[24-26]<\/sup>\uff1b\u53e3\u670dBPs\u7684\u60a3\u8005\uff0cMRONJ\u53d1\u751f\u7387\u5219\u4e3a(0.1\uff5e0.7)\/10 000<sup>[27-29]<\/sup>\u3002\u9aa8\u8d28\u758f\u677e\u60a3\u8005(\u53e3\u670dBPs)\u53d1\u751fMRONJ\u7684\u6f5c\u4f0f\u671f\u6bd4\u6076\u6027\u80bf\u7624\u60a3\u8005\uff08\u9759\u8109\u6ce8\u5c04BPs\uff09\u957f<sup>[30]<\/sup>\u3002\u9664\u7ed9\u836f\u65b9\u5f0f\u5916\uff0c\u7528\u836f\u65f6\u95f4\u4e5f\u662fMRONJ\u7684\u5371\u9669\u56e0\u7d20\u4e4b\u4e00\u3002\u764c\u75c7\u60a3\u8005\u7ecf\u8fc72\u5e74\u4ee5\u4e0a\u7684\u5511\u6765\u81a6\u9178\u9759\u8109\u6ce8\u5c04\u6cbb\u7597\uff084 mg\/\u6b21\uff0c1\u6b21\/\u6708\uff09\uff0cMRONJ\u53d1\u75c5\u7387\u4e3a3.8%\uff5e18%\uff0c\u660e\u663e\u9ad8\u4e8e\u6cbb\u7597\u65f6\u95f4\u57282\u5e74\u5185\u7684\u60a3\u8005\uff08\u53d1\u75c5\u7387\u4e3a1.6%\uff5e4%\uff09\u3002\u5bf9\u4e8e\u63a5\u53d7\u5730\u8212\u5355\u6297\u6cbb\u7597\u7684\u60a3\u8005\uff0cMRONJ\u7684\u53d1\u75c5\u7387\u4e3a1.9%\uff08\uff1c2\u5e74\uff09\u548c6.9%\uff08\uff1e2\u5e74\uff09<sup>[31]<\/sup>\u3002MRONJ\u672f\u540e\u590d\u53d1\u7387\u548c\u7528\u836f\u65f6\u95f4\u4e5f\u5bc6\u5207\u76f8\u5173\uff0c\u4f7f\u7528\u5511\u6765\u81a6\u9178\u8d85\u8fc718\u4e2a\u6708\uff0c\u4f1a\u589e\u52a0MRONJ\u672f\u540e\u590d\u53d1\u7684\u98ce\u9669<sup>[32]<\/sup>\u3002\u6b64\u5916\uff0c\u5316\u7597\u836f\u7269\u6216\u7c7b\u56fa\u9187\u7c7b\u836f\u7269\u7684\u5408\u5e76\u4f7f\u7528\u4e5f\u4f1a\u589e\u52a0\u60a3\u75c5\u98ce\u9669\uff0c\u7cd6\u76ae\u8d28\u6fc0\u7d20\u4e0e\u6297\u9aa8\u5438\u6536\u836f\u7269\u8054\u5408\u7528\u836f\uff0c\u53ef\u80fd\u4f1a\u589e\u52a0MRONJ\u7684\u53d1\u751f\u98ce\u9669<sup>[33-36]<\/sup>\u3002<\/p>\n<p>2.2<\/p>\n<p>\u53e3\u8154\u76f8\u5173\u56e0\u7d20<\/p>\n<p>&nbsp; &nbsp; &nbsp;&nbsp;\u7259\u69fd\u5916\u79d1\u624b\u672f\u662fMRONJ\u6700\u5e38\u89c1\u7684\u5371\u9669\u56e0\u7d20\u3002\u5728MRONJ\u60a3\u8005\u4e2d\uff0c\u62d4\u7259\u88ab\u8ba4\u4e3a\u662f\u6613\u611f\u4e8b\u4ef6\uff08\u6bd4\u4f8b\u4e3a62%\uff5e82%\uff09<sup>[33,37-38]<\/sup>\u3002\u63a5\u53d7\u9aa8\u6539\u826f\u836f\u7269\u6cbb\u7597\u7684\u9aa8\u8d28\u758f\u677e\u60a3\u8005\uff0c\u62d4\u7259\u540eMRONJ\u7684\u53d1\u75c5\u7387\u7ea6\u4e3a1%<sup>[39]<\/sup>\uff1b\u800c\u63a5\u53d7\u9aa8\u6539\u826f\u836f\u7269\u6cbb\u7597\u7684\u6076\u6027\u80bf\u7624\u60a3\u8005\uff0c\u62d4\u7259\u540eMRONJ\u7684\u53d1\u75c5\u7387\u53ef\u8fbe25%\uff5e28%<sup>[40-41]<\/sup>\u3002\u63a5\u53d7\u6297\u9aa8\u5438\u6536\u836f\u7269\u6cbb\u7597\u7684\u60a3\u8005\u5728\u63a5\u53d7\u5176\u4ed6\u7259\u69fd\u5916\u79d1\u624b\u672f\uff08\u5982\u7259\u79cd\u690d\u6216\u7259\u5468\u624b\u672f\uff09\u540e\u4e5f\u6709\u53d1\u751fMRONJ\u7684\u98ce\u9669\uff0c\u4f8b\u5982\uff0c\u63a5\u53d7\u5730\u8212\u5355\u6297\u6cbb\u7597\u7684\u9aa8\u8d28\u758f\u677e\u60a3\u8005\uff0c\u53e3\u8154\u5185\u690d\u5165\u79cd\u690d\u4f53\u540e\uff0cMRONJ\u7684\u53d1\u75c5\u7387\u4e3a0.5%<sup>[39]<\/sup>\u3002\u5bf9\u4f7f\u7528\u6297\u9aa8\u5438\u6536\u836f\u7269\u7684\u764c\u75c7\u60a3\u8005\uff0c\u5219\u66f4\u5e94\u8c28\u614e\u8fdb\u884c\u8fd9\u4e9b\u7259\u69fd\u5916\u79d1\u624b\u672f\u64cd\u4f5c\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; MRONJ\u5728\u4e0a\u3001\u4e0b\u988c\u9aa8\u90fd\u53ef\u51fa\u73b0\uff0c\u51fa\u73b0\u5728\u4e0b\u988c\u9aa8\u7684\u6bd4\u7387(75%)\u662f\u4e0a\u988c\u9aa8(25%)\u76843\u500d\uff0c\u4ea6\u53ef\u51fa\u73b0\u5728\u53cc\u988c\uff084.5%\uff09<sup>[33,37]<\/sup>\u3002\u6234\u7528\u4e49\u9f7f\u4e0e\u4f7f\u7528\u5511\u6765\u81a6\u9178\u7684\u764c\u75c7\u60a3\u8005MRONJ\u7684\u98ce\u9669\u589e\u52a0\u76f8\u5173<sup>[42]<\/sup>\u3002\u5728\u63a5\u53d7\u5511\u6765\u81a6\u9178\u3001\u4f0a\u73ed\u81a6\u9178\u6216\u5e15\u7c73\u81a6\u9178\u9759\u8109\u6ce8\u5c04\u6cbb\u7597\u7684\u764c\u75c7\u60a3\u8005\u4e2d\uff0c\u6234\u7528\u4e49\u9f7f\u7684\u4eba\u60a3MRONJ\u7684\u98ce\u9669\u4e3a\u5bf9\u7167\u7ec4\u76842\u500d<sup>[43]<\/sup>\u3002\u5df2\u5b58\u5728\u7684\u611f\u67d3\u6027\u53e3\u8154\u75be\u75c5\uff08\u5982\u7259\u5468\u75c5\u6216\u6839\u5c16\u5468\u75be\u75c5\uff09\u4e5f\u88ab\u8ba4\u4e3a\u662fMRONJ\u7684\u98ce\u9669\u56e0\u7d20\u4e4b\u4e00<sup>[34,37]<\/sup>\u3002\u5728\u60a3\u6709MRONJ\u7684\u764c\u75c7\u60a3\u8005\u4e2d\uff0c50%\u7684\u75c5\u4f8b\u5b58\u5728\u611f\u67d3\u6027\u53e3\u8154\u75be\u75c5<sup>[33-44]<\/sup>\u3002<\/p>\n<p>2.3<\/p>\n<p>\u5168\u8eab\u56e0\u7d20<\/p>\n<p>&nbsp; &nbsp; &nbsp;&nbsp;\u56e0\u539f\u53d1\u75be\u75c5\uff08\u5982\u6076\u6027\u80bf\u7624\u3001\u9aa8\u8d28\u758f\u677e\u7b49\u75be\u75c5\uff09\u9020\u6210\u7684\u76f8\u5173\u836f\u7269\u4f7f\u7528\u5242\u91cf\u662f\u8bc4\u4f30MRONJ\u98ce\u9669\u7684\u91cd\u8981\u53c2\u6570\u3002\u6076\u6027\u80bf\u7624\u56e0\u7528\u836f\u5242\u91cf\u8f83\u5927\uff0cMRONJ\u7684\u53d1\u75c5\u7387\uff08\uff1c5%\uff09\u8f83\u9aa8\u8d28\u758f\u677e\uff08\uff1c0.05%\uff09\u663e\u8457\u63d0\u9ad8\u3002\u764c\u75c7\u7c7b\u578b\u4e0d\u540c\uff0cMRONJ\u60a3\u75c5\