Govil Nandini, DeMayo William M, Hirsch Barry E, McCall Andrew A
1 Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania, USA.
2 Division of Otology/Neurotology, Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2017 Jan;156(1):156-160. doi: 10.1177/0194599816670137. Epub 2016 Oct 3.
Objective Surgeons often report musculoskeletal discomfort in relation to their practice, but few understand optimal ergonomic positioning. This study aims to determine which patient position-sitting versus supine-is ergonomically optimal for performing otologic procedures. Study Design Observational study. Setting Outpatient otolaryngology clinic setting in a tertiary care facility. Subjects and Methods We observed 3 neurotologists performing a standardized simulated cerumen debridement procedure on volunteers in 2 positions: sitting and supine. The Rapid Upper Limb Assessment (RULA)-a validated tool that calculates stress placed on the upper limb during a task-was used to evaluate ergonomic positioning. Scores on this instrument range from 1 to 7, with a score of 1 to 2 indicating negligible risk of developing posture-related injury. The risk of musculoskeletal disorders increases as the RULA score increases. Results In nearly every trial, RULA scores were lower when the simulated patient was placed in the supine position. When examined as a group, the median RULA scores were 5 with the patient sitting and 3 with the patient in the supine position ( P < .0001). When the RULA scores of the 3 neurotologists were examined individually, each had a statistically significant decrease in score with the patient in the supine position. Conclusion This study indicates that patient position may contribute to ergonomic stress placed on the otolaryngologist's upper limb during in-office otologic procedures. Otolaryngologists should consider performing otologic procedures with the patient in the supine position to decrease their own risk of developing upper-limb musculoskeletal disorders.
目的 外科医生经常报告与其执业相关的肌肉骨骼不适，但很少有人了解最佳的人体工程学姿势。本研究旨在确定哪种患者体位（坐姿与仰卧位）在人体工程学上最适合进行耳科手术。 研究设计 观察性研究。 设置 三级医疗设施中的门诊耳鼻喉科诊所。 对象与方法 我们观察了3位神经耳科医生在2种体位下对志愿者进行标准化模拟耵聍清理手术：坐姿和仰卧位。使用快速上肢评估（RULA）——一种经过验证的工具，用于计算任务期间上肢所承受的压力——来评估人体工程学姿势。该工具的评分范围为1至7分，1至2分表明发生姿势相关损伤的风险可忽略不计。随着RULA评分增加，肌肉骨骼疾病的风险也会增加。 结果 在几乎每一次试验中，当模拟患者处于仰卧位时，RULA评分较低。作为一个整体进行检查时，患者坐姿时的RULA评分中位数为5分，仰卧位时为3分（P <.0001）。单独检查3位神经耳科医生的RULA评分时，每位医生在患者仰卧位时的评分均有统计学显著下降。 结论 本研究表明，在门诊耳科手术过程中，患者体位可能会给耳鼻喉科医生的上肢带来人体工程学压力。耳鼻喉科医生应考虑让患者仰卧位进行耳科手术，以降低自身发生上肢肌肉骨骼疾病的风险。
