硬膜外类固醇注射治疗由椎间盘突出引起的坐骨神经痛在世界范围内越来越多地使用。但其有效性仍存在争议。本文旨在分析硬膜外注射类固醇治疗腰椎间盘突出症坐骨神经痛的疗效。1月,从PubMed和其他数据库中收集了研究硬膜外类固醇注射在治疗腰椎间盘突出症引起的坐骨神经痛中使用的随机对照试验(RCT)。2008年至12月,2023年,试验组采用硬膜外类固醇注射,对照组采用硬膜外局部麻醉药和/或安慰剂。疼痛缓解率,通过数字评定量表(NRS)和视觉模拟量表(VAS)评分进行评估,和功能恢复,通过罗兰莫里斯残疾问卷(RMDQ)和奥斯威西残疾指数(ODI)评分进行评估,进行记录和比较。Meta分析由ReviewManager进行。与对照组相比,硬膜外类固醇注射已被证明是有效的提供短期(3个月内)[MD=0.44,95CI(0.20,0.68),p=0.0003]和中期(6个月内)[MD=0.66,95CI(0.09,1.22),p=0.02]腰椎间盘突出症引起的坐骨神经痛的疼痛缓解,而其长期止痛效果有限。然而,硬膜外类固醇注射的给药没有导致坐骨神经功能的显著改善在短[MD=0.79,95CI=(0.39,1.98),p=0.19]和长期[MD=0.47,95%CI=(-0.86,1.80),通过IOD评估p=0.49]。此外,分析显示,硬膜外类固醇注射导致腰椎间盘突出症患者阿片类药物使用减少[MD=-14.45,95%CI=(-24.61,-4.29),p=0.005]。硬膜外注射类固醇的发生率较低。硬膜外类固醇注射在缓解腰椎间盘突出症引起的坐骨神经痛方面具有明显的短期至中期疗效。因此,建议将其作为坐骨神经痛患者的可行治疗选择。
Epidural steroid injection for the treatment of sciatica caused by disc herniation is increasingly used worldwide, but its effectiveness remains controversial. The
review aiming to analyze the efficacy of epidural steroid injection on sciatica caused by lumbar disc herniation. Randomized controlled trials (RCTs) investigating the use of epidural steroid injections in the management of sciatica induced by lumbar disc herniation were collected from PubMed and other databases from January, 2008 to December, 2023, with epidural steroid injection in the test group and epidural local anesthetic and/or placebo in the control group. Pain relief rate, assessed by numerical rating scale (NRS) and visual analogue scale (VAS) scores, and function recovery, evaluated by Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI) scores, were recorded and compared. Meta-analysis was performed by
Review Manager. In comparison to the control group, epidural steroid injections have been shown to be effective for providing short- (within 3 months) [MD = 0.44, 95%CI (0.20, 0.68), p = 0.0003] and medium-term (within 6 months) [MD = 0.66, 95%CI (0.09,1.22), p = 0.02] pain relief for sciatica caused by lumbar disc herniation, while its long-term pain-relief effect were limited. However, the administration of epidural steroid injections did not lead to a significant improvement on sciatic nerve function in short- [MD = 0.79, 95%CI = (0.39, 1.98), p = 0.19] and long-term [MD = 0.47, 95% CI = (-0.86, 1.80), p = 0.49] assessed by IOD. Furthermore, the analysis revealed that administering epidural steroid injections resulted in a reduction in opioid usage among patients with lumbar disc herniation [MD = -14.45, 95% CI = (-24.61, -4.29), p = 0.005]. The incidence of epidural steroid injection was low. Epidural steroid injection has demonstrated notable efficacy in relieving sciatica caused by lumbar disc herniation in short to medium-term. Therefore, it is recommended as a viable treatment option for individuals suffering from sciatica.