张平, 张伟伟, 白希婧, 肖玉霞, 陈浩, 张英, 黄沪涛. 口腔医生工作相关肌肉骨骼疾患影响因素及发生模式分析[J]. 环境与职业医学, 2021, 38(7): 679-686. DOI: 10.13213/j.cnki.jeom.2021.21026
引用本文: 张平, 张伟伟, 白希婧, 肖玉霞, 陈浩, 张英, 黄沪涛. 口腔医生工作相关肌肉骨骼疾患影响因素及发生模式分析[J]. 环境与职业医学, 2021, 38(7): 679-686. DOI: 10.13213/j.cnki.jeom.2021.21026
ZHANG Ping, ZHANG Weiwei, BAI Xijing, XIAO Yuxia, CHEN Hao, ZHANG Ying, HUANG Hutao. Influencing factors and occurrence patterns of work-related musculoskeletal diseases in dentists[J]. Journal of Environmental and Occupational Medicine, 2021, 38(7): 679-686. DOI: 10.13213/j.cnki.jeom.2021.21026
Citation: ZHANG Ping, ZHANG Weiwei, BAI Xijing, XIAO Yuxia, CHEN Hao, ZHANG Ying, HUANG Hutao. Influencing factors and occurrence patterns of work-related musculoskeletal diseases in dentists[J]. Journal of Environmental and Occupational Medicine, 2021, 38(7): 679-686. DOI: 10.13213/j.cnki.jeom.2021.21026

口腔医生工作相关肌肉骨骼疾患影响因素及发生模式分析

Influencing factors and occurrence patterns of work-related musculoskeletal diseases in dentists

  • 摘要: 背景

    工作相关肌肉骨骼疾患(WMSDs)是造成我国伤残调整寿命年的重要原因。口腔医生由于其工作特点,易发生WMSDs,应得到积极的关注。

    目的

    调查口腔医生的WMSDs患病情况,分析其发生与不良工效学因素之间的关系,并探讨WMSDs可能的发生模式。

    方法

    采用肌肉骨骼疾患调查表,于2020年4月15-22日以口腔医生自填的方式进行调查。调查内容包括口腔医生的一般情况、身体各主要部位的WMSDs患病情况、不良工效学因素等内容,采用logistic回归分析WMSDs可能的影响因素,并运用潜在类别分析(latent class analysis,LCA)探索其可能的发生模式。

    结果

    本次调查共收到有效问卷614份。过去12个月中口腔医生WMSDs总患病率为82.4%,其中颈部、腰部、肩部、上背部患病率分别为75.2%、50.8%、49.7%、46.4%。多因素logistic回归分析显示,体位评价"一般"和"差"、长时间低头可以增加颈部WMSDs的患病风险(OR=2.383、11.454、3.351,P < 0.01),而口内照明"非常好"可以降低风险(OR=0.373,P < 0.01);体位评价"一般"和"差"、背部同一姿势可以增加腰部WMSDs的患病风险(OR=2.484、3.310、2.887,P < 0.01),而口内照明"非常好"(OR=0.500)以及椅背抵住腰(OR=0.627)则可以降低腰部WMSDs的患病风险(P < 0.05);相对于工龄1~5年,工龄6~10年的口腔医生肩部发生WMSDs的风险为1.748倍(OR=1.748,P < 0.05),长时间歪头(OR=1.862)和手肘抬高(OR=1.460)也是肩部WMSDs的影响因素(P < 0.05);相对于男性,女性上背部发生WMSDs的风险为1.460倍(OR=1.460,P < 0.05);相对于工龄1~5年,工龄11~15年和>15年的口腔医生上背部发生WMSDs的风险为2.068倍和2.225倍(OR=2.068、2.225,P < 0.05)。LCA将口腔医生身体各部位WMSDs患病情况分为5类:颈肩腰上背部疼痛组、轻微疼痛组、颈肩腰上背腕手臀腿部疼痛组、仅腰部疼痛组、颈肩腰腕手部疼痛组,潜在类别概率分别为0.564、0.199、0.119、0.077和0.042。颈部、腰部、肩部、上背部同时患WMSDs与背部同一姿势、口内照明"非常好"存在统计学关联,其OR(95% CI)分别为3.220(1.232~8.414)、0.410(0.175~0.960)。

    结论

    口腔医生WMSDs患病率较高,应采取综合措施促进口腔医生避免不良工效学体位,减少WMSDs的发生。

     

    Abstract: Background

    Work-related musculoskeletal disorders (WMSDs) are an important cause of disability adjusted life years in China. Dentists are prone to WMSDs due to their work characteristics, which requires more attention.

    Objective

    This study is designed to investigate the prevalence of WMSDs in dentists, analyze the relationship between the occurrence of WMSDs and adverse ergonomic factors, and explore the possible occurrence patterns of WMSDs.

    Methods

    A self-administered musculoskeletal disease questionnaire was used to investigate the dentists nationwide from April 15 to 22, 2020. The survey included the general information of dentists, the prevalence of WMSDs affecting different body parts, and adverse ergonomic factors. Logistic regression was used to analyze the possible influencing factors of WMSDs, and latent class analysis (LCA) was used to describe possible WMSDs occurrence patterns.

    Results

    A total of 614 valid questionnaires were received. In the past 12 months, the total prevalence rate of WMSDs was 82.4%. The prevalence rates of WMSDs in neck, low back, shoulder, and upper back were 75.2%, 50.8%, 49.7%, and 46.4%, respectively. The multiple logistic regression analysis results showed that "fair" and "bad" posture evaluation and head bent for a long time increased the risk of neck WMSDs (OR=2.383, 11.454, 3.351, P < 0.01), while "excellent" lighting in patient's mouth reduced the risk (OR=0.373, P < 0.01). The risk of low back WMSDs was increased by "fair" and "bad" posture evaluation and keeping same lumbar posture (OR=2.484, 3.310, 2.887, P < 0.01), while the risk was decreased by "excellent" lighting in the patient's mouth (OR=0.500) and seat lumbar support (OR=0.627) (P < 0.05). Compared with 1-5 years of working age, the risk of shoulder WMSDs was 1.748 times higher (OR=1.748, P < 0.05) for dentists with 6-10 years of working age. Head tilted for a long time (OR=1.862) and elbow elevated for a long time (OR=1.460) were also risk factors for shoulder WMSDs (P < 0.05). Compared with men, the risk of upper back WMSDs in women was 1.460 times higher (OR=1.460, P < 0.05). The risk of upper back WMSDs was 2.068 times and 2.225 times higher (OR=2.068, 2.225, P < 0.05) for dentists with 11-15 years and >15 years of working age compared with those with 1-5 years of working age. The prevalence of WMSDs in different body parts of dentists was classified into five classes by LCA: neck, shoulder, low back, and upper back pain class; minor pain class; neck, shoulder, low back, upper back, wrist, hand, hip, leg pain class; only low back pain class; and neck, shoulder, low back, wrist, and hand pain class. The potential category probabilities of the five classes were 0.564, 0.199, 0.119, 0.077, and 0.042, respectively. Keeping same lumbar posture and "excellent" lighting in patient's mouth were associated with WMSDs in neck, low back, shoulder, and upper back at the same time, with ORs (95% CIs) of 3.220 (1.232-8.414) and 0.410 (0.175-0.960), respectively.

    Conclusion

    The prevalence of WMSDs in selected dentists is high. Comprehensive measures should be taken to avoid adverse ergonomic postures and reduce the incidence of WMSDs among dentists.

     

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