某汽车公司工人多部位肌肉骨骼疾患及危险因素

Co-occurrence of musculoskeletal disorders and influence factors among Chinese auto workers

目的分析汽车工人多部位肌肉骨骼疾患（MSDs）患病的分布规律、影响因素，及不同部位MSDs的相互联系。方法采用整群随机抽样的方法，在某汽车公司采用经修改的北欧国家MSDs标准调查表对3998名汽车生产工人进行横断面调查，得到有效问卷3800份。多部位MSDs的影响因素采用muhinomiallogistic进行分析；不同部位之间的关联程度利用log—binomial模型，以某一部位是否患MSDs为因变量，其他部位为自变量，计算现患比（prevalenceratio，PR值）来评估。结果汽车工人MSDs的患病以多部位为主，其中2个或2个以上部位的占64．5％（2452／3800），1个部位的仅占12．3％（469／3800）。各部位MSDs相互关联的PR值在1．5-6．7之间，PR值的差异均有统计学意义（P〈0．叭）。汽车生产工人颈和肩、背与肩和腰、肘与腕／手、腰与颈、腕，手与腰、髋／臀与腰、膝与腰、踝／足与肘MSDs的联系比其他部位更为密切。多因素muhinomiallogistic回归分析发现，对汽车工人多部位MSDs影响最为突出的职业因素是不良姿势，包括经常以不舒服的姿势工作、颈前倾、颈扭转（OR值分别为3．39、1．93、1．38）；其次是劳动组织：工间休息使3个以上部位MSDs的患病风险降到31％，而人员短缺则使患病风险上升到1．75倍；重体力劳动中推拉重物（超过20kg）OR值为1．76。结论汽车生产工人MSDs的患病以多部位为主；各部位MSDs具有较高的关联度；汽车工人患多部位MSDs的主要职业危险因素是不良姿势、劳动组织和重体力劳动。

Objective To analyze the prevalence and risk factors of multiple musculoskeletal disorders （MSDs） in auto workers and the associations between MSDs at different sites. Methods A cross-sectional survey was conducted in 3998 workers, who were selected from a Chinese auto corporation by cluster random sampling, using the revised Nordic MSDs standard questionnaire; 3800 completed questionnaires were returned. Multinomial logistic regression analysis was performed to assess the risk factors for multiple MSDs. The log- binomial model was used to calculate the prevalence ratios （PRs） of MSDs at different sites and evaluate the associations between MSDs at different sites. Results Of the 3800 subjects, 2452 （64.5%） had MSDs at two or more sites, and 469 （12.3%） had MSDs at one site. The PRs varied from 1.5 to 6.7, with significant differences among different sites （P〈0.01）. Relatively close associations were found between the MSDs at neck and shoulders, back and shoulders/waist, elbows and wrists/hands, waist and neck, wrists/hands and waist, hip and waist, knees and waist, and ankles/feet and elbows. The multinomial logistic regression analysis indicated that the highest risk factor for MSDs was poor posture, including often working in an uncomfortable posture, neck bending forward, and neck twisting （ORs = 3.39, 1.93, and 1.38）, followed by labor organization, in which break between tasks could decrease the risk of MSDs at three or more sites to 31%, staff shortage, which could increase the risk of MSDs by 75%, and pushing and pulling heavy objects （〉20 kg） （0R=1.76）. Conclusion Most auto workers with MSDs have multiple sites affected, and there are high associations between the MSDs at different sites. The major risk factors for multiple MSDs in auto workers include poor posture, labor organization, and heavy physical labor.