u98ce\u9669\u4e5f\u4e0d\u76f8\u540c<sup>[43-45]<\/sup>\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u9664\u539f\u53d1\u75be\u75c5\u5916\uff0c\u75be\u75c5\u539f\u53d1\u5e74\u9f84\u53ca\u6027\u522b\u4e5f\u662fMRONJ\u7684\u5371\u9669\u56e0\u7d20\u3002\u5973\u6027\u4eba\u7fa4\u4e2dMRONJ\u53d1\u75c5\u7387\u8f83\u9ad8\uff0c\u53ef\u80fd\u662f\u7531\u4e8e\u539f\u53d1\u75be\u75c5(\u5982\u9aa8\u8d28\u758f\u677e\u75c7\uff0c\u4e73\u817a\u764c)\u4e2d\u5973\u6027\u60a3\u75c5\u7387\u8f83\u9ad8\uff1b\u8bca\u65adMRONJ\u65f6\u60a3\u8005\u7684\u5e73\u5747\u5e74\u9f84\u4e3a65.2\u5c81\uff0c\u4ea6\u670940\u5c81\u53ca\u4ee5\u4e0b\u60a3\u75c5\u7684\u62a5\u9053\u300224\u5c81\u4ee5\u4e0b\u7684\u60a3\u8005\u7528\u6297\u9aa8\u5438\u6536\u5242\u6cbb\u7597\u826f\u6027\u9aa8\u75be\u75c5\uff0c\u5373\u4f7f\u5ef6\u957f\u6cbb\u7597\u65f6\u95f4\uff0c\u4e5f\u6ca1\u6709\u589e\u52a0MRONJ\u7684\u98ce\u9669<sup>[33,35,42-44]<\/sup>\u3002\u5176\u4ed6\u7cfb\u7edf\u6027\u75be\u75c5\uff0c\u5982\u9ad8\u8840\u538b\u3001\u8d2b\u8840(\u8840\u7ea2\u86cb\u767d\uff1c10 g\/dL)\u548c\u7cd6\u5c3f\u75c5\uff0c\u4e5f\u53ef\u80fd\u589e\u52a0MRONJ\u7684\u98ce\u9669<sup>[33,35]<\/sup>\u3002<\/p>\n<p>3&nbsp; \u8bca\u65ad<\/p>\n<p>3.1<\/p>\n<p>\u4e34\u5e8a\u8868\u73b0<\/p>\n<p>&nbsp; &nbsp; &nbsp;&nbsp;MRONJ\u7684\u4e3b\u8981\u4e34\u5e8a\u8868\u73b0\u5305\u62ec<sup>[46]<\/sup>\uff1a\u2460\u7070\u9ec4\u6216\u7070\u9ed1\u8272\u9aa8\u8d28\u66b4\u9732\uff0c\u8fb9\u7f18\u5149\u6ed1\u6216\u53c2\u5dee\u4e0d\u9f50\uff1b\u2461\u53e3\u5916\u6216\u53e3\u5185\u7aa6\u9053\uff1b\u2462\u7c97\u7cd9\u9aa8\u8d28\u8868\u9762\u8fb9\u7f18\u7684\u8f6f\u7ec4\u7ec7\u53ef\u80fd\u51fa\u73b0\u7ea2\u80bf\u3001\u75bc\u75db\u3001\u6e83\u75a1\u6216\u5265\u8131\u3002\u968f\u7740\u75c5\u53d8\u7684\u53d1\u5c55\uff0c\u8fd8\u53ef\u51fa\u73b0\u4e00\u7cfb\u5217\u5178\u578b\u4f53\u5f81\uff1a\u75c5\u53d8\u533a\u75bc\u75db\u3001\u9ebb\u6728\u3001\u95f4\u9699\u611f\u67d3\u3001\u5f00\u53e3\u53d7\u9650\u3001\u75c5\u53d8\u533a\u7259\u677e\u52a8\u8131\u843d\u53ca\u75c5\u7406\u6027\u9aa8\u6298\uff0c\u5e76\u53ef\u80fd\u8fdb\u4e00\u6b65\u5f15\u8d77\u5168\u8eab\u75c7\u72b6\u3002MRONJ\u7684\u65e9\u671f\u8bca\u65ad\u76f8\u5bf9\u56f0\u96be\uff0c\u60a3\u8005\u65e9\u671f\u901a\u5e38\u6ca1\u6709\u660e\u663e\u7684MRONJ\u7279\u5f81\u6027\u4e34\u5e8a\u8868\u73b0\uff0c\u4f46\u53ef\u8868\u73b0\u4e3a\u4e00\u4e9b\u975e\u7279\u5f02\u6027\u7684\u75c7\u72b6\u548c\u5f71\u50cf\u5b66\u6539\u53d8<sup>[47]<\/sup>\uff0c\u5982\u4e0a\u988c\u7aa6\u708e\u3001\u989e\u4e0b\u988c\u5173\u8282\u708e\u7b49\u3002<\/p>\n<p>3.2<\/p>\n<p>\u5f71\u50cf\u5b66\u8868\u73b0<\/p>\n<p>&nbsp; &nbsp;&nbsp;\u4e0eORNJ\u76f8\u6bd4\uff0cMRONJ\u75c5\u7076\u8fb9\u754c\u5728\u5f71\u50cf\u5b66\u68c0\u67e5\u4e2d\u8868\u73b0\u5f97\u66f4\u4e3a\u6e05\u6670\u3002MRONJ\u4e0d\u540c\u9636\u6bb5\u5f71\u50cf\u5b66\u8868\u73b0\u5404\u5f02\uff08\u56fe1\uff09\uff0c\u4e3b\u8981\u8868\u73b0\u4e3a\uff1a\u4e0d\u540c\u7a0b\u5ea6\u7684\u9aa8\u8d28\u786c\u5316\uff0c\u9aa8\u8d28\u786c\u5316\u9996\u5148\u7d2f\u53ca\u7259\u69fd\u5d74\u548c\u786c\u9aa8\u677f\uff0c\u665a\u671f\u988c\u9aa8\u53ef\u5448\u5e7f\u6cdb\u786c\u5316\uff1b\u5b58\u5728\u6301\u7eed\u7684\u7259\u69fd\u7a81\u7f3a\u5931\u3001\u5468\u56f4\u9aa8\u5c0f\u6881\u7ed3\u6784\u7d0a\u4e71\uff1b\u5f25\u6f2b\u6027\u9aa8\u8d28\u6eb6\u89e3\u7834\u574f\u53ca\u6b7b\u9aa8\u5f62\u6210\u3002\u8f6f\u7ec4\u7ec7\u80bf\u5757\u548c\u9aa8\u819c\u65b0\u751f\u9aa8\u5f62\u6210\u7b49\u5f81\u8c61\u76f8\u5bf9\u5c11\u89c1\uff0c\u901a\u5e38\u4e0e\u5408\u5e76\u611f\u67d3\u6709\u5173\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; AAOMS\u6700\u65b0\u6307\u5357\u5bf9MRONJ\u7684\u5f71\u50cf\u5b66\u8868\u73b0\u8fdb\u884c\u4e86\u603b\u7ed3<sup>[7]<\/sup>\u3002X\u7ebf\u5e73\u7247\uff1a\u2460\u62d4\u7259\u90e8\u4f4d\u9aa8\u6539\u5efa\u5ef6\u8fdf\u6216\u7f3a\u5931\uff1b\u2461\u4e0e\u7259\u5468\u75be\u75c5\u65e0\u5173\u7684\u7259\u69fd\u9aa8\u7f3a\u635f\u548c\u5438\u6536\uff1b\u2462\u7259\u69fd\u9aa8\u53ca\u5468\u8fb9\u9aa8\u8d28\u7684\u533a\u57df\u6027\u786c\u5316\uff1b\u2463\u7259\u5468\u97e7\u5e26\u589e\u539a\u4e0e\u6a21\u7cca\uff1b\u2464\u4e0d\u89c4\u5219\u9aa8\u7834\u574f\u3001\u9aa8\u5c0f\u6881\u6539\u53d8\u6216\u6b7b\u9aa8\u5f62\u6210\uff1b\u2465\u53e3\u8154-\u4e0a\u988c\u7aa6\u7618\u7b49\u3002CT\uff1a\u677e\u8d28\u9aa8\u653e\u5c04\u5bc6\u5ea6\u503c\u5347\u9ad8\u662f\u53d1\u73b0\u65e9\u671f\u9aa8\u574f\u6b7b\u7684\u826f\u597d\u6307\u6807\u3002\u78c1\u5171\u632f\u6210\u50cf\uff08MRI\uff09\uff1a\u53ef\u8bc4\u4f30\u9aa8\u9ad3\u53d8\u5316\uff0c\u4e14\u53ef\u4ee5\u786e\u5b9a\u9aa8\u9ad3\u708e\u6025\u6027\u9636\u6bb5\u524d\u7684\u9aa8\u8d28\u53d8\u5316<sup>[48]<\/sup>\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u672c\u5171\u8bc6\u8ba4\u4e3a\uff0c\u5b8c\u5584\u7684\u672f\u524d\u5f71\u50cf\u5b66\u68c0\u67e5\u5fc5\u4e0d\u53ef\u5c11\uff0c\u5bf9\u8bc4\u4f30\u988c\u9aa8\u574f\u6b7b\u7684\u7a0b\u5ea6\u5177\u6709\u91cd\u8981\u7684\u53c2\u8003\u610f\u