The Role of Dynamic Three-Dimensional Trunk Motion in Occupationally-Related Low Back Disorders: The Effects of Workplace Factors, Trunk Position, and Trunk Motion Characteristics on Risk of Injury
The Role of Dynamic Three-Dimensional Trunk Motion in Occupationally-Related Low Back Disorders: The Effects of Workplace Factors, Trunk Position, and Trunk Motion Characteristics on Risk of Injury
复制标题
动态三维躯干运动在职业相关腰部疾病中的作用：工作场所因素、躯干位置和躯干运动特征对受伤风险的影响
作者：
W. Marras;S. Lavender;S. Leurgans;S. Rajulu;W. G. Allread;F. Fathallah;S. Ferguson
目前用于控制与职业相关的腰部疾病风险的人体工程学技术包括在举重活动期间对脊柱负荷进行静态评估。这可能是有问题的，因为一些生物力学模型和流行病学研究表明，举重的动态特性会增加脊柱负荷和职业性腰背疾病的风险。很难将这种运动信息纳入工作场所评估中，因为躯干运动变得危险的速度尚未确定。进行了一项体内研究，以评估三维动态躯干运动对工业职业举重过程中腰部疾病风险的影响。对 48 个不同行业的 400 多个重复性工业起重工作进行了研究。对这些行业现有的医疗和伤害记录进行了检查，以便可以确定历史上被归类为与职业相关的腰部疾病高风险或低风险的特定工作。工人佩戴三轴电动测角仪，记录工人从事这些高风险或低风险工作时腰椎的三维角位置、速度和加速度特征。还记录了每项重复性提升任务的工作场所和个人特征。基于生物力学合理性，开发了多重逻辑回归模型，并表明五种躯干运动和工作场所因素的组合可以很好地区分职业相关腰背疾病风险的高风险和低风险（优势比：10.7）。这些因素包括 1) 提升频率、2) 负载力矩、3) 躯干横向速度、4) 躯干扭转速度和 5) 躯干矢状角。该分析表明，通过适当改变在举重过程中观察到的这五个因素，高风险群体成员的几率可能会降低近 11 倍。研究发现该模型的预测能力比当前提升指南的预测能力高出三倍以上。这项研究虽然没有证明因果关系，但表明生物力学因素与腰背疾病风险之间存在关联。该模型可用作设计工作场所的定量、客观措施，从而最大限度地降低职业相关腰背疾病的风险。
Current ergonomic techniques for controlling the risk of occupationally-related low back disorder consist of static assessments of spinal loading during lifting activities. This may be problematic because several biomechanical models and epidemiologic studies suggest that the dynamic characteristics of a lift increase spine loading and the risk of occupational low back disorder. It has been difficult to include this motion information in workplace assessments because the speed at which trunk motion becomes dangerous has not been determined. An in vivo study was performed to assess the contribution of three-dimensional dynamic trunk motions to the risk of low back disorder during occupational lifting in industry. More than 400 repetitive industrial lifting jobs were studied in 48 varied industries. Existing medical and injury records in these industries were examined so that specific jobs historically categorized as either high-risk or low-risk for reported occupationally-related low back disorder could be identified. A triaxial electrogoniometer was worn by workers and documented the three-dimensional angular position, velocity, and acceleration characteristics of the lumbar spine while workers lifted in these high-risk or low-risk jobs. Workplace and individual characteristics were also documented for each of the repetitive lifting tasks. A multiple logistic regression model was developed, based on biomechanical plausibility, and indicated that a combination of five trunk motion and workplace factors distinguished between high and low risk of occupationally-related low back disorder risk well (odds ratio: 10.7). These factors included 1)lifting frequency, 2) load moment, 3) trunk lateral velocity, 4) trunk twisting velocity, and 5) the trunk sagittal angle. This analysis implies that by suitably varying these five factors observed during the lift collectively, the odds of high-risk group membership may decrease by almost 11 times. The predictive power of this model was found to be more than three times greater than that of current lifting guidelines. This study though not proving causality, indicates an association between the biomechanical factors and low back disorder risk. This model could be used as a quantitative, objective measure to design the workplace so that the risk of occupationally-related low back disorder is minimized.