Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_6034_Библиотеки_им_академика_М_И_Перельмана.pdf
compensation costs if they are implemented correctly.
However, experience has also shown that unless workers are accepting of workplace redesign, the interventions will not be effective.
A proven method to maximize the effectiveness of
workplace interventions is through the implementation of
an ergonomics process. These processes are designed to
address occupational health issues in a timely manner and
create an environment that fosters worker acceptance of
engineering interventions. Ergonomics processes grew out
of efforts to control musculoskeletal disorders in meat
packing facilities (164). The logic behind this approach is
to develop a system or process to identify and correct musculoskeletal problems associated with work. It is considered a process instead of a program since it is intended to
become an ongoing surveillance and correction component of the business operation instead of a one-time effort.
The process is intended to encourage management and
labor to communicate and work as a team to accomplish
a common goal of worker health. In order to address the
psychosocial issues in the workplace, a ke y component of
an ergonomics process is worker empowerment. Workers
are encouraged to take an active role in the process and
take control and ownership of work design suggestions
and changes. Thus, the process encourages a participatory approach. Benefits of such an approach include
increased worker motivation, job satisfaction, and greater
acceptance of change. The goal is to create an environment where the success of the operation is the objective
as opposed to the interests of any given individual.
There are several functions of a successful ergonomics
process. These functions include: management leadership
and commitment, employee participation, job analysis
leading to injury prevention and control, training, medical management, program evaluation, and documentation. A successful process begins with the creation of
an ergonomics committee. The committee composition
should be balanced between management and labor to
encourage a balanced effort to work toward the common
goal. Committee members should include those involved
with the design of work layout as well as those empowered to dictate scheduling. In addition, labor representatives to the committee should include those employees
who have broad experience with many of the jobs in the
facility as well as those emplo y ees w ho can communicate
well with the majority of the other workers. This committee then becomes the center of all ergonomic-related
activities within the facility.
The ergonomics process is actually a system where the
different components of the system interact to produce
the desired effect. The interactions within this system are
shown in Fig. 17-8. This f igure indicates that the ergonomics committee is at the heart of the interactions with
all the components of the process. The process begins
with management involvement. Ergonomics processes
must be driven from the top down. Thus, management
CHAPTER 17/OCCUPATIONAL ERGONOMICS / 193
FIG. 17-8. The interaction of elements within an ergonomics
process.
must initiate the process and visibly demonstrate commitment to the process. In addition, management must
provide resources to the committee. These resources
should include financial resources so that physical interventions can be implemented as well as access to information such as injury records, production schedules, and
so forth.
As indicated in Figure 17-8, the fundamental responsibilities of the ergonomics committee are threefold. First,
the committee must monitor the workplace to determine
where clusters of work-related musculoskeletal injuries
are located. Techniques for surveillance include injury
reports as well as surveying w orkers for symptom recording. In order that ergonomic efforts become preventive
rather than reactive it is important to solicit the cooperation of all workers in this effort. Medical personnel can
help facilitate this effort by helping the committee interpret the trends in an objective fashion. The second
responsibility of the committee is the prevention and control of occupationally related musculoskeletal disorders.
For the purposes of LBD , the techniques discussed earlier
can be employed to help isolate the nature of any potential problems associated with the design of work. The
issue of interest here is often “how much exposure to risk
factors is too much exposure?” Thus, quantitative methods can be used to help determine which changes are
needed and their likely impact. As indicated in the figure,
ergonomic experts can be useful in assisting the committee in performing these assessments. The third responsibility of the committee is the training and education of
the workers. Several levels of training are typically necessary. All workers should receive short duration awareness training to inform them that an ergonomics process
is in place, familiarize them with risk factors, and explain
to them how to interact with the process. In addition,
workers should receive training as to the types of symptoms that need to be reported to the committee for prevention to be successful. Higher level training should also
194 /SECTION III/THE INJURED WORKER
be provided to engineers and supervisors. In general,
training should be of sufficient detail so that management
understands the functioning of the process and so that
they do not become an impediment to the process success. Both medical professionals and ergonomic specialists can facilitate these activities.
Medical management and the ergonomic experts serve
as resources to the committee for the process responsibilities. The goal of a process is not to make the ergonomics
committee into ergonomics experts, but to encourage
them to actively involve experts to accomplish the goals
of the process. These experts can be valuable in terms of
advising the committee as to how and when to perform
surveillance activities as well as suggesting appropriate
interventions for a given situation.
It is imperative that the pro gram be evaluated regularly
to justify its continuation. Issues such as the achievement
of program goals, reductions of musculoskeletal disorders, hazard reduction, and employee feedback should be
considered. Corrective actions should be taken in response to the evaluation. Finally, documentation is an
important part of a successful program. Records should
be kept that document the changes made to the workplace
and that can serve as justif ication of expenditures. These
records can also be used to transfer knowledge to new
team members.
Ergonomics processes can hav e a significant impact on
musculoskeletal risk, but only if the process is performed
correctly and maintained. Keys to process maintenance
include strong direction, realistic goals, establishment of
a system to address employee concerns, early intervention success, and publicity for the intervention.
