Lumbar Intervertebral Disc Herniation and Work: A Case Report

職業性腰椎椎間盤突出：案例報告

蔡明道(Ming-Dow Tsay) ； 周怡君(Yi-Jiun Chou) ； 楊洽洲(Qia-Zhou Yang) ； 羅世忠(Shu-Zon Lou)

《童綜合醫學雜誌》 11卷1期 (2017/06) Pp. 54-61

摘要

It is known that ergonomic hazards usually contribute to the occurrence of musculoskeletal Cumulative Trauma Disorders (CTDs). Especially, lumbar intervertebral disc herniation (LIDH) is a common CTD. Here, we describe a 38-year-old worker with heavy loads at a steel plant for 8-11 hours per day. He began this work since May 2004, and a year consisted of approximately 260 workdays. He was mainly responsible for loading heavy metal materials weighing 20 to 50 kg. Further, the loads on his L4-L5 (4th and 5th lumbar vertebrae) were exceeded than 3200 N (Newton), and the cumulative exposure loads on the lumbar also reached proximally to 43 × 10^6Nh (Newton hour) over the criteria at 25 × 10^6 Nh, which according to the diagnostic criteria for the recognition of occupational LIDH established by our government, the above results exceeded the exposure threshold. A review of medical history revealed that the patient developed LIDH after work exposure, corresponding to the temporality in the diagnostic criteria. Also, medical literature indicates that prolonged loading of heavy materials with bending can increase the risk of LIDH. The patient has no personal history of major trauma, rheumatoid arthritis, or genetic or immunological diseases; hence, another general causes were also ruled out. After the occupational identification report was completed, the results were transferred to an appraisal review unit, and the patient received reasonable compensation. Currently, the patient is assigned a non-weight-loading task and receives regular rehabilitation.

關鍵字

ergonomic hazard ； lumbar intervertebral disc herniation (LIDH) ； evidence of exposure ； evidence of disease ； appropriate temporality

並列摘要

眾所皆知，人因性危害通常引發肌肉骨骼累積性傷病。尤其腰椎椎間盤突出是常見肌肉骨骼累積性傷病。在此，我們敘述一位38 歲在鋼鐵工廠從事負重員工，每天工作8-11 小時。他從2004 年五月開始，每年工作天約260 日。他主要負責搬抬鋼鐵材料重20 到50 公斤。進一步，根據我們政府制定職業性腰椎椎間盤突出認定診斷標準，第四腰椎、第五腰椎受力超過3200N（牛頓），累積劑量為43×10^6 Nh（牛頓．小時）超過診斷標準25×10^6 Nh，結果工作暴露超過標準閾值。醫學史回顧顯示負重工作會產生腰椎椎間盤突出，符合診斷標準適當的時序性。醫學文獻也指出長時間彎腰搬運重物，有增加罹患腰椎間盤突出的風險。個案病史過去無重大外傷、風濕性關節炎或其他遺傳和免疫關節疾病，因此大致排除其他原因。個案職業病鑑定報告完成後，轉送鑑定審查單位並且獲得理賠。現在個案配工到非負重作業區與接受定期復健治療。

並列關鍵字

人因性危害 ； 腰椎椎間盤突出 ； 暴露的證據 ； 疾病的證據 ； 適當的時序性