消化内镜操作者肩颈肘部工作有关肌肉骨骼疾患调查

Investigation of the occurrence of musculoskeletal disorders at shoulder,neck and elbow of digestive endoscopy operators

目的调查内镜操作量对消化内镜医生肩、颈、肘部肌肉骨骼疾患(Musculoskeletal disorders, MSDs)的影响, 探讨对于MSDs的预防控制措施。方法于2019年12月至2020年3月, 采用随机抽样选取四川省市级及以上医院的200名消化内镜医生作为研究对象, 根据内镜操作量分为低操作组(108人, 总操作量<5 000例/年)与高操作组(92人, 总操作量>5 000例/年), 应用《UCLA肩关节评分系统》《田中靖久颈椎病量表》和《改良An和Morrey肘关节评分系统》分别对肩、颈、肘部发生疼痛医生(62、26、20人)开展MSDs情况调查, 采用χ2检验比较两组各部位患病的基本情况。结果低操作组和高操作组消化内镜医生疼痛部位以肩部最多, 分别占25.9%(28/108)、37.0%(34/92)。肩部发生疼痛医生中肩部偶尔疼痛最多(41.9%, 26/62), 功能正常最多(32%, 20/62);前屈角度超过150°最多(40.3%, 25/62)。颈部发生疼痛医生中颈部常有轻微疼痛占58%(15/26), 疼痛偶尔对上肢产生影响占61.5%(16/26), 对手指产生影响占53.8%(14/26);对体征感觉产生轻度障碍占65.0%(15/26);腱反射正常占88.5%(23/26);对手的影响为无力、不适而无功能障碍占53.8%(14/26);肌力正常(2分)和产生轻度减退的内镜医生各占50.0%(13/26), 各组间差异无统计学意义(P=0.234、1.000、1.000、0.050、0.680、0.539、0.431、0.239)。肘部发生疼痛医生中轻度损失占55.0%(11/20), 轻度不稳定占65.0%(13/20), 轻微疼痛占55.0%(11/20)。结论 MSDs是内镜医师面临的健康问题之一, 应采取针对性的预防措施。

Objective To investigate the effect of endoscopic operation volume on musculoskeletal disorders(MSDs)of shoulder,neck and elbow.Methods From December 2019 to March 2020,random sampling was used to select 200 gastroenterologists from hospitals at or above the municipal level in Sichuan Province as the research object.Gastroenterologists were divided into 108 eadoscop in the low operation group(The operation volume is less than 5000 cases)and 92 eadoscop in the high operation group(The operation volume is more than 5000 cases)according to the operation volume.MSDS was investigated by UCLA shoulder scoring system,Tanaka Jingjiu cervical spondylosis scale and improved An and Morrey elbow scoring system,and the chi-square test was used to compare the basic conditions of different body parts in the two groups.The basic condition of each part of the two groups was tested and compared.Results Compared with the low operation group,the age and working years of the high operation group were longer,and the difference was statistically significant(P<0.001).The most painful part between the two groups was the shoulder,accounting for 25.9%(28/108)and 37.0%(34/92),respectively.Occasional shoulder pain was the most(41.9%,26/62)and normal function was the most(32.3%,20/62);The forward flexion angle exceeds 150°at most(40.3%,25/62).Slight pain often occurred in the neck,accounting for 57.7%(15/26),the occasional impact of pain on the upper limbs accounted for 61.5%(16/26),and the impact on the fingers accounted for 53.8%(14/26);65.0%(15/26)had mild disturbance to the sense of signs;Normal tendon reflex accounted for 88.5%(23/26);The influence of opponents was weakness,discomfort and no dysfunction,accounting for 53.8%(14/26);Endoscopists with normal muscle strength(2 points)and mild decline accounted for 50.0%(13/26)respectively,and there was no significant difference among the groups(P=0.234、1.000、1.000、0.050、0.680、0.539、0.431、0.239).The elbow score scale showed that mild loss accounted for 55.0%(11/20),mild instability accounted for 65%(13/20),and mild pain accounted for 55.0%(11/20).Conclusion MSDs is a health problem faced by endoscopists,and targeted preventive measures should be taken for its possible causes.