4e49\u3002MRONJ\u7684\u5f71\u50cf\u5b66\u68c0\u67e5\u7279\u70b9\u53ca\u4f7f\u7528\u5efa\u8bae\u603b\u7ed3\u89c1\u88683\u3002<\/p>\n<p>3.3<\/p>\n<p>\u7ec4\u7ec7\u75c5\u7406\u5b66\u8868\u73b0<\/p>\n<p>&nbsp; &nbsp; &nbsp;MRONJ\u7684\u75c5\u7406\u5b66\u4e3b\u8981\u8868\u73b0\u4e3a\u9aa8\u574f\u6b7b\u53ca\u9aa8\u9ad3\u708e\u3002\u901a\u5e38\u53ef\u89c1\u4f53\u79ef\u8f83\u5927\u7684\u6b7b\u9aa8\u5f62\u6210\uff0c\u6b7b\u9aa8\u8868\u73b0\u4e3a\u9aa8\u7ec6\u80de\u6d88\u5931\u3001\u9aa8\u9677\u7a9d\u7a7a\u865a\uff0c\u6b7b\u9aa8\u5c40\u90e8\u8868\u9762\u6709\u65f6\u53ef\u89c1\u7834\u9aa8\u7ec6\u80de\uff0c\u6b7b\u9aa8\u5e38\u88ab\u83cc\u843d\u3001\u708e\u6027\u8089\u82bd\u7ec4\u7ec7\u6216\u9cde\u72b6\u4e0a\u76ae\u5305\u7ed5\u3002\u6b7b\u9aa8\u65c1\u672a\u53d1\u751f\u5178\u578b\u574f\u6b7b\u7684\u9aa8\u7ec4\u7ec7\u5448\u660e\u663e\u9aa8\u9ad3\u708e\u8868\u73b0\uff0c\u7834\u9aa8\u53ca\u6210\u9aa8\u6d3b\u8dc3\uff0c\u9aa8\u8868\u9762\u89c1\u55dc\u78b1\u6027\u84dd\u8272\u53cd\u6298\u7ebf\uff0c\u9aa8\u5c0f\u6881\u95f4\u7ea4\u7ef4\u3001\u8840\u7ba1\u589e\u751f\uff0c\u7ec4\u7ec7\u6c34\u80bf\uff0c\u5927\u91cf\u6dcb\u5df4\u7ec6\u80de\u3001\u6d46\u7ec6\u80de\u6d78\u6da6\u3002\u9aa8\u76ae\u8d28\u8868\u9762\u53cd\u5e94\u6027\u65b0\u9aa8\u5f62\u6210\uff08\u56fe2\uff09\u3002MRONJ\u75c5\u53d8\u75c5\u7406\u8868\u73b0\u53ef\u5206\u4e3a\u708e\u75c7\u533a\u3001\u9aa8\u786c\u5316\u533a\u3001\u9aa8\u53cd\u5e94\u5e26\uff0c\u708e\u75c7\u533a\u89c1\u6e38\u79bb\u6b7b\u9aa8\u5757\uff1b\u9aa8\u786c\u5316\u533a\u73af\u7ed5\u708e\u75c7\u533a\uff0c\u6b64\u533a\u9aa8\u7ec4\u7ec7\u53ef\u89c1\u6570\u91cf\u4e0d\u7b49\u7a7a\u9aa8\u9677\u7a9d\uff0c\u65e0\u8840\u8fd0\u6216\u8840\u8fd0\u5dee\uff1b\u9aa8\u53cd\u5e94\u5e26\u4f4d\u4e8e\u9aa8\u786c\u5316\u5e26\u548c\u6b63\u5e38\u9aa8\u7ec4\u7ec7\u4e4b\u95f4\uff0c\u6210\u9aa8\u53ca\u7834\u9aa8\u6d3b\u8dc3<sup>[49]<\/sup>\u3002\u7ec4\u7ec7\u75c5\u7406\u5b66\u68c0\u67e5\u662f\u652f\u6301\u4e34\u5e8a\u8bca\u65ad\u5e76\u4e0eORNJ\u7b49\u75be\u75c5\u9274\u522b\u7684\u91cd\u8981\u4f9d\u636e\u3002\u8003\u8651\u5230MRONJ\u60a3\u8005\u672f\u540e\u521b\u53e3\u6108\u5408\u80fd\u529b\u8f83\u5dee\uff0c\u6545\u4e00\u822c\u60c5\u51b5\u4e0b\u4e0d\u5efa\u8bae\u505a\u6d3b\u7ec4\u7ec7\u68c0\u67e5\u3002<\/p>\n<p>3.4<\/p>\n<p>\u8bca\u65ad\u6807\u51c6<\/p>\n<p>&nbsp; &nbsp; &nbsp;\u2460\u6709\u6297\u9aa8\u5438\u6536\u836f\u7269\u3001\u6297\u8840\u7ba1\u751f\u6210\u836f\u7269\u6216\u514d\u75ab\u8c03\u8282\u5242\u7b49\u836f\u7269\u6cbb\u7597\u53f2\uff0c\u65e0\u5934\u9888\u90e8\u653e\u7597\u53f2\u3002\u2461\u5177\u6709\u4ee5\u4e0b\u5178\u578b\u4e34\u5e8a\u75c7\u72b6\u53ca\u4f53\u5f81\u5e76\u6301\u7eed8\u5468\u4ee5\u4e0a\uff1a\u988c\u9762\u90e8\u8f6f\u7ec4\u7ec7\u708e\u6027\u80bf\u80c0\u3001\u5c40\u90e8\u6d41\u8113\u3001\u75bc\u75db\u3001\u4e0b\u5507\u9ebb\u6728\u3001\u4f24\u53e3\u957f\u671f\u4e0d\u6108\u3001\u7aa6\u9053\u5f62\u6210\u3001\u988c\u9aa8\u5916\u9732\u3001\u6b7b\u9aa8\u5f62\u6210\u3001\u5f00\u53e3\u53d7\u9650\u7b49\u3002\u2462\u6392\u9664\u6076\u6027\u80bf\u7624\u9aa8\u8f6c\u79fb\u3002\u2463\u5f71\u50cf\u5b66\u68c0\u67e5\u5177\u6709MRONJ\u7684\u5178\u578b\u8868\u73b0\uff1aX\u7ebf\u5e73\u7247\u8868\u73b0\u4e3a\u9aa8\u8d28\u7a00\u758f\u3001\u9aa8\u8d28\u7834\u574f\u3001\u7f3a\u635f\u53ca\u6b7b\u9aa8\u5f62\u6210\u6216\u75c5\u7406\u6027\u9aa8\u6298\u3002CT\u626b\u63cf\u663e\u793a\u75c5\u7076\u5185\u5f25\u6f2b\u6027\u9aa8\u786c\u5316\u3001\u6591\u7247\u72b6\u3001\u866b\u8680\u6837\u9aa8\u8d28\u7834\u574f\u5438\u6536\u533a\u3001\u9aa8\u76ae\u8d28\u7834\u574f\u3001\u9aa8\u819c\u589e\u751f\u6216\u75c5\u7406\u6027\u9aa8\u6298\u3002\u4e0b\u988c\u9aa8\u708e\u75c7\u4e2d\u5fc3\u533a\u8868\u73b0\u4ee5\u9aa8\u8d28\u5438\u6536\u4e3a\u4e3b\uff0c\u53ef\u51fa\u73b0\u6b7b\u9aa8\u5206\u79bb\u6216\u4e0d\u5206\u79bb\uff0c\u5916\u5468\u9aa8\u8d28\u589e\u751f\uff0c\u9aa8\u9ad3\u8154\u5bc6\u5ea6\u589e\u52a0\u3001\u4e0b\u988c\u7ba1\u5f71\u50cf\u4e0d\u6e05\u7b49\uff1b\u4e0a\u988c\u9aa8\u5219\u6613\u51fa\u73b0\u6b7b\u9aa8\u5206\u79bb\u53ca\u4e0a\u988c\u7aa6\u5185\u8f6f\u7ec4\u7ec7\u708e\u75c7\u7b49\u3002\u2464\u7ec4\u7ec7\u75c5\u7406\u5b66\u8868\u73b0\uff1a\u6b7b\u9aa8\u4e2d\u5fc3\u533a\u57df\u53ef\u89c1\u7a7a\u865a\u9aa8\u9677\u7a9d\u3001\u9aa8\u9ad3\u8154\u5185\u7684\u9aa8\u9ad3\u7ec4\u7ec7\u6709\u4e0d\u540c\u7a0b\u5ea6\u7684\u7ea4\u7ef4\u5316\u548c\u708e\u75c7\u7ec6\u80de\u6d78\u6da6\u3001\u53d8\u6027\u9aa8\u5468\u56f4\u53ef\u89c1\u5927\u91cf\u7834\u9aa8\u7ec6\u80de\u548c\u6210\u9aa8\u7ec6\u80de\u3002\u7535\u955c\u4e0b\u663e\u793a\u9aa8\u7ec6\u80de\u76b1\u7f29\uff0c\u7ec6\u80de\u5668\u6d88\u5931\uff0c\u7ec6\u80de\u6838\u7684\u67d3\u8272\u8d28\u51dd\u96c6\uff0c\u9aa8\u57fa\u8d28\u7684\u80f6\u539f\u7ea4\u7ef4\u6eb6\u89e3\u53d8\u6027\u3002\u540c\u65f6\u5177\u5907\u2460\u3001\u2461\u3001\u2462\uff0c\u4ee5\u53ca\u2463\u6216\u2464\u5176\u4e2d1\u9879\u5373\u53ef\u8bca\u65ad\u4e3aMRONJ\u3002<\/p>\n<p>3.5<\/p>\n<p>\u9274\u522b\u8bca\u65ad<