CONCLUSIONS
This review has shown that LBDs are common in the
workplace and associated with occupational tasks when
the risk factors of manual materials handling, bending
and twisting, and whole-body vibration are present. The
load-tolerance relationship represents a sound biomechanically plausible avenue to support the epidemiologic
findings. Sophisticated biologically assisted biomechanical models have been developed that have been used to
quantitatively assess many situations (in the laboratory)
that are common to workplaces. There are also a host of
quantitative workplace assessment tools available to
assess risk directly at the w ork site. These tools appear to
be most sensitive if they are multifactorial in nature and
assess the load movement exposure and torso kinematic
responses to work situations in three-dimensional space.
The more precisely these job requirements are documented the better the association with risk. Finally, the
implementation of ergonomic change in the workplace
must consider psychosocial issues in the workplace in
order to foster worker acceptance of change. The imple-
mentation of an ergonomics process can be useful for
these purposes.
REFERENCES
1. Tichauer ER. The biomechanical basis of ergonomics. New York:
John Wiley and Sons, 1978.
2. Government Accounting Office. Worker protection: private sector
ergonomics programs yield positive results. Washington, DC: Government Accounting Office, 1997.
3. National Research Council. Musculoskeletal disorders and the workplace: low back and upper extremity. Washington DC, National Academy Press, 2001.
4. National Institute for Occupational Safety and Health. Worker health
chartbook. Cincinnati, 2000.
5. Vingard E, Mortimer M, Wiktorin C, et al. Seeking care for low back
pain in the general population: a two-year follow-up study: results
from the MUSIC-Norrtalje study. Spine 2002;27:2159–2165.
6. Guo HR, Tanaka S, Cameron LL, et al. Back pain among workers in
the United States: national estimates and workers at high risk. Am J
Ind Med 1995;28:591–602.
7. Guo HR, Tanaka S, Halperin WE, et al. Back pain prevalence in US
industry and estimates of lost workdays. Am J Public Health
1999;89:1029–1035.
8. National Institute for Occupational Safety and Health. Musculoskeletal disorders and workplace factors. Washington, DC: Department of
Health and Human Services, 1997.
9. Hoogendoorn WE, van Poppel MN, Bongers PM, et al. Physical load
during work and leisure time as risk factors for back pain [see Comments]. Scand J Work Environ Health 1999;25:387–403.
10. Norman R, Wells R, Neumann P, et al. A comparison of peak vs
cumulative physical work exposure risk factors for the reporting of
low back pain in the automotive industry. Clin Biomech (Bristol,
Avon) 1998;13:561–573.
11. Kumar S. Cumulative load as a risk factor for back pain. Spine
1990;15:1311–1316.
12. Videman T, Nurminen M, Troup JD. 1990 Volvo Award in clinical sciences. Lumbar spinal pathology in cadaveric material in relation to
history of back pain, occupation, and physical loading. Spine 1990;
15:728–740.
13. Seidler A, Bolm-Audorff U, Heiskel H, et al. The role of cumulative
physical work load in lumbar spine disease: risk factors for lumbar
osteochondrosis and spondylosis associated with chronic complaints.
Occup Environ Med 2001;58:735–746.
14. Bongers PM, de Winter CR, Kompier MA, et al. Psychosocial factors
at work and musculoskeletal disease. Scand J Work Environ Health
1993;19:297–312.
15. Karasek R, Brisson C, Kawakami N, et al. The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol
1998;3:322–355.
16. van Poppel MN , Koes BW, Deville W, et al. Risk factors for back pain
incidence in industry: a prospective study. Pain 1998;77:81–86.
17. Hoogendoorn WE, van Poppel MN, Bongers PM, et al. Systematic
review of psychosocial factors at work and private life as risk factors
for back pain. Spine 2000;25:2114–2125.
18. Davis KG, Heaney CA. The relationship between psychosocial work
characteristics and low back pain: underlying methodological issues.
Clin Biomech (Bristol, Avon) 2000;15:389–406.
19. Frank JW, Kerr MS, Brooker AS, et al. Disability resulting from occupational low back pain. Part I: What do we know about primary prevention? A review of the scientific evidence on prevention before disability begins. Spine 1996;21:2908–2917.
20. Waddell G. The back pain revolution. Edinburgh: Churchill Livingstone, 1999.
21. Waddell G. Biopsychosocial anal ysis of low back pain. Baillieres Clin
Rheumatol 1992;6:523–557.
22. Krause N, Ragland DR, Fisher JM, et al. Psychosocial job factors,
physical workload, and incidence of work-related spinal injury: a 5year prospective study of urban transit operators. Spine 1998;23:
2507–2516.
23. Tubach F, Leclerc A, Landre MF, et al. Risk factors for sick leave due
CHAPTER 17/OCCUPATIONAL ERGONOMICS / 195
to low back pain: a prospective study. J Occup Environ Med
2002;44:451–458.
24. McGill SM. The biomechanics of low back injury: implications on
current practice in industry and the clinic. J Biomech 1997;30:4
65–475.
25. Bogduk N. The anatomical basis for spinal pain syndromes. J Manipulative Physiol Ther 1995;18:603–605.
26. Cavanaugh JM. Neural mechanisms of lumbar pain. Spine
1995;20:1804–1909.
