超声引导下95%乙醇行关节囊周围神经群（PENG）化学消融治疗髋关节骨关节炎疼痛及改善生活质量的疗效：一项前瞻性、双盲、随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：周倩 编辑：周倩 审校：曹莹
骨关节炎（coxarthrosis）引起的慢性髋部疼痛严重影响患者生活质量，且常规保守治疗常效果不足。超声引导下关节囊周围神经群（PENG）乙醇化学神经溶解术是一种微创介入技术，可能提供长期镇痛效果。本研究旨在评估95%乙醇PENG神经溶解术对比假手术在慢性髋痛患者中的疗效与安全性。
方法
本研究为单中心、双盲、随机对照试验（RCT），纳入100名保守治疗无效的慢性髋痛患者（中位年龄82岁[IQR 74-89]，49%为男性），按1:1随机分配至乙醇神经溶解组（n=50）或假手术组（n=50）。主要结局为术后7天、30天、3个月和6个月时疼痛强度（数字评分量表，NRS）。次要结局包括阿片类药物消耗量（口服吗啡毫克当量）、生活质量（EQ-5D-5L量表）及神经功能缺损情况。
结果
乙醇神经溶解组在所有时间点的NRS评分均显著低于假手术组（p < 0.0001），平均NRS从基线6.0（标准差SD 0.9）降至7天3.1（SD 0.8）、30天2.9（SD 0.7）、3个月2.8（SD 0.7）和6个月3.0（SD 0.7）。阿片类药物消耗量在神经溶解组显著更低（7天时IQR 1.5 mg vs. 11.5 mg，P=0.002），且效果持续至6个月。生活质量（EQ-5D-5L评分）在神经溶解组显著改善（p< 0.0001），且未观察到任何神经功能缺损。
超声引导下乙醇神经溶解术治疗PENG是一种安全有效的干预措施，可缓解慢性髋关节疼痛并减少阿片类药物依赖，但需要进一步的多中心试验来验证长期疗效。
原始文献：Reysner M, Reysner T, et al. Chemical ablation of pericapsular nerve group with 95% ethanol for pain relief and quality of life in patients with hip osteoarthritis: a prospective, double-blinded, randomised, controlled trial. Br J Anaesth. 2025 Aug;135(2):382-389.
Chemical ablation of pericapsular nerve group with 95% ethanol for pain relief and quality of life in patients with hip osteoarthritis: a prospective, double-blinded, randomised, controlled trial
ABSTRACT
Background: Chronic hip pain from osteoarthritis greatly diminishes quality of life, and standard treatments often fail to provide sufficient relief. Ultrasound-guided pericapsular nerve group (PENG) neurolysis using ethanol is a minimally invasive technique that may provide extended analgesia. This study evaluated the efficacy and safety of ultrasound-guided 95% ethanol neurolysis of the PENG compared with a sham procedure in patients with chronic hip pain.
Methods: This double-blinded, single-centre, RCT included 100 patients (median age: 82 yr [IQR 74-89]; 49% male) with chronic hip pain unresponsive to conservative treatments. Participants were assigned to either ethanol neurolysis (n=50) or a sham procedure (n=50). The primary outcome was pain intensity (numeric rating scale [NRS]) assessed at 7 days, 30 days, 3 months, and 6 months. Secondary outcomes included opioid consumption (oral morphine equivalents), quality of life (EQ-5D-5L), and neurological deficits.
Results: Ethanol neurolysis significantly reduced NRS scores at all follow-ups (P<0.0001). The mean NRS scores decreased from baseline 6.0 (sd 0.9) to 3.1 (0.8) at 7 days, 2.9 (0.7) at 30 days, 2.8 (0.7) at 3 months, and 3.0 (0.7) at 6 months. Opioid consumption was lower in the neurolysis group at 7 days (median [IQR]: 1.5 [0.5-3.5] mg vs 11.5 [9.1-13.7] mg, P=0.002) and remained reduced through 6 months. Quality of life improved significantly (P<0.0001), and no neurological deficits were observed.
Conclusions: Ultrasound-guided ethanol neurolysis of the PENG is a safe and effective intervention for chronic hip pain, providing long-term relief and reducing opioid dependency. Further multicentre trials are needed to validate long-term outcomes.