| 摘要: | 目前國內肌肉骨骼疾病患者有越來越多的趨勢。大多數工作場所勞工都有可能發生肌肉骨骼之危害，醫院工作者亦類同。本研究主要目的為了解醫院行政部門工作人員其肌肉骨骼傷害盛行狀況，以腕隧道症候群(Carpal Tunnel Syndrome；CTS)為例，評估此疾病目前臨床診斷方法之一致性。 本研究以中部某教學醫院144位行政人員為研究對象，參與率為90﹪，進行二階段評估;第一階段以問卷了解工作人員基本資料、工作情形及其自覺肌肉骨骼疼痛情形;第二階段則以醫師問診、理學檢查及神經傳導檢查來確認是否為CTS患者，並用個案觀察及錄影方式來分析行政人員作業時各種動作之頻率及期間。 研究結果顯示醫院行政人員大部分都有肌肉骨骼方面疾病，以肩(65.1%)、頸(61.2%)、下背(54.3%)及手/腕(51.3%)等部位有較高盛行率，且以醫事課最為嚴重。在醫師問診，以右肩(54.6%)、右肘及右腕/手(49.5%)情況較為嚴重。CTS診斷部份，若以神經傳導檢查為診斷標準，則問卷方法之敏感度及特定度分別為48.0%及45.3%、醫師問診則為59.1%及53.2%，理學檢查為36.4%及67.1﹪；若以理學檢查為診斷標準，則醫師問診之敏感度及特定度為89.5%及72.2%。以邏輯式迴歸分析各診斷方法中影響CTS之危險因素，經問卷調查醫事課及服務組罹患CTS危險性高於行政部 （OR=4.30及OR=4.62）；而經理學檢查及神經傳導檢查，服務組 明顯高於其他兩組（OR=1.13及OR=5.05）；工作年資在1-3及3-10 年的員工經理學檢查其罹患CTS危險性高於其他員工（OR=1.38 及OR=1.61）。經醫師問診者為CTS者其上肢暴露指標為高暴露組 其危險性高於其他兩組，呈現劑量與效應關係。 因此，應提高勞工對於肌肉骨骼疾病認知，建立正確操作姿勢 與動作以預防人因工程方面危害，另外對於CTS之診斷仍需與職業 病或專科醫師共同訂定職業病認定及評估方法，以提供職業病認定 依據參考。; Recently, workers suffered from increasing risk of musculoskeletal disorders than before. Repetitive and forceful use of wrist and finger flexors is purported to be an occupational risk factor carpel tunnel syndrome (CTS), especially workers serve in hospital. The objective of this study is to assess the prevalence of musculoskeletal disorders in administrative staffs of hospital and to evaluate validity in the different diagnostic tools to CTS. 144 administrative staffs (participant rate was 90﹪) were enrolled in a teaching hospital of Taichung. All subjects were interviewed by a modified NMQ questionnaire including demographic information、work situation and history of musculoskeletal disorders. Workers suffered from CTS were diagnostic by physician diagnosis, physical examination and nerve conduction velocity (NCV) test. For monitoring workers’ motion in different division, frequency and posture of motion were recorded by video and direct observation, and then transferred to photographic films. All data was analyzed by SPSS software. Chi-square test and logistic regression model were investigated the risk factors to CTS. Sensitivity, specificity and PPV and NPV were use to compared the validity in different diagnostic tools. The results showed that administrative staffs were found the highest prevalence of musculoskeletal disorders using NMQ questionnaire: shoulder（65.1﹪）、neck（61.2﹪）、low back（54.3﹪）and hand/wrist（51.3﹪）, particularly served in registry department. The prevalence of symptoms were shoulder（54.6﹪） and right elbow and hand/wrist（49.5﹪） by physician examination. Using NCV as a golden standard to diagnosis of CTS, the sensitivity and specificity to questionnaire was 48.0﹪and 45.3﹪, and to physician examination was 59.1﹪ and 53.2﹪, to physical examination was 36.4﹪and 67.1﹪, respectively. However, in diagnosis of CTS by physical examination , the sensitivity and specificity to physician examination was 89.5﹪and 72.2﹪, respectively. Using logistic regression analysis, CTS was affected were different divisions, worker duration and cumulative exposure ergonomic stress in extremity. Medical affairs division and service division were higher risk than administrative division（OR=4.30 and OR=4.62） and this results were consistent with physical examination and NCV study （OR=1.13 and OR=5.05）. Work durations of 1 to 3 and 3 to 10 years had higher risk to CTS compared to lower one year（OR=1.38 and OR=1.61）. Workers who diagnoses to CTS by physician examination were higher in heavy cumulative exposure ergonomic stress in extremity exposure, which showed a dose-response relationship In conclusion, it is important to provide the adequate knowledge regarding musculoskeletal disorder and teach the correct posture and action during work to prevent the damage of ergonomics in hospital workers. Moreover, it is necessary to discuss with medical specialist to setup diagnosing tool of occupation disease. |
