職業性肌肉骨骼疾病與就業場所相關暴露因子之探討：腕道症候群及腰部椎間盤疾患

The Relationship Between Work-related Musculoskeletal Disorders and Workplace Exposure Factors - CTS And HIVD

楊善圍(Shan-Wei Yang)

指導教授 ： 郭育良

共同指導教授 ： 黃耀輝(Yaw-Huei Hwang)

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(2013年)

https://doi.org/10.6342/NTU.2013.02012

摘要

職業性肌肉骨骼疾病 (Work-related musculoskeletal disorders, WMSDs) 在國際間已成為最常見的職業疾病，因職業性肌肉骨骼疾病連帶而來財務花費也高居所有職業性疾病之冠。在台灣，職業性肌肉骨骼疾病幾乎佔了所有職業性疾病的一半，而且也耗費了相當多的勞保補償。
本研究希望能找到罹患職業性肌肉骨骼疾病的高風險行業，以及釐清人因相關因子與勞工自覺肌肉骨骼症狀與罹患職業性肌肉骨骼疾病之關係；另外，亦期望能以工作場所人因暴露以及勞工自覺痠痛症狀調查，發展偵測罹患職業性肌肉骨骼疾病風險之方法。職業性肌肉骨骼疾病種類繁多，本研究選取腕道症候群 (Carpal tunnel syndrome, CTS)為上肢部位代表、腰部椎間盤疾患 (Herniation of intervertebral disc, HIVD)為頸椎、腰椎部位代表，進行深入的探討。
利用生態研究架構，將兩個互相獨立的資料庫依89個行業別作為連結：(1)臺灣職業傷病通報系統，取得2008-2011四年間腕道症候群及腰部椎間盤疾患的通報資料，並分性別算出調整年齡之標準化發生率為依變項；(2) 勞研所2010年之工作環境安全衛生狀況認知調查，取得勞工自填之工作環境人因暴露因子及勞工自覺痠痛且影響工作表現在各行業之暴露比例為自變項。
以各行業總就業人口數為比重，線性迴歸分析結果顯示：「重複性手部動作」(β: 0.027, 95% CI: 0.008, 0.046)　是男性罹患腕道症候群主要的危險因子、「使用震動的手部工具」 (β: 0.124, 95% CI: 0.063, 0.185)則是女性罹患腕道症候群主要的危險因子；在腰部椎間盤疾患部分，男性以「全身震動」 (β: 0.106, 95% CI: 0.082, 0.133)及「搬運重物」 (β: 0.008, 95% CI: 0.001, 0.015)、女性以「全身震動」 (β: 0.086, 95% CI: 0.016, 0.157)及「不自然的姿勢」 (β: 0.030, 95% CI: 0.008, 0.052)為主要危險因子，此外，更發現男性與女性與各別的二種因子都有顯著的加成作用，同時暴露於二種因子而罹患腰部椎間盤疾患的危險性，高於僅暴露於單一種危險因子。
本研究亦針對一光電廠進行上肢肌肉骨骼問題的調查，結果顯示：在填答問卷之359位員工之中，76位有自覺肌肉骨骼不適症狀，而其中有19位被超音波診斷出確實有肌肉骨骼的問題。最常見的上肢肌肉骨骼問題為旋轉肌袖症候群 (N=17) 以及肩峰鎖骨關節腫脹 (N=7)。
工作場所人因暴露因子以及勞工自覺痠痛症狀，與職業性肌肉骨骼疾病確實有其相關性，更深入探討相關貢獻量以及機轉有其必要性。且此方法可以使用相當簡單的問卷取得相關資料，未來應可以用來發展篩檢各種工作場所，以評估或預測各職業場所引起職業性肌肉骨骼疾病之相關風險。

關鍵字

職業性肌肉骨骼疾病 ； 腕道症候群 ； 腰部椎間盤疾患 ； 人因工程 ； 自覺症狀 ； 通報系統 ； 共同作用

並列摘要

Work-related musculoskeletal disorders (WMSDs) have become the most common occupational diseases internationally. Expenses due to WMSDs are most important among all occupational diseases. In Taiwan, WMSDs accounted for almost 50% of the total occupational diseases, and caused a significant portion of labor insurance payments.
The aim of this study is to find the high risk industries which have higher WMSDs incidence. Therefore, we wish to develop a method which use workplace factors to detect the risk of workers suffering from WMSDs. Because carpal tunnel syndrome (CTS) and herniation of intervertebral disc (HIVD) was the most two common WMSDs, this study chose these two WMSDs as outcome variables.
We designed an ecological study using two separate databases: (1) Taiwan's occupational disease and injury notification system (ODIS). (2) Survey of Perceptions of Safety and Health in the Work Environment in 2010. We used the CTS and HIVD as cases reported on ODIS from 2008 to 2011 to calculate the age-adjusted standardized incidence rates (SIR) as dependent variable. The independent variables included the self-reported ergonomic factors and self-reported musculoskeletal discomforts. The two databases were connecting by 89 job divisions.
In this study, linear regression was used to find the relationship between workplace factors and CTS and HIVD, and we used the number of employed workers in each job category as weighting. From this study, we found out that “repetitive hand movements” (β: 0.027, 95% CI: 0.008, 0.046) was a major risk factor for male with CTS and “vibration from hand tools” (β: 0.124, 95% CI: 0.063, 0.185) for female with CTS. As for HIVD, the risk factors were “whole body vibration” (β: 0.106, 95% CI: 0.082, 0.133) and “heavy lifting” (β: 0.008, 95% CI: 0.001, 0.015) for male, and “whole body vibration” (β: 0.086, 95% CI: 0.016, 0.157) and “awkward posture” (β: 0.030, 95% CI: 0.008, 0.052) for female respectively. Moreover, “whole body vibration” and “heavy lifting” showed significant additive effect for the male and “whole body vibration”; “awkward posture” showed significant additive effect for the female.
A field study was conducted in a factory, in order to understand the gap between self-reported symptoms and diagnosed musculoskeletal disorders in upper extremities. A total of 359 questionnaires were completed. There were 76 workers having self-reported musculoskeletal symptoms and a total of 19 workers were diagnosed as having musculoskeletal disorders by ultrasound. The most frequently diagnosed conditions were rotator cuff syndrome (N=17) and acromioclavicular joint distention (N=7).
In conclusion, the workplace factors had relationship with the incidence of WMSDs. Such factors can be identified by sample screening tools as questionnaire. By using this approach, it is possible to screen various kinds of workplaces and assess or predict the risk of WMSDs. Also, this will promote future efforts to improve the effectiveness in ergonomic intervention in workplaces and also establish the model for prevention against WMSDs.

並列關鍵字

WMSDs ； Carpal tunnel syndrome (CTS) ； Herniation of intervertebral disc (HIVD) ； Ergonomic ； Self-reported discomforts ； Surveillance ； combination of risk factors

參考文獻

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