肩部WMSDs发生率与个体及工作相关因素的结构方程分析  

Structural equation analysis of the incidence of shoulder WMSDs and individual and work-related factors

作　　者：周爽 王忠旭[2] 凌瑞杰 徐擎 张华东[3] 刘移民[4] 李刚[5] 尹艳[6] 邵华[7] 李珏[8] 张恒东[9] 邱兵[10] 王大宇[11] 曾强[12] 叶研[13] 肖斌[14] 邹华[15] 陈建超[16] 黎东霞 刘永泉 刘吉祥[19] 蒋恩霏[20] 漆骏[21] 梅良英 赵显锋 杨咪咪 贾宁[2] Zhou Shuang;Wang Zhongxu;Ling Ruijie;Xu Qing;Zhang Huadong;Liu Yimin;Li Gang;Yin Yan;Shao Hua;Li Jue;Zhang Hengdong;Qiu Bing;Wang Dayu;Zeng Qiang;Ye Yan;Xiao Bin;Zou Hua;Chen Jianchao;Li Dongxia;Liu Yongquan;Liu Jixiang;Jiang Enfei;Qi Jun;Mei Liangying;Zhao Xianfeng;Yang Mimi;Jia Ning(Office of Comprehensive Management of Occupational Disease Prevention and Control,Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine(Hubei Provincial Occupational Disease Hospital),Wuhan 430015,China;Laboratory of Occupational Protection and Ergonomics,National Institute of Occupational Health and Poison Control,Chinese Center for Disease Control and Prevention,Beijing 100050,China;Office of the Director,Chongqing Center for Disease Control and Prevention,Chongqing 400042,China;Department of Occupational Health Management,Guangzhou Institute of Occupational Disease Control and Prevention,Guangzhou 510620,China;Occupational Disease Prevention Institute,Liaoning Provincial Center for Disease Control and Prevention,Shenyang 110399,China;Department of Occupational Health,Shanghai Center for Disease Control and Prevention,Shanghai 200051,China;Testing and Evaluation Center,Shandong Academy of Occupational Health and Occupational Medicine,Jinan 255030,China;Office of Beijing Institute of Chemical Industry Occupational Disease Prevention and Treatment,Beijing 100195,China;Occupational Disease Prevention Institute,Jiangsu Provincial Center for Disease Control and Prevention,Nanjing 210009,China;Office of Public Health Emergency Management,Civil Aviation Medical Center,Civil Aviation Administration of China,Beijing 100010,China;Department of Physical Examination,Tianjin Occupational Diseases Precaution and Therapeutic Hospital,Tianjin 300011,China;Institute of Occupational Health,Tianjin Centers for Disease Control and Prevention,Tianjin 300011,China;Institute of Occupational Health,Beijing Center for Disease Control and Prevention,Beijing 100013,China;Institute of Physical Factors Monitoring,Guangdong Province

机构地区：[1]湖北省中西医结合医院(湖北省职业病医院)职业病防治综合管理办公室,武汉430015 [2]中国疾病预防控制中心职业卫生与中毒控制所职业防护与工效学研究室,北京100050 [3]重庆市疾病预防控制中心主任办公室,重庆400042 [4]广州市职业病防治院职业卫生管理科,广州510620 [5]辽宁省疾病预防控制中心职业病防治所,沈阳110399 [6]上海市疾病预防控制中心职业健康科,上海200051 [7]山东省职业卫生与职业病防治研究院检测评价中心,济南255030 [8]北京市化工职业病防治院院办公室,北京100195 [9]江苏省疾病预防控制中心职业病防治所,南京210009 [10]中国民用航空局民用航空医学中心民航公共卫生应急管理办公室,北京100010 [11]天津市职业病防治院体检科,天津300011 [12]天津市疾病预防控制中心职业健康所,天津300011 [13]北京市疾病预防控制中心职业卫生所,北京100013 [14]广东省职业病防治院物理因素监测所,广州510300 [15]浙江省疾病预防控制中心职业健康与辐射防护所,杭州310051 [16]福建省职业病与化学中毒预防控制中心医务科,福州350025 [17]贵州省职业病防治院院办公室,贵阳610599 [18]江西省职业病防治研究院职业病医院,南昌330006 [19]宁夏疾病预防控制中心办公室,银川750003 [20]四川省疾病预防控制中心职业与辐射卫生所,成都610044 [21]云南省疾病预防控制中心职业健康与放射卫生所,昆明650118 [22]湖北省疾病预防控制中心卫生监测所,武汉430070 [23]陕西省疾病预防控制中心职业与放射卫生所,西安710054

