TESIS
RENDAHNYA KADAR ESTROGEN MERUPAKAN
FAKTOR RISIKO TERJADINYA OSTEOARTHRITIS
LUMBAL PADA WANITA PASCA MENOPAUSE
DENGAN KELUHAN
LOW BACK PAIN
PUTU BUDI SUCITRA
I KETUT SUYASA
PROGRAM PENDIDIKAN DOKTER SPESIALIS I
BAGIAN/SMF ORTHOPAEDI DAN TRAUMATOLOGI
UNIVERSITAS UDAYANA
DENPASAR
RENDAHNYA KADAR ESTROGEN MERUPAKAN
FAKTOR RISIKO TERJADINYA OSTEOARTHRITIS
LUMBAL PADA WANITA PASCA MENOPAUSE
DENGAN KELUHAN
LOW BACK PAIN
Tesis untuk Memperoleh Gelar Spesialis Orthopaedi dan Traumatologi Pada Bagian/SMF Orthopaedi dan Traumaologi
Fakultas Kedokteran Universitas Udayana Rumah Sakit Umum Pusat Sanglah Denpasar
PUTU BUDI SUCITRA NIM 0914118201
PROGRAM PENDIDIKAN DOKTER SPESIALIS I
BAGIAN/SMF ORTHOPAEDI DAN TRAUMATOLOGI
UNIVERSITAS UDAYANA
DENPASAR
UCAPAN TERIMA KASIH
Penulis mengucapkan syukur kehadapan Tuhan Yang Maha Esa karena berkat
rahmat-Nya usulan penelitian yang berjudul Rendahnya Kadar Estrogen Merupakan Faktor Risiko
Terjadinya Osteoarthritis Lumbal Pada Wanita Pasca Menopause Dengan Keluhan Low Back
Paininidapat diselesaikan.
Penulis mengucapkan terimakasih kepada :
1. Prof. DR. dr. Ketut Suastika, Sp.PD-KEMD, FINASIM, sebagai Rektor Fakultas
Kedokteran Universitas Udayana.
2. Prof. Dr. dr Putu Astawa, Sp.OT, Mkes, selaku Dekan Fakultas Kedokteran Universitas
Udayana
3. Prof. Dr. dr. Ketut Siki Kawiyana, Sp.B., Sp.OT(K), sebagai ketua program studi
Orthopaedi dan Traumatologi FK Udayana–RSUP Sanglah Denpasar dan sebagai
Pembimbing I atas bimbingan dan arahannya dalam perbaikan usulan penelitian
tersebut.
4. dr. I Ketut Suyasa,Sp.B., Sp.OT(K), selaku pembimbing II, atas nasihat dan
bimbingannya untuk bisa terselesainya usulan penelitian tersebut.
5. Seluruh staff pengajar Orthopaedi dan Traumatologi FK Udayana RSUP Sanglah
Denpasar atas dukungan guna terselesaikanya usulan penelitisan tersebut.
6. DR. dr. Elysanti Dwi Martadiani, Sp.Rad, sebagai pembimbing bidang radiologi dan
7. DR. dr. AA Wiradewi Lestari, Sp.PK sebagai pembimbing bidang patologi klinik dan
seluruh staff Patologi Klinik RSUP Sanglah, Denpasar, atas bimbingan dan
dukungannya sehingga penelitian tersebut dapat diselesaikan.
8. Semua dosen pengajar Combined Degree Pascasarjana Universitas Udayana yang telah
banyak memberikan masukan dan bimbingan.
9. Rekan-rekan serta semua pihak yang telah membantu dalam penulisan laporan ini.
Penulis menyadari masih ada kekurangan dalam penelitian ini. Oleh karena itu dengan
segala keredahan hati penulis menerima saran dan kritik untuk perbaikan penelitian ini.
Denpasar, Februari 2015
RENDAHNYA KADAR ESTROGEN MERUPAKAN FAKTOR RISIKO TERJADINYA OSTEOARTHRITIS LUMBAL PADA WANITA PASCA MENOPAUSE DENGAN
KELUHAN LOW BACK PAIN
*Putu Budi Sucitra
**I Ketut Suyasa
Low back pain (LBP) adalah merupakan salah satu keluhan yang paling umum dirasakan sepanjang hidup manusia. Keluhan nyeri tulang belakang dapat terjadi baik pada wanita usia muda maupun pada usia yang lebih tua. Penelitian di Amerika Serikat kelainan pada punggung dan tulang belakang lebih sering didapatkan pada wanita daripada pria (73,3 berbanding 57,7 per 1000 populasi) dan paling umum terjadi pada usia antara 45 dan 65 tahun. Hal ini sesuai dengan usia pasca menopause. Salah satu penyebab keluhan LBP adalah osteoarthrtitis lumbal. Beberapa penelitian sudah mempelajari adanya hubungan antara OA pada lutut dengan defisiensi estrogen. Namun masih belum banyak yang mempelajari hubungan antara OA lumbal dan rendahnya kadar estrogen.