27. Cavanaugh JM, Ozaktay AC, Yamashita T, et al. Mechanisms of low
back pain: a neurophysiologic and neuroanatomic study. Clin Orthop
1997;166–180.
28. Kallakuri S, Cavanaugh JM, Blagoev DC. An immunohistochemical
study of innervation of lumbar spinal dura and longitudinal ligaments.
Spine 1998;23:403–411.
29. Siddall PJ, Cousins MJ. Spinal pain mechanisms. Spine 1997;22:
98–104.
30. Dwyer A, Aprill C, Bogduk N. Cervical zygapophyseal joint pain patterns. I: A study in normal volunteers. Spine 1990;15:453–457.
31. Ozaktay AC, Cavanaugh JM, Blagoev DC, et al. Phospholipase A2induced electrophysiologic and histologic changes in rabbit dorsal
lumbar spine tissues. Spine 1995;20:2659–2668.
32. Yamashita T, Minaki Y, Ozaktay AC, et al. A morphological study of
the fibrous capsule of the human lumbar facet joint. Spine 1996;
21:538–543.
33. Bogduk N. The lumbar disc and low back pain. Neurosurg Clin N Am
1991;2:791–806.
34. Cavanaugh JM, Kallakuri S, Ozaktay AC. Innervation of the rabbit
lumbar intervertebral disc and posterior longitudinal ligament. Spine
1995;20:2080–2085.
35. Chen C, Cavanaugh JM, Ozaktay AC, et al. Effects of phospholipase
A2 on lumbar nerve root structure and function. Spine 1997;22:
1057–1064.
36. Ozaktay AC, Kallakuri S, Cavanaugh JM. Phospholipase A2 sensitivity of the dorsal root and dorsal root ganglion. Spine 1998;23:
1297–1306.
37. Dinarello CA. Proinflammatory cytokines. Chest 2000;118:503–508.
38. Jager M. Biomechanisches Modell des Menschen zu Analyse und
Beureilung der Belastung der Wirbelsaule bie der Handhabung von
Lasten in VDI Berlage, Vol. 33, Reihe 17 Boeechnik Nr. 1987.
39. Fyhrie DP, Schaffler MB. Failure mechanisms in human vertebral
cancellous bone. Bone 1994;15:105–109.
40. Gunning JL, Callaghan JP, McGill SM. Spinal posture and prior loading history modulate compressive strength and type of failure in the
spine: a biomechanical study using a porcine cervical spine model.
Clin Biomech (Bristol, Avon) 2001;16:471–480.
41. Kirkaldy-Willis WH. The three phases of the spectrum of degenerative diseases. In: Kirkaldy-Willis WH, ed. Managing low back pain.
New York: Churchill-Livingston, 1998.
42. Brinkmann P. Pathology of the vertebral column. Ergonomics
1985;28:77–80.
43. Moore RJ. The vertebral end-plate: what do we know? European
Spine J 2000;9:92–96.
44. Siddall PJ, Cousins MJ. Neurobiology of pain. Int Anesthesiol Clin
1997;35:1–26.
45. Brinkmann P, Biggermann M, Hilweg D. Fatigue fracture of human
lumbar vertebrae. Clin Biomech (Bristol, Avon) 1988;3:S1–S23.
46. Callaghan JP, McGill SM. Intervertebral disc herniation: studies on a
porcine model exposed to highly repetitive flexion/extension motion
with compressive force. Clin Biomech (Bristol, Avon) 2001;16:
28–37.
47. Holmes AD, Hukins DW, Freemont AJ. End-plate displacement during compression of lumbar vertebra-disc-vertebra segments and the
mechanism of failure. Spine 1993;18:128–135.
48. Begeman PC, Visarius H, Nolte LP, et al. Viscoelastic shear responses
of the cadaver and hybrid III lumbar response. In: Proceedings of the
38th Stapp Car Crash Conference; Ft. Lauderdale, FL; 1994.
49. Krypton P, Berlemen U, Visarino H, et al. Response of the lumbar
spine due to shear loading. In: Kang KH, ed. Injury prevention
through biomechanics. Wayne State University, Detroit, Michigan,
May 4–5
50. Vernon-Roberts B, Pirie CJ. Degenerative changes in the intervertebral discs of the lumbar spine and their sequelae. Rheumatol Rehabil
1977;16:13–21.
51. Vernon-Roberts B, Pirie CJ. Healing trabecular microfractures in the
bodies of lumbar vertebrae. Ann Rheum Dis 1973;32:406–412.
52. Kornberg M. MRI diagnosis of traumatic Schmorl’s node. A case
report. Spine 1988;13:934–935.
53. Adams MA, Hutton WC. Prolapsed intervertebral disc. A hyperflexion
injury 1981 Volvo Award in Basic Science. Spine 1982;7:184–191.
54. Punnett L, Fine LJ, Keyserling WM, et al. Back disorders and nonneutral trunk postures of automobile assembly workers. Scand J Work
Environ Health 1991;17:337–346.
55. Marras WS, Lavender SA, Leurgans SE, et al. Biomechanical risk
factors for occupationally related low back disorders. Ergonomics
1995;38:377–410.
