Department of Translational Medicine-Hand Surgery, Lund University, Malmö, Sweden.
Department of Orthopedics, Helsingborgs lasarett, Helsingborg, Sweden.
BMJ Open. 2024 Jun 18;14(6):e080777. doi: 10.1136/bmjopen-2023-080777.
The occurrence of hand and forearm disorders related to vibration exposure, adjusted for relevant background factors, is scarcely reported. We analysed the prevalence of such conditions in a large population cohort, stratified by sex, and associations with exposure to vibrating hand-held tools.
This is a retrospective cohort study.
Individuals in the Malmö Diet and Cancer Study cohort (MDCS; inclusion 1991-1996; followed until 2018) were asked, 'does your work involve working with vibrating hand-held tools?' (response: 'not at all', 'some' and 'much'). Data were cross-linked with national registers to identify treatment for carpal tunnel syndrome (CTS), ulnar nerve entrapment (UNE), Dupuytren's disease, trigger finger or first carpometacarpal joint (CMC-1) osteoarthritis (OA). Cox regression models, unadjusted and adjusted (age, sex, prevalent diabetes, smoking, hypertension and alcohol consumption), were performed to analyse the effects of reported vibration exposure.
Individuals in the MDCS who had answered the questionnaire on vibration exposure (14 342 out of the originally 30 446 individuals in MDCS) were included in the study.
In total, 12 220/14 342 individuals (76%) reported 'no' exposure, 1392/14 342 (9%) 'some' and 730/14 342 (5%) 'much' exposure to vibrating hand-held tools. In men, 'much' exposure was independently associated with CTS (HR 1.71 (95% CI 1.11 to 2.62)) and UNE (HR 2.42 (95% CI 1.15 to 5.07)). 'Some' exposure was independently associated with UNE in men (HR 2.10 (95% CI 1.12 to 3.95)). 'Much' exposure was independently associated with trigger finger in women (HR 2.73 (95% CI 1.49 to 4.99)). We found no effect of vibration exposure on Dupuytren's disease or CMC-1 OA. 'Much' vibration exposure predicted any hand and forearm diagnosis in men (HR 1.44 (95% CI 1.08 to 1.80)), but not in women.
Vibration exposure by hand-held tools increases the risk of developing CTS and UNE and any common hand and forearm conditions in men, whereas women only risk trigger finger and CMC-1 OA. Adjustment for relevant confounders in vibration exposure is crucial.
与振动暴露相关的手部和前臂疾病的发生情况，在调整了相关背景因素后，鲜有报道。我们分析了在一个大型人群队列中，按性别分层的这种情况的患病率，并分析了其与使用振动手持工具之间的关联。
这是一项回顾性队列研究。
在马尔默饮食与癌症研究队列（MDCS；纳入时间 1991-1996 年；随访至 2018 年）的个体被问及“您的工作是否涉及使用振动手持工具？”（回答：“根本没有”、“有些”和“很多”）。数据与国家登记处交叉链接，以确定腕管综合征（CTS）、尺神经卡压（UNE）、杜普伊特伦挛缩、扳机指或第一掌腕关节（CMC-1）骨关节炎（OA）的治疗情况。未调整和调整（年龄、性别、现患糖尿病、吸烟、高血压和饮酒）的 Cox 回归模型用于分析报告的振动暴露的影响。
在 MDCS 中回答了关于振动暴露的问卷的个体（最初的 MDCS 中的 30446 人中的 14342 人）被纳入研究。
总共，12220/14342 人（76%）报告“无”暴露，1392/14342（9%）“有些”暴露，730/14342（5%）“很多”暴露于振动手持工具。在男性中，“很多”暴露与 CTS（HR 1.71（95%CI 1.11-2.62））和 UNE（HR 2.42（95%CI 1.15-5.07））独立相关。“有些”暴露与男性的 UNE 独立相关（HR 2.10（95%CI 1.12-3.95））。“很多”暴露与女性的扳机指独立相关（HR 2.73（95%CI 1.49-4.99））。我们没有发现振动暴露对杜普伊特伦挛缩或 CMC-1 OA 的影响。“很多”振动暴露可预测男性的任何手部和前臂疾病（HR 1.44（95%CI 1.08-1.80）），但对女性没有影响。
使用手持工具进行振动暴露会增加男性患 CTS 和 UNE 以及任何常见手部和前臂疾病的风险，而女性仅会增加扳机指和 CMC-1 OA 的风险。在振动暴露中调整相关混杂因素至关重要。
