Olsen N, Nielsen S L, Voss P
Br J Ind Med. 1982 Feb;39(1):82-8. doi: 10.1136/oem.39.1.82.
ABSTRACT In a study of vibration-induced white finger (VWF) 39 chain saw operators, being representative of 365 lumberjacks according to a completed questionnaire, underwent clinical investigation. In a medical interview 13 of the 39 had VWF and 26 were without finger symptoms. In the subjects with VWF both hands were equally affected, the third and fourth finger most frequently; the thumbs were always normal. A cold provocation test, measuring the finger systolic blood pressure with a cuff technique during combined body cooling and finger cooling to 30, 15, and 6°C, was applied to the 39 chain saw operators and to 20 age-matched outdoor workers who had not used vibrating hand tools. The finger most often showing Raynaud's phenomenon was cold provoked, and a non-affected finger was used as a reference. The systolic pressure gradient measured at 30°C from the upper arm to the cooled finger was increased in the chain sawyers most severely affected by VWF compared with the control group and with the chain sawyers without VWF (p <0·02). Raynaud's phenomenon was verified by digital arterial closure (zero pressure in the finger) at 15 or 6°C in 12 of 13 chain sawyers having anamnestic and clinical evidence of VWF. Chain sawyers without VWF had an increased digital arterial response to cold at 15 and 6°C compared with the control group (p <0·05) and had a decreased cold response compared with chain sawyers with VWF (p <0·05). In chain sawyers without VWF 13 subjects with an exposure period of 10-23 years had an increased cold response at 6°C compared with 13 subjects with an exposure period of one to three years (p <0·05). Only one of 38 chain saws did not exceed the exposure limit proposed by the International Standardisation Organisation. The results of the present study indicate that vibrations induce hyperresponsiveness to cold in the exposed arteries, even in chain sawyers without finger symptoms. The exposure to vibration therefore should be reduced to eliminate this damage. The presented cold provocation test may be used to diagnose Raynaud's phenomenon and to disclose an abnormal digital arterial cold response before subjective symptoms have appeared.
摘要 在一项关于振动性白指（VWF）的研究中，根据一份完整问卷，39名链锯操作员作为365名伐木工人的代表接受了临床调查。在医学访谈中，39人中有13人患有VWF，26人无手指症状。在患有VWF的受试者中，双手受影响程度相同，第三和第四指最常受累；拇指总是正常的。对这39名链锯操作员和20名未使用振动手动工具的年龄匹配的户外工作者进行了冷激发试验，在身体和手指联合冷却至30、15和6°C期间，用袖带技术测量手指收缩压。最常出现雷诺现象的手指进行冷激发试验，并将未受影响的手指作为对照。与对照组和无VWF的链锯操作员相比，受VWF影响最严重的链锯操作员在30°C时从上臂到冷却手指测量的收缩压梯度增加（p<0.02）。在13名有VWF既往史和临床证据的链锯操作员中，12人在15或6°C时通过数字动脉闭塞（手指零压力）证实了雷诺现象。与对照组相比，无VWF的链锯操作员在15和6°C时对寒冷的数字动脉反应增强（p<0.05），与有VWF的链锯操作员相比，寒冷反应降低（p<0.05）。在无VWF的链锯操作员中，13名暴露10 - 23年的受试者在6°C时的寒冷反应比13名暴露1 - 3年的受试者增强（p<0.05）。38把链锯中只有一把未超过国际标准化组织提出的暴露限值。本研究结果表明，即使在无手指症状的链锯操作员中，振动也会导致暴露的动脉对寒冷反应过度。因此，应减少振动暴露以消除这种损害。所介绍的冷激发试验可用于诊断雷诺现象，并在主观症状出现之前揭示异常的数字动脉寒冷反应。
