Schwarze S, Blome O, Notbohm G
Institut für Arbeitsmedizin und Sozialmedizin, Heinrich-Heine-Universität Düsseldorf, Germany.
Orthopade. 2002 Oct;31(10):957-72. doi: 10.1007/s00132-002-0364-3.
First an overview of the significance of musculoskeletal diseases in terms of national economy and social politics is given, and then the historical development of the occupational disease "disk-related spinal disorders" is outlined. The most important court decisions and the actual state of jurisprudence on this matter are summarized, emphasizing the questions which still have to be answered in the course of medical evaluation of a spinal occupational disease. Based on a joint research project on the spinal effects of whole-body vibrations, an analysis of lumbar X-rays is presented which aimed at detecting specific patterns of response corresponding to the respective extent of strain. In spite of a statistically significant relationship between the clinical diagnosis of a lumbar syndrome and the severity of the degenerative radiological changes on the one hand and vibration exposure on the other hand, the evaluation of the lumbar X-rays did not show any clear radiological pattern related to the exposure. Furthermore, starting points for prevention are discussed. With regard to whole-body vibration, the technical possibilities of reducing the amount of vibration load are still not completely exhausted. However, during preventive measures of occupational health usually carried out as medical screening examinations, the occupational health physician again will face some of the same problems which have already been met with respect to the medical evaluation. Thus, a suggestion is made to modify the traditional concepts of the Professional Industrial Associations on occupational diseases in order to take into account the peculiarities of disk-related spinal disorders.
首先概述了肌肉骨骼疾病在国民经济和社会政治方面的重要性，然后概述了职业病“椎间盘相关脊柱疾病”的历史发展。总结了最重要的法院判决及此事的法理学现状，强调了在脊柱职业病医学评估过程中仍需回答的问题。基于一项关于全身振动对脊柱影响的联合研究项目，提出了一项腰椎X光分析，旨在检测与相应应变程度相对应的特定反应模式。尽管一方面腰椎综合征的临床诊断与退行性放射学改变的严重程度之间存在统计学上的显著关系，另一方面与振动暴露也存在统计学上的显著关系，但腰椎X光评估并未显示出与暴露相关的任何明确放射学模式。此外，还讨论了预防的起点。关于全身振动，减少振动负荷量的技术可能性尚未完全穷尽。然而，在通常作为医学筛查检查进行的职业健康预防措施中，职业健康医生再次会面临一些在医学评估方面已经遇到的相同问题。因此，建议修改专业行业协会关于职业病的传统概念，以考虑椎间盘相关脊柱疾病的特殊性。
