Department of Rehabilitation Medicine, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Republic of Korea.
Am J Phys Med Rehabil. 2012 Dec;91(12):1039-50. doi: 10.1097/PHM.0b013e318264573a.
The aim of this study was to conduct a randomized, blinded, prospective outcome study on the short-term benefits of the Kambin triangle vs. the supraneural approach for the treatment of lumbar radicular pain.
Subjects with lumbar radicular pain (n = 100) were randomly assigned to undergo transforaminal epidural steroid injection using either the Kambin triangle approach or the supraneural approach. Primary outcomes were measured with a verbal numeric pain scale and the Oswestry Disability Index, and the results at 2 and 12 wks after the procedure were compared between the groups. Secondary outcomes included patient satisfaction and the incidence of complications during the transforaminal epidural steroid injection procedure.
For both groups, the verbal numeric pain scale and Oswestry Disability Index scores improved 2 wks after the injections, and this improvement was maintained through the 12-wk follow-up. The verbal numeric pain scale, Oswestry Disability Index, and effectiveness scores were not significantly different between groups. Neural contact occurred in nine cases with the supraneural approach; no patients experienced neural contact with the Kambin triangle approach.
The Kambin triangle approach can be used instead of the supraneural approach in cases where it is difficult to place the needle at the anterior epidural space.
本研究旨在对经皮椎间孔入路腰椎间盘切除术治疗腰椎根性痛的短期疗效进行随机、双盲、前瞻性研究，比较 Kambin 三角入路与神经上入路的疗效。
选择腰椎根性痛患者（n=100），随机分为两组，分别采用 Kambin 三角入路和神经上入路行经皮椎间孔入路硬膜外类固醇注射治疗。主要结局指标采用视觉模拟评分法和 Oswestry 功能障碍指数进行评估，比较两组患者在治疗后 2 周和 12 周的结果。次要结局指标包括患者满意度和经皮椎间孔入路硬膜外类固醇注射治疗过程中的并发症发生率。
两组患者的视觉模拟评分法和 Oswestry 功能障碍指数评分在注射后 2 周均有改善，且在 12 周随访中保持改善。两组间视觉模拟评分法、Oswestry 功能障碍指数和有效率评分无显著差异。神经上入路组有 9 例出现神经接触，而 Kambin 三角入路组无患者出现神经接触。
在难以将针尖置于硬膜外前间隙的情况下，Kambin 三角入路可替代神经上入路。
