Noël B
Service de Dermatologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Int Arch Occup Environ Health. 2000 Apr;73(3):150-5. doi: 10.1007/s004200050021.
Skin, arteries and nerves of the upper extremities can be affected by vibration exposure. Recent advances in skin and vascular biology as well as new investigative methods, have shown that neurovascular symptoms may be due to different vascular and neurological disorders which should be differentiated if proper management is to be evaluated. Three types of vascular disorder can be observed in the vibration white finger: digital organic microangiopathy, a digital vasospastic phenomenon and arterial thrombosis in the upper extremities. An imbalance between endothelin-1 and calcitonin-gene-related peptide is probably responsible for the vasospastic phenomenon. Moreover, paresthesiae can be due to either a diffuse vibration neuropathy or a carpal tunnel syndrome. A precise diagnosis is then necessary to adapt the treatment to individual cases. A classification describing the type and severity of the vascular lesions is presented. Asymptomatic lesions are included for adequate epidemiological studies and risk assessment of vibrating tools. Monitoring of vibration exposed workers should include not only a questionnaire about symptoms, but also a clinical evaluation including diagnostic tests for the screening of early asymptomatic neurovascular injuries.
上肢的皮肤、动脉和神经会受到振动暴露的影响。皮肤与血管生物学的最新进展以及新的研究方法表明，神经血管症状可能是由不同的血管和神经疾病引起的，如果要评估适当的治疗方法，就应该对这些疾病进行区分。在振动性白指中可观察到三种血管疾病类型：手指器质性微血管病、手指血管痉挛现象以及上肢动脉血栓形成。内皮素-1与降钙素基因相关肽之间的失衡可能是血管痉挛现象的原因。此外，感觉异常可能是由于弥漫性振动性神经病变或腕管综合征引起的。因此，需要进行精确诊断，以便针对个体病例调整治疗方案。本文提出了一种描述血管病变类型和严重程度的分类方法。无症状病变也包括在内，以便进行充分的流行病学研究和振动工具的风险评估。对接触振动的工人进行监测不仅应包括关于症状的问卷调查，还应包括临床评估，包括用于筛查早期无症状神经血管损伤的诊断测试。
