Koes Bart W, Scholten Rob J P M, Mens Jan M A, Bouter Lex M
Institute for Research in Extramural Medicine, Vrije Universiteit, 1081 BT Amsterdam, The Netherlands Institute for Rehabilitation Medicine, Erasmus Universiteit, Rotterdam, The Netherlands.
Pain. 1995 Dec;63(3):279-288. doi: 10.1016/0304-3959(95)00124-7.
The purpose of the study was to assess the efficacy of epidural steroid injections for low-back pain. Data was obtained using computer-aided search of published randomized clinical trials and assessment of the methods of the studies. Twelve randomized clinical trials evaluating epidural steroid injections were identified. Data was extracted based on scores for quality of the methods, using 4 categories (study population, interventions, effect measurement, and data presentation and analysis) and the conclusion of the author(s) with regard to the efficacy of epidural steroid injections. Method scores of the trials ranged from 17 to 72 points (maximum 100 points). Eight trials showed method scores of 50 points or more. Of the 4 best studies (> 60 points), 2 reported positive outcomes and 2 reported negative results. Overall, 6 studies indicated that the epidural steroid injection was more effective than the reference treatment and 6 reported it to be no better or worse than the reference treatment. There appeared to be no relationship between the methodological quality of the trials and reported outcomes. In conclusion, there are flaws in the design of most studies. The best studies showed inconsistent results of epidural steroid injections. The efficacy of epidural steroid injections has not been established. The benefits of epidural steroid injections, if any, seem to be of short duration only. Future research efforts are warranted, but more attention should be paid to the methods of the trials.
本研究的目的是评估硬膜外类固醇注射治疗腰痛的疗效。通过计算机辅助检索已发表的随机临床试验并评估研究方法来获取数据。共识别出12项评估硬膜外类固醇注射的随机临床试验。根据方法质量得分提取数据，使用4个类别（研究人群、干预措施、效果测量以及数据呈现与分析）以及作者关于硬膜外类固醇注射疗效的结论。试验的方法得分在17至72分之间（满分100分）。8项试验的方法得分在50分及以上。在4项最佳研究（>60分）中，2项报告了阳性结果，2项报告了阴性结果。总体而言，6项研究表明硬膜外类固醇注射比对照治疗更有效，6项报告其与对照治疗效果相当。试验的方法学质量与报告的结果之间似乎没有关联。总之，大多数研究的设计存在缺陷。最佳研究显示硬膜外类固醇注射的结果不一致。硬膜外类固醇注射的疗效尚未确立。硬膜外类固醇注射的益处（如果有的话）似乎仅持续较短时间。未来有必要进行研究，但应更加关注试验方法。
