Stock S R
Community Medicine Residency Program, McMaster University, Hamilton, Ontario, Canada.
Am J Ind Med. 1991;19(1):87-107. doi: 10.1002/ajim.4700190111.
In the past 10 years there has been growing awareness among occupational health professionals worldwide of the large burden of illness associated with musculoskeletal disorders of the neck and upper limbs. It has been suggested that these disorders are associated with highly repetitive work and are due, at least in part, to ergonomic factors. This review examines the epidemiologic evidence of the relationship between workplace ergonomic factors such as repetition, force, static muscle loading, and extreme joint position and the development of muscle, tendon, and nerve entrapment disorders of the neck and upper limbs of exposed workers. An extensive search for relevant studies was undertaken. Of 54 potentially relevant studies identified, three met the a priori inclusion criteria. The validity of these studies was assessed, and one study was found to have major flaws. Criteria to demonstrate causality were also applied and were met in the most rigorously conducted study. When the results of these studies are compared and aggregated where appropriate, they provide strong evidence of a causal relationship between repetitive, forceful work and the development of musculoskeletal disorders of the tendons and tendon sheaths in the hands and wrists and nerve entrapment of the median nerve at the carpal tunnel. The comparison of exposed to controls for hand/wrist tendinitis gives an unadjusted common odds ratio of 9.1 (95% CI 4.9-16.2). The adjusted odds ratio for carpal tunnel syndrome is 15.5 (95% CI 1.7-141.5) based on the most rigorous study.
在过去10年里，全球职业健康专业人员越来越意识到与颈部和上肢肌肉骨骼疾病相关的巨大疾病负担。有人认为，这些疾病与高度重复性工作有关，至少部分是由人体工程学因素导致的。本综述研究了诸如重复、用力、静态肌肉负荷和极端关节位置等工作场所人体工程学因素与暴露工人颈部和上肢肌肉、肌腱和神经卡压性疾病发展之间关系的流行病学证据。我们对相关研究进行了广泛搜索。在确定的54项潜在相关研究中，有3项符合预先设定的纳入标准。我们评估了这些研究的有效性，发现其中一项研究存在重大缺陷。我们还应用了证明因果关系的标准，在最严格开展的研究中满足了这些标准。当比较这些研究的结果并在适当情况下进行汇总时，它们提供了有力证据，证明重复性、高强度工作与手部和腕部肌腱和腱鞘的肌肉骨骼疾病发展以及腕管正中神经卡压之间存在因果关系。手部/腕部腱鞘炎暴露组与对照组的比较得出未调整的共同优势比为9.1（95%可信区间4.9 - 16.2）。根据最严格的研究，腕管综合征的调整后优势比为15.5（95%可信区间1.7 - 141.5）。
