Department of Rheumatology, Institute of Bone and Joint Research, University of Sydney, Level 4, Building 35, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
Rheumatology (Oxford). 2012 Feb;51(2):250-61. doi: 10.1093/rheumatology/ker108. Epub 2011 May 17.
To examine the association between work place exposure and CTS by meta-analysis, including analyses with respect to exposure to hand force, repetition, vibration and wrist posture.
All relevant peer-reviewed articles published between January 1980 and December 2009 were identified by a systematic search using the MEDLINE, CINAHL and PubMed databases. Papers were critiqued independently by two researchers and the relevant exposure information was extracted. Using the raw data of exposed and unexposed cases, a cumulative effect of specific exposure risks were calculated for hand force, repetition, a combination of force and repetition, vibration and wrist posture using the statistical program, Stata version 11 (StataCorp, College Station, TX, USA). Heterogeneity, meta-regression, publication bias and subgroup sensitivity analyses were performed.
Thirty-seven studies from English-language literature met the inclusion criteria. Using National Institute for Occupational Health and Safety criteria for case definition, a significant positive association between CTS and hand force, repetition, use of vibratory tools and wrist posture was observed with approximate doubling of risk for all exposures. Significant heterogeneity among studies was observed for most exposures and metaregression analyses identified CTS case definition, study design, country and risk of bias score to be the significant determinants. When a more conservative definition of CTS was employed to include nerve conduction abnormality with symptoms and/or signs, risk factors significantly associated with an increased risk of CTS among exposed workers were: vibration [odds ratio (OR) 5.40; 95% CI 3.14, 9.31], hand force (OR 4.23; 95% CI 1.53, 11.68) and repetition (OR 2.26; 95% CI 1.73, 2.94). There was a non-significant trend for the association between CTS and combined exposure to both force and repetition (OR 1.85; 95% CI 0.99, 3.45) and wrist posture (OR 4.73; 95% CI 0.42, 53.32).
Occupational exposure to excess vibration, increased hand force and repetition increase the risk of developing CTS. Workplace strategies to avoid overexposure to these risk factors should be implemented.
通过荟萃分析研究工作场所暴露与 CTS 的关系，包括对手部力量、重复动作、振动和手腕姿势等暴露因素的分析。
通过系统检索 MEDLINE、CINAHL 和 PubMed 数据库，检索 1980 年 1 月至 2009 年 12 月期间发表的所有同行评审文章。由两位研究人员独立对论文进行评估，并提取相关暴露信息。使用 Stata 版本 11（StataCorp，College Station，TX，USA）统计程序，根据暴露和未暴露病例的原始数据，计算手部力量、重复动作、力量和重复动作组合、振动和手腕姿势特定暴露风险的累积效应。进行了异质性、meta 回归、发表偏倚和亚组敏感性分析。
从英文文献中筛选出 37 项符合纳入标准的研究。使用美国国家职业安全与健康研究所（NIOSH）的病例定义标准，发现 CTS 与手部力量、重复动作、振动工具使用和手腕姿势之间存在显著正相关，所有暴露因素的风险约增加一倍。大多数暴露因素的研究之间存在显著的异质性，meta 回归分析确定 CTS 的病例定义、研究设计、国家和偏倚风险评分是显著的决定因素。当采用更严格的 CTS 定义，包括有症状和/或体征的神经传导异常时，与暴露工人 CTS 风险增加显著相关的危险因素包括：振动（比值比[OR]5.40；95%可信区间[CI]3.14，9.31）、手部力量（OR 4.23；95% CI 1.53，11.68）和重复动作（OR 2.26；95% CI 1.73，2.94）。手部力量和重复动作联合暴露（OR 1.85；95% CI 0.99，3.45）和手腕姿势（OR 4.73；95% CI 0.42，53.32）与 CTS 之间存在非显著趋势。
职业性接触过度振动、手部力量增加和重复动作会增加 CTS 的发病风险。应实施避免过度暴露于这些危险因素的工作场所策略。
