Rozenberg S, Dubourg G, Khalifa P, Paolozzi L, Maheu E, Ravaud P
Department of Rheumatology, Pitié Teaching Hospital, Paris, France.
Rev Rhum Engl Ed. 1999 Feb;66(2):79-85.
Several randomized trials have suggested recently that epidural steroid injections may not be a valid treatment in common low back pain and sciatica. To clarify this issue, we conducted a critical appraisal of relevant randomized trials published up to 1997. Attention was directed to methodological quality, results, and clinical implications.
A Medline search identified 13 trials published between 1966 and 1997. Trial methodology was evaluated using a 100-point grid based on four groups of items, namely study population, therapeutic intervention, evaluation method, and data presentation and analysis.
Methodology quality scores ranged from 12 to 84 and were unrelated to the results of epidural steroid therapy. Five trials demonstrated greater pain relief within the first month in the steroid group as compared to the control group. Eight trials found no measurable benefits. Obstacles to meaningful comparisons across studies included differences in the patient populations, steroid used, volume injected, and number of injections. None of the published studies used the injection modalities that are standard practice in France.
Whether epidural steroids are effective in common low back pain and sciatica cannot be determined based on our review.
近期多项随机试验表明，硬膜外注射类固醇可能并非治疗常见下腰痛和坐骨神经痛的有效方法。为阐明这一问题，我们对截至1997年发表的相关随机试验进行了批判性评价。重点关注方法学质量、结果及临床意义。
通过医学文献数据库检索，确定了1966年至1997年间发表的13项试验。采用基于四组项目（即研究人群、治疗干预、评估方法以及数据呈现与分析）的100分制网格对试验方法进行评估。
方法学质量评分在12至84分之间，且与硬膜外类固醇治疗结果无关。五项试验表明，与对照组相比，类固醇组在第一个月内疼痛缓解更为明显。八项试验未发现可衡量的益处。跨研究进行有意义比较的障碍包括患者人群、所用类固醇、注射量及注射次数的差异。已发表的研究均未采用法国的标准注射方式。
基于我们的综述，无法确定硬膜外类固醇对常见下腰痛和坐骨神经痛是否有效。