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u5728\u4e34\u5e8a\u4e0a\uff0c\u5e38\u9700\u8981\u5c06MRONJ\u4e0e\u5316\u8113\u6027\u9aa8\u9ad3\u708e\u53caORNJ\u8fdb\u884c\u9274\u522b\uff0c\u53d1\u751f\u5728\u4e0b\u988c\u9aa8\u7684\u90e8\u5206\u75c5\u4f8b\u8fd8\u9700\u4e0e\u988c\u9aa8\u8f6c\u79fb\u764c\u9274\u522b\u3002\u4ece\u75c5\u53f2\u3001\u5f71\u50cf\u5b66\u3001\u4e34\u5e8a\u8868\u73b0\u548c\u7ec4\u7ec7\u75c5\u7406\u5b66\u7279\u70b9\u7b49\u65b9\u9762\u53ef\u8fdb\u884c\u9274\u522b\u8bca\u65ad\uff0c\u800c\u5176\u4e2d\u6700\u91cd\u8981\u7684\u9274\u522b\u8981\u70b9\u662f\u75c5\u53f2\u3002MRONJ\u60a3\u8005\u5747\u6709\u660e\u786e\u7684\u76f8\u5173\u836f\u7269\u4f7f\u7528\u53f2\uff0c\u53e3\u8154\u988c\u9762\u5916\u79d1\u533b\u5e08\u5728\u63a5\u8bca\u65f6\u5e94\u4ed4\u7ec6\u8be2\u95ee\u65e2\u5f80\u53f2\u53ca\u7528\u836f\u53f2\u3002\u672c\u75c5\u4e0e\u5316\u8113\u6027\u988c\u9aa8\u9aa8\u9ad3\u708e\u3001ORNJ\u548c\u988c\u9aa8\u8f6c\u79fb\u764c\u7684\u9274\u522b\u8981\u70b9\u89c1\u88684\u3002<\/p>\n<p>4&nbsp; &nbsp;\u5206\u7c7b\u3001\u5206\u671f<\/p>\n<p>&nbsp; &nbsp; &nbsp;\u4e3a\u4fbf\u4e8e\u5bf9MRONJ\u4e25\u91cd\u7a0b\u5ea6\u8fdb\u884c\u5206\u7ea7\uff0c2009\u5e74AAOMS\u63d0\u51fa\u4e86\u7ecf\u5178\u76844\u5206\u671f\u6cd5<sup>[5]<\/sup>\uff0c\u5e76\u57282014\u5e74\u610f\u89c1\u4e66\u4e2d\u5bf9\u8be5\u5206\u671f\u8fdb\u884c\u4e86\u4fee\u6b63<sup>[6]<\/sup>\uff0c\u4ee5\u4fbf\u66f4\u51c6\u786e\u5730\u6307\u5bfc\u4e34\u5e8a\u8bca\u7597\uff1a0\u671f\uff0c\u65e0\u660e\u663e\u9aa8\u574f\u6b7b\u4e34\u5e8a\u8868\u73b0\uff0c\u4f46\u5b58\u5728\u975e\u7279\u5f02\u6027\u75c7\u72b6\u53ca\u5f71\u50cf\u5b66\u5f02\u5e38\uff1b\u2160\u671f\uff0c\u6b7b\u9aa8\u66b4\u9732\u6216\u53ef\u63a2\u53ca\u9aa8\u9762\u7684\u76ae\u80a4\u7618\u7ba1\u5f62\u6210\uff0c\u4f46\u65e0\u660e\u663e\u611f\u67d3\u53ca\u5176\u4ed6\u4e34\u5e8a\u75c7\u72b6\uff1b\u2161\u671f\uff0c\u6b7b\u9aa8\u66b4\u9732\u6216\u53ef\u63a2\u53ca\u9aa8\u9762\u7684\u76ae\u80a4\u7618\u7ba1\u5f62\u6210\uff0c\u540c\u65f6\u4f34\u6709\u5c40\u90e8\u611f\u67d3\u6216\u76f8\u5e94\u7684\u4e34\u5e8a\u75c7\u72b6\uff1b\u2162\u671f\uff0c\u6b7b\u9aa8\u66b4\u9732\u6216\u53ef\u63a2\u53ca\u9aa8\u9762\u7684\u76ae\u80a4\u7618\u7ba1\u5f62\u6210\uff0c\u4f34\u75bc\u75db\u53ca\u611f\u67d3\uff0c\u540c\u65f6\u81f3\u5c11\u6ee1\u8db3\u4ee5\u4e0b1\u9879\u8868\u73b0\uff1a\u2460\u574f\u6b7b\u9aa8\u8d28\u8d85\u8fc7\u7259\u69fd\u9aa8\u533a\u57df\uff1b\u2461\u75c5\u7406\u6027\u9aa8\u6298\uff1b\u2462\u53e3\u5916\u76ae\u80a4\u7618\u53e3\uff1b\u2463\u53e3\u5185\u76f8\u4ea4\u901a\u7684\u7618\u7ba1\uff1b\u2464\u9aa8\u75c5\u635f\u7a81\u7834\u4e0b\u988c\u9aa8\u4e0b\u7f18\u6216\u4e0a\u988c\u7aa6\u3002\u57282009\u5e74AAOMS\u63d0\u51fa0\u671f\u7684\u6982\u5ff5\u540e\uff0c\u4e00\u4e9b\u7ec4\u7ec7\u5728MRONJ\u4e34\u5e8a\u6307\u5357\u4e2d\u4e5f\u76f8\u7ee7\u589e\u52a0\u4e860\u671f<sup>[55-57]<\/sup>\u30020\u671f\u7684\u754c\u5b9a\u4e00\u76f4\u662f\u5b66\u672f\u754c\u8f83\u6709\u4e89\u8bae\u7684\u95ee\u9898\uff0c\u9488\u5bf9\u8fd9\u4e00\u4e89\u8bae\uff0c2022\u5e74AAOMS\u6700\u65b0\u610f\u89c1\u4e66\u4e2d\u660e\u786e\u6307\u51fa\u201c0\u671f\u201d\u4e3aMRONJ\u9ad8\u98ce\u9669\u60a3\u8005\u7591\u4f3c\u51fa\u73b0\u9aa8\u574f\u6b7b\u7684\u5206\u671f\uff0c\u4e0d\u4f5c\u4e3aMRONJ\u7684\u8bca\u65ad\u6807\u51c6\u3002\u56e0\u6b64\uff0cAAOMS\u51b3\u5b9a\u4fdd\u7559\u73b0\u6709\uff082014 AAOMS\uff09\u7684\u5206\u7c7b\u7cfb\u7edf<sup>[6]<\/sup>\uff0c\u4e0d\u505a\u4efb\u4f55\u4fee\u6539\u3002\u76ee\u524d\uff0c\u6700\u5e38\u89c1\u7684MRONJ\u5206\u671f\u7cfb\u7edf\u5305\u62ecAAOMS\u5206\u671f\u7cfb\u7edf<sup>[7]<\/sup>\u3001\u4e0d\u826f\u4e8b\u4ef6\u901a\u7528\u672f\u8bed\u6807\u51c6\uff08CTCAE\uff095.0\u53ca2017\u5e74\u56fd\u9645\u7279\u522b\u5c0f\u7ec4\u5236\u8ba2\u7684ONJ\u5206\u671f\u7cfb\u7edf\uff0c\u5176\u4e2dAAOMS\u76844\u5206\u671f\u6cd5\u5e94\u7528\u6700\u5e7f\u3002\u7136\u800c\uff0c\u968f\u7740\u5bf9MRONJ\u4e0d\u540c\u4e34\u5e8a\u8868\u73b0\u3001\u5f71\u50cf\u5b66\u8868\u73b0\u53ca\u8bca\u7597\u65b9\u5f0f\u7684\u75c5\u4f8b\u62a5\u9053\u9010\u6e10\u589e\u52a0\uff0cAAOMS\u7ecf\u51784\u5206\u671f\u6cd5\u7684\u5c40\u9650\u6027\u9010\u6e10\u663e\u9732\u30022020\u5e74\uff0c\u4f55\u60a6\u7b49\u57fa\u4e8e74\u4f8bMRONJ\u60a3\u8005\u7684\u5f71\u50cf\u5b66\u8868\u73b0\u53ca\u5916\u79d1\u8bca\u7597\u7ecf\u9a8c\uff0c\u7ed3\u5408\u56fd\u5185\u5916\u4ee5\u5f80\u7684\u75c5\u4f8b\u62a5\u9053\u548cAAOMS\u5206\u671f\uff0c\u63d0\u51fa\u4e86\u65b0\u7684MRONJ\u4e34\u5e8a\u5206\u671f\u7cfb\u7edf\uff08MRONJ\u4f55\u6c0f\u5206\u7c7b\u6cd5\uff09\uff0c\u540c\u65f6\u7ed9\u51fa\u76f8\u5e94\u7684\u6cbb\u7597\u7b56\u7565<sup>[58]<\/sup>\u3002\u8be5\u7814\u7a76\u8bc1\u660e\u6e05\u521b\u672f\u5bf9\u2160A\u671f\u53ca\u2161A\u671f\u60a3\u8005\u6cbb\u7597\u7684\u53ef\u884c\u6027\u548c\u6709\u6548\u6027\uff0c\u800c\u5bf9\u4e8e\u65e0\u660e\u663e\u754c\u9650\u7684\u2160B\u3001\u2161B\u671f\u75c5\u4f8b\uff0c\u6e05\u521b\u672f\u5219\u4e0d\u9002\u7528\u3002\u65b0\u5206\u671f\u76840\