PDF(Pubmed)
Abstract：
UNASSIGNED: Evaluate ergonomic differences of various modalities for performing middle ear surgery.
UNASSIGNED: Observational study.
UNASSIGNED: Two academic tertiary care centers.
UNASSIGNED: Attending physicians and residents performing middle ear surgery were photographed intraoperatively. Intraoperative photographs were analyzed using the validated Rapid Upper Limb Assessment (RULA) tool to measure musculoskeletal disease (MSD) risk. Descriptive statistics and significance testing were used to characterize and compare ergonomic differences between surgical modalities. Multivariable ordinal regression was performed to assess factors associated with increased MSD risk, as determined by the final RULA score.
UNASSIGNED: Most of our 110 intraoperative photos featured attendings (82.7%) performing combined middle ear surgery and mastoidectomy (60.0%). Body angles and the final RULA score varied significantly among modalities. On subset analysis, microscopic surgery exhibited significantly worse wrist, trunk, and neck angles compared to endoscopic and exoscopic surgery. Exoscopic surgery had significantly lower final RULA scores than both endoscopic and microscopic surgery, indicating significantly lower MSD risk. Microscopic and endoscopic surgery final scores did not vary significantly. In a multivariable ordinal regression of factors associated with increased RULA score, exoscopic surgery had statistically significantly less ergonomic risk relative to microscopic surgery (odds ratio = 0.12, 95% confidence interval = [0.03-0.43]).
UNASSIGNED: Exoscopic, endoscopic, and microscopic surgery all featured low ergonomic risk, although exoscopic middle ear surgery demonstrated the lowest risk profile among studied surgical modalities. This demonstrates the importance of using each modality in combination with other ergonomic interventions to provide meaningful musculoskeletal benefits.
UNASSIGNED: Observational study.
UNASSIGNED: Two academic tertiary care centers.
UNASSIGNED: Attending physicians and residents performing middle ear surgery were photographed intraoperatively. Intraoperative photographs were analyzed using the validated Rapid Upper Limb Assessment (RULA) tool to measure musculoskeletal disease (MSD) risk. Descriptive statistics and significance testing were used to characterize and compare ergonomic differences between surgical modalities. Multivariable ordinal regression was performed to assess factors associated with increased MSD risk, as determined by the final RULA score.
UNASSIGNED: Most of our 110 intraoperative photos featured attendings (82.7%) performing combined middle ear surgery and mastoidectomy (60.0%). Body angles and the final RULA score varied significantly among modalities. On subset analysis, microscopic surgery exhibited significantly worse wrist, trunk, and neck angles compared to endoscopic and exoscopic surgery. Exoscopic surgery had significantly lower final RULA scores than both endoscopic and microscopic surgery, indicating significantly lower MSD risk. Microscopic and endoscopic surgery final scores did not vary significantly. In a multivariable ordinal regression of factors associated with increased RULA score, exoscopic surgery had statistically significantly less ergonomic risk relative to microscopic surgery (odds ratio = 0.12, 95% confidence interval = [0.03-0.43]).
UNASSIGNED: Exoscopic, endoscopic, and microscopic surgery all featured low ergonomic risk, although exoscopic middle ear surgery demonstrated the lowest risk profile among studied surgical modalities. This demonstrates the importance of using each modality in combination with other ergonomic interventions to provide meaningful musculoskeletal benefits.
摘要：
■评估进行中耳手术的各种方式的人体工程学差异。
■观察性研究。
■两个学术三级护理中心。
■进行中耳手术的主治医师和住院医师在术中拍照。使用经过验证的快速上肢评估（RULA）工具分析术中照片，以测量肌肉骨骼疾病（MSD）风险。描述性统计和显著性测试用于表征和比较手术方式之间的人体工程学差异。进行多变量有序回归以评估与MSD风险增加相关的因素，由最终RULA得分决定。
■我们的110张手术照片中，大多数患者（82.7％）进行了中耳手术和乳突切除术（60.0％）。身体角度和最终RULA得分在不同模式之间差异很大。关于子集分析，显微手术表现出明显更差的手腕，树干,和颈部角度相比，内窥镜和腹腔镜手术。内镜手术的最终RULA评分明显低于内镜手术和显微镜手术，表明MSD风险显著降低。显微镜和内窥镜手术的最终评分没有显着变化。在与RULA评分增加相关因素的多变量有序回归中，与显微手术相比,腹腔镜手术的人体工程学风险显著降低(比值比=0.12,95%置信区间=[0.03-0.43]).
■异形，内窥镜,和显微手术都具有低人体工程学风险，尽管在所研究的手术方式中，腹腔镜中耳手术的风险最低。这证明了将每种方式与其他人体工程学干预措施结合使用以提供有意义的肌肉骨骼益处的重要性。
■观察性研究。
■两个学术三级护理中心。
■进行中耳手术的主治医师和住院医师在术中拍照。使用经过验证的快速上肢评估（RULA）工具分析术中照片，以测量肌肉骨骼疾病（MSD）风险。描述性统计和显著性测试用于表征和比较手术方式之间的人体工程学差异。进行多变量有序回归以评估与MSD风险增加相关的因素，由最终RULA得分决定。
■我们的110张手术照片中，大多数患者（82.7％）进行了中耳手术和乳突切除术（60.0％）。身体角度和最终RULA得分在不同模式之间差异很大。关于子集分析，显微手术表现出明显更差的手腕，树干,和颈部角度相比，内窥镜和腹腔镜手术。内镜手术的最终RULA评分明显低于内镜手术和显微镜手术，表明MSD风险显著降低。显微镜和内窥镜手术的最终评分没有显着变化。在与RULA评分增加相关因素的多变量有序回归中，与显微手术相比,腹腔镜手术的人体工程学风险显著降低(比值比=0.12,95%置信区间=[0.03-0.43]).
■异形，内窥镜,和显微手术都具有低人体工程学风险，尽管在所研究的手术方式中，腹腔镜中耳手术的风险最低。这证明了将每种方式与其他人体工程学干预措施结合使用以提供有意义的肌肉骨骼益处的重要性。
