调查在职钢铁工人群体膝关节骨关节炎（KOA）的流行情况，及其与膝关节影像学表现、代谢性疾病、生活习惯、职业劳动习惯等因素的相关关系，为我国产业工人运动系统职业病早防早治提供理论依据。

本研究为横断面调查，对首钢股份公司迁安钢铁公司在职职工进行了膝关节影像学检查与基本的体格检查，测量股胫角（FTA）、胫骨近端内侧角（MPTA）、胫骨平台后倾角（PTSA）共4项膝关节力线数据，以问卷调查形式采集其病史、生活习惯、职业劳动习惯等信息并进行WOMAC评分，根据影像学是否表现KOA征象、根据问卷的自我报告可否诊断为KOA、结合客观指标可否诊断为KOA对上述人群进行KOA筛查，并以此为因变量进行Logistic回归分析等统计，分析所纳入研究要素与其是否被诊断为KOA之间的关系。

调查共纳入615名受访者的1230个膝关节。受访者以男性为主（534例，86.83%），平均年龄为（41.36±6.93）岁。自我报告诊断KOA者46例（7.48%），结合客观指标诊断KOA者65例（10.57%），受访者至少有一个膝关节被发现影像学KOA征象的受访者有480例（78.05%，其中单膝发现者35例、5.69%，双膝发现者445例、72.36%），累及膝关节共计925个（75.20%）。对所纳入的变量进行统计分析，从业时间、骨关节炎家族史、糖尿病、冠心病、重度体力活动、长距离步行/上下楼梯/久站/久坐的劳动习惯与根据问卷的自我报告诊断KOA相关，年龄、从业时间、骨关节炎家族史、糖尿病、高脂血症、冠心病、久坐的劳动习惯与结合客观指标诊断KOA相关，年龄、糖尿病、心律失常、高尿酸血症和/或痛风、弯腰的劳动习惯与影像学发现KOA征象相关。在症状与功能方面，影像学发现KOA征象或诊断为KOA者，WOMAC评分显著升高。在影像学测量指标方面，影像学是否发现KOA征象或根据问卷的自我报告诊断能否为KOA，所测诸角度均差异无统计学意义，而结合客观指标诊断为KOA者的PTSA角度显著增大。

在职钢铁工人KOA患病率与影像学表现KOA征象者比例较高。年龄、从业时间、骨关节炎家族史、部分代谢性疾病及部分劳动习惯可能是KOA发生的危险因素。

To investigate the prevalence of knee osteoarthritis (KOA) in active steel workers and its correlation with factors such as knee imaging, metabolic diseases, lifestyle, and occupational work habits, in order to provide a theoretical basis for the early prevention and treatment of occupational musculoskeletal diseases among industrial workers in China.

This study was a cross-sectional survey. Knee joint imaging examinations and basic physical examinations were conducted on the on-the-job employees of Qian’an Iron and Steel Company of Shougang Co., LTD. Knee joint force line data such as femoral-tibial angle (FTA), medial proximal tibial angle (MPTA), and posterior tibial plateau angle (PTSA) were measured. The information such as medical history, living habits, and occupational labor habits was collected in the form of questionnaires, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were calculated. KOA screening was carried out for the above-mentioned population based on signs present on imaging, the self-report questionnaire, and objective indicators. Logistic regression analysis and other statistics were conducted to analyze the relationship between the included variables and KOA.

A total of 1230 knees from 615 respondents were included in the survey. Respondents were predominantly male (534 cases, 86.83%) with a mean age of (41.36±6.93) years. There were 925 knees (75.20%) with radiographic evidence of KOA, and 480 respondents (78.05%, including 35 cases or 5.69% with evidence in one knee and 445 cases or 72.36% with evidence in both knees) had at least one knee with radiographic evidence of KOA. There were 46 cases (7.48%) with a self-reported diagnosis of KOA based on the questionnaire, and 65 cases (10.57%) with a diagnosis of KOA based on objective indicators. Statistical analysis of the included variables showed that age, diabetes, arrhythmia, hyperuricemia and/or gout, and bending at work were associated with radiographic signs of KOA. Age, years of employment, family history of osteoarthritis, diabetes, hyperlipidemia, coronary heart disease, sedentary work habits, and objective indicators were associated with the diagnosis of KOA, whereas years of employment, family history of osteoarthritis, diabetes, coronary heart disease, heavy physical activity, and long-distance walking/stair climbing/long standing time/sedentary work habits were associated with the self-reported diagnosis based on questionnaires of KOA. In terms of symptoms and function, the WOMAC score was significantly higher in those with radiographic signs of KOA or diagnosed with KOA. In terms of radiographic measurement indicators, there was no statistically significant difference in the measured angles between those with radiographic signs of KOA or those diagnosed with KOA based on self-report questionnaires, whereas the PTSA angle was significantly increased in those diagnosed with KOA based on objective indicators.

The prevalence of KOA among steelworkers and the proportion of those with radiographic evidence of KOA are both high. Age, years of employment, family history of osteoarthritis, some metabolic diseases, and some work habits may be risk factors for the development of KOA.