u671f\u5b9a\u4e49\u4e0eAAOMS\u5206\u671f\u4e2d0\u671f\u7684\u5b9a\u4e49\u5b58\u5728\u4e00\u5b9a\u5dee\u5f02\u3002\u8be5\u4e34\u5e8a\u5206\u671f\u80fd\u591f\u51c6\u786e\u800c\u5ba2\u89c2\u5730\u63cf\u8ff0MRONJ\u60a3\u8005\u7684\u4e34\u5e8a\u7279\u5f81\u53ca\u4e25\u91cd\u7a0b\u5ea6\uff0c\u5e76\u4e3a\u6cbb\u7597\u65b9\u6848\u7684\u5236\u5b9a\u63d0\u4f9b\u6307\u5bfc\u3002\u672c\u5171\u8bc6\u7ecf\u8fc7\u4e13\u5bb6\u8ba8\u8bba\u540e\u91c7\u7528\u8be5\u4e34\u5e8a\u5206\u671f\uff08\u88685\uff09\u3002<\/p>\n<p>5&nbsp; &nbsp;\u6cbb\u7597<\/p>\n<p>5.1<\/p>\n<p>&nbsp;\u6cbb\u7597\u76ee\u6807<\/p>\n<p>&nbsp; &nbsp; &nbsp; MRONJ\u7684\u6cbb\u7597\u76ee\u6807\u662f\u6d88\u9664\u75bc\u75db\uff0c\u63a7\u5236\u8f6f\u786c\u7ec4\u7ec7\u611f\u67d3\uff0c\u5e76\u5c3d\u91cf\u9632\u6b62\u75c5\u53d8\u8303\u56f4\u6269\u5927\uff0c\u540c\u65f6\u914d\u5408\u764c\u75c7\u7b49\u539f\u53d1\u75be\u75c5\u7684\u6cbb\u7597\uff0c\u63d0\u9ad8\u60a3\u8005\u7684\u751f\u6d3b\u8d28\u91cf\u3002\u4e00\u65e6\u786e\u8bcaMRONJ\uff0c\u53e3\u8154\u988c\u9762\u79d1\u533b\u5e08\u9700\u8981\u4e0e\u5185\u79d1\u3001\u80bf\u7624\u79d1\u3001\u611f\u67d3\u79d1\u7b49\u533b\u5e08\u5171\u540c\u534f\u5546\uff0c \u5236\u5b9a\u6cbb\u7597\u8ba1\u5212\u3002<\/p>\n<p>5.2<\/p>\n<p>\u975e\u624b\u672f\u6cbb\u7597<\/p>\n<p>5.2.1&nbsp; \u6297\u83cc\u836f\u7269<\/p>\n<p>&nbsp; &nbsp; &nbsp; MRONJ\u7684\u5168\u8eab\u6297\u611f\u67d3\u6cbb\u7597\u5206\u4e3a\u9884\u9632\u6027\u7528\u836f\u548c\u6cbb\u7597\u6027\u7528\u836f2\u7c7b\u3002\u6cbb\u7597\u6027\u7528\u836f\u4e3b\u8981\u9488\u5bf9\u4e25\u91cd\u5c40\u90e8\u611f\u67d3\u75c7\u72b6\u548c\u5168\u8eab\u611f\u67d3\u75c7\u72b6\u3002\u7406\u60f3\u7684\u6297\u83cc\u836f\u7269\u5e94\u8be5\u7279\u5f02\u6027\u9488\u5bf9\u7ec6\u83cc\uff0c\u540c\u65f6\u65e0\u526f\u4f5c\u7528\u4e14\u8d39\u7528\u8f83\u4f4e<sup>[59]<\/sup>\u3002\u4e0d\u4ec5\u80fd\u5bf9\u5bc4\u5c45\u5728\u75c5\u7076\u5904\u7684\u7ec6\u83cc\u5177\u6709\u6740\u4f24\u6548\u679c\uff0c\u540c\u65f6\u80fd\u6291\u5236\u56e0\u4e3a\u521b\u53e3\u957f\u671f\u66b4\u9732\u800c\u4ea7\u751f\u7684\u53d8\u5f02\u83cc\u3002\u9488\u5bf9MRONJ\u60a3\u8005\uff0c\u63a8\u8350\u7684\u6cbb\u7597\u6027\u6297\u83cc\u836f\u7269\u5305\u62ec\u9752\u9709\u7d20\u3001\u963f\u83ab\u897f\u6797\u3001\u706d\u6ef4\u7075\u3001\u55b9\u8bfa\u916e\u3001\u514b\u6797\u9709\u7d20\u3001\u5f3a\u529b\u9709\u7d20\u3001\u7ea2\u9709\u7d20\u3001\u73af\u4e19\u6c99\u661f\u3001\u897f\u4ed6\u6c99\u661f\u7b49<sup>[60-61]<\/sup>\u3002\u5355\u72ec\u4f7f\u7528\u6297\u83cc\u836f\u7269\u901a\u5e38\u53ef\u6709\u6548\u51cf\u5c11\u75c5\u635f\u5904\u7684\u83cc\u7fa4\u6570\u91cf\uff0c\u5fc5\u8981\u65f6\u4ea6\u53ef\u8fdb\u884c\u6297\u83cc\u836f\u7269\u8054\u7528<sup>[62]<\/sup>\u3002\u672c\u5171\u8bc6\u8ba4\u4e3a\uff0c\u7531\u4e8e\u611f\u67d3\u83cc\u7fa4\u7684\u5dee\u5f02\u53ca\u4e2a\u4f53\u5dee\u5f02\uff0c\u6297\u83cc\u836f\u7269\u7684\u9009\u62e9\u5e94\u7ed3\u5408\u7ec6\u83cc\u57f9\u517b\u3001\u836f\u654f\u8bd5\u9a8c\u7ed3\u679c\u53ca\u5f53\u5730\u7ec6\u83cc\u5fae\u751f\u7269\u6d41\u884c\u60c5\u51b5\uff0c\u9009\u62e9\u6700\u6709\u6548\u7684\u6297\u83cc\u836f\u7269\u3002\u9664\u7ec6\u83cc\u5916\uff0c\u53e3\u8154\u5fae\u751f\u6001\u4e2d\u8fd8\u6709\u771f\u83cc\uff0c\u4ee5\u767d\u8272\u5ff5\u73e0\u83cc\u4e3a\u4e3b\u3002\u5f53\u53e3\u8154\u5fae\u751f\u6001\u5e73\u8861\u88ab\u6253\u7834\u65f6\uff0c\u53ef\u7ee7\u53d1\u771f\u83cc\u611f\u67d3\uff0c\u800c\u4fb5\u88ad\u6027\u771f\u83cc\u611f\u67d3\u53ef\u52a0\u91cd\u9aa8\u7ec4\u7ec7\u7834\u574f\u3002\u56e0\u6b64\uff0c\u5fc5\u8981\u65f6\u9700\u8054\u5408\u6297\u771f\u83cc\u6cbb\u7597\u3002\u6cbb\u7597\u6027\u6297\u83cc\u836f\u7269\u7684\u4f7f\u7528\u5e94\u6301\u7eed\u81f3\u76f8\u5173\u4f53\u5f81\u548c\u75c7\u72b6\u7f13\u89e3\u6216\u6d88\u9664\u3002<\/p>\n<p>5.2.2&nbsp; \u9ad8\u538b\u6c27<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u9ad8\u538b\u6c27\uff08hyperbaric oxygen, HBO\uff09\u6cbb\u7597\u53ef\u4fc3\u8fdb\u6bdb\u7ec6\u8840\u7ba1\u589e\u6b96\uff0c\u589e\u52a0\u7ec4\u7ec7\u7684\u6709\u6548\u542b\u6c27\u91cf\uff0c\u52a0\u5feb\u5f62\u6210\u4fa7\u652f\u5faa\u73af\uff0c\u63d0\u9ad8\u767d\u7ec6\u80de\u6d3b\u529b\uff0c\u8fd1\u5e74\u6765\u88ab\u7528\u4e8e\u8f85\u52a9\u6cbb\u7597\u988c\u9aa8\u9aa8\u9ad3\u708e\u3001ORNJ\u7b49\u75be\u75c5\u3002HBO\u6cbb\u7597\u901a\u8fc7\u4ea7\u751f\u4e00\u6c27\u5316\u6c2e\u5408\u9176\u7684\u5e95\u7269\uff08O2\u548cL-\u7cbe\u6c28\u9178\uff09\u53ca\u4ea7\u751f\u8d85\u6c27\u81ea\u7531\u57fa\uff0c\u63d0\u4f9b\u6d3b\u6027\u6c27\u3001\u6c2e\uff0c\u800c\u6d3b\u6027\u6c27\u3001\u6c2e\u662f\u7834\u9aa8\u7ec6\u80de\u5206\u5316\u548c\u6fc0\u6d3b\u7684\u4fe1\u53f7<sup>[63-66]<\/sup>\u3002\u56e0\u6b64\uff0cHBO\u88ab\u8ba4\u4e3a\u662f\u4e00\u79cd\u53ef\u80fd\u6cbb\u7597MRONJ\u7684\u65b9\u5f0f<sup>[67]<\/sup>\u3002\u6bcf\u59292\u6b21\u3001\u6bcf\u6b212 