出　　处：《中华劳动卫生职业病杂志》2025年第2期91-100,共10页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金："十四五"国家重点研发计划资助项目(2022YFC2503205);中国疾病预防控制中心职业卫生与中毒控制所职业健康风险评估与国家职业卫生标准制定项目(102393220020090000020)。

摘　　要：目的调查我国职业人群肩部工作相关肌肉骨骼疾患(work-related musculoskeletal disorders,WMSDs)发生率,并探索其与个人和工作相关因素的内在联系。方法于2024年4月,回顾分析2018年6月至2023年12月我国22个省份、29个重点行业的73497份《中文版肌肉骨骼疾患电子问卷》,收集不同地区重点职业人群的一般资料、WMSDs发生情况及其相关危险因素等信息。综合运用χ^(2)检验、验证性因子分析,探讨重点职业人群肩部疲劳及疼痛与个体因素、工作类型、工作姿势和工作组织的关系,并基于结构方程模型分析其内在联系。结果女性、缺乏体育锻炼者、以不舒服的姿势工作和工作时颈部大幅前倾者均与较高的肩部疲劳、疼痛发生率有关(P<0.05)。结构方程模型分析显示,工作类型、工作姿势与工作组织呈强相关(r=0.58、0.55);工作组织和工作类型与肩部疲劳分别呈强相关(r=0.65)和中等相关(r=0.21);肩部疲劳与肩部疼痛呈中等相关(r=0.40)。个体因素、工作类型、工作姿势和肩部疲劳均可直接影响肩部疼痛(OR=0.07、-0.09、0.17、0.40),工作类型和工作姿势还可通过肩部疲劳间接影响肩部疼痛(OR=0.08、0.03),而工作组织仅通过肩部疲劳间接影响肩部疼痛(OR=0.26)。结论肩部疼痛的主要影响因子是肩部疲劳,其次是工作姿势、个体因素。结构方程模型更好地反映了工作类型、工作姿势和工作组织与肩部WMSDs之间复杂相关关系,改善工作姿势和工作组织可能是控制肩部疲劳对肩部疼痛影响的有效方法。ObjectiveTo investigate the incidence of shoulder work-related musculoskeletal disorders(WMSDs)among occupational population in China,and to explore their intrinsic association with personal and work-related factors.MethodsIn April 2024,73497 valid questionnaires of the Chinese version of the Musculoskeletal Disorders Electronic Questionnaire were retrospectively analyzed from June 2018 to December 2023 in 22 provinces and 29 key industries in China,and the general information,occurrence of WMSDs and related risk factors of key occupational populations in different regions in China were collected.By using Chi-square test and confirmatory factor analysis,the relationship between shoulder fatigue and pain in key occupational groups and individual factors,work type,work posture and work organization was discussed,and the internal relationship was analyzed based on structural equation model.ResultsHigher incidence of shoulder fatigue and pain were associated with female,lack of physical exercise,uncomfortable working posture and neck leaning forward(P<0.05).Structural equation model analysis showed that work type,work posture and work organization were strongly correlated(r=0.58,0.55).Work organization and work type were strongly correlated with shoulder fatigue(r=0.65)and moderately correlated with shoulder fatigue(r=0.21).Shoulder fatigue was moderately associated with shoulder pain(r=0.40).Individual factors,work type,work posture and shoulder fatigue could directly affect shoulder pain(OR=0.07,-0.09,0.17 and 0.40),and work type and work posture could also indirectly affect shoulder pain through shoulder fatigue(OR=0.08,0.03).Work organization only indirectly affected shoulder pain through shoulder fatigue(OR=0.26).ConclusionThe main influencing factor of shoulder pain is shoulder fatigue,followed by work posture and individual factors.Structural equation model can better reflect the complex relationship between work type,work posture and work organization and shoulder WMSDs.Improving work posture and work organiz

关 键 词：肩痛 肩部疲劳 肌肉骨骼系统 工作相关肌肉骨骼疾患 结构方程模型 

分 类 号：R68[医药卫生—骨科学]