Bovenzi M, Franzinelli A, Scattoni L, Vannuccini L
Institute of Occupational Health, University of Trieste, Italy.
Occup Environ Med. 1994 Jun;51(6):361-5. doi: 10.1136/oem.51.6.361.
In a six year follow up study of the handarm vibration syndrome, 62 stoneworkers operating hand held vibrating tools in 10 travertine quarries and mills were first investigated in 1985 and then in 1991. The frequency weighted acceleration of vibration from the rock drills and stone hammers used by the travertine workers exceeded 20 m/s2, indicating a hazardous work activity according to the proposal of the EC directive for physical agents. A clinical examination and a cold provocation test were repeated with the same procedures as those adopted at the time of the first survey. The stoneworkers were divided into groups according to current work state: active stoneworkers who continued to use powered tools during the follow up (n = 21, median exposure time 22 years), and ex-stoneworkers with retirement vibration free intervals of three years (n = 22, median exposure time 27.5 years) and of six years (n = 19, median exposure time 20 years). In the group of active stoneworkers, a 38% onset a new cases of vibration-induced white finger (VWF) was found during the follow up (p < 0.01). Among the retired stoneworkers affected with VWF (n = 24), one recovered from VWF, one showed improvement, 20 remained stationary, and two deteriorated. The ex-stoneworkers experienced no significant change in sensorineural disturbances and a decrease in musculoskeletal symptoms of the upper limbs. At the cold provocation test, the currently active stoneworkers with VWF showed, on a group basis, a delayed finger rewarming time between the two examinations (p = 0.002). An abnormal response to cold provocation persisted in the fingers of the ex-stoneworkers with VWF, even in those reporting subjective improvement. These findings indicate a tendency towards the irreversibility of sensorineural and VWF symptoms in a group of ex-stoneworkers with prolonged exposure to high vibration levels in the past. The increased occurrence of VWF in the active stone workers after a few extra years of vibrating tool usage argues for an urgent implementation of preventive measures in the stone industry.
在一项关于手臂振动综合征的六年随访研究中，1985年对10个石灰华采石场和加工厂中操作手持振动工具的62名石匠进行了首次调查，随后在1991年再次进行调查。石灰华工人使用的凿岩机和石锤的频率加权振动加速度超过20米/秒²，根据欧盟物理因素指令的提议，这表明该工作活动具有危险性。按照首次调查时采用的相同程序，重复进行临床检查和冷激发试验。根据当前工作状态将石匠分为几组：随访期间继续使用电动工具的在职石匠（n = 21，中位暴露时间22年），以及退休后有三年（n = 22，中位暴露时间27.5年）和六年（n = 19，中位暴露时间20年）无振动间隔的前石匠。在在职石匠组中，随访期间发现有38%出现了新的振动性白指（VWF）病例（p < 0.01）。在受VWF影响的退休石匠（n = 24）中，1人从VWF中康复，1人有所改善，20人病情稳定，2人病情恶化。前石匠的感觉神经障碍无明显变化，上肢肌肉骨骼症状有所减轻。在冷激发试验中，目前患有VWF的在职石匠在两次检查之间，从群体来看，手指复温时间延迟（p = 0.002）。即使那些报告主观症状有所改善的前石匠，其患有VWF的手指对冷激发试验仍有异常反应。这些发现表明，一组过去长期暴露于高振动水平的前石匠，其感觉神经和VWF症状有不可逆的趋势。在使用振动工具几年后，在职石匠中VWF的发生率增加，这表明石材行业迫切需要实施预防措施。
