Lam Kuen, Wong Denis, Tam Cheuk Kwan, Wah Shu Hong, Myint Ma Wai Wai Jennifer, Yu Teresa Kim Kam, So Kar Kui, Cheung Gloria, Au Kai Man, Fu Ming Hung, Wu Yee Ming, Kng Carolyn Poey
Shatin Cheshire Home, Hong Kong, China.
Department of Prosthetic and Orthotic, Haven of Hope Hospital, Hong Kong, China.
J Am Med Dir Assoc. 2015 Mar;16(3):238-46. doi: 10.1016/j.jamda.2014.10.005. Epub 2014 Nov 25.
To evaluate the effectiveness of ultrasound-guided phenol nerve block in the treatment of severe hip adductor spasticity in long-term care patients.
Double-blind placebo-controlled trial with a 9-month follow-up period.
A 250-bed long-term care hospital and the infirmary units of 5 regional hospitals.
Twenty-six long-term care patients with bilateral severe chronic hip adductor spasticity affecting perineal hygiene and nursing care.
Patients were randomized to 2 groups that received ultrasound and electrical stimulator guided obturator nerve block using either 5% phenol in aqueous solution or saline.
The primary outcome measure was the Modified Ashworth Scale, which reflected the severity of hip adductor spasticity. Secondary outcomes included Goal Attainment Scale (GAS), hygiene score, distances between the knees during fast and slow passive hip abductions; passive range of movement for hip extension and knee extension. Pain was assessed using the Pain Assessment in Advanced Dementia Scale.
Twenty-six patients (7 males; mean age = 77, standard deviation = 14) were recruited. At week 6 post-injection, 12/16 (75%) patients in the treatment group vs 1/10 (10%) patients in the control group had at least 1-point reduction of Modified Ashworth Scale (P = .001) on both hip adductors. There was also significant improvement in the GAS, as well as the hygiene score, resting position, and distances between the knees during fast and slow passive hip abductions in the treatment group, which persisted until week 36. No significant difference in the Pain Assessment in Advanced Dementia Scale was found between the 2 groups. No serious phenol nerve block related adverse effects were reported.
Obturator neurolysis with 5% aqueous phenol as guided by both ultrasound and electrical stimulation can safely and effectively reduce hip adductor spasticity, thus, improving hygiene scores and patient-centered outcomes measured by the GAS in affected long-term care residents.
评估超声引导下苯酚神经阻滞治疗长期护理患者重度髋内收肌痉挛的有效性。
为期9个月随访期的双盲安慰剂对照试验。
一家拥有250张床位的长期护理医院以及5家地区医院的医务室。
26名长期护理患者，双侧重度慢性髋内收肌痉挛影响会阴卫生和护理。
患者被随机分为两组，分别接受超声和电刺激引导下的闭孔神经阻滞，使用5%苯酚水溶液或生理盐水。
主要观察指标为改良Ashworth量表，反映髋内收肌痉挛的严重程度。次要观察指标包括目标达成量表（GAS）、卫生评分、快速和缓慢被动髋外展时双膝之间的距离；髋关节伸展和膝关节伸展的被动活动范围。使用晚期痴呆疼痛评估量表评估疼痛。
招募了26名患者（7名男性；平均年龄 = 77岁，标准差 = 14）。注射后第6周，治疗组12/16（75%）的患者双侧髋内收肌改良Ashworth量表至少降低1分，而对照组为1/10（10%）（P = 0.001）。治疗组的GAS、卫生评分、休息姿势以及快速和缓慢被动髋外展时双膝之间的距离也有显著改善，这种改善持续到第36周。两组在晚期痴呆疼痛评估量表上没有显著差异。未报告与苯酚神经阻滞相关的严重不良反应。
在超声和电刺激引导下，使用5%苯酚水溶液进行闭孔神经松解术可安全有效地减轻髋内收肌痉挛，从而提高受影响的长期护理居民的卫生评分以及以患者为中心的GAS测量结果。
