本文選題：肌肉骨骼疾患 + 危險因素��； 參考：《山東大學(xué)》2013年碩士論文

【摘要】：背景 肌肉骨骼疾患(Musculoskeletal disorders, MSDs)是指影響肌肉、骨骼、神經(jīng)、肌腱、韌帶、關(guān)節(jié)、軟骨和椎間盤的損傷和／或功能障礙。癥狀輕者會有不舒適或輕微疼痛等感覺,而癥狀嚴(yán)重者常常無法工作,需借助藥物或特殊工具訓(xùn)練,且治療效果不佳。MSDs在全世界的工作人群中很普遍并且是一個嚴(yán)重問題。鑒于此,美國國家職業(yè)安全與健康研究所(National Institute for Occupational Safety and Health, NIOSH)在2002年把MSDs列為重點(diǎn)研究的10個職業(yè)衛(wèi)生問題之一,世界衛(wèi)生組織把2000年至2010年確定為“骨與關(guān)節(jié)病十年”。農(nóng)業(yè)作為勞動力密集型產(chǎn)業(yè),尤其受到MSDs的影響。果農(nóng)和菜農(nóng)等某些勞動力密集型行業(yè)中MSDs患病率尤其突出。中國,作為農(nóng)業(yè)大國,農(nóng)民的MSDs卻沒有引起足夠的重視。因此研究農(nóng)民的MSDs及其影響因素具有重要意義。 大棚蔬菜已經(jīng)在山東壽光地區(qū)廣泛種植,由于其良好的經(jīng)濟(jì)效益正向全國范圍內(nèi)迅速普及。然而大棚蔬菜種植是一項(xiàng)十分艱辛的工作,加上蔬菜大棚的特殊工作環(huán)境(高溫、高濕、高二氧化碳濃度等)及特殊的工作方式(手工作業(yè)、體力勞動、特殊體位)等使大棚菜農(nóng)具有較高的職業(yè)健康危險因素暴露,大棚菜農(nóng)更易患上諸如骨關(guān)節(jié)炎、下背痛、頸肩痛等MSDs。 MSDs的可疑危險因素除職業(yè)因素外,還包括個體因素、心理社會因素等。MSDs的危險因素在實(shí)際的人群調(diào)查中難以準(zhǔn)確測量,難以計(jì)算各個危險因素的相對水平。并且在現(xiàn)況研究中可疑危險因素與疾病之問的因果關(guān)系難以確定。結(jié)構(gòu)方程模型(Structural Equation Model, SEM)是一種建立、估計(jì)和驗(yàn)證因果關(guān)系的方法,可以篩選可疑危險因素并估計(jì)危險因素相對大小,被譽(yù)為二十世紀(jì)統(tǒng)計(jì)學(xué)的三大進(jìn)展之一。近二十年來SEM在慢病等醫(yī)學(xué)領(lǐng)域得到了廣泛應(yīng)用,但是使用SEM分析MSDs危險因素的研究卻尚未見報道。本文使用SEM篩選大棚菜農(nóng)MSDs的危險因素并對危險因素相對大小進(jìn)行評估,對MSDs的預(yù)防、干預(yù)研究具有重要的指導(dǎo)和借鑒意義。 目的 調(diào)查大棚菜農(nóng)和對照菜農(nóng)MSDs患病情況,探索大棚菜農(nóng)MSDs的危險因素,估計(jì)危險因素相對大小水平,提出針對大棚菜農(nóng)MSDs的預(yù)防措施和建議。 方法 采用分層整群抽樣方法,使用北歐國家肌肉骨骼疾患調(diào)查問卷與荷蘭肌肉骨骼疾患調(diào)查問卷對某蔬菜大棚種植基地的大棚菜農(nóng)和鄰近村莊的非大棚菜農(nóng)(對照組)進(jìn)行面對面回顧性問卷調(diào)查,計(jì)算患病率,比較患病情況,并使用結(jié)構(gòu)方程模型分析大棚菜農(nóng)MSDs的危險因素。 結(jié)果 患病率 共調(diào)查639名大棚菜農(nóng)和318名對照菜農(nóng)。大棚菜農(nóng)MSDs患病率為61.2%,對照菜農(nóng)MSDs患病率為43.4%,并且大棚菜農(nóng)MSDs患病率高于對照菜農(nóng)(P0.05)。大棚菜農(nóng)前四位MSDs依次是下背疾患、肩部疾患、膝部疾患和頸部疾患。大棚菜農(nóng)下背疾患、肩部疾患、膝部疾患和頸部疾患的患病率分別為49.6%、29.0%、24.6%和12.8%,對照菜農(nóng)分別為28.0%、11.6%、10.7%和4.4%,并且大棚菜農(nóng)下背疾患、肩部疾患、膝部疾患和頸部疾患患病率均高于對照菜農(nóng)(P＜0.05)。 誤工臥床情況 大棚菜農(nóng)因MSDs誤工364人,誤工率為57.0%,對照菜農(nóng)因MSDs誤工135人,誤工率為42.5%,并且大棚菜農(nóng)MSDs誤工率高于對照菜農(nóng)(P＜0.05)。大棚菜農(nóng)下背疾患、肩部疾患、膝部疾患和頸部疾患的誤工率分別為45.5%、25.0%、23.9%和12.5%,對照菜農(nóng)分別為27.7%、11.3%、10.7%和3.8%,并且大棚菜農(nóng)下背疾患、肩部疾患、膝部疾患和頸部疾患的誤工率均高于對照菜農(nóng)(P＜0.05)。