Penelitian ini merupakan suatu penelitian observasional analitik dengan pendekatan studi kasus dan kontrol (case control study) untuk mengetahui apakah defisiensi estrogen merupakan faktor risiko terjadinya OA lumbal pada wanita pasca menopause yang menderita LBP. Dengan mengukur kadar estrogen (E2) pada pasien wanita pasca menopause dengan keluhan LBP kemudian dinilai ada tidaknya OA lumbal yang didiagnosis secara radiologis.
22 pasien wanita pasca menopause dengan keluhan LBP yang datang ke poliklinik orthopaedi RSUP Sanglah yang memenuhi kriteria inklusi dimasukkan sebagai sampel penelitian. Masing-masing 11 pasien masuk dalam kelompok kasus dan kontrol.Dari analisis statistik Chi-square didapatkan perbedaan yang bermakna antara kejadian OA lumbal dengan rendahnya kadar estrogen (OR=6,600, 95% CI=0,011-0,633, p=0,010).
Dari hasil analisa statistik tersebut dapat disimpulkan bahwa semakin rendah kadar estrogen maka risiko terjadinya OA lumbal pada wanita pascamenopause dengan keluhan LBP akan semakin tinggi. Terapi pengganti estrogen dapat dipertimbangkan pemberiannya untuk mencegah terjadinya OA lumbal.
LOW ESTROGEN LEVELSAS A RISK FACTOR
FORLUMBAROSTEOARTHRITISIN POSTMENOPAUSAL
WOMENCOMPLAINTWITHLOWBACK PAIN
*Putu Budi Sucitra
**I Ketut Suyasa
Lowback pain(LBP) is one ofthe most common complaintsthroughout thehumanlife. Spinalpaincanoccur in bothyoung andaged womenatan older age. Researchin theUnited Statesabnormalities in theback and spineis morecommon inwomen than men(73.3 versus57.7per 1,000population) andis most commonbetween the ages of45and65years. This is consistent withpost-menopausal age. One of thecauses ofLBPisosteoarthrtitislumbar. Someresearchhasstudiedthe relationshipbetweenOAof the kneewithestrogen deficiency. Butstill notmanywho studythe relationshipbetweenlumbarOAandestrogen deficiency.
This study isanobservationalstudywitha casestudy approachandcontrols(case control study) todeterminewhetherestrogen deficiencyis arisk factor forlumbarOAin postmenopausal womensuffering fromLBP. By measuringthe levels ofestrogen level(E2) inpostmenopausalfemale patientswithLBPcomplaintsthenassessedthe presence or absenceof OAradiologically.
22postmenopausalfemale patientswithLBPcomplaintsthatcometothe outpatient clinicin Sanglah Hospitalwhomet the inclusion criteriaincluded as asample. Each of these11 patients wereincluded in thecase and control groups. FromChi-squarestatistical analysiswe foundsignificant differencebetweenthe incidence oflumbarOAwithlow estrogen level (OR =6.6,95% CI=0,011-0,633,p=0.010).
Fromthe results ofthestatisticalanalysisit can be concludedthat the lowerlevels of estrogen, the risk oflumbarOAin postmenopausal womenwithLBPcomplaintswill be higher. Estrogenreplacementtherapycanbe consideredtopreventlumbarOA.
DAFTAR ISI
Sampul Dalam ... i
Persyaratan Gelar ... ii
Ucapan Terima Kasih ... iii
Abstrak ... v
Abstract ... vi
Daftar Isi ... vii
Daftar Gambar ... xi
Daftar Tabel ... xiii
Daftar Lampiran ... xiv
Daftar Singkatan ... xv
BAB I PENDAHULUAN ... Error! Bookmark not defined.