h\u30012\u4e2a\u5927\u6c14\u538b\u7684HBO\u6cbb\u7597\uff0c\u53ef\u7f29\u77edMRONJ\u7684\u6108\u5408\u65f6\u95f4\u3001\u51cf\u8f7b\u60a3\u8005\u75bc\u75db\uff0c\u6539\u5584\u751f\u6d3b\u8d28\u91cf<sup>[68]<\/sup>\u3002<\/p>\n<p>5.2.3&nbsp;&nbsp;\u5df1\u916e\u53ef\u53ef\u78b1\u4e0e\u7ef4\u751f\u7d20 E&nbsp;<\/p>\n<p>&nbsp; &nbsp; \u5df1\u916e\u53ef\u53ef\u78b1\uff08pentoxifylline\uff0cPEN\uff09\u4e0e\u7ef4\u751f\u7d20 E\uff08tocopherol\uff0cTO\uff09\u8054\u5408\u5e94\u7528\uff08PENTO\uff09\u4e8eORNJ\u5df2\u6709\u591a\u5e74\u5386\u53f2\u3002\u56e0 PENTO\u5bf9\u4e8eORNJ\u7684\u7597\u6548\u663e\u8457\uff0c\u4e5f\u6709\u5b66\u8005\u5c06\u5176\u7528\u4e8eMRONJ\u7684\u6cbb\u7597\u3002\u63a8\u8350\u7684\u7528\u836f\u5242\u91cf\uff1aPEN 400 mg, bid\uff1bTO 400\uff5e500 IU, bid<sup>[69-70]<\/sup>\u3002<\/p>\n<p>5.2.4&nbsp;&nbsp;\u7279\u7acb\u5e15\u80bd<\/p>\n<p>&nbsp; &nbsp; &nbsp;\u7279\u7acb\u5e15\u80bd\uff08teriparatide\uff09\u662f\u7532\u72b6\u65c1\u817a\u6fc0\u7d20\u7684\u4eba\u5de5\u5408\u6210\u591a\u80bd\uff0c\u4e34\u5e8a\u5e38\u7528\u6765\u6cbb\u7597\u96be\u6cbb\u6027\u9aa8\u8d28\u758f\u677e\uff0c\u5e76\u4e8e\u8fd1\u5e74\u6765\u7528\u4e8e\u6cbb\u7597MRONJ\u3002\u5176\u901a\u8fc7Wnt\u3001RANK\/RANKL\u7b49\u4fe1\u53f7\u901a\u8def\u8c03\u8282\u6210\u9aa8\u3001\u7834\u9aa8\u5206\u5316\uff0c\u5e76\u53ef\u4f5c\u7528\u4e8eT\u7ec6\u80de\uff0c\u4ece\u800c\u8d77\u5230\u9aa8\u514d\u75ab\u8c03\u8282\u4f5c\u7528<sup>[71]<\/sup>\u3002\u8fde\u7eed\u5e94\u7528\u7279\u7acb\u5e15\u80bd8\u5468\uff0c\u53ef\u4f7f\u9aa8\u574f\u6b7b\u75c7\u72b6\u597d\u8f6c\uff0c\u75c5\u53d8\u8303\u56f4\u51cf\u5c0f<sup>[72-73]<\/sup>\u3002\u8fde\u7eed\u5e94\u7528\u7279\u7acb\u5e15\u80bd6\u4e2a\u6708\u81f31\u5e74\uff0c\u53ef\u964d\u4f4e\u60a3\u8005\u4e34\u5e8a\u5206\u671f<sup>[74-75]<\/sup>\u3002\u63a8\u8350\u7684\u7528\u6cd5\u7528\u91cf\u4e3a20 \u03bcg\/d\uff0c\u76ae\u4e0b\u6ce8\u5c04\uff0c\u6301\u7eed8\u5468\u4ee5\u4e0a\uff0c\u6839\u636e\u9aa8\u8d28\u6108\u5408\u60c5\u51b5\u8c03\u6574\u7528\u836f\u65f6\u95f4<sup>[72,76]<\/sup>\u3002\u7136\u800c\uff0c\u7279\u7acb\u5e15\u80bd\u53ef\u4fc3\u8fdb\u80bf\u7624\u751f\u6210\uff0c\u5bf9\u4e8e\u80bf\u7624\u60a3\u8005\u5f15\u8d77\u7684MRONJ\uff0c\u5e94\u8be5\u907f\u514d\u4f7f\u7528\u3002<\/p>\n<p>5.3<\/p>\n<p>&nbsp;\u624b\u672f\u6cbb\u7597<\/p>\n<p>5.3.1&nbsp;\u624b\u672f\u6cbb\u7597\u7684\u9002\u5e94\u8bc1\u4e0e\u7981\u5fcc\u8bc1<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u672c\u5171\u8bc6\u8ba4\u4e3a\uff0c\u82e5MRONJ\u60a3\u8005\u988c\u9aa8\u6709\u6b7b\u9aa8\u6216\u9aa8\u8d28\u5f02\u5e38\u4f34\u53cd\u590d\u611f\u67d3\uff0c\u5e94\u8003\u8651\u624b\u672f\u6cbb\u7597\u3002\u7136\u800c\uff0c\u5f53\u60a3\u8005\u5b58\u5728\u4ee5\u4e0b\u72b6\u51b5\u65f6\uff0c\u4e0d\u5b9c\u8fdb\u884c\u624b\u672f\u6cbb\u7597\uff1a\u2460\u6076\u6027\u80bf\u7624\u9aa8\u8f6c\u79fb\u5904\u4e8e\u4e0d\u7a33\u5b9a\u671f\u3002\u2461\u5408\u5e76\u590d\u6742\u5168\u8eab\u75be\u75c5\uff0c\u65e0\u6cd5\u901a\u8fc7\u9ebb\u9189\u8bc4\u4f30\u3002<\/p>\n<p>5.3.2&nbsp; &nbsp;\u6e05\u521b\u672f<\/p>\n<p>&nbsp; &nbsp; &nbsp;\u9488\u5bf9\u988c\u9aa8\u75c5\u635f\u4e0e\u5468\u56f4\u9aa8\u7ec4\u7ec7\u95f4\u5b58\u5728\u4e00\u5b9a\u754c\u7ebf\uff0c\u6216\u660e\u786e\u5206\u754c\uff0c\u751a\u81f3\u574f\u6b7b\u9aa8\u7ec4\u7ec7\u5448\u6e38\u79bb\u72b6\u6001\u3001\u4e0e\u6b63\u5e38\u9aa8\u7ec4\u7ec7\u95f4\u5df2\u5f62\u6210\u8f6f\u7ec4\u7ec7\u9ecf\u819c\u76f8\u9694\u7684\u60a3\u8005\uff0c\u53ea\u9700\u6458\u9664\u6b7b\u9aa8\u5373\u53ef\u5b8c\u6210\u5916\u79d1\u5e72\u9884\u3002\u6e05\u521b\u672f\u6ce8\u610f\u4e8b\u9879\uff1a\u2460\u5f7b\u5e95\u6e05\u9664\u75c5\u53d8\u9aa8\u8d28\u53ca\u5f02\u5e38\u8f6f\u7ec4\u7ec7\uff1b\u2461\u672f\u533a\u8f6f\u7ec4\u7ec7\u4e25\u5bc6\u5bf9\u4f4d\u7f1d\u5408\uff08\u6216\u4ee5\u7898\u4eff\u7eb1\u6761\u6253\u5305\u7f1d\u5408\uff09\u3002\u624b\u672f\u540c\u65f6\u53ef\u4f7f\u7528\u8840\u5c0f\u677f\u6d53\u7f29\u5236\u54c1\uff0c\u63d0\u9ad8MRONJ\u624b\u672f\u7597\u6548\uff0880%\uff5e100%\uff09<sup>[77-81]<\/sup>\u3002\u6e05\u521b\u672f\u9002\u7528\u4e8e\u4f55\u6c0f\u5206\u7c7b\u6cd5\u2160A\u671f\u548c\u2161A\u671f\u60a3\u8005\u3002<\/p>\n<p>5.3.3&nbsp;&nbsp;\u4e0a\u988c\u9aa8\u90e8\u5206\u5207\u9664\u672f<\/p>\n<p>&nbsp; &nbsp; &nbsp;&nbsp;\u5bf9\u4e8e\u4e0a\u988c\u9aa8\u5f02\u5e38\u9aa8\u7ec4\u7ec7\u4e0e\u6b63\u5e38\u9aa8\u7ec4\u7ec7\u95f4\u65e0\u660e\u663e\u754c\u9650\u7684\u75c5\u4f8b\uff0c\u65e0\u6cd5\u901a\u8fc7\u7b80\u5355\u7684\u6b7b\u9aa8\u6458\u9664\u53ca\u6e05\u521b\u672f\u53bb\u9664\u75c5\u7076\u7ec4\u7ec7\uff0c\u5219\u9700\u884c\u4e0a\u988c\u9aa8\u90e8\u5206\u5207\u9664\u672f\u3002\u4e0a\u988c\u9aa8\u540e\u7259\u533a\u7684MRONJ\u56e0\u9aa8\u8d28\u75c5\u635f\u7a81\u7834\u4e0a\u988c\u7aa6\u5e95\uff0c\u5e38\u5f15\u8d77\u5355\u4fa7\u4e0a\u988c\u7aa6\u708e\u75c7<sup>[82]<\/sup>\u3002\u5bf9\u4e8e\u51fa\u73b0\u4e0a\u988c\u7aa6\u708e\u75c7\u7684\u60a3\u8005\uff0c\u53ef\u540c\u671f\u884c\u60a3\u4fa7\u4e0a\u988c\u7aa6\u6839\u6cbb\u672f\uff0c\u4ee5\u51cf\u5c11\u5c40\u90e8\u708e\u75c7\uff0c\u4fc3\u8fdb\u672f\u533a\u6108\u5408\uff0c\u907f\u514d\u75c5\u635