BACKGROUND The Centers for Disease Control defines work-related musculoskeletal disorders as disorders of the nerves, muscles, tendons, joints, spinal discs, and cartilage that are caused or exacerbated by the environment or nature of work. Previous meta-analyses have characterized work-related musculoskeletal disorders among interventionists, general surgeons, and other surgical subspecialties, but prevalence estimates, prognosis, and ergonomic considerations vary by study and surgical specialty. QUESTIONS/PURPOSES (1) What is the career prevalence of work-related musculoskeletal disorders in orthopaedic surgeons? (2) What is the treatment prevalence associated with work-related musculoskeletal disorders in orthopaedic surgeons? (3) What is the disability burden of work-related musculoskeletal disorders in orthopaedic surgeons? (4) What is the scope of orthopaedic surgical ergonomic assessments and interventions? METHODS A systematic review of English-language studies from PubMed, MEDLINE, Embase, and Scopus was performed in December 2022 and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that presented prevalence estimates of work-related musculoskeletal disorders or assessed surgical ergonomics in orthopaedic surgery were included. Reviews, case reports, gray literature (conference abstracts and preprints), and studies with mixed-surgeon (nonorthopaedic) populations were excluded. The search yielded 5603 abstracts; 24 survey-based studies with 4876 orthopaedic surgeons (mean age 48 years; 79% of surgeons were men) were included for an analysis of work-related musculoskeletal disorders, and 18 articles were included for a descriptive synthesis of ergonomic assessment. Quality assessment using the Joanna Briggs Institute Tool revealed that studies had a low to moderate risk of bias, largely because of self-reporting survey-based methodology. Because of considerable heterogeneity and risk of bias, prevalence outcomes were not pooled and instead are presented as ranges (mean I2 = 91.3%). RESULTS The career prevalence of work-related musculoskeletal disorders in orthopaedic surgeons ranged from 37% to 97%. By anatomic location, the prevalence of work-related musculoskeletal disorders in the head and neck ranged from 4% to 74%; back ranged from 9% to 77%; forearm, wrist, and hand ranged from 12% to 54%; elbow ranged from 3% to 28%; shoulder ranged from 3% to 34%; hip and thigh ranged from 1% to 10%; knee and lower leg ranged from 1% to 31%; and foot and ankle ranged from 4% to 25%. Of orthopaedic surgeons reporting work-related musculoskeletal disorders, 9% to 33% had a leave of absence, practice restriction or modification, or early retirement, and 27% to 83% received some form of treatment. Orthopaedic surgeons experienced biomechanical, cardiovascular, neuromuscular, and metabolic stress during procedures. Interventions to improve orthopaedic surgical ergonomics have been limited, but have included robotic assistance, proper visualization aids, appropriate use of power tools, and safely minimizing lead apron use. In hip and knee arthroplasty, robotic assistance was the most effective in improving posture and reducing caloric expenditure. In spine surgery, proper use of surgical loupes was the most effective in improving posture. CONCLUSION Although the reported ranges of our main findings were wide, even on the low end of the reported ranges, work-related musculoskeletal disability among orthopaedic surgeons appears to be a substantial concern. We recommend that orthopaedic residency training programs incorporate surgical ergonomics or work injury lectures, workshops, and film review (alongside existing film review of surgical skills) into their curricula. We suggest hospitals engage in shared decision-making with surgeons through anonymous needs assessment surveys to implement wellness programs specific to surgeons' musculoskeletal needs. We urge institutions to assess surgeon ergonomics during routine quality assessment of novel surgical instruments and workflows. LEVEL OF EVIDENCE Level III, prognostic study.

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与工作相关的肌肉骨骼疾病的高患病率和骨科手术中基于证据的有限人体工程学：系统评价。

背景技术疾病控制中心将与工作相关的肌肉骨骼疾病定义为由环境或工作性质引起或加剧的神经、肌肉、肌腱、关节、椎间盘和软骨的疾病。以前的荟萃分析已经描述了介入医生、普通外科医生和其他外科亚专业中与工作相关的肌肉骨骼疾病的特征，但患病率估计、预后和人体工程学考虑因素因研究和外科专业而异。问题/目的 (1) 骨科医生中与工作相关的肌肉骨骼疾病的职业患病率是多少？(2) 骨科医生中与工作相关的肌肉骨骼疾病相关的治疗率是多少？(3) 骨科医生因工作相关的肌肉骨骼疾病造成的残疾负担是什么？(4) 骨科手术人体工程学评估和干预的范围是什么？方法 2022 年 12 月对 PubMed、MEDLINE、Embase 和 Scopus 的英语研究进行了系统评价，并根据系统评价和荟萃分析指南的首选报告项目进行了报告。包括对与工作相关的肌肉骨骼疾病的患病率进行估计或评估骨科手术中的手术人体工程学的研究。评论、病例报告、灰色文献（会议摘要和预印本）以及混合外科医生（非骨科）人群的研究被排除在外。检索产生 5603 条摘要；纳入了 24 项基于调查的研究，涉及 4876 名骨科医生（平均年龄 48 岁；79% 的外科医生是男性），用于分析与工作相关的肌肉骨骼疾病，并纳入 18 篇文章用于人体工程学评估的描述性综合。使用乔安娜·布里格斯研究所工具进行的质量评估显示，研究存在低至中等偏倚风险，这主要是由于基于自我报告的调查方法。由于相当大的异质性和偏倚风险，患病率结果并未汇总，而是以范围形式呈现（平均 I2 = 91.3%）。结果 骨科医生职业中与工作相关的肌肉骨骼疾病患病率为 37% 至 97%。按解剖部位划分，头颈部与工作相关的肌肉骨骼疾病的患病率在 4% 至 74% 之间；回报率从 9% 到 77% 不等；前臂、手腕和手的比例从 12% 到 54% 不等；肘部范围从3%到28%；肩部范围从3%到34%；臀部和大腿范围为1%至10%；膝盖和小腿范围从 1% 到 31%；足部和脚踝的比例从 4% 到 25% 不等。在报告与工作相关的肌肉骨骼疾病的骨科医生中，9% 至 33% 的人曾请假、执业限制或调整或提前退休，27% 至 83% 的人接受了某种形式的治疗。骨科医生在手术过程中会经历生物力学、心血管、神经肌肉和代谢压力。改善骨科手术人体工程学的干预措施有限，但包括机器人辅助、适当的可视化辅助、适当使用电动工具以及安全地减少铅围裙的使用。在髋关节和膝关节置换术中，机器人辅助在改善姿势和减少热量消耗方面最有效。在脊柱手术中，正确使用手术放大镜对于改善姿势最有效。结论 尽管我们主要发现的报告范围很宽，即使是在报告范围的低端，但骨科医生中与工作相关的肌肉骨骼残疾似乎是一个重大问题。我们建议骨科住院医师培训计划将手术人体工程学或工伤讲座、研讨会和影片回顾（以及现有的手术技能影片回顾）纳入其课程中。我们建议医院通过匿名需求评估调查与外科医生共同决策，以实施针对外科医生肌肉骨骼需求的健康计划。我们敦促各机构在新型手术器械和工作流程的常规质量评估过程中评估外科医生的人体工程学。证据级别 III 级，预后研究。