Kyllönen E S, Väänänen H K, Vanharanta J H, Heikkinen J E
Department of Physical Medicine and Rehabilitation, Oulu University, Finland.
Spine (Phila Pa 1976). 1999 Apr 1;24(7):704-8. doi: 10.1097/00007632-199904010-00018.
A 2-year randomized controlled trial.
To examine the possible preventive or aggravating effect of estrogen-progestin treatment on the back symptoms of slim premenopausal women with low lumbar spine bone mineral density.
The incidence of back pain, sciatica, or both starts to increase clearly among 45-54-year-old Finnish women.
Forty-eight 39- to 49-year-old premenopausal women with a body mass index of 21 or less and a lumbar spine bone mineral density (L2-L4) of 1.1 +/- 1 g/cm3 or less compared with the normative population were recruited into the study. The women were assigned randomly to receive either estradiol-noretisteron acetate treatment or placebo. Back pain, symptoms, and disability were assessed with the Million and Oswestry questionnaires and pain drawings during the follow-up period at 0, 12, and 24 months. Inquiry also was made concerning previous back pain and sciatica history.
There was a statistically significant decrease in nighttime back pain (P < 0.001) and the total Oswestry disability scores (P < 0.004) in the hormone-treated group compared with the control group during the follow-up, but no statistically significant differences were found in daytime back pain. At baseline, the cumulative incidence in a history of pain radiating from the buttock to the foot in this osteopenic study group was 31/48, (64.5%; 95% CI 50.5-78.6), which is much more than the predicted 20/48, (42.4%; 95% CI 39.0-45.7) at this age according to a previous population study. The cumulative incidence of at least one back pain episode 44/48, (91.7%; 95% CI 83.6-99.8) was somewhat higher in these participants than was predicted for a comparative population of women this age, 38/48 (79.2%; 95% CI 70.2-87.3).
It seems that this regimen may have alleviating effects on nighttime back pain and functional back disability in slim osteopenic premenopausal women.
一项为期2年的随机对照试验。
探讨雌激素 - 孕激素治疗对腰椎骨密度低的苗条绝经前女性背部症状可能产生的预防或加重作用。
在45 - 54岁的芬兰女性中，背痛、坐骨神经痛或两者并发的发病率开始明显上升。
招募了48名39至49岁、体重指数为21或更低且腰椎骨密度（L2 - L4）与正常人群相比为1.1 +/- 1 g/cm³或更低的绝经前女性参与研究。这些女性被随机分配接受雌二醇 - 醋酸炔诺酮治疗或安慰剂。在随访期的0、12和24个月时，使用Million问卷、Oswestry问卷和疼痛绘图评估背痛、症状和残疾情况。还询问了既往背痛和坐骨神经痛病史。
与对照组相比，随访期间激素治疗组的夜间背痛（P < 0.001）和Oswestry残疾总评分（P < 0.004）有统计学显著下降，但白天背痛未发现统计学显著差异。在基线时，该骨质减少研究组中从臀部放射至足部疼痛病史的累积发生率为31/48（64.5%；95%置信区间50.5 - 78.6），远高于根据先前人群研究在该年龄预测的20/48（42.4%；95%置信区间39.0 - 45.7）。这些参与者中至少发生一次背痛发作的累积发生率为44/48（91.7%；95%置信区间83.6 - 99.8），略高于该年龄女性对照人群预测的38/48（79.2%；95%置信区间70.2 - 87.3）。
对于苗条的骨质减少绝经前女性，该治疗方案似乎对夜间背痛和功能性背部残疾有缓解作用。
