- 學位論文
台灣印刷工業平版印刷機操作人員肌肉骨骼不適盛行率與危害因子之探討
A Study of Musculoskeletal Symptoms Prevalence and Human Factor Hazards for Printing Press Workers
摘要
印刷製造業是台灣重要的中小企業。印刷機操作員因長時間的工作與站立，且需大量搬運重物，加上不良姿勢與上肢重複性動作等，是造成工作潛在的危險因子，極易釀成肌肉骨骼不適，影響工作效能，亟需加以重視。本研究之目的在探討我國印刷廠平版印刷機操作員肌肉骨骼傷病盛行率，以及工作中肌肉骨骼的危害因子，做為未來政府與產業相關單位政策實施與工作改善之參考。 本研究為橫斷性研究，進行問卷調查，以台灣北、中、南各三家印刷廠，共計六家印刷工廠之印中工作人員為對象，共發出問卷153份，回收有效問卷138份中有91位屬平版印刷機操作員，對照組群為47位，實施北歐肌肉骨骼問卷調查表(NMQ)、人因工程檢核表(MSDs)等，對肌肉骨骼不適症狀調查，所獲得之數據再以卡方檢定、單變量邏輯斯迴歸與多變量邏輯斯迴歸，並校正年齡、工作年資、BMI因子、運動與吸菸，分析暴露危險因子與肌肉骨骼不適症狀之相關性。在肌肉骨骼問卷(NMQ)方面發現，印刷機操作員自述問卷中無論在上肢部位(頸部、肩部、手肘、手腕、上背)或下背後腰與下肢部位(臀部、膝部、小腿、腳踝)較行政人員多肌肉骨骼不適症狀，其中印刷機操作員在下背後腰感到不適比例最高有75%自評有不適，其次為頸部有71%，第三為手腕有66%。用肌肉骨骼傷害人因工程檢點表(MSDs)檢核結果，評估上下肢部位危險因子以邏輯斯迴歸分析統計方法，並校正年齡、工作年資、BMI因子、運動與吸菸，以四組人員(二手、裁切人員、領機和行政人員)主訴各部位肌肉骨骼不適程度(包含:酸、疼痛、麻木)評分為應變項，分別將上肢及下肢各部位危險因子為自變項探討，可得到在工作中有不當姿勢:下背後腰不當姿勢:身體前俯大於20度，身體前府大於45度，長時間站立無支撐，推/拉重物，下背後腰分別β值為0.10(0.05~0.15)P-value為0.0002。在手部施力上，抓握超過4.5kg。不當姿勢:手腕前彎大於20度;背彎大於30度和右手腕與左手腕有相關，右手腕與左手腕分別OR為0.14(0.06-0.22)P-value為0.0005、OR為0.17 (0.09-0.25) P-value為0.0001；左右手肘重複性作業:鍵盤輸入作業和其他類工作交雜，其他工作量佔50%~75%和右手肘和左手肘有相關，OR為0.10(0.001-0.20)P-value為0.048、OR為0.08(0.023-0.14)P-value為0.007。本研究更進一步採美國密西根大學(University of Michigan)三度空間力學評估程式(3D SSPP)發現，三組印刷機操作員和行政人員背部受力之結果分別為:1)二手與裁切人員每秒平均搬運背部受力為3267牛頓；2)裁切人員每秒平均搬運背部受力為2799牛頓；3)領機每秒平均搬運背部受力為2525牛頓；4)行政人員每秒平均搬運背部受力為705牛頓。 整體而言，印刷機操作員有高比例之肌肉骨骼不適問題，應改善印刷機操作人員在上肢部位或背部與下肢部位的肌肉骨骼不適症狀。建議後續研究者應從人因工程設計及個人保護去預防此肌肉骨骼不適問題。
並列摘要
Printing industry is an important medium and small enterprise in Taiwan. Printing press workers work and stand for a long time and move lots of heavy stuff during their daily job routine. Besides, they work with faulty posture and repetitive upper limb actions. These are potential dangerous factors for work which may cause musculoskeletal disorders and influence working effectiveness. We have to pay attention to these factors. The purpose of this research lies in discussing the prevalence of musculoskeletal disorders suffered by offset printing press workers in domestic printing factories. In addition, the research discusses the hazard factors for working muscle and bone. It will serve as a reference for the implementation of policies and improvement of working environments used by governmental and industrial organizations in the future. This research is a cross-sectional research with questionnaires. The objects are printing press workers from 6 printing factories, three in northern, middle, and southern Taiwan respectively. Totally 153 questionnaires are issued and 138 effective questionnaires are returned. Among them, there are 91 printing press workers of which 47 administrative groups are in the contrast group. We survey musculoskeletal disorders through Nordic Musculoskeletal Questionnaire (NMQ) and MSDs check list. The obtained figures are checked by Chi-square test, univariate logistic regression, and multivariate logistic regression. Then we correct ages, working experiences, BMI factors, exercise, and smoking, analyzing the correlation between the exposure to hazard factors and the musculoskeletal disorders. Results of the Nordic Musculoskeletal