足踝部WMSDs及其不良工效学因素的结构方程分析与建模  

Structural equation analysis and modeling of fect and ankles WMSDs and its adverse ergonomic factors

作　　者：张曦 贾宁[2] 孙新[3] 张美辨 徐擎 张华东[4] 凌瑞杰 刘移民[6] 王致[7] 李刚[8] 尹艳[9] 邵华[10] 李珏[11] 张恒东[12] 祁妍敏[1] 邱兵[1] 刘铁兵[1] 王大宇[13] 曾强[14] 王如刚[15] 叶研[15] 肖斌[16] 邹华[17] 陈建超[18] 黎东霞 刘永泉 时庆华 刘吉祥[21] 蒋恩霏[22] 漆骏[23] 梅良英 赵显锋 杨咪咪 郭新苇 王忠旭[2] Zhang Xi;Jia Ning;Sun Xin;Zhang Meibian;Xu Qing;Zhang Huadong;Ling Ruijie;Liu Yimin;Wang Zhi;Li Gang;Yin Yan;Shao Hua;Li Jue;Zhang Hengdong;Qi Yanmin;Qiu Bing;Liu Tiebing;Wang Dayu;Zeng Qiang;Wang Rugang;Ye Yan;Xiao Bin;Zou Hua;Chen Jianchao;Li Dongxia;Liu Yongquan;Shi Qinghua;Liu Jixiang;Jiang Enfei;Qi Jun;Mei Liangying;Zhao Xianfeng;Yang Mimi;Guo Xinwei;Wang Zhongxu(Civil Aviation Public Health Emergency Management Office,Civil Aviation Medicine Center,Civil Aviation Administration of China,Beijing 100123,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;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;Office of Hubei Clinical Medical Research Center for Occupational Diseases and Poisoning,Wuhan 430024,China;Guangzhou Institute of Occupational Disease Control and Prevention,Guangzhou 510620,China;Key Laboratory of Occupational Environment and Health,Guangzhou Institute of Occupational Disease Control and Prevention,Guangzhou 510620;Occupational Disease Prevention Institute,Liaoning Provincial Health Service Center,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;Tianjin Occupational Disease Prevention and Therapeutic Hospital,Tianjin 300011,China;Institute of Occupational Health,Tianjin Center for Diseases precauction and Therapeutic,Tianjin 300011,China;Institute of O

机构地区：[1]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,北京100123 [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]中国疾病预防控制中心职业卫生与中毒控制所,北京100050 [4]重庆市疾病预防控制中心主任办公室,重庆400042 [5]湖北省职业病与中毒临床医学研究中心办公室,武汉430024 [6]广州市职业病防治院职业卫生管理科,广州510620 [7]广州市职业病防治院职业环境与健康重点实验室,广州510620 [8]辽宁省疾病预防控制中心职业病防治所,沈阳110399 [9]上海市疾病预防控制中心职业健康科,上海200051 [10]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 [11]北京市化工职业病防治院院办公室,北京100195 [12]江苏省疾病预防控制中心职业病防治所,南京210009 [13]天津市职业病防治院体检科,天津300011 [14]天津市疾病预防控制中心职业健康所,天津300011 [15]北京市疾病预防控制中心职业卫生所,北京100013 [16]广东省职业病防治院物理因素监测所,广州510300 [17]浙江省疾病预防控制中心职业健康与辐射防护所,杭州310051 [18]福建省职业病与化学中毒预防控制中心医务科,福州350025 [19]贵州省职业病防治院院办公室,贵阳610599 [20]江西省职业病防治研究院职业病医院,南昌330006 [21]宁夏疾病预防控制中心办公室,银川750003 [22]四川省疾病预防控制中心职业与辐射卫生所,成都610044 [23]云南省疾病预防控制中心职业健康与放射卫生所,昆明650022 [24]湖北省疾病预防控制中心卫生监测所,武汉430070 [25]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101-109,共9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);民航公共卫生监测预警能力提升项目(2024-164)。

