Lander Lina, Lou Wendy, House Ron
Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada.
Occup Med (Lond). 2007 Jun;57(4):284-9. doi: 10.1093/occmed/kqm012. Epub 2007 Apr 11.
Workers exposed to hand-arm vibration are at risk of developing the neurological abnormalities of hand-arm vibration syndrome (HAVS). The Stockholm classification of the neurological component of HAVS is based on history and physical examination. There is a need to determine the association between neurological tests and the Stockholm scale.
The main objective of this study was to compare the Stockholm neurological scale and the results of current perception threshold (CPT) tests and nerve conduction studies (NCS).
Detailed physical examinations were done on 162 subjects referred for HAVS assessment at a specialist occupational health clinic. All subjects had NCS and measurement of CPT. The Stockholm neurological classification was carried out blinded to the results of these neurological tests and compared to the test results.
The nerve conduction results indicated that median and ulnar neuropathies proximal to the hand are common in workers being assessed for HAVS. Digital sensory neuropathy was found in only one worker. Neither the nerve conduction results nor the current perception results had a strong association with the Stockholm neurological scale. Exposure to vibration in total hours was the main variable associated with the Stockholm neurological scale [right hand: OR 1.30, 95% CI (1.10-1.54); left hand: OR 1.18, 95% CI (1.0-1.39)].
Workers being assessed for HAVS should have nerve conduction testing to detect neuropathies proximal to the hand. Quantitative sensory tests such as current perception measurement are insufficient for diagnostic purposes but may have a role in screening workers exposed to vibration.
接触手臂振动的工人有患手臂振动综合征（HAVS）神经功能异常的风险。HAVS神经学成分的斯德哥尔摩分类基于病史和体格检查。有必要确定神经学测试与斯德哥尔摩量表之间的关联。
本研究的主要目的是比较斯德哥尔摩神经学量表与电流感觉阈值（CPT）测试和神经传导研究（NCS）的结果。
在一家专业职业健康诊所，对162名因HAVS评估而转诊的受试者进行了详细的体格检查。所有受试者均进行了NCS和CPT测量。在不知道这些神经学测试结果的情况下进行斯德哥尔摩神经学分类，并与测试结果进行比较。
神经传导结果表明，在接受HAVS评估的工人中，手部近端的正中神经和尺神经病变很常见。仅在一名工人中发现了指感觉神经病变。神经传导结果和电流感觉结果与斯德哥尔摩神经学量表均无强烈关联。总振动暴露小时数是与斯德哥尔摩神经学量表相关的主要变量[右手：比值比（OR）1.30，95%置信区间（CI）（1.10 - 1.54）；左手：OR 1.18，95%CI（1.0 - 1.39）]。
接受HAVS评估的工人应进行神经传导测试以检测手部近端的神经病变。诸如电流感觉测量等定量感觉测试不足以用于诊断目的，但可能在筛查接触振动的工人中发挥作用。