56. Marras WS, Lavender SA, Leurgans SE, et al. 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. Spine 1993;18:617–628.
57. Jager M, Luttmann A, Laurig W. Lumbar load during one-hand bricklaying. Int J Industr Ergo 1991;8:261–277.
58. Yingling VR, McGill SM. Anterior shear of spinal motion segments.
Kinematics, kinetics, and resultant injuries observed in a porcine
model. Spine 1999;24:1882–1889.
59. Yingling VR, McGill SM. Mechanical properties and failure mechanics of the spine under posterior shear load: observations from a
porcine model. J Spinal Disord 1999;12:501–508.
60. Adams MA, Hutton WC. The relevance of torsion to the mechanical
derangement of the lumbar spine. Spine 1981;6:241–248.
61. Farfan HF, Cossette JW, Robertson GH, et al. The effects of torsion on
the lumbar intervertebral joints: the role of torsion in the production
of disc degeneration. J Bone Joint Surg [Am] 1970;52:468–497.
62. Adams MA, Hutton WC. Gradual disc prolapse. Spine 1985;10:
524–531.
63. Gordon SJ, Yang KH, Mayer PJ, et al. Mechanism of disc rupture. A
preliminary report. Spine 1991;16:450–456.
64. Snook SH, Webster BS, McGorry RW, et al. The reduction of chronic
nonspecific low back pain through the control of early morning lumbar flexion. A randomized controlled trial. Spine 1998;23:2601–2607.
65. Fathallah FA, Marras WS, Wright PL. Diurnal variation in trunk kinematics during a typical work shift. J Spinal Disord 1995;8:20–25.
66. Adams M, McNally D, Wagstaff J, et al. Abdominal stress concentrations in lumbar intervertebral discs following damage to the vertebral
bodies: a cause of disc failure. Eur Spine J 1993;1:214–221.
67. Chaffin DB, Andersson GBJ, Martin BJ. Occupational biomechanics.
New York: John Wiley and Sons, 1999.
68. National Institute for Occupational Safety and Health. Work practices
guide for manual lifting. Washington, DC: Department of Health and
Human Services, 1981.
69. Noyes FR, De Lucas JL, Torvik PJ . Biomechanics of ligament failure:
an analysis of strain-rate sensitivity and mechanisms of failure in primates. J. Bone Joint Surgery 1994;56A:236–253.
70. Fathallah FA, Marras WS, Parnianpour M. The role of complex,
simultaneous trunk motions in the risk of occupation-related low back
disorders. Spine 1998;23:1035–1042.
71. Heylings DJ. Supraspinous and interspinous ligaments of the human
lumbar spine. J Anat 1978;125:127–131.
72. Marras WS, Allread WG, Burr DL, et al. Prospective validation of a
low-back disorder risk model and assessment of ergonomic interventions associated with manual materials handling tasks [In Process
Citation]. Ergonomics 2000;43:1866–1886.
73. Marras WS, Fine LJ, Ferguson SA, et al. The effectiveness of commonly used lifting assessment methods to identify industrial jobs
associated with elevated risk of low-back disorders. Ergonomics
1999;42:229–245.
74. Adams M, Dolan P. Recent advances in lumbar spinal mechanics and
their clinical significance. Clin Biomech (Bristol, Avon) 1995;
10:3–19.
75. McGill SM, Norman RW. Effects of an anatomically detailed erector
spinae model on L4/L5 disc compression and shear. J Biomech 1987;
20:591–600.
76. Potvin JR, McGill SM, Norman RW. Trunk muscle and lumbar ligament contributions to dynamic lifts with varying degrees of trunk
flexion [see Comments]. Spine 1991;16:1099–1107.
77. McGill S, Seguin J, Bennett G. Passive stiffness of the lumbar torso
in flexion, extension, lateral bending, and axial rotation. Effect of belt
wearing and breath holding. Spine 1994;19:696–704.
196 /SECTION III/THE INJURED WORKER
78. Solomonow M, He Zhou B, Baratta RV, et al. Biexponential recovery
model of lumbar viscoelastic laxity and reflexive muscular activity
after prolonged cyclic loading. Clin Biomech (Bristol, Avon) 2000;
15:167–175.
79. Solomonow M, Zhou BH, Harris M, et al. The ligamento-muscular
stabilizing system of the spine. Spine 1998;23:2552–2562.
80. Stubbs M, Harris M, Solomonow M, et al. Ligamento-muscular protective reflex in the lumbar spine of the feline. J Electromyogr Kinesiol 1998;8:197–204.
81. Wang JL, P arnianpour M, Shirazi-Adl A, et al. Viscoelastic finite-element analysis of a lumbar motion segment in combined compression
and sagittal flexion. Effect of loading rate. Spine 2000;25:310–18.
82. Gedalia U, Solomonow M, Zhou BH, et al. Biomechanics of
increased exposure to lumbar injury caused by cyclic loading. Part 2.
Recovery of reflexive muscular stability with rest. Spine 1999;24:
2461–2467.
83. Solomonow M, Zhou B, Baratta RV, et al. Neuromuscular disorders
associated with static lumbar flexion: a feline model. J Electromyogr
Kinesiol 2002;12:81–90.