Questionnaire (NMQ) show that printing press workers complained about more musculoskeletal disorder (i.e., sores, pains and numbness) than administrative workers either in the upper limbs (neck, shoulders, elbows, wrists and upper back) or in the lower back/lower limbs (buttocks, knees, shanks, ankles). The printing press workers reported the highest percentage, or 75%, of discomforts in the lower back, followed by 71% of neck discomforts and 66% of wrist discomfort. The results were examined using a Musculoskeletal Disorders (MSDs) Checklist, with the upper/lower limb risk factors evaluated in a logistic regression analysis and the respondents’ data (i.e., age, superiority on job, BMI factor, exercise and smoking) adjusted. The dependent variables were the degree of musculoskeletal disorder (i.e., soars, pains and numbness) in each body part complained and rated by four groups of respondents (assistants, cutters, lead operators and administrative workers) while the independent variables were the risk factors in parts of upper/lower limbs. The respondents’ improper postures while working were derived from the analysis. Firstly, improper postures regarding the lower back included body bent forward more than 20 degrees, body bent forward more than 45 degrees, standing for long periods of time without support, and pushing/pulling weights, with a 0.10 (0.05-0.15) β-value and a 0.0002 P-value for the lower back. While the respondents had hand-grip strength of averagely 4.5 kilograms, the improper postures regarding hands/wrists included wrists bent forward more than 20 degrees and the back bent more than 30 degrees, which were proved statistically related to the right and left wrists, given the 0.14 (0.06-0.22) OR and 0.0005 P-value for the right wrist, and the 0.17 (0.09-0.25) OR and 0.0001 P-value for the left. As for the repetitive tasks performed by both elbows, a task that mixes keyboard-enabled data entry with other miscellaneous tasks, and miscellaneous tasks that account for 50%-75% of the workload proved statistically related to the right/left elbow, with a 0.10 (0.001-0.20) OR and a 0.048 P-value; a 0.08 (0.023-0.14) OR and a 0.007 P-value, respectively. This research further adopts 3D SSPP developed by University of Michigan, USA. We found the back loading results of three groups of printing press workers and administrative personnel are as follows: 1) each time of moving by helper will cause the back loading of 3267 N; 2) each time of moving by cutters will cause the back loading of 2799 N; 3) each time of moving by press operator will cause the back loading of 2525 N; 4) each time of moving by administrative personnel will cause the back loading of 705 N. Generally speaking, the majority of printing press workers suffers from the musculoskeletal disorders. We should figure out how to improve the situation of their musculoskeletal disorders of upper limb, lower back, waist, and lower limb. This research suggests future researchers pay attention to the designing of ergonomics and personal protection for the prevention of musculoskeletal disorders in the future.