台灣之上肢職業性肌肉骨骼疾病致因探討：職業傷病通報系統與工作環境安全衛生狀況認知調查分析

Risk factors of cause upper-extremity musculoskeletal diseases in Taiwan: Analysis of data from the occupational disease and injury reporting systems and survey of perceptions of safety and health in the work environment

劉珮吟(Pei-Yin Liu)

指導教授 ： 郭育良

共同指導教授 ： 黃耀輝

國立臺灣大學/公共衛生學院/職業醫學與工業衛生研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.01792

摘要

職業病的發生不僅會使勞工失能甚至死亡，對國家而言醫療的直接花費與間接的成本損失和人力資源花費，更是一項龐大的負擔。近年來各國就業者的肌肉骨骼疾病是最嚴重的職業健康問題之一。台灣職業傷病通報系統之職業性肌肉骨骼疾病通報案例佔總通報量的62.2%，發病部位以上肢疾病案例為最頻繁，佔職業性肌肉骨骼疾病的61.3%，頸椎/脊椎和下肢各佔了33.7%和2.0%；台灣勞工保險之手臂肩頸疾病給付人次也逐年攀升，顯示國內就業者之上肢肌肉骨骼疾病問題日趨嚴重。
為了瞭解台灣就業者罹患上肢肌肉骨骼疾病與暴露因子之關係，因此利用2008年至2010年由全國九家職業傷病防治中心以及其網絡醫院之職業醫學科醫師通報與工作相關之職業病的職業傷病通報系統以代表全國就業者罹病情形，並結合2007年勞工安全衛生研究所所做的「工作環境安全衛生狀況認知調查」做為全國就業者之暴露資訊。從職業傷病通報系統中篩選出4種常見的上肢肌肉骨骼疾病作分析，分別為腕道症候群、手及腕部之肌腱及腱鞘炎、肩部肌腱及滑液囊疾病和外側肱骨髁上炎，再個別計算出每個上肢肌肉骨骼疾病之各行業標準化發生率(Standardized Incidence Rate, SIR)，並與工作環境安全衛生狀況認知調查中各行業別之暴露情形作連結。
從分析結果發現，男性工作之暴露因子為手部反覆動作、工作姿勢不自然以及使用振動手部工具較易罹患上肢肌肉骨骼疾病；女性則是以有全身振動、使用振動手部工具、較高工作壓力及每週較長工作時數為罹病之危險因子。
不僅是工作姿勢或動作會影響上肢肌肉骨骼疾病的產生，相關工作壓力也會是造成或是促使疾病發生的危險因子，因此可從工作環境、使用工具的設計及調節工作與休息時間去著手，以減低就業者上肢肌肉骨骼疾病的發生率。

關鍵字

職業傷病通報系統 ； 職業性肌肉骨骼疾病 ； 上肢肌肉骨骼疾病 ； 工作物理因子 ； 心理因素

並列摘要

Occupational diseases not only cause labor disability, but also cause them death. The direct treatment costs and other indirect costs, such as human resources cost and prime cost, would be huge burden to countries. In recent years, occupational musculoskeletal disorder is one of the most serious occupational health problems in the world. The occupational musculoskeletal disorder cases accounted for 62.2% of total in Taiwan's occupational injury and disease notification system in 2008 to 2010. Conditions of the upper-extremity cases (61.3%) were the most frequently reported, followed by cervical spine/lumbar spine cases (33.7%) and lower-extremity cases (2.0%). The arm/shoulder/neck claims cases of Taiwan labor insurance were increased in every year. The occupational upper-extremity musculoskeletal disorder seems to be a serious problem among workers.
Our aim was to assess the ecological association between upper-extremity musculoskeletal diseases standardized incidence rates and work-related risk factors. We used two types of data base. One was “Occupational injury and disease reporting system” from 2008 to 2010, and we screened out 1027 cases of those who suffered from upper-extremity musculoskeletal disorder in this reporting system. Then, we calculated standardized incidence rates (yearly age-adjusted incidence rates by sex) of upper-extremity musculoskeletal disorder (cases per 105 population per year) of all industries. Another data base was “Survey of perceptions of safety and health in the work environment in 2007 (Taiwan)” to regard as every industries work-related exposure data of national working population. We regressed standardized incidence rates for the specified upper-extremity musculoskeletal diseases (carpal tunnel syndrome, hand/wrist tendinitis, tendon or bursa in shoulder, lateral epicondylitis of elbow) against work-related exposure data, weighted by the size of sex-specific national populations.
We found male with upper-extremity musculoskeletal diseases were associated with repetitive hand movements, tiring or painful position, and vibration from hand tools. In female, upper-extremity musculoskeletal diseases were associated with whole body vibration, vibration from hand tools, high job strain, and longer working hours.
Not only physical factors cause upper-extremity musculoskeletal diseases, but also psychosocial factors would affect diseases. Therefore, we can improve the working conditions, redesign hand tool for user or management work time to decrease the incidence rate of upper-extremity musculoskeletal diseases.

並列關鍵字

occupational injury and disease reporting system ； ccupational musculoskeletal diseases ； upper-extremity musculoskeletal diseases ； physical factors ； psychosocial factors

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