1.1 Latar Belakang ... Error! Bookmark not defined.
1.2 Rumusan Masalah ... Error! Bookmark not defined.
1.3 Tujuan Penelitian ... Error! Bookmark not defined.
1.3.1 Tujuan Umum ... Error! Bookmark not defined.
1.3.2 Tujuan Khusus ... Error! Bookmark not defined.
1.4 Manfaat Penelitian ... Error! Bookmark not defined.
1.4.2 Manfaat praktis ... Error! Bookmark not defined.
BAB II KAJIAN PUSTAKA ... Error! Bookmark not defined.
2.1 Low Back Pain (LBP) ... Error! Bookmark not defined.
2.1.1 Definisi... Error! Bookmark not defined.
2.1.2 Epidemiologi ... Error! Bookmark not defined.
2.1.3 Patofisiologi ... Error! Bookmark not defined.
2.2 Osteoarthritis Lumbal ... Error! Bookmark not defined.
2.2.1 Anatomi Lumbal Spine ... Error! Bookmark not defined.
2.2.2 Biomekanik Lumbal Spine ... Error! Bookmark not defined.
2.2.3 Nyeri yang Berasal dari Sendi Facet... Error! Bookmark not defined.
2.2.4 Imaging pada Lumbal Spine ... Error! Bookmark not defined.
2.2.5 Patofisiologi terjadinya OA Lumbal ... Error! Bookmark not defined.
2.3 Menopause ... Error! Bookmark not defined.
2.4 Estrogen ... Error! Bookmark not defined.
2.4.1 Biosintesis Estrogen ... Error! Bookmark not defined.
2.4.2 Metabolisme Estrogen ... Error! Bookmark not defined.
2.4.3 Reseptor Estrogen ... Error! Bookmark not defined.
2.5 Defisiensi Estrogen ... Error! Bookmark not defined.
2.6 Efek Defisiensi Estrogen pada Turnover dan Arsitektur TulangError! Bookmark not
2.7 Efek Defisiensi Estrogen pada Pembentukan OsteoklasError! Bookmark not defined.
2.8 Patofisiologi Terjadinya OA ... Error! Bookmark not defined.
2.9 Hubungan Estrogen dan OA ... Error! Bookmark not defined.
2.9.1 Penelitian Hubungan Kadar Estrogen dengan Terjadinya OAError! Bookmark not
defined.
2.9.2 Penelitian pada Manusia ... Error! Bookmark not defined.
BAB III KERANGKA BERPIKIR, KONSEP, DAN HIPOTESIS PENELITIANError!
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3.1 Kerangka Berpikir ... Error! Bookmark not defined.
3.2 Konsep Penelitian ... Error! Bookmark not defined.
3.3 Hipotesis ... Error! Bookmark not defined.
BAB IV METODE PENELITIAN ... Error! Bookmark not defined.
4.1 Rancangan Penelitian ... Error! Bookmark not defined.
4.2 Lokasi dan Waktu Penelitian ... Error! Bookmark not defined.
4.3 Populasi dan Sampel Penelitian ... Error! Bookmark not defined.
4.3.1 Populasi penelitian ... Error! Bookmark not defined.
4.3.2 Sampel Penelitian ... Error! Bookmark not defined.
4.3.2.1 Kriteria Inklusi dan Eksklusi PenelitianError! Bookmark not defined.
4.3.2.2 Besar Sampel ... Error! Bookmark not defined.
4.4 Variabel Penelitian ... Error! Bookmark not defined.
4.4.1 Klasifikasi dan Identifikasi Variabel ... Error! Bookmark not defined.
4.4.2 Definisi Operasional Variabel ... Error! Bookmark not defined.
4.5 Instrumen Penelitian ... Error! Bookmark not defined.
4.6 Prosedur Penelitian ... Error! Bookmark not defined.
4.7 Alur Penelitian ... Error! Bookmark not defined.
4.8 Pengolahan dan Analisis Data ... Error! Bookmark not defined.
5. BAB V HASIL PENELITIAN ... Error! Bookmark not defined.
5.1 Analisis Sampel ... Error! Bookmark not defined.
5.2 Analisis Deskriptif ... Error! Bookmark not defined.
5.2.1 Data demografis sampel penelitian ... Error! Bookmark not defined.
5.2.2 Data deskriptif masing-masing variabel penelitianError! Bookmark not defined.
5.3 Analisis Inferensial ... Error! Bookmark not defined.
5.3.1 Uji Normalitas... Error! Bookmark not defined.
5.3.2 Uji Komparatif ... Error! Bookmark not defined.
5.3.2.1 Uji Independent t-test ... Error! Bookmark not defined.
5.3.2.2 Uji Chi-Square ... Error! Bookmark not defined.
BAB VI PEMBAHASAN HASIL PENELITIAN Error! Bookmark not defined.
