某轨道客车装配车间工人工作相关肌肉骨骼疾患工效学干预研究
Study on ergonomic intervention to relieve work-related musculoskeletal disorders among assembly workers in a railway vehicle manufacturing enterprise
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摘要:
背景 工作相关肌肉骨骼疾患（WMSDs）发生于多种职业人群中。因其给机体带来的多种不适及造成的严重疾病负担，已经成为职业健康领域值得关注的重要问题。如何预防和控制WMSDs是亟待解决的公共卫生问题之一。
目的 评估采用工效学培训联合梯凳改善措施对某轨道客车制造业装配车间工人WMSDs的干预效果，为WMSDs的预防控制提供科学依据。
方法 采用方便抽样的方法，于2017年8—12月选择某轨道客车企业250名装配车间工人，应用“中国肌肉骨骼疾患问卷”进行流行病学调查，使用“工效学检查要点”进行现场工效学检查并进行工人访谈。根据以上调查结果，于2018年9月至2019年2月在装配车间实施为期6个月的梯凳改善联合工效学培训的干预。通过干预前后的横断面调查结果进行干预效果的评估。干预效果包括干预前后工人WMSDs认知水平、工效学负荷暴露水平和WMSDs症状发生情况，其中WMSDs症状强度、症状持续时间、症状发生频率评分从低到高分别以0~10、1~4、1~5分评定。
结果 干预后，装配车间工人对WMSDs类型、影响部位、影响因素、预防措施和疾患症状的认知率均有上升，分别从52.3%、51.9%、25.5%、19.1%和51.5%上升到68.5%、61.3%、48.1%、40.9%和61.3%（P＜0.05）。干预后，装配车间工人“头部频繁后仰”项中“经常”的比例由34.6%降至21.8%，“长时间保持身体后仰”项中“经常”的比例由26.6%降至15.0%，“手臂频繁举起”项中“从不”的比例由3.4%升至9.0%（P＜0.05）。干预后，装配车间工人颈、肩、上背、下背、肘、手/腕、臀/腿、膝和踝/足部的症状强度评分均有下降，中位数大多由6分下降到3分（P＜0.05）；症状持续时间评分仅颈部有所下降（P＜0.05），其余部位干预前后差异无统计学意义；下背、手/腕和臀/腿部的症状发生频率评分的中位数由3分下降到2分（P＜0.05）。
结论 对客车制造业装配工人实施为期6个月的工作场所梯凳改善结合工效学培训的干预，可提高作业工人WMSDs相关知识的认知水平，降低其不良姿势的暴露频率以及WMSDs的症状强度、症状持续时间和症状发生频率。
Abstract:Background Work-related musculoskeletal diseases (WMSDs) occur in a variety of occupational populations. Because of their various discomfort and serious disease burden, they have become an important issue worthy of attention in the field of occupational health. The prevention and control of WMSDs is one of the public health problems to be solved.
Objective To evaluate the intervention effect on WMSDs among assembly workers in a railway vehicle manufacturing enterprise, so as to provide scientific basis for the prevention and control of WMSDs.
Methods A total of 250 assembly workers in a railway vehicle manufacturing enterprise were selected using convenience sampling from August to December 2017. The Chinese Musculoskeletal Questionnaire was used for epidemiological investigation, and the Ergonomic Checkpoints was used for ergonomic inspection and worker interview. According to the above survey results, a six-month intervention plan including stepladder improvement and ergonomics training were implemented in the assembly workshop from September 2018 to February 2019. The intervention effects including the awareness of WMSDs, the exposure level of ergonomic load, and the occurrence of WMSDs symptoms were evaluated with relevant cross-sectional survey results before and after the intervention. The scores of WMSDs symptom intensity, symptom duration, and symptom frequency from low to high were 0-10, 1-4, and 1-5, respectively.
Results After the intervention, the awareness rates of assembly workers on WMSDs types, affected body sites, influencing factors, preventive measures, and symptoms all increased from 52.3%, 51.9%, 25.5%, 19.1%, and 51.5% to 68.5%, 61.3%, 48.1%, 40.9%, and 61.3%, respectively (P<0.05). After the intervention, the proportion of assembly workers who "often" bend their head backwards frequently decreased from 34.6% to 21.8%, the proportion who "often" keep their trunk backward for a long time decreased from 26.6% to 15.0%, and the proportion who "never" raise their arms frequently increased from 3.4% to 9.0% (P<0.05). After the intervention, the scores of WMSDs symptom intensity in neck, shoulders, upper back, low back, elbows, hands/wrists, hips/thighs, knees, and ankles/feet all decreased, and the medians were mostly decreased from 6 to 3 (P<0.05); the scores of WMSDs symptom duration only decreased in neck (P<0.05) and there was no significant difference in the other body sites before and after the intervention; the median scores of WMSDs symptom frequency in low back, hands/wrists, and hips/thighs decreased from 3 to 2 (P<0.05).
Conclusion The six-month intervention of stepladder improvement and ergonomics training among assembly workers in a railway vehicle manufacturing enterprise can improve workers' awareness of WMSDs, and reduce the exposure frequency of awkward postures and the intensity, duration, and frequency of WMSDs symptoms.
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