Chen Kaiwen, Gao Tian, Yang Shuo, Zhu Yu, Lyu Feizhou, Jiang Jianyuan, Xia Xinlei, Zheng Chaojun
Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, New York, USA.
World Neurosurg. 2023 Oct;178:e802-e818. doi: 10.1016/j.wneu.2023.08.014. Epub 2023 Aug 10.
To quantify self-esteem in patients with Hirayama disease (HD) and investigate the impact of this psychosocial factor on surgical outcomes in HD.
The Rosenberg Self-Esteem Scale (RSES) was measured in 58 patients with HD before anterior cervical fusion. These patients further underwent motor unit number estimation, handgrip strength, disabilities of the arm, shoulder and hand (DASH), Beck Anxiety Inventory (BAI) and Beck Depression Index (BDI) before and 18 months after operation. Furthermore, the International Physical Activity Questionnaire (IPAQ) was administered to all patients at postoperative 18-month assessments.
Compared with the general population, patients with HD showed a relatively lower RSES, and RSES was negatively associated with both postoperative DASH (r = -0.431, P < 0.05) and preoperative to postoperative changes (r = -0.295, P < 0.05) and positively associated with IPAQ (r = 0.472, P < 0.05). Similar to the difference in postoperative DASH scores, more patients with low self-esteem felt postoperative aggravated motor dysfunction than those with high/normal self-esteem (P < 0.05). Postoperative BDI exerted a partial mediating effect on the relationship between RSES and DASH scores (B = -0.30, P < 0.05), and postoperative BAI played a partial mediating effect on the relationship between RSES and IPAQ scores (B = 0.30, P < 0.05).
The self-esteem of HD patients may be below the population norms. Importantly, relatively low self-esteem in HD patients may cause/worsen postoperative depression and anxiety, thereby resulting in poor self-reported surgical prognosis and an inactive lifestyle after operation. Therefore, perioperative treatment and rehabilitation efforts in HD patients, especially those with low self-esteem, should account for both physiological and psychological symptoms.
量化平山病（HD）患者的自尊水平，并研究这种社会心理因素对HD手术结局的影响。
在58例HD患者行颈椎前路融合术前，采用罗森伯格自尊量表（RSES）进行测量。这些患者在手术前和术后18个月还进行了运动单位数量估计、握力、手臂、肩部和手部功能障碍（DASH）、贝克焦虑量表（BAI）和贝克抑郁量表（BDI）评估。此外，在术后18个月评估时，对所有患者进行国际体力活动问卷（IPAQ）调查。
与普通人群相比，HD患者的RSES相对较低，且RSES与术后DASH评分（r = -0.431，P < 0.05）以及术前至术后的变化（r = -0.295，P < 0.05）均呈负相关，与IPAQ呈正相关（r = 0.472，P < 0.05）。与术后DASH评分的差异类似，自尊水平低的患者比自尊水平高/正常的患者术后运动功能障碍加重的情况更多（P < 0.05）。术后BDI在RSES与DASH评分之间的关系中起部分中介作用（B = -0.30，P < 0.05），术后BAI在RSES与IPAQ评分之间的关系中起部分中介作用（B = 0.30，P < 0.05）。
HD患者的自尊可能低于人群平均水平。重要的是，HD患者相对较低的自尊可能导致/加重术后抑郁和焦虑，从而导致自我报告的手术预后较差以及术后生活方式不积极。因此，HD患者围手术期的治疗和康复措施，尤其是自尊水平低的患者，应兼顾生理和心理症状。
