工作相关肌肉骨骼系统疾病及其预防控制标准研究

Research on work-related musculoskeletal disorders and their ergonomic standards for prevention and control

防治工作相关肌肉骨骼疾患(WMSDs)是新时期职业健康工作面临的挑战之一。WMSDs是影响职业人群健康的常见疾病,其典型特征是疼痛和行动能力限制。WMSDs可发生在身体的特定部位,也可以发生在多个部位;其不仅可引起组织改变,还可能导致其他周围组织的变化。暴露于各种工效学危险因素是WMSDs的职业特征。WMSDs对劳动者和用人单位均造成巨大的疾病负担。WMSDs的预防控制遵循职业危害控制的基本原则,包括工程控制、管理控制与作业控制、个体防护等。国际标准化组织(ISO)、美国职业安全与健康管理局、美国政府工业卫生师协会均发布了大量关于WMSDs预防控制的工效学标准,其中部分ISO标准已被我国等同采用。为预防工效学危险因素所引起的健康危害,我国发布了近80项推荐性工效学标准。国际劳工组织和一些国家或地区已将WMSDs纳入职业病目录管理。我国目前纳入职业病目录的WMSDs包括职业性手臂振动病、滑囊炎(限于井下工人),以及股静脉血栓综合征、股动脉闭塞症或淋巴管闭塞症(限于刮研作业人员)共3种疾病。与国际比较,我国在WMSDs的工效学预防控制标准、WMSDs的职业病目录管理及其诊断标准等方面仍存在差距;尚存在缺乏因果关系的惟一性判定标准、无法实现对劳动者的盲法观察、现有观察方法易受到偏倚的影响、传统的职业接触与疾病模式框架难以适应WMSDs等局限。未来可调整预防WMSDs的常规流行病学研究形式、应用可穿戴装备和可视化设备和组合有关信息平台的优势等方面,以期从新的职业接触和临床评估视角,研究新技术与环境之间的相互作用,预防控制WMSDs。

The prevention and treatment of work-related musculoskeletal diseases(WMSDs)is one of the challenges facing occupational health work in the new era.WMSDs is a common disease that affects the health of the occupational population and is typically characterized by pain and limited mobility.WMSDs can occur in a specific part of the body or in multiple parts of the body.It can not only cause tissue changes,but also may cause changes in other surrounding tissues.Exposure to various ergonomic risk factors is an occupational characteristic of WMSDs.WMSDs causes a huge disease burden for both workers and employers.The prevention and control of WMSDs follow the basic principles of occupational hazard control,including engineering control,administrative control and operation control,and individual protection.The International Organization for Standardization(ISO),the U.S.Occupational Safety and Health Administration,and the American Conference of Governmental Industrial Hygienists have all issued a large number of ergonomics standards for the prevention and control of WMSDs.Some ISO standards have been adopted as equivalent in China.To prevent health hazards caused by ergonomic hazard factors,China has issued nearly 80 recommended ergonomics standards.The International Labor Organization and some countries or regions have included WMSDs in the management of occupational diseases.The occupational diseases currently included in China′s occupational disease list are occupational hand-arm vibration disease,bursitis(limited to underground work),and femoral venous thrombosis syndrome,femoral artery occlusion or lymphatic vessel occlusion(limited to grinders).Compared with other countries,there are still gaps in the ergonomic prevention and control standard of WMSDs,the occupational disease list management and diagnosis standard of WMSDs in China.There are still limitations such as the lack of unique criteria for causality,the inability to achieve blind observation of workers,the vulnerability of existing observation methods to bias,and the difficulty of adapting traditional occupational exposure and disease model framework to WMSDs.In the future,we can adjust the conventional epidemiological research forms for the prevention of MSDs,apply wearable equipment and visualization equipment,and combine the advantages of relevant information platforms,so as to study the interaction between new technologies and the environment from the perspective of new occupational exposure and clinical evaluation,and prevent and control WMSDs.