摘　　要：目的构建结构方程模型,探讨我国职业人群足踝部工作相关肌肉骨骼疾患(work-related musculoskeletal disorders,WMSDs)与各类危险因素的作用水平,为预防足踝部WMSDs提供科学依据。方法筛选2018年6月至2023年12月使用《中文版肌肉骨骼疾患电子问卷》调查的73497份全国职业流行病学个案数据。通过不良工效学因素及其来源分类标准和验证性因子分析分别对全国重点职业人群足踝部WMSDs及其相关危险因素(包括个体因素、工作组织、工作姿势、工作类型、疲劳情况等)进行调查,并对其进行结构方程模型假设、拟合、验证以及路径和中介效应分析。模型拟合评价指标包括卡方比自由度(χ^(2)/df)、规范拟合指数(NFI)、塔克-刘易斯指数(TLI)、拟合优度指数(GFI)、调整拟合优度指数(AGFI)和近似均方根误差(RMSEA)。结果本研究共调查73497名职业人员,足踝部局部肌肉疲劳与WMSDs发生率分别为17.17%和12.06%;调整后的结构方程模型拟合指标基本达标(GFI=1,AGFI=1,RMESA=0.042,NFI=0.716,TLI=0.663);对足踝部WMSDs影响前三位的因素依次为足踝部肌肉疲劳、工作类型和工作组织,标准化路径系数分别为0.221、0.105和0.095,对足踝部肌肉疲劳影响列前二位的因素分别为工作组织和工作类型,标准化路径系数分别为0.548和0.383;足踝部肌肉疲劳、工作类型、工作组织和工作姿势对足踝部WMSDs存在直接效应,效应值依次为0.221、0.105、0.095、0.077;工作组织和工作类型还可通过足踝部肌肉疲劳产生间接效应,效应值依次为0.121和0.084。结论足踝部肌肉疲劳在工作组织和工作类型所致足踝部WMSDs间发挥中介效应,足踝部肌肉疲劳是导致足踝部WMSDs的重要因素,建议用人单位和管理者及早发现作业疲劳并采取相应的预防和干预措施,可对预防足踝部WMSDs起到较为关键的作用。ObjectiveTo explore the structural equation model to explore the levels of work-related musculoskeletal disorders(WMSDs)and various risk factors in the feet and ankle of China's occupational population,providing scientific basis for for preventing WMSDs in feet and ankles.MethodsData of 73497 national occupational epidemiological cases were selected from June 2018 to December 2023 used the Chinese version of the Electronic Questionnaire on Musculoskeletal Disorders.The adverse ergonomic factors and their source classification standard and confirmatory factor analysis were used to investigate foot and ankle WMSDs and their related risk factors(including individual factors,work organization,work posture,work type,fatigue,etc.)in key occupational groups in China,and structural equation model hypothesis,fitting,verification,and path and intermediary effect analysis were carried out.The model fit evaluation indexes included Chi-square specific degrees of freedom(χ^(2)/df),gauge fit index(NFI),Tucker Lewis index(TLI),goodness of Fit index(GFI),adjusted Goodness of Fit index(AGFI)and approximate root mean square error(RMSEA).ResultsA total of 73497 occupational workers were surveyed,with local muscle fatigue and WMSDs incidence rates in the feet and ankles being 17.17%and 12.06%,respectively.The fitting index of the adjusted structural equation model basically meets the standard(GFI=1,AGFI=1,RMESA=0.042,NFI=0.716,TLI=0.663).The top three factors affecting feet and ankle WMSDs are feet and ankle muscle fatigue,work type,and work organization,with standardized path coefficients of 0.221,0.105,and 0.095,respectively.The top two factors affecting feet and ankle muscle fatigue are work organization and work type,with standardized path coefficients of 0.548 and 0.383,respectively.Feet and ankle muscle fatigue,work type,work organization,and work posture have a direct effect on feet and ankle WMSDs,with effect values of 0.221,0.105,0.095,and 0.077,respectively.The organization and type of work can also have indirect effects t

关 键 词：肌肉骨骼系统 足踝部 工作相关肌肉骨骼疾患 危险因素 结构方程模型 

分 类 号：R135[医药卫生—劳动卫生]