84. Solomonow M, Zhou BH, Baratta RV, et al. Biomechanics of
increased exposure to lumbar injury caused by cyclic loading: Part 1.
Loss of reflexive muscular stabilization. Spine 1999;24:2426–2434.
85. McGill S. Low back disorder. Champaign, Illinois: Human Kinetics,
2002.
86. Cripton P, Berlemen U, Visarino H, et al. Response of the lumbar
spine due to shear loading in injury prevention through biomechanics.
Yang KH, ed. At the proceedings of Injury Prevention through Biomechanics, Wayne State University, Detroit, Michigan, May 4–5,
1995.
87. Marras WS, Granata KP. Changes in trunk dynamics and spine loading during repeated trunk exertions. Spine 1997;22:2564–2570.
88. McGill SM. Electromyographic activity of the abdominal and low
back musculature during the generation of isometric and dynamic
axial trunk torque: implications for lumbar mechanics. J Orthop Res
1991;9:91–103.
89. Marras WS, Granata KP. A biomechanical assessment and model of
axial twisting in the thoracolumbar spine. Spine 1995;20:1440–1451.
90. Pope MH, Andersson GB, Broman H, et al. Electromyographic studies of the lumbar trunk musculature during the development of axial
torques. J Orthop Res 1986;4:288–297.
91. Pope MH, Svensson M, Andersson GB, et al. The role of prerotation
of the trunk in axial twisting efforts. Spine 1987;12:1041–1045.
92. Carter DR. Biomechanics of bone. In: Nahum HM, Melvin J, eds. Biomechanics of trauma. Norwalk, CT: Appleton Century Crofts, 1985.
93. Woo SL-Y, Gomez MA, Akeson WH. Mechanical behaviors of soft
tissues: measurements, modifications, injuries, and treatment. In:
Nahum HM, Melvin J, eds. Biomechanics of trauma. Norwalk, CT:
Appleton Century Crofts, 1985.
94. Porter RW, Adams MA, Hutton WC. Ph ysical acti vity and the strength
of the lumbar spine. Spine 1989;14:201–203.
95. Brinkmann P, Biggermann M, Hilweg D. Prediction of the compressive strength of human lumbar vertebrae. Clin Biomech (Bristol,
Avon) 1989;4:S1–S27.
96. Videman T, Nurminen M, Troup JD. 1990 Volvo Award in clinical sciences. Lumbar spinal pathology in cadaveric material in relation to
history of back pain, occupation, and physical loading. Spine 1990;
15:728–740.
97. Chaffin DB, Park KS. A longitudinal study of low-back pain as associated with occupational weight lifting factors. Am Ind Hyg Assoc J
1973;34:513–525.
98. Ciriello VM, Snook SH, Blick AC, et al. The effects of task duration
on psychophysically-determined maximum acceptable weights and
forces. Ergonomics 1990;33:187–200.
99. Snook SH. The design of manual handling tasks. Ergonomics 1978;
21:963–985.
100. Snook SH. Psychophysical considerations in permissible loads.
Ergonomics 1985;28:327–330.
101. Snook SH. Psychophysical acceptability as a constraint in manual
working capacity. Ergonomics 1985;28:331–335.
102. Snook SH. Approaches to preplacement testing and selection of
workers. Ergonomics 1987;30:241–247.
103. Snook SH, Ciriello VM. The design of manual handling tasks: revised
tables of maximum acceptable weights and forces. Ergonomics 1991;
34:1197–1213.
104. Waters TR, Putz-Anderson V, Garg A. Applications manual for the
revised NIOSH lifting equation. Cincinnati: National Institute for
Occupational Safety and Health, 1994.
105. Cady LD, Bischoff DP, O’Connell ER, et al. Strength and fitness and
subsequent back injuries in firefighters. J Occup Med 1979;21:
269–272.
106. Cady LD, Jr., Thomas PC, Karwasky RJ. Program for increasing
health and physical fitness of f ire fighters. J Occup Med 1985;27:
110–114.
107. Burton AK, Tillotson KM, Main CJ, et al. Psychosocial predictors of
outcome in acute and subchronic low back trouble. Spine 1995;20:
722–728.
108. Marras WS, Davis KG, Heane y CA, et al. The influence of psychosocial stress, gender, and personality on mechanical loading of the lumbar spine. Spine 2000;25:3045–3054.
109. Davis K, Marras WS, Heaney CA, et al. The impact of mental processing and pacing on spine loading. Spine 2002 (in press).
110. Chaffin DB, Herrin GD, Keyserling WM, et al. A method for evaluating the biomechanical stresses resulting from manual materials handling jobs. Am Ind Hyg Assoc J 1977;38:662–675.
111. Chaffin DB, Baker WH. A biomechanical model for analysis of symmetric sagittal plane lifting. AIIE Transactions 1970;2:16–27.
112. Herrin GD, Jaraiedi M, Anderson CK. Prediction of overexertion
injuries using biomechanical and psychophysical models. Am Ind
Hyg Assoc J 1986;47:322–330.
113. Schultz AB, Andersson GB. Analysis of loads on the lumbar spine.
Spine 1981;6:76–82.
