Zhong S W, Jia N, Sun X, Zhang M B, Xu Q, Zhang H D, Ling R J, Liu Y M, 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, Guo X W, Wang Z, Wang Z X
Occupational Health Surveillance Center, Guangzhou Institute of Occupational Disease Control and Prevention, Guangzhou 510620, 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.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2025 Apr 20;43(4):254-263. doi: 10.3760/cma.j.cn121094-20240703-00296.
To explore the structural relationship between WMSDs in the upper limbs and various risk factors in the occupational population in China, based on a large sample epidemiological survey and structural equation analysis, and to establish a structural equation model, so as to lay a foundation for the prevention and control of such diseases. The Chinese version of the Musculoskeletal Disorders Electronic Questionnaire was used to conduct a nationwide survey on the prevalence of WMSDs in the upper extremity. Six factors related to WMSDs in the upper extremity were extracted by the classification standard of adverse ergonomic factors and their source and confirmatory factor analysis, including work organization, work type, upper extremity work posture, individual factors, upper extremity fatigue and upper extremity WMSDs. The structural equation analysis was carried out and the structural equation model was established. The incidence of WMSDs and fatigue in the upper limbs was 24.44% and 43.76%, respectively. The adjusted structural equation model fitting indicators were generally up to the standard (GFI=1.000, AGFI=1.000, RMSEA=0.043, NFI=0.808, TLI=0.784) . The four exogenous latent variables of work organization, work type, upper limb work posture and individual factors were correlated. There was a strong positive correlation between job type and upper limb work posture (=0.865) , a moderate positive correlation between work organization and job type and upper limb work posture (=0.570, 0.490) , and a weak negative correlation between individual factors and the other three exogenous latent variables. Upper limb work posture and individual factors had direct effects on upper limb WMSDs, and the effect coefficients were 0.10 and 0.06, respectively. Upper limb fatigue played a mediating role between work organization, work type, upper limb work posture and upper limb WMSDs. The effect coefficient was 0.46, and the composition ratios of indirect effects were 100.0%, 100.0%, and 38.3%, respectively. The direct path effect of upper limb work posture, individual factors and upper limb WMSDs was weaker than the mediating path through upper limb fatigue. When carrying out the prevention and control of upper limbWMSDs, it is necessary to comprehensively consider the pathogenesis path of upper limb muscle fatigue and upper limb WMSDs caused by work organization, work type, and upper limb work posture, so as to provide theoretical reference for improving the prevention and control level of such diseases.
为探讨我国职业人群上肢肌肉骨骼疾病（WMSDs）与各种危险因素之间的结构关系，基于大样本流行病学调查和结构方程分析，建立结构方程模型，为这类疾病的防治奠定基础。采用中文版肌肉骨骼疾病电子问卷对全国上肢WMSDs患病率进行调查。通过不良工效学因素及其来源分类标准和验证性因素分析，提取与上肢WMSDs相关的6个因素，包括工作组织、工作类型、上肢工作姿势、个体因素、上肢疲劳和上肢WMSDs。进行结构方程分析并建立结构方程模型。上肢WMSDs和疲劳的发生率分别为24.44%和43.76%。调整后的结构方程模型拟合指标总体达标（GFI = 1.000，AGFI = 1.000，RMSEA = 0.043，NFI = 0.808，TLI = 0.784）。工作组织、工作类型、上肢工作姿势和个体因素这4个外生潜变量之间存在相关性。工作类型与上肢工作姿势之间呈强正相关（= 0.865），工作组织与工作类型以及上肢工作姿势之间呈中度正相关（= 0.570，0.490），个体因素与其他3个外生潜变量之间呈弱负相关。上肢工作姿势和个体因素对上肢WMSDs有直接影响，效应系数分别为0.10和0.06。上肢疲劳在工作组织、工作类型、上肢工作姿势和上肢WMSDs之间起中介作用。效应系数为0.46，间接效应的构成比分别为100.0%、100.0%和38.3%。上肢工作姿势、个体因素与上肢WMSDs的直接路径效应弱于通过上肢疲劳的中介路径。在进行上肢WMSDs的防治时，有必要综合考虑工作组织、工作类型和上肢工作姿势引起的上肢肌肉疲劳和上肢WMSDs的发病机制路径，为提高这类疾病的防治水平提供理论参考。
