Barbieri P G, Corulli Alessandra, Pezzotti Chiara, Benvenuti Alessandra
Servizio Prevenzione e Sicurezza Ambienti di Lavoro, ASL Brescia.
Med Lav. 2009 May-Jun;100(3):197-210.
Current statistics show that work-related carpal tunnel syndrome (CTS) has been increasing constantly over the last ten years. Nevertheless, available data on the incidence of CTS in the general population and on the occupational proportion of the aetiology of this disease suggest considerable underreporting of work-related cases, which reflects on the number of cases reported to INAIL (National Insurance Institute for Industrial Accidents) and does not give an accurate epidemiological picture of their origin and distribution. For this reason, in the course of a prevention programme of upper limb disorders due to biomechanical overload, a second experiment concerning CTS surveillance system was carried out by collecting self-reported information via postal questionnaires. The aim of this study was to estimate the prevalence of work-related cases in the selected group of the general population and to identify work tasks and factories with significant risk of CTS clusters.
From the hospital discharge lists of the Province of Brescia for 2001 and 2005, 1558 surgical cases were selected, aged 18-65 years, excluding housewives (nearly 25% of the total); thus 637 surgical cases were included in the study (68.6% female and 31.4% male).
Obesity frequency was observed to be higher in the sample than in the general population. This was not the case for diabetes. The probability of surgical CTS cases attributable to occupational exposure was estimated by dividing the 637 cases into three exposure categories:probable, possible and improbable with results of respectively 44.4%, 36.6% and 19%; in the first category, the frequency among females was 78.8%. The CTS cases among females less than 40 years old was 40% in the probable exposure category versus 10% into the improbable exposure category. In the latter category, the prevalence of concomitant hand tendinitis was 11% versus 22% in the probable exposure category. Obese patients fell into the three occupational risk groups in the same proportion. Among the 283 STC cases considered as probable occupational exposure cases, only 11 were reported as required by law to the Occupational Health Service. Whereas a number of work tasks and work sectors with high risk factors were confirmed, there were relatively few factories with a possible presence of clusters, probably due to the small sample size compared to the general population and to the density of the factories potentially at risk. The epidemiological surveillance thus carried out provided more evidence confirming the serious underreporting of the work-related STC cases in a highly industrialised province and also provided useful information on the local situation regarding high-risk occupations, which need to be addressed via interventions of primary prevention should, possibly with greater involvement of the occupational physicians.
当前统计数据显示，在过去十年中，与工作相关的腕管综合征（CTS）一直在持续增加。然而，关于普通人群中CTS的发病率以及该疾病病因的职业比例的现有数据表明，与工作相关的病例报告严重不足，这反映在向意大利国家工业事故保险协会（INAIL）报告的病例数量上，并且无法准确呈现其起源和分布的流行病学情况。因此，在一项针对生物力学过载导致的上肢疾病预防计划中，通过邮政问卷收集自我报告信息，开展了第二项关于CTS监测系统的实验。本研究的目的是估计选定普通人群组中与工作相关病例的患病率，并识别存在CTS聚集显著风险的工作任务和工厂。
从布雷西亚省2001年和2005年的医院出院清单中，选取了1558例年龄在18 - 65岁之间的外科手术病例，不包括家庭主妇（约占总数的25%）；因此，637例外科手术病例被纳入研究（女性占68.6%，男性占31.4%）。
观察到样本中的肥胖发生率高于普通人群。糖尿病情况并非如此。通过将637例病例分为三类暴露类别来估计职业暴露导致的外科CTS病例的概率：可能、可能和不太可能，结果分别为44.4%、36.6%和19%；在第一类中，女性的频率为78.8%。40岁以下女性中，可能暴露类别中的CTS病例占40%，而不太可能暴露类别中为10%。在后一类中，合并手部腱鞘炎的患病率为11%，而可能暴露类别中为22%。肥胖患者在三个职业风险组中的比例相同。在被视为可能职业暴露病例的283例腕管综合征病例中，只有11例依法报告给了职业健康服务机构。虽然确认了一些具有高风险因素的工作任务和工作部门，但可能存在聚集的工厂相对较少，这可能是由于与普通人群相比样本量较小以及潜在风险工厂的密度所致。如此进行的流行病学监测提供了更多证据，证实了在一个高度工业化省份中与工作相关的腕管综合征病例报告严重不足的情况，并且还提供了关于当地高风险职业情况的有用信息，可能需要通过一级预防干预措施来解决，职业医生可能需要更多参与。