114. Hughes RE, Chaffin DB. The effect of strict muscle stress limits on
abdominal muscle force predictions for combined torsion and extension loadings. J Biomech 1995;28:527–533.
115. Schultz A, Andersson GB, Ortengren R, et al. Analysis and quantitative myoelectric measurements of loads on the lumbar spine when
holding weights in standing postures. Spine 1982;7:390–397.
116. Bean JC, Chaffin DB, Schultz AB. Biomechanical model calculation
of muscle contraction forces: a double linear programming method. J
Biomech 1988;21:59–66.
117. Marras WS, King AI, Joynt RL. Measurement of loads on the lumbar
spine under isometric and isokinetic conditions. Spine 1984;9:176–187.
118. Marras WS, Davis KG. Spine loading during asymmetric lifting using
one versus two hands. Ergonomics 1998;41:817–834.
119. Granata KP, Marras WS. An EMG-assisted model of trunk loading
during free-dynamic lifting. J Biomech 1995;28:1309–1317.
120. Granata KP, Marras WS. An EMG-assisted model of loads on the
lumbar spine during asymmetric trunk extensions. J Biomech 1993;
26:1429–1438.
121. Granata KP, Marras WS. Relation between spinal load factors and the
high-risk probability of occupational low-back disorder. Ergonomics
1999;42:1187–1199.
122. Marras WS, Davis KG, Granata KP. Trunk muscle activities during
asymmetric twisting motions. J Electromyo gr Kinesiol 1998;8:247–256.
123. Marras WS, Davis KG, Splittstoesser RE. Spine loading during w hole
body free dynamic lifting. Columbus, Ohio: The Ohio State University Press, 2001.
124. Marras WS, Granata KP. Spine loading during trunk lateral bending
motions. J Biomech 1997;30:697–703.
125. Marras WS, Granata KP. The development of an EMG-assisted model
to assess spine loading during whole-body free-dynamic lifting. J
Electromyogr Kinesiol 1997;7:259–268.
126. Marras WS, Sommerich CM. A three-dimensional motion model of
loads on the lumbar spine: I. Model structure. Hum Factors 1991;33:
123–137.
127. Marras WS, Sommerich CM. A three-dimensional motion model of
loads on the lumbar spine: II. Model validation. Hum Factors 1991;
33:139–149.
128. McGill SM. The influence of lordosis on axial trunk torque and trunk
muscle myoelectric activity. Spine 1992;17:1187–1193.
129. McGill SM. A myoelectrically based dynamic three-dimensional
model to predict loads on lumbar spine tissues during lateral bending.
J Biomech 1992;25:395–414.
130. Marras WS, Davis KG, Jorgensen MJ. Spine loading and gender.
Spine 2002 (in press).
131. Marras WS, Davis KG, Ferguson SA, et al. Spine loading characteristics of patients with low back pain compared with asymptomatic
individuals. Spine 2001;26:2566–2574.
CHAPTER 17/OCCUPATIONAL ERGONOMICS / 197
132. Mirka GA, Marras WS. A stochastic model of trunk muscle coactivation during trunk bending. Spine 1993;18:1396–1409.
133. Granata KP, Marras WS, Davis KG. Variation in spinal load and trunk
dynamics during repeated lifting exertions. Clin Biomech (Bristol,
Avon) 1999;14:367–375.
134. Marras WS, Granta KP, Davis KG. Variability in spine loading model
performance. Clin Biomech (Bristol, Avon) 1999;14:505–514.
135. Granata KP, Marras WS. The influence of trunk muscle coactivity on
dynamic spinal loads. Spine 1995;20:913–919.
136. Davis KG, Marras WS. Assessment of the relationship between box
weight and trunk kinematics: does a reduction in box weight necessarily correspond to a decrease in spinal loading? [In Process Citation]. Hum Factors 2000;42:195–208.
137. Davis KG, Marras WS, Waters TR. Reduction of spinal loading
through the use of handles. Ergonomics 1998;41:1155–1168.
138. Davis KG, Marras WS, Waters TR. The e v aluation of spinal loads during lowering and lifting. Clin Biomech (Bristol, Avon) 1998;13:
141–152.
139. Marras WS, Granata KP, Davis KG, et al. Effects of box features on
spine loading during warehouse order selecting. Ergonomics 1999;42:
980–996.
140. Ferguson SA, Gaudes-MacLaren LL, Marras WS, et al. Spinal loading when lifting from industrial storage bins. Ergonomics 2002;45:
399–414.
141. Marras WS, Davis KG, Kirking BC, et al. Spine loading and trunk
kinematics during team lifting. Ergonomics 1999;42:1258–1273.
142. Marras WS, Davis KG, Kirking BC, et al. A comprehensive analysis
of low-back disorder risk and spinal loading during the transferring
and repositioning of patients using different techniques. Ergonomics
1999;42:904–926.
143. McGill SM, Norman RW, Sharratt MT. The effect of an abdominal
belt on trunk muscle activity and intra-abdominal pressure during
squat lifts. Ergonomics 1990;33:147–160.
144. Marras WS, Jorgensen MJ, Davis KG. Effect of foot movement and
an elastic lumbar back support on spinal loading during free-dynamic
symmetric and asymmetric lifting exertions. Ergonomics 2000;43:
653–668.