f\u8fdb\u5c55\uff1b\u5bf9\u4e8e\u65e0\u4e0a\u988c\u7aa6\u708e\u75c7\u7684\u60a3\u8005\uff0c\u53ef\u4ec5\u884c\u4e0a\u988c\u9aa8\u90e8\u5206\u5207\u9664\u672f\u3002\u4e0a\u988c\u9aa8\u90e8\u5206\u5207\u9664\u672f\u9002\u7528\u4e8e\u4f55\u6c0f\u5206\u7c7b\u6cd5\u2160B\u671f\u3001\u2161B\u671f\u53ca\u90e8\u5206\u2162\u671f\u60a3\u8005\u3002<\/p>\n<p>5.3.4&nbsp; &nbsp;\u4e0a\u988c\u9aa8\u6b21\u5168\u6216\u5168\u5207\u9664\u672f<\/p>\n<p>&nbsp; &nbsp; &nbsp;&nbsp;\u5bf9\u4e8e\u4e0a\u988c\u9aa8\u5f25\u6563\u578b\u6b7b\u9aa8\u4f34\u660e\u663e\u4e0a\u988c\u7aa6\u708e\u75c7\u6216\u4e0a\u988c\u9aa8\u9aa8\u8d28\u6539\u53d8\u7a81\u7834\u7736\u4e0b\u5b54\u3001\u7d2f\u53ca\u6216\u4e0d\u7d2f\u53ca\u7736\u5e95\u6216\u9885\u5e95\u7b49\u533a\u57df\u8005\uff0c\u53ef\u6839\u636e\u9aa8\u8d28\u75c5\u53d8\u8303\u56f4\u9009\u62e9\u4e0a\u988c\u9aa8\u6b21\u5168\u6216\u5168\u5207\u9664\u672f\u3002\u5bf9\u4e8e\u2162\u671f\u4e0a\u988c\u9aa8MRONJ\u60a3\u8005\uff0c\u7531\u4e8e\u4e0a\u988c\u9aa8\u7684\u89e3\u5256\u5f62\u6001\u7279\u6b8a\uff0c\u4e14\u2162\u671f\u75c5\u53d8\u53ef\u80fd\u7d2f\u53ca\u98a7\u9aa8\u3001\u4e0a\u988c\u7aa6\u3001\u9f3b\u8154\u7b49\u89e3\u5256\u7ed3\u6784\uff0c\u5f7b\u5e95\u5207\u9664\u75c5\u53d8\u9aa8\u8d28\u540e\uff0c\u53ef\u80fd\u9020\u6210\u9762\u90e8\u584c\u9677\u7b49\u75c7\u72b6\uff0c\u4e25\u91cd\u5f71\u54cd\u60a3\u8005\u7684\u751f\u5b58\u8d28\u91cf\u3002\u53ef\u91c7\u7528\u5c40\u90e8\u5e26\u8482\u8f6f\u7ec4\u7ec7\u74e3\u3001\u6e38\u79bb\u8840\u7ba1\u5316\u76ae\u74e3\u53ca\u8d5d\u590d\u4f53\u4fee\u590d\u4e0a\u988c\u9aa8\u7f3a\u635f\uff0c\u6539\u5584\u53e3\u9f3b\u7618\u3001\u8bed\u97f3\u529f\u80fd\u53ca\u7f8e\u5b66\u6548\u679c<sup>[83-84]<\/sup>\u3002\u4e0a\u988c\u9aa8\u6b21\u5168\u6216\u5168\u5207\u9664\u672f\u9002\u7528\u4e8e\u4f55\u6c0f\u5206\u7c7b\u6cd5\u2162\u671f\u60a3\u8005\u3002<\/p>\n<p>5.3.5&nbsp; &nbsp;\u4e0b\u988c\u9aa8\u8fb9\u7f18\u9aa8\u5207\u9664\u672f\u53ca\u90e8\u5206\u5207\u9664\u672f<\/p>\n<p>&nbsp; &nbsp; &nbsp;\u5bf9\u4e8e\u4e0b\u988c\u9aa8\u5f02\u5e38\u9aa8\u7ec4\u7ec7\u4e0e\u6b63\u5e38\u9aa8\u7ec4\u7ec7\u95f4\u65e0\u660e\u663e\u754c\u9650\u7684\u75c5\u4f8b\uff0c\u9700\u884c\u4e0b\u988c\u9aa8\u8fb9\u7f18\u9aa8\u5207\u9664\u672f\u6216\u90e8\u5206\u5207\u9664\u672f\u3002\u5728\u53bb\u9664\u75c5\u53d8\u9aa8\u8d28\u7684\u540c\u65f6\uff0c\u522e\u9664\u90e8\u5206\u5065\u5eb7\u9aa8\u7ec4\u7ec7\uff0c\u76f4\u8fbe\u65b0\u9c9c\u6e17\u8840\u7684\u9aa8\u9762\u3002\u6ce8\u610f\u4e8b\u9879\uff1a\u2460\u672f\u533a\u8f6f\u7ec4\u7ec7\u65e0\u5f20\u529b\u4e25\u5bc6\u7f1d\u5408\uff1b\u2461\u5c3d\u91cf\u4fdd\u62a4\u4e0b\u7259\u69fd\u795e\u7ecf\u8840\u7ba1\u675f\u3002\u4e0b\u988c\u9aa8\u8fb9\u7f18\u9aa8\u5207\u9664\u672f\u53ca\u90e8\u5206\u5207\u9664\u672f\u9002\u7528\u4e8e\u4f55\u6c0f\u5206\u7c7b\u6cd5\u2160B\u671f\u60a3\u8005\u3002<\/p>\n<p>5.3.6&nbsp; &nbsp;\u4e0b\u988c\u9aa8\u8282\u6bb5\u6027\u9aa8\u5207\u9664\u672f<\/p>\n<p>&nbsp; &nbsp; &nbsp;&nbsp;\u5bf9\u4e8e\u75c5\u53d8\u8303\u56f4\u8d85\u8fc7\u4e0b\u7259\u69fd\u795e\u7ecf\u7ba1\u7684\u60a3\u8005\uff0c\u4e0d\u5b9c\u884c\u4e0b\u988c\u9aa8\u90e8\u5206\u5207\u9664\u672f\uff0c\u53ef\u8003\u8651\u884c\u4e0b\u988c\u9aa8\u8282\u6bb5\u5207\u9664\u672f\u3002\u5bf9\u4e8e\u5168\u8eab\u6761\u4ef6\u5dee\uff0c\u4e0d\u9002\u5408\u884c\u9aa8\u7ec4\u7ec7\u74e3\u6216\u8f6f\u7ec4\u7ec7\u74e3\u4fee\u590d\u7684\u60a3\u8005\uff0c\u53ef\u91c7\u53d6\u5355\u7eaf\u9aa8\u5207\u9664\u624b\u672f\uff0c\u4ee5\u91cd\u5efa\u949b\u677f\u6865\u63a5\u988c\u9aa8\u7f3a\u635f<sup>[85]<\/sup>\uff1b\u5bf9\u4e8e\u5168\u8eab\u60c5\u51b5\u8f83\u597d\u7684\u60a3\u8005\uff0c\u53ef\u91c7\u53d6\u91cd\u5efa\u624b\u672f\u3002\u988c\u9aa8\u91cd\u5efa\u9996\u9009\u8840\u7ba1\u5316\u9aa8\u7ec4\u7ec7\u74e3\uff0c\u56e0\u4e3a\u5176\u4e0d\u4ec5\u53ef\u4ee5\u6062\u590d\u988c\u9aa8\u7684\u5916\u5f62\u7ed3\u6784\uff0c\u4e5f\u4e3a\u540e\u671f\u7684\u7259\u5217\u4fee\u590d\u521b\u9020\u6761\u4ef6\u3002\u5bf9\u4e8e\u4e0d\u9002\u5b9c\u5e94\u7528\u9aa8\u7ec4\u7ec7\u74e3\u4fee\u590d\u7684\u60a3\u8005\uff0c\u53ef\u884c\u8f6f\u7ec4\u7ec7\u74e3\u4fee\u590d\u3002\u82e5\u8f6f\u7ec4\u7ec7\u91cf\u4e0d\u8db3\uff0c\u53ef\u8054\u5408\u988f\u4e0b\u5c9b\u72b6\u74e3\u53ca\u4e0b\u988c\u4e0b\u817a\u8f6c\u4f4d\u6cbb\u7597<sup>[86]<\/sup>\u3002\u5bf9\u4e8e\u590d\u6742\u7f3a\u635f\uff0c\u5982\u8f6f\u3001\u786c\u7ec4\u7ec7\u5747\u7f3a\u635f\u8f83\u5927\u7684\u60a3\u8005\uff0c\u5355\u4e00\u9aa8\u74e3\u6216\u8f6f\u7ec4\u7ec7\u74e3\u4e0d\u80fd\u6ee1\u8db3\u9700\u6c42\u65f6\uff0c\u53ef\u884c\u8840\u7ba1\u5316\u9aa8\u7ec4\u7ec7\u74e3+\u8840\u7ba1\u5316\u8f6f\u7ec4\u7ec7\u74e3\u4e32\u8054\u4fee\u590d\u3002\u4e0b\u988c\u9aa8\u8282\u6bb5\u6027\u5207\u9664\u672f\u4f34\u6216\u4e0d\u4f34\u91cd\u5efa\u4fee\u590d\u9002\u7528\u4e8e\u4f55\u6c0f\u5206\u7c7b\u6cd5\u2161B\u671f\u548c\u2162\u671f\u60a3\u8005\u3002<\/p>\n<p>5.3.7&nbsp; &nbsp;\u624b\u672f\u5207\u9664\u8fb9\u754c\u7684\u786e\u5b9a<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u672f\