Comparison of the caudal and lumbar approaches to the epidural space
Comparison of the caudal and lumbar approaches to the epidural space
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DOI：
10.1136/ard.59.11.879
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发表时间：
2000-11-01
影响因子：
27.4
通讯作者：
Arden, NK
中科院分区：
文献类型：
--
作者：
Price, CM;Rogers, PD;Arden, NK
目的 - 研究使用腰椎和尾侧入路进行硬膜外注射的准确性。确定哪些因素（如果有）可预测成功放置。方法：将 200 名连续转至疼痛诊所进行硬膜外注射类固醇的患者随机分配到两组中的一组。 L 组采用腰椎入路进入硬膜外腔，C 组采用尾部入路进入硬膜外腔。然后两组均使用欧乃派克和图像增强器进行硬膜外造影以确定针的位置。结果-体重指数（BMI）、操作者等级和注射途径是成功放置的预测因素。 93% 的腰椎注射和 64% 的尾侧硬膜外注射放置正确 (p < 0.001)。临床上认为正确放置的 97% 的腰椎注射和 85% 的尾侧硬膜外注射均经过放射学证实。对于临床印象为“可能”的硬膜外注射，91% 的腰部注射正确放置，但只有 45% 的尾部注射正确放置。肥胖与成功植入的机会降低相关（比值比 (OR) 0.34（95% 置信区间 (CI) 0.17 至 0.72）BMI >30 v BMI
Objectives-To investigate the accuracy of placement of epidural injections using the lumbar and caudal approaches. To identify which factors, if any, predicted successful placement.Methods-200 consecutive patients referred to a pain clinic for an epidural injection of steroid were randomly allocated to one of two groups. Group L had a lumbar approach to the epidural space and group C a caudal approach to the epidural space. Both groups then had epidurography performed using Omnipaque and an image intensifier to determine the position of the needle.Results-Body mass index (BMI), grade of operator, and route of injection were predictors of a successful placement. 93% of lumbar and 64% of caudal epidural injections were correctly placed (p < 0.001). 97% of lumbar and 85% of caudal epidural injections clinically thought to be correctly placed were confirmed radiographically. For epidural injections where the clinical impression was "maybe", 91% of lumbar injections, but only 45% of caudal injections were correctly placed. Obesity was associated with a reduced chance of successful placement (odds ratio (OR) 0.34 (95% confidence interval (CI) 0.17 to 0.72) BMI >30 v BMI