145. Jorgensen MJ, Marras WS. The effect of lumbar back support tension
on trunk muscle activity. Clin Biomech (Bristol, Avon) 2000;15:
292–294.
146. Granata KP, Marras WS, Davis KG. Biomechanical assessment of
lifting dynamics, muscle activity and spinal loads while using three
different styles of lifting belt. Clin Biomech (Bristol, Avon) 1997;12:
107–115.
147. Marras WS, Granata KP, Davis KG, et al. Low back disorder risk and
spine loading during the use of lifting assistance devices (LADs).
Columbus, Ohio: The Ohio State University, 1996.
148. McGill SM, Norman RW, Cholewicki J . A simple pol ynomial that predicts low-back compression during complex 3-D tasks. Ergonomics
1996;39:1107–1118.
149. F athallah FA, Marras WS, Parnianpour M. Regression models for predicting peak and continuous three-dimensional spinal loads during
symmetric and asymmetric lifting tasks. Hum Factors 1999;41:
373–388.
150. Cholewicki J, McGill S. Mechanical stability of the in vivo lumbar
spine: implications of injury and chronic low back pain. Clin Biomech (Bristol, Avon) 1996;11:1–15.
151. Cholewicki J, VanVliet IJ. Relative contribution of trunk muscles to
the stability of the lumbar spine during isometric exertions. Clin Biomech (Bristol, Avon) 2002;17:99–105.
152. Cholewicki J, Simons AP, Radebold A. Effects of external trunk loads
on lumbar spine stability. J Biomech 2000;33:1377–1385.
153. Granata KP, Marras WS. Cost-benefit of muscle cocontraction in protecting against spinal instability [In Process Citation]. Spine 2000;25:
1398–1404.
154. Granata KP, Orishimo KF. Response of trunk muscle coactivation to
changes in spinal stability. J Biomech 2001;34:1117–1123.
155. Granata KP, Wilson SE. Trunk posture and spinal stability. Clin Biomech (Bristol, Avon) 2001;16:650–659.
156. Panjabi MM. The stabilizing system of the spine. P art II. Neutral zone
and instability hypothesis. J Spinal Disord 1992;5:390–396; discussion 397.
157. Panjabi MM. The stabilizing system of the spine. Part I. Function,
dysfunction, adaptation, and enhancement. J Spinal Disord 1992;5:
383–389; discussion 397.
158. Cholewicki J, Polzhofer GK, Radebold A. Postural control of trunk
during unstable sitting. J Biomech 2000;33:1733–1737.
159. Granata KP, Orishimo KF, Sanford AH. Trunk muscle coactivation
in preparation for sudden load. J Electromyogr Kinesiol 2001;11:
247–254.
160. Ayoub MM, Bethea NJ, Deivanayagam S, et al. Determination and
modeling of lifting capacity. Lubbock, TX: Texas Tech University,
1978.
161. Liles DH, Deiv ana yagam S, Ayoub MM, et al. A job severity index for
the evaluation and control of lifting injury. Hum Factors 1984;26:
683–693.
162. Waters TR, Putz-Anderson V, Garg A, et al. Revised NIOSH equation
for the design and evaluation of manual lifting tasks. Ergonomics
1993;36:749–776.
163. Government Accounting Office. Worker protection: private sector
ergonomics programs yield positive results. Washington DC, 1997.
164. Occupational Safety and Health Administration. Ergonomics pro gram
management guidelines for meatpacking plants. W ashington DC, U.S.
Department of Labor, 1993.
SECTION IV
Surgery
CHAPTER 18
Preparation for Surgery
Orso L. Osti, Simon Macklin, and Hiroaki Nakamura
PREOPERA TIVE ASSESSMENT
Significant changes have occurred over the last 30 years
in the way patients are counseled before surgery. It is
paramount that plainly written information on the relevant surgical procedure, containing appropriate illustrations, be available to patients before surgery. Audiovisual equipment can be used; however, in view of the
emotional implications of surgical intervention for pain,
a face-to-face preoperative discussion between the surgeon and patient is advised. The surgeon needs to ensure that all appropriate imaging is available at the time
of the surgery and that a recent body pain drawing is
available to confir m the site and pattern of distribution
of preoperative symptoms. Obtaining informed written
consent, which should include financial details of the
surgery, is mandatory before the operation. The consent
form should be signed by the surgeon and patient at the
same time and, preferably, within days of the operation.
Consent should be obtained immediately before scheduling the patient for surgery and one should reappraise
the consent form with the patient on the day of the operation.
PREANESTHETIC ASSESSMENT
A detailed preanesthetic assessment is an essential prerequisite to safe anesthetic practice. It offers the anesthetist the opportunity to identify the presence of comorbid medical conditions, arrange for optimization of those
conditions if required, identify other confounding factors
(e.g., difficult venous access or airway), discuss options
for preoperative medication and postoperative analgesia,
and obtain informed consent for the anesthetic. It is
important to discuss the possible requirement for blood
transfusion at this point and explore potential strategies
for blood conservation. This may be particularly relevant
in those with a religious objection to the use of homologous blood products.