u4e2d\u5982\u4f55\u786e\u5b9a\u624b\u672f\u5207\u9664\u8fb9\u754c\uff0c\u4e00\u76f4\u662fMRONJ\u6cbb\u7597\u4e2d\u7684\u96be\u9898\u3002\u82e5\u75c5\u53d8\u53bb\u9664\u4e0d\u5b8c\u5168\uff0c\u53ef\u80fd\u5bfc\u81f4\u75c5\u60c5\u52a0\u91cd\u6216\u590d\u53d1<sup>[87]<\/sup>\u3002\u5f71\u50cf\u5b66\u68c0\u67e5\u53ef\u663e\u793a\u75c5\u53d8\u8303\u56f4\uff0c\u4f46\u672f\u4e2d\u5e38\u53d1\u73b0\u5b9e\u9645\u60c5\u51b5\u8f83\u5f71\u50cf\u5b66\u68c0\u67e5\u7ed3\u679c\u66f4\u4e25\u91cd<sup>[88]<\/sup>\u3002\u5bf9\u4e8e\u5c40\u9650\u578b\u60a3\u8005\uff0c\u53bb\u9664\u6b7b\u9aa8\u540e\u901a\u5e38\u53ef\u786e\u5b9a\u6b63\u5e38\u9aa8\u754c\u9650\uff1b\u5bf9\u4e8e\u5f25\u6563\u578b\u60a3\u8005\uff0c\u9700\u6839\u636e\u672f\u4e2d\u8840\u4f9b\u60c5\u51b5\u5224\u65ad\u6b63\u5e38\u9aa8\u7684\u754c\u9650\u3002<\/p>\n<p>6&nbsp;&nbsp;\u591a\u5b66\u79d1\u7efc\u5408\u6cbb\u7597<\/p>\n<p>&nbsp; &nbsp; &nbsp; MRONJ\u60a3\u8005\u901a\u5e38\u5408\u5e76\u6076\u6027\u80bf\u7624\u7b49\u590d\u6742\u5168\u8eab\u75be\u75c5\uff0c\u56e0\u6b64\u5728\u75be\u75c5\u6cbb\u7597\u8fc7\u7a0b\u4e2d\u5e94\u5efa\u7acb\u4e00\u79cd\u591a\u5b66\u79d1\u7efc\u5408\u6cbb\u7597\u65b9\u6848\u30022019\u5e74\uff0c\u764c\u75c7\u652f\u6301\u7597\u6cd5\u591a\u56fd\u5b66\u4f1a\uff08MASCC\uff09\u3001\u56fd\u9645\u53e3\u8154\u80bf\u7624\u5b66\u4f1a\uff08ISOO\uff09\u53ca\u7f8e\u56fd\u4e34\u5e8a\u80bf\u7624\u534f\u4f1a\uff08ASCO\uff09\u5171\u540c\u5236\u5b9a\u4e86\u300aMASCC\/ISOO\/ASCO\u836f\u7269\u76f8\u5173\u6027\u988c\u9aa8\u574f\u6b7b\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\u300b\uff0c\u5176\u4e2d\u5f3a\u8c03\u4e86\u591a\u5b66\u79d1\u7efc\u5408\u6cbb\u7597\uff08multidisciplinary treatment\uff0cMDT\uff09\u5728MRONJ\u6cbb\u7597\u4e2d\u7684\u91cd\u8981\u6027\u3002\u6307\u5357\u4e2d\u5236\u5b9a\u4e86MRONJ\u7684MDT\u65b9\u6cd5\uff1a\u5f53\u764c\u75c7\u60a3\u8005\u524d\u5f80\u7efc\u5408\u533b\u9662\u5c31\u8bca\u65f6\uff0c\u80bf\u7624\u79d1\u533b\u5e08\u4e0e\u53e3\u8154\u988c\u9762\u5916\u79d1\u533b\u5e08\u53ef\u8fdb\u884c\u4f1a\u8bca\uff0c\u5f53\u9762\u6c9f\u901a\u60a3\u8005\u7684\u75c5\u60c5\u5e76\u5171\u540c\u5236\u5b9a\u6cbb\u7597\u8ba1\u5212\u7b49<sup>[89]<\/sup>\u3002\u5728\u6b64\u57fa\u7840\u4e0a\uff0c\u672c\u5171\u8bc6\u63d0\u51fa\u8fdb\u4e00\u6b65\u5efa\u8bae\uff1a\u9488\u5bf9MRONJ\u7684\u764c\u75c7\u60a3\u8005\uff0c\u5e94\u5f53\u5efa\u7acb\u4e00\u79cdMDT\u4e34\u5e8a\u7ba1\u7406\u7cfb\u7edf\uff0c\u5305\u62ec\u80bf\u7624\u79d1\u3001\u53e3\u8154\u988c\u9762\u5916\u79d1\u3001\u8425\u517b\u79d1\u3001\u611f\u67d3\u79d1\u3001\u653e\u5c04\u79d1\u53ca\u5eb7\u590d\u79d1\u533b\u5e08\u3002\u80bf\u7624\u79d1\u533b\u5e08\u5728\u5bf9\u60a3\u8005\u7528\u836f\u524d\u5e94\u901a\u8fc7\u7cfb\u7edf\u8054\u7cfb\u53e3\u8154\u988c\u9762\u5916\u79d1\u533b\u5e08\uff0c\u5bf9\u60a3\u8005\u8fdb\u884c\u5168\u9762\u7684\u53e3\u8154\u68c0\u67e5\u548c\u6cbb\u7597\uff0c\u9884\u5148\u51cf\u5c11MRONJ\u53d1\u751f\u7684\u98ce\u9669\u56e0\u7d20\u3002\u9488\u5bf9\u5df2\u786e\u8bcaMRONJ\u7684\u80bf\u7624\u60a3\u8005\uff0c\u53e3\u8154\u988c\u9762\u5916\u79d1\u533b\u5e08\u5e94\u901a\u8fc7\u7cfb\u7edf\u8054\u7cfb\u80bf\u7624\u79d1\u533b\u5e08\uff0c\u4e86\u89e3\u60a3\u8005\u80bf\u7624\u8fdb\u5c55\u3001\u5168\u8eab\u72b6\u51b5\u53ca\u7528\u836f\u53f2\uff0c\u540c\u65f6\u8bf7\u80bf\u7624\u79d1\u533b\u5e08\u8bc4\u4f30\u7ee7\u7eed\u7528\u836f\u7684\u5fc5\u8981\u6027\u3002\u6700\u540e\uff0c\u7cfb\u7edf\u5185\u5404\u79d1\u5ba4\u533b\u5e08\u5171\u540c\u5236\u5b9a\u6cbb\u7597\u65b9\u6848\u53ca\u5eb7\u590d\u6cbb\u7597\u8ba1\u5212\uff0c\u4ee5\u8fbe\u5230\u6700\u4f18\u7684\u6cbb\u7597\u6548\u679c\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u957f\u671f\u4ee5\u6765\uff0c\u624b\u672f\u524d\u7684\u505c\u836f\u65f6\u95f4\u662f\u5404\u5b66\u79d1\u533b\u5e08\u5171\u540c\u5173\u6ce8\u7684\u95ee\u9898\u3002\u672c\u5171\u8bc6\u5efa\u8bae\uff0c\u5728MRONJ\u60a3\u8005\u63a5\u53d7\u624b\u672f\u6cbb\u7597\u524d\uff0c\u5e94\u4e0e\u76f8\u5173\u5b66\u79d1\u786e\u8ba4\u5168\u8eab\u75be\u75c5\u63a7\u5236\u60c5\u51b5\u826f\u597d\u540e\uff0c\u505c\u836f1\u4e2a\u6708\u4ee5\u4e0a\uff0c\u8840\u6db2\u5316\u9a8c\u5404\u9879\u6307\u6807\u826f\u597d\uff0c\u65b9\u53ef\u8fdb\u884c\u624b\u672f\u3002<\/p>\n<p>7&nbsp; &nbsp;\u7597\u6548\u8bc4\u4ef7<\/p>\n<p>&nbsp; &nbsp; &nbsp; &nbsp;MRONJ\u60a3\u8005\u5747\u9700\u5b9a\u671f\u590d\u67e5\uff0c\u672f\u540e1\u5e74\u5185\u6bcf3\u4e2a\u6708\u590d\u67e5\u4e00\u6b21\uff0c1\u5e74\u540e\u6bcf\u534a\u5e74\u590d\u67e5\u4e00\u6b21\u3002\u672c\u5171\u8bc6\u7ecf\u4e13\u5bb6\u8ba8\u8bba\u540e\u63d0\u51fa\u7528\u201c\u6cbb\u6108\u201d\u201c\u6539\u5584\u201d\u201c\u7a33\u5b9a\u201d\u6216\u201c\u8fdb\u5c55\u201d\u6765\u8bc4\u4ef7\u7597\u6548\uff0c\u5728\u672f\u540e3\u4e2a\u6708\u8fdb\u884c\u521d\u6b65\u7597\u6548\u8bc4\u4ef7\uff0c\u672f\u540e1\u5e74\u8fdb\u884c\u7a33\u5b9a\u7597\u6548\u8bc4\u4ef7\uff08\u88686\uff09\u3002<\/p>\n<p>8&nbsp; 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