RENDAHNYA KADAR ESTROGEN MERUPAKAN FAKTOR … fileMasing-masing 11 pasien masuk dalam kelompok kasus dan kontrol.Dari analisis statistik Chi-square didapatkan perbedaan yang bermakna

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

2015

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

2015

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

staffradiologi atas dukungannya guna bisa terselesainya penelitian tersebut.

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

Penulis

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.

Kata kunci: Osteoarthritis lumbal, defisiensi estrogen, pasca menopause.

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.

Keywords: Osteoarthritislumbar, estrogen deficiency, postmenopause.

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.

1.4.1 Manfaat teoritis ...................................... 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

defined.

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!

Bookmark not defined.

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.

4.3.2.3 Cara Pemilihan 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.

7.1 Simpulan Penelitian ......................................... Error! Bookmark not defined.

7.2 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!


Gambar 5.2 Perbandingan rerata BMI berdasarkan kelompok kasus dan kontrolError!


Gambar 5.3 Grafik status gizi sampel penelitian berdasarkan kelompok kasus dan kontrol Error!


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


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!


Gambar 5.8 Grafik jumlah kadar estrogen berdasarkan nilai median pada kelompok kasus dan

kontrol ............................................... Error! Bookmark not defined.

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!


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!


Tabel 5.5 Hasil analisis chi-square status gizi berdasarkan kelompok kasus dan kontrol Error!


Tabel 5.6 Hasil analisis chi-square kadar estrogen berdasarkan kelompok kasus dan kontrol

............................................................... Error! Bookmark not defined.

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.

Lampiran 7. Analisis statistik dengan SPSS® 20.0 For WindowsError! Bookmark not defined.

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RENDAHNYA KADAR ESTROGEN MERUPAKAN FAKTOR … fileMasing-masing 11 pasien masuk dalam kelompok kasus dan kontrol.Dari analisis statistik Chi-square didapatkan perbedaan yang bermakna