A number of specific questions should be considered:
Is there a previous anesthetic history? If so, were there
any complications? Are there cardiac, respiratory, or
endocrine comorbidities? Is airway management expected to be difficult?
Most institutions have guidelines for appropriate preoperative investigations based on the patient’s age and
comorbidities. Table 18-1 shows the guidelines currently
in use at the Royal Adelaide Hospital.
PREOPERATIVE MEDICATIONS
With few exceptions, therapeutic drugs taken for concurrent diseases should be continued up to the time of
surgery (1). The notable exceptions to this rule are:
aspirin and other nonselective nonsteroidal antiinflammatory drugs (NSAIDS), hypoglycemic agents, and monoamine oxidase inhibitors. Aspirin and nonselective
NSAIDS (which act on both cyclooxygenase 1 and 2
enzymes) should be discontinued for 7 to 10 days before
surgery to allow recovery of platelet aggregation. The
newer cyclooxygenase 2 inhibitors (e.g., rofecoxib and
celecoxib) are free from platelet aggregation inhibition
and can be continued up to the time of surgery without a
risk of increased bleeding because of platelet dysfunction.
A range of new specific platelet aggregation inhibitors,
clopidogrel (Iscover [Bristol-Myers Squibb Pharmaceuticals, Australia] and Plavix [Sanovi-Synthelabs,
Australia]) or ticlopidine (Ticlid [Roche Products,
Australia]), recently have been introduced for use in
patients with acute coronary syndrome or for use in
thromboembolic prophylaxis. These should be stopped at
least 5 days prior to surgery to prevent excess bleeding
owing to platelet dysfunction.
Monoamine oxidase inhibitors are associated with a
high incidence of CNS side effects if piperidine-based
opioids are used for analgesia. These side effects may be
201
202 /SECTION IV/SURGERY
TABLE 18-1. The current guidelines for preoperative investigations in use at the Royal Adelaide Hospital
Investigations Clinical Indications
Electrocardiogram Men aged 45 years and over
(ECG)
a
Women aged 50 years and over
Hypertension
Current or past significant cardiac
disease
Current or past significant
circulatory disease
Current or past significant
pulmonary disease
Diabetes mellitus; person aged 35
years and over
Renal disease
Thyroid or other metabolic disease
Morbid obesity
Sleep apnea
History of alcoholism
Cardiac drug therapy
Radiation or chemotherapy
Other clinical indications
Chest x-ray (CXR)
b
Current or past significant
pulmonary disease
Asthma or COAD that is debilitating
or with a change of symptoms
Ongoing pulmonary infection
(productive cough with colored
sputum or a change in nature of
sputum)
Cardiovascular disease
Current or past significant
disease, or
A change in symptoms
Cardiothoracic procedure since
last CXR
Cardiac pacemaker or implanted
defibrillator
Thyroidectomy for information on
trachea
Malignancy
Sleep apnea
Radiation or chemotherapy
Other clinical indications
Compete blood Aged 65 years or over and when
examination clinically indicated
c,d
(CBE)
Surgery with a potential for
significant blood loss
Recent history of blood loss or
donation
Known anemias
Bleeding disorders
Anticoagulation therapy
Malignancy, including hematologic
Radiation or chemotherapy
Renal disease
(continued)
a
An ECG is valid for 6 months unless there has been a change in symptoms or clinically indicated.
b
If a CXR is clinically indicated, obtain a CXR if none was obtained in the last year or if symptoms
have changed since the last CXR.
c
A hemoglobin level +/− platelet count my suffice in the majority of cases.
d
A CBE is valid 6 months unless clinically indicated.
e
Valid for 6 months if last set of results is normal unless clinically indicated.
f
g
Specify tests required (i.e., spirometry, blood gases, or carbon monoxide diffusion factor)
h
Valid for 1 year unless clinically indicated.
i
Valid for 1 year unless symptoms have changed or clinically indicated.
Investigations Clinical Indications
CBE, continued Histor y of alcoholism
Severe chronic disease
History of current infection
Other clinical indications (e.g.,
platelet count for regional
anesthesia)
Biochemistry (Urea Aged 65 years or over and when
and electrolytes)
e
clinically indicated
Renal disease
Diabetes mellitus
Cardiovascular disease
Hypertension
Adrenal and other endocrine
disease
Liver disease
Cardiac drugs
Diuretics
Steroids
Chemotherapy
Fluid and electrolyte abnormality
(e.g., diarrhea, malabsorption,
or bowel preparation)
Other clinical indications
Liver function tests
f
Pancreatic disease
Bleeding disorder
History of or exposure to hepatitis
Human immunodeficiency virus or
acquired immunodeficiency
syndrome
History of alcoholism
Chemotherapy
Other clinical indications
Lung function tests
g,h
History of lung disease, dyspnea,
or orthopnea and
Need to determine degree of
Determine baseline condition,
Cardiothoracic procedure
Significant skeletal abnormality
(e.g., kyphoscoliosis)
Morbid obesity
Other clinical indications
Echocardiogram Previously uninvestigated or
(ECHO)
i
undocumented heart murmur
Severe cardiac disease or
symptoms of severe dyspnea
or unstable angina where an
assessment of left ventricular
function is valuable
reversibility or
in anticipation of
postoperative ventilation