Guo X W, Wang Z X, Sun X, Zhang M B, Xu Q, Zhang H D, Ling R J, Liu Y M, Wang Z, Li G, Yin Y, Shao H, Li J, Zhang H D, Qiu B, Wang D Y, Zeng Q, Wang R G, Ye Y, Xiao B, Zou H, Chen J C, Li D X, Liu Y Q, Shi Q H, Liu J X, Jiang E F, Qi J, Mei L Y, Zhao X F, Yang M M, Jia N
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.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2024 Dec 20;42(12):927-936. doi: 10.3760/cma.j.cn121094-20240507-00201.
To investigate the relationships and impacts between various occupational ergonomic hazards and hand and wrist fatigue, as well as work-related musculoskeletal disorders (WMSDs) of the hand and wrist, and to propose targeted preventive and intervention measures for adverse occupational ergonomic factors causing WMSDs of the hand and wrist. From 2018 to December 2023, a nationwide epidemiologic survey study of wrist WMSDs was conducted using the Chinese version of the electronic questionnaire system for musculoskeletal disorders.A total of 88, 609 valid questionnaires were collected. The exclusion criteria were as follows: patients with congenital spinal deformities, as well as those with wrist WMSDs caused by external injuries, infectious diseases, and malignant tumors. A total of 73, 497 questionnaires were finally included in the study analysis, with an effective questionnaire return rate of 82.5%. Exploratory factor analysis was used to analyze and summarize the factors affecting wrist WMSDs from the questionnaires, including individual factors, work organization, work type, wrist work posture, wrist fatigue, and wrist WMSDs as latent variables, and to hypothesize, fit, and validate the structural aspect model, as well as to conduct mediation effect analysis. The incidence of WMSDs and fatigue in wrist was 12.19% and 16.30% respectively. The fitting indexes of the modified structural equation model were basically up to the standard (GFI was 0.981, AGFI was 0.973, RMSEA was 0.031, NFI was 0.863, IFI and CFI were 0.865). There is a correlation between individual factors, work organization, wrist working posture and work type. There was a low negative correlation between individual factors and other factors, and there was a positive correlation between work organization, work type and wrist WMSDs (=0.346, 0.295), and these two factors were positively correlated with wrist fatigue height (=0.862, 0.599), and were positively correlated with wrist working posture (=0.443, 0.620). There was moderate positive correlation between wrist working posture and wrist fatigue (=0.469). The three most influential factors on wrist WMSDs were work organization, individual factor and work type, and the path coefficients were 0.247, 0.210 and 0.136, respectively. The first two factors that have the greatest influence on wrist fatigue are work organization and work type, and the path coefficients are 0.758 and 0.188, respectively. Individual factors, work type, wrist working posture and work organization had direct effects on wrist WMSDs, and the effect values were 0.093, 0.253, 0.718 and 0.583, respectively. Wrist fatigue played a partial mediating role between individual factors, work type, wrist working posture and work organization and wrist WMSDs, with the indirect effect ratio of 25.6%, 45.8%, 3.2% and 65.5%. Wrist fatigue plays an important mediating role in the path of various factors affecting wrist WMSDs, especially in the path of work organization, work type, individual factors and wrist WMSDs. Poor wrist working posture is an important risk factor that directly affects the occurrence of wrist WMSDs.
探讨各种职业工效学危害与手部和腕部疲劳以及手部和腕部工作相关肌肉骨骼疾病（WMSDs）之间的关系和影响，并针对导致手部和腕部WMSDs的不良职业工效学因素提出有针对性的预防和干预措施。2018年至2023年12月，使用中文版肌肉骨骼疾病电子问卷系统在全国范围内开展了腕部WMSDs的流行病学调查研究。共收集到88609份有效问卷。排除标准如下：先天性脊柱畸形患者，以及由外伤、传染病和恶性肿瘤引起的腕部WMSDs患者。最终共有73497份问卷纳入研究分析，有效问卷回收率为82.5%。采用探索性因素分析从问卷中分析和总结影响腕部WMSDs的因素，包括个体因素、工作组织、工作类型、腕部工作姿势、腕部疲劳和腕部WMSDs作为潜在变量，并对结构方面模型进行假设、拟合和验证，以及进行中介效应分析。腕部WMSDs和疲劳的发生率分别为12.19%和16.30%。修正后的结构方程模型的拟合指标基本达标（GFI为0.981，AGFI为0.973，RMSEA为0.031，NFI为0.863，IFI和CFI为0.865）。个体因素、工作组织、腕部工作姿势和工作类型之间存在相关性。个体因素与其他因素之间存在低负相关，工作组织、工作类型与腕部WMSDs之间存在正相关（=0.346，0.295），这两个因素与腕部疲劳高度呈正相关（=0.862，0.599），与腕部工作姿势呈正相关（=0.443，0.620）。腕部工作姿势与腕部疲劳之间存在中度正相关（=0.469）。对腕部WMSDs影响最大的三个因素是工作组织、个体因素和工作类型，路径系数分别为0.247、0.210和0.136。对腕部疲劳影响最大的前两个因素是工作组织和工作类型，路径系数分别为0.758和0.188。个体因素、工作类型、腕部工作姿势和工作组织对腕部WMSDs有直接影响，效应值分别为0.093、0.253、0.718和0.583。腕部疲劳在个体因素、工作类型、腕部工作姿势和工作组织与腕部WMSDs之间起部分中介作用，间接效应比分别为25.6%、45.8%、3.2%和65.5%。腕部疲劳在影响腕部WMSDs的各种因素路径中起重要中介作用，尤其是在工作组织、工作类型、个体因素和腕部WMSDs的路径中。不良的腕部工作姿势是直接影响腕部WMSDs发生的重要危险因素。