大棚菜農(nóng)因MSDs臥床62人,對照菜農(nóng)因MSDs臥床2人,大棚菜農(nóng)高于對照菜農(nóng)MSDs的臥床率(P＜0.05)。 危險因素結(jié)構(gòu)方程模型分析 下背疾患在下背疾患的SEM中,潛因變量大棚菜農(nóng)下背疾患的決定系數(shù)為0.847,力量施加因素、靜態(tài)負(fù)荷、動態(tài)負(fù)荷、人體工效學(xué)環(huán)境因素、重復(fù)性負(fù)荷和社會心理學(xué)因素與下背疾患的結(jié)構(gòu)系數(shù)分別為0.385、0.342、0.122、0.064、0.040和0.098(P＜0.05)。力量施加因素、靜態(tài)負(fù)荷、人體工效學(xué)環(huán)境因素、動態(tài)負(fù)荷、社會心理學(xué)因素、重復(fù)性負(fù)荷和年齡因素對潛因變量下背疾患的總體影響分別是0.385、0.342、0.285、0.122、0.098、0.040和0.034。大棚環(huán)境中潛變量人體工效學(xué)環(huán)境因素對潛變量大棚菜農(nóng)靜態(tài)負(fù)荷的直接影響為0.646。 肩部疾患在肩部疾患的SEM中,潛因變量大棚菜農(nóng)肩部疾患的決定系數(shù)為0.654,大棚因素、重復(fù)性負(fù)荷因素、力量施加因素、年齡因素、肩部姿勢、性別和不舒適體位因素與肩部疾患的結(jié)構(gòu)系數(shù)分別為0.448、0.283、0.106、0.079、0.069、0.065和0.033(P＜0.05)。大棚因素、重復(fù)性負(fù)荷、力量施加因素、年齡、肩部姿勢、性別、不舒適體位因素對潛因變量肩部疾患的總體影響分別為0.660、0.283、0.106、0.079、0.069、0.065和0.033。大棚因素對大棚菜農(nóng)力量施加因素的直接影響為0.553,對大棚菜農(nóng)重復(fù)性負(fù)荷因素的直接影響為0.544。 膝部疾患在膝部疾患的SEM中,潛因變量大棚菜農(nóng)膝部疾患的決定系數(shù)為0.674,大棚菜農(nóng)不舒適體位因素、個體因素(身高、體重)、社會心理學(xué)因素和平時健康狀況與大棚菜農(nóng)膝部疾患的結(jié)構(gòu)系數(shù)分別為0.632、0.259、0.089和0.039(P＜0.05)。不舒適體位因素、個體因素(身高、體重)、社會心理學(xué)因素和平時健康狀況對大棚菜農(nóng)膝部疾患的總體影響分別為0.632、0.259、0.089和0.039。 頸部疾患在頸部疾患的SEM中,潛因變量大棚菜農(nóng)頸部疾患的決定系數(shù)為0.736,重復(fù)性負(fù)荷、頸部姿勢、個體因素(年齡)、不舒適體位因素和社會心理學(xué)因素與大棚菜農(nóng)頸部疾患的結(jié)構(gòu)系數(shù)分別為0.559、0.344、0.037、0.030和0.001(P＜0.05)。重復(fù)性負(fù)荷、頸部姿勢、個體因素(年齡)、不舒適體位因素和社會心理學(xué)因素對大棚菜農(nóng)頸部疾患的總體影響分別為0.559、0.344、0.037、0.030和0.001。 結(jié)論 1.大棚菜農(nóng)MSDs患病率較高,主要表現(xiàn)為下背疾患、肩部疾患、膝部疾患和頸部疾患,并且大棚菜農(nóng)因MSDs明顯影響了工作。 2.大棚菜農(nóng)下背疾患的主要危險因素為力量施加、靜態(tài)負(fù)荷、人體工效學(xué)環(huán)境和動態(tài)負(fù)荷；肩部疾患的主要危險因素為大棚因素、重復(fù)性負(fù)荷和力量施加因素；膝部疾患的主要危險因素為不舒適體位和肥胖；頸部疾患的主要危險因素為重復(fù)性負(fù)荷和頸部姿勢。 3.建議：完善大棚配置；優(yōu)化工作組織安排；改進(jìn)操作方式。
[Abstract]:Background

Musculoskeletal disorders ( MSDs ) refer to the damage and / or dysfunction affecting muscles , bones , nerves , tendons , ligaments , joints , cartilage and intervertebral discs . Symptoms may be uncomfortable or painful . The World Health Organization ( WHO ) has identified MSDs as one of the 10 occupational health problems of the focus study in 2002 .

