Objective: To investigate the relationships and impacts between various occupational ergonomic hazards and hand and wrist fatigue, as well as work-related musculoskeletal disorders (WMSDs) of the hand and wrist, and to propose targeted preventive and intervention measures for adverse occupational ergonomic factors causing WMSDs of the hand and wrist. Methods: From 2018 to December 2023, a nationwide epidemiologic survey study of wrist WMSDs was conducted using the Chinese version of the electronic questionnaire system for musculoskeletal disorders.A total of 88, 609 valid questionnaires were collected. The exclusion criteria were as follows: patients with congenital spinal deformities, as well as those with wrist WMSDs caused by external injuries, infectious diseases, and malignant tumors. A total of 73, 497 questionnaires were finally included in the study analysis, with an effective questionnaire return rate of 82.5%. Exploratory factor analysis was used to analyze and summarize the factors affecting wrist WMSDs from the questionnaires, including individual factors, work organization, work type, wrist work posture, wrist fatigue, and wrist WMSDs as latent variables, and to hypothesize, fit, and validate the structural aspect model, as well as to conduct mediation effect analysis. Results: The incidence of WMSDs and fatigue in wrist was 12.19% and 16.30% respectively. The fitting indexes of the modified structural equation model were basically up to the standard (GFI was 0.981, AGFI was 0.973, RMSEA was 0.031, NFI was 0.863, IFI and CFI were 0.865). There is a correlation between individual factors, work organization, wrist working posture and work type. There was a low negative correlation between individual factors and other factors, and there was a positive correlation between work organization, work type and wrist WMSDs (r=0.346, 0.295), and these two factors were positively correlated with wrist fatigue height (r=0.862, 0.599), and were positively correlated with wrist working posture (r=0.443, 0.620). There was moderate positive correlation between wrist working posture and wrist fatigue (r=0.469). The three most influential factors on wrist WMSDs were work organization, individual factor and work type, and the path coefficients were 0.247, 0.210 and 0.136, respectively. The first two factors that have the greatest influence on wrist fatigue are work organization and work type, and the path coefficients are 0.758 and 0.188, respectively. Individual factors, work type, wrist working posture and work organization had direct effects on wrist WMSDs, and the effect values were 0.093, 0.253, 0.718 and 0.583, respectively. Wrist fatigue played a partial mediating role between individual factors, work type, wrist working posture and work organization and wrist WMSDs, with the indirect effect ratio of 25.6%, 45.8%, 3.2% and 65.5%. Conclusion: Wrist fatigue plays an important mediating role in the path of various factors affecting wrist WMSDs, especially in the path of work organization, work type, individual factors and wrist WMSDs. Poor wrist working posture is an important risk factor that directly affects the occurrence of wrist WMSDs.
目的： 探讨各类工效学危险因素与腕部疲劳和腕部工作相关肌肉骨骼疾患（work-related musculoskeletal disorders，WMSDs）的相关关系和影响关系，为不良工效学因素导致腕部WMSDs提出有针对性的预防和干预措施。 方法： 于2018年1月至2023年12月，采用中文版《肌肉骨骼疾患电子问卷系统》在全国范围内进行腕部WMSDs流行病学调查研究，共收集有效问卷88 609份。排除标准：先天性脊柱畸形患者，因外伤、传染病和恶性肿瘤等因素导致腕部WMSD s的患者。最终纳入研究共73 497份，问卷回收有效率为82.5%。采用探索性因子分析从问卷中分析归纳出腕部WMSDs影响因素（个体因素、工作组织、工作类型、腕部工作姿势、腕部疲劳），将腕部WMSDs作为潜变量进行结构方面模型的假设、拟合和验证，并进行中介效应分析。 结果： 腕部WMSDs发生率为12.19%，疲劳发生率为16.30%，修正后的结构方程模型拟合指标基本达标（GFI=0.981，AGFI=0.973，RMSEA=0.031，NFI=0.863，IFI=0.865，CFI=0.865）。工作组织、工作类型与腕部WMSDs间均存在正相关关系（r=0.346、0.295），且这两种因素均与腕部疲劳呈正相关（r=0.862、0.599），并与腕部工作姿势正相关（r=0.443、0.620），而腕部工作姿势与腕部疲劳存在正向中度相关（r=0.469）。对腕部WMSDs的影响程度最大的前三个因素分别为工作组织、个体因素和工作类型，路径系数分别为0.247、0.210、0.136；对腕部疲劳影响程度最大的前两个因素分别为工作组织、工作类型，路径系数分别为0.758、0.188。个体因素、工作类型、腕部工作姿势以及工作组织对腕部WMSDs有直接效应，效应值分别为0.093、0.253、0.718、0.583；腕部疲劳在个体因素、工作类型、腕部工作姿势和工作组织与腕部WMSDs间均发挥部分中介作用，间接效应构成比分别为25.6%（0.032/0.125）、45.8%（0.214/0.467）、3.2%（0.024/0.741）、65.5%（1.105/1.688）。 结论： 腕部疲劳在工作组织、工作类型和个体因素影响腕部WMSDs的路径中起到关键作用。不良腕部工作姿势是直接影响腕部WMSDs发生的主要危险因素。.
Keywords: Ergonomic factors; Fatigue; Musculoskeletal system; Structural equation models; Work-related musculoskeletal disorders; Wrist.