BAB VII KESIMPULAN DAN SARAN ... Error! Bookmark not defined.
DAFTAR GAMBAR
Gambar 2.1 Anatomi tulang belakang lumbal ... Error! Bookmark not defined.
Gambar 2.2 Gambar sendi facet lumbal. ... Error! Bookmark not defined.
Gambar 2.3 Gambar CT-Scan sendi facet. ... Error! Bookmark not defined.
Gambar 2.4 Pergerakan tulang belakang lumbal. .. Error! Bookmark not defined.
Gambar 2.5 Fleksi dan ekstensi tulang belakang lumbal.Error! Bookmark not defined.
Gambar 2.6 Rotasi tulang belakang lumbal. ... Error! Bookmark not defined.
Gambar 2.7 Gambar distribusi referred pain dari sendi facet.Error! Bookmark not defined.
Gambar 2.8 Gambaran pencitraan sendi facet. ... Error! Bookmark not defined.
Gambar 2.9 Gambaran foto polos oblik tulang belakang lumbal.Error! Bookmark not defined.
Gambar 2.10 Struktur kimia estrone, estradiol, dan estriol.Error! Bookmark not defined.
Gambar 2.11 Biosintesis estrogen di ovarium. ... Error! Bookmark not defined.
Gambar 2.12 Metabolisme estrogen. ... Error! Bookmark not defined.
Gambar 3.1 Konsep penelitian ... Error! Bookmark not defined.
Gambar 4.1 Skema studi kasus kontrol... Error! Bookmark not defined.
Gambar 4.2 Alur penelitian... Error! Bookmark not defined.
Gambar 5.1 Rerata umur sampel penelitian berdasarkan kelompok kasus dan kontrol Error!
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Gambar 5.2 Perbandingan rerata BMI berdasarkan kelompok kasus dan kontrolError!
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Gambar 5.3 Grafik status gizi sampel penelitian berdasarkan kelompok kasus dan kontrol Error!
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Gambar 5.4 Grafik perbandingan rerata umur saat menopause pada kelompok kasus dan kontrol
... Error! Bookmark not defined.
Gambar 5.5 Grafik perbandingan rerata lamanya menopause pada kelompok kasus dan kontrol
... Error! Bookmark not defined.
Gambar 5.6 Grafik perbandingan lamanya keluhan LBP pada kelompok kasus dan kontrol
Gambar 5.7 Grafik perbandingan rerata kadar estradiol pada kelompok kasus dan kontrol Error!
Bookmark not defined.
Gambar 5.8 Grafik jumlah kadar estrogen berdasarkan nilai median pada kelompok kasus dan
DAFTAR TABEL
Tabel 2.1 Tabel kadar hormon estrogen ... Error! Bookmark not defined.
Tabel 5.1 Data demografis sampel berdasarkan kasus dan kontrolError! Bookmark not
defined.
Tabel 5.2 Ringkasan rerata variabel penelitian berdasarkan kelompok kasus dan kontrol Error!
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Tabel 5.3 Uji normalitas data variabel-variabel penelitianError! Bookmark not defined.
Tabel 5.4 Hasil uji komparabilitas variabel penelitian untuk kelompok kasus dan kontrol Error!
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Tabel 5.5 Hasil analisis chi-square status gizi berdasarkan kelompok kasus dan kontrol Error!
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Tabel 5.6 Hasil analisis chi-square kadar estrogen berdasarkan kelompok kasus dan kontrol
DAFTAR LAMPIRAN
Lampiran 1. Ethical Clearance Penelitian ... Error! Bookmark not defined.
Lampiran 2. Surat Ijin Penelitian ... Error! Bookmark not defined.
Lampiran 3. Kuesioner Penelitian... Error! Bookmark not defined.
Lampiran 4. Informed Consent Penelitian ... Error! Bookmark not defined.
Lampiran 5. Hasil pemeriksaan estradiol... Error! Bookmark not defined.
Lampiran 6. Kesimpulan hasil pemeriksaan radiologis dan penentuan kelompok kasus dan
kontrol ... Error! Bookmark not defined.
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