Greenhouse vegetable has been widely cultivated in Shouguang area of Shandong province , because its good economic benefit is rapidly popularized in the whole country . However , vegetable planting in greenhouse is a very arduous task , and the special working environment of vegetable greenhouse ( high temperature , high humidity , high carbon dioxide concentration , etc . ) and special working mode ( manual operation , manual labor , special body position ) etc . and special working mode ( manual operation , manual labor , special body position ) etc . make the large - shed vegetable farm have higher occupational health risk factor exposure , and the large - shed vegetable farm is more susceptible to MSDs such as osteoarthritis , lower back pain , and cervical shoulder pain .

The risk factors of MSDs are difficult to accurately measure in the actual population survey , it is difficult to calculate the relative level of risk factors . The structural equation model ( SEM ) is a method to establish , estimate and verify the causal relationship .

Purpose

To investigate the prevalence of MSDs in vegetable agriculture and control vegetable , explore the risk factors of large shanty vegetable agriculture MSDs , estimate the relative size level of dangerous factors , and put forward the preventive measures and suggestions for the large shanty vegetable agriculture MSDs .

method

Using a stratified cluster sampling method , a face - to - face retrospective survey was conducted to investigate the prevalence and prevalence of non - large shantyvegetable farmers ( control group ) in a vegetable greenhouse planting base and the non - large shannon ( control group ) of neighboring villages by using a questionnaire of musculoskeletal disorders in the Nordic countries and a questionnaire survey of musculoskeletal disorders in the Netherlands . The risk factors of the large - shed vegetable agriculture MSDs were analyzed by using the structural equation model .

Results

Prevalence

The prevalence of MSDs was 61.2 % , and the prevalence of MSDs was 43.4 % . The prevalence of MSDs was 49.6 % , 29.0 % , 24 . 6 % and 12 . 8 % , respectively , and that of the control group were 28 . 0 % , 11.6 % , 10.7 % and 4.4 % , respectively .

error - bed condition

The rate of misdiagnosis was 45.7 % , 25.0 % , 23.9 % and 12.5 % , respectively , and the rate of misdiagnosis in vegetable and rural areas was 27.5 % , 25.0 % , 10.9 % and 12.5 % , respectively , and the rate of error in the middle - back disease , shoulder disease , knee disease and neck disease was higher than that of control vegetable growers ( P < 0.05 ) .

Analysis of Structural Equation Model of Risk Factors

The main factors , static load , ergonomic environmental factors , dynamic load , social psychological factors , repetitive load and age factors were 0.385 , 0.342 , 0.285 , 0.122 , 0.098 , 0.040 and 0.034 respectively .

In the SEM of shoulder disease , the determinants of shoulder disease were 0.648 , 0.283 , 0.106 , 0.079 , 0.069 , 0.065 and 0.033 respectively ( P & lt ; 0.05 ) .

In the SEM of knee disease , the determinants of knee disease were 0.632 , 0.259 , 0.089 and 0.039 ( P & lt ; 0.05 ) . The overall effects of non - comfortable physical factors , individual factors ( height , weight ) , social psychology factor and normal health status on the knee disease were 0.632 , 0.259 , 0.089 and 0.039 , respectively .

In the SEM of cervical diseases , the determinants of neck disease were 0.759 , 0.344 , 0.037 , 0.030 and 0.001 respectively ( P < 0.05 ) . The overall effects of repetitive load , neck posture , individual factor ( age ) , discomfort posture factors and social psychology factors on the neck disease were 0.5559 , 0.344 , 0.037 , 0.030 and 0.001 , respectively .

Conclusion

1 . The prevalence of MSDs in large shanty vegetable was higher , mainly manifested as lower back disease , shoulder disease , knee disease and neck disease .

2 . The main risk factors of back - to - back diseases are force application , static load , ergonomic environment and dynamic load .
The main risk factors of shoulder disease are the factors of greenhouse factor , repetitive load and force application .
The main risk factors of knee disease are discomfort body position and obesity .
The main risk factors for neck disease are repetitive load and neck posture .

3 . Recommendation : perfect the shed configuration ;
Optimizing organization of work organization ;
improve that mode of operation .

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R139.2

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