Jonovska Suzana, Francisković Tanja, Kvesić Ante, Nikolić Hary, Brekalo Zrinko, Pavlović Eduard, Bilić Daliborka Dalija
Department of Pediatric Surgery, School of Medicine, University of Rijeka, Rijeka, Croatia.
Coll Antropol. 2007 Jun;31(2):463-9.
Self-esteem involves the evaluative and affective dimensions of self-concept. It could be influenced by stress situations such as diseases or injuries, especially in the period of puberty and adolescence. The aim of this study was to establish the influence of isolated long tubular bone limbs' fractures in children and adolescents and type of its treatment (conservative or active surgical treatment-various techniques) on self-esteem of patients, as well as to establish relationships between self-esteem, depression, anxiety and perception of the social support in the mentioned patients. This prospective clinical trial comprehends 135 patients, 94 male and 41 female, aged 10 to 18, treated for the mentioned fractures in the period from October 2003 until March 2005 in Departments for Pediatric Surgery of three hospitals: the Clinical Hospital Center in Rijeka (88.8% patients), the Clinical Children's Hospital in Zagreb (9.7%), both in Croatia, and 1.5% of the patients in the Clinical Hospital in Mostar (Bosnia and Herzegovina). 53.3% of the patients were treated conservatively, 29.6% of them underwent the elastic stable intramedullary nailing (ESIN), while the remaining 17.1% of the patients were treated with other surgical techniques (AO-plates or Kirschner-wire ostheosyntheses). The basic methods of work were self-reported questionnaires: Rosenberg Self-esteem Scale (RSS), to establish the degree of self-esteem; Children Depression Inventory (CDI), to establish existence and degree of depression; Spielberg State Trait Anxiety Inventory (STAI)-form STAI2, to establish general anxiety; and Test of Perception of Social Support (TPSS). RSS, CDI and STAI2 were administered twice to the patients: at baseline and after 6 months of the trauma, whereas TPSS once, after 1 month of the trauma. Our results point at an decreased self-esteem followed by increased depression and increased general anxiety indicators in all patients within 1 week of experienced trauma, especially in those who underwent the ESIN method, whereas after 6 months of the experienced trauma, self-esteem significantly increased and depression and general anxiety indicators were greatly reduced in all patients. The type of treatment of fractures has no influence on the perception of the social support. Our results suggest that the ESIN method (regardless of its good surgical results and advantages in relation to many other surgical techniques) reduces self-esteem more than conservatively treatment of fractures and AO-plates and K-wire ostheosyntheses. At the same time self-esteem has been recuperated faster in patients treated with ESIN method. Thus, there is no difference in the influence of the type of the treatment of fractures on self-esteem, but in the dynamics of its recuperation in patients according to type of treatment of fractures. Anyway, from a psychological point of view, any type of surgical treatment could be additional stressor, so it should be practiced with criticism and according to the strict surgical indications.
自尊涉及自我概念的评价和情感维度。它可能会受到诸如疾病或损伤等应激情况的影响，尤其是在青春期和青少年时期。本研究的目的是确定儿童和青少年孤立的长管状骨四肢骨折及其治疗类型（保守治疗或积极手术治疗——各种技术）对患者自尊的影响，以及确定上述患者自尊、抑郁、焦虑与社会支持感知之间的关系。这项前瞻性临床试验纳入了135例患者，其中男性94例，女性41例，年龄在10至18岁之间，于2003年10月至2005年3月期间在三家医院的小儿外科接受上述骨折治疗：里耶卡临床医院中心（88.8%的患者）、萨格勒布临床儿童医院（9.7%），均在克罗地亚，以及莫斯塔尔临床医院（波斯尼亚和黑塞哥维那）1.5%的患者。53.3%的患者接受了保守治疗，29.6%的患者接受了弹性稳定髓内钉固定术（ESIN），其余17.1%的患者接受了其他手术技术治疗（AO钢板或克氏针骨固定术）。基本的研究方法是自我报告问卷：罗森伯格自尊量表（RSS），用于确定自尊程度；儿童抑郁量表（CDI），用于确定抑郁的存在和程度；斯皮尔伯格状态特质焦虑量表（STAI）——STAI2形式，用于确定总体焦虑；以及社会支持感知测试（TPSS）。RSS、CDI和STAI2对患者进行了两次测量：在基线时和创伤后6个月，而TPSS在创伤后1个月进行了一次测量。我们的结果表明，在经历创伤的1周内，所有患者的自尊均下降，随后抑郁和总体焦虑指标增加，尤其是那些接受ESIN方法治疗的患者，而在经历创伤6个月后，所有患者的自尊显著增加，抑郁和总体焦虑指标大幅降低。骨折的治疗类型对社会支持感知没有影响。我们的结果表明，ESIN方法（无论其良好的手术效果以及相对于许多其他手术技术的优势）比骨折的保守治疗、AO钢板和克氏针骨固定术更能降低自尊。同时，接受ESIN方法治疗的患者自尊恢复得更快。因此，骨折治疗类型对自尊的影响没有差异，但根据骨折治疗类型，患者自尊恢复的动态过程存在差异。无论如何，从心理学角度来看，任何类型的手术治疗都可能是额外的应激源，因此应该谨慎实施并严格遵循手术指征。
