Bovenzi M
Institute of Occupational Medicine, University of Trieste, Centro Tumori, Italy.
Int Arch Occup Environ Health. 1998 Nov;71(8):509-19. doi: 10.1007/s004200050316.
The complex of vascular, neurologic, and osteoarticular disorders occurring in the upper limbs of vibration-exposed workers is called hand-arm vibration syndrome. There is epidemiologic evidence for an increased occurrence of peripheral sensorineural disorders in occupational groups working with vibrating tools. An excess risk for wrist osteoarthrosis and for elbow arthrosis and osteophytosis has been reported in workers exposed to shocks and low-frequency vibration of high magnitude from percussive tools. However, there are too few epidemiology data to enable reliable conclusions to be drawn about exposure-response relationships for both sensorineural disturbances and bone and joint disorders caused by hand-transmitted vibration. Cross-sectional and longitudinal epidemiology studies have shown that occupational exposure to hand-transmitted vibration from a great variety of hand-held tools is significantly associated with an increased occurrence of digital vasospastic disorders called vibration-induced white finger (VWF). The proposal of an exposure-response relationship for VWF has been included in an annex to the international standard ISO 5349. The findings of several epidemiology studies have shown a poor agreement between the risk for VWF observed in various occupational groups and that predicted by the ISO 5349 model. Both overestimation and underestimation of the occurrence of VWF have been reported by investigators. It has been argued that the current ISO frequency-weighting curve for hand-transmitted vibration may be inappropriate for the assessment of vibration-induced adverse vascular effects. Alternative exposure-response relationships for VWF have been suggested in recent epidemiology studies. The epidemiology data used to construct current exposure-response relationships for vibration-induced injuries are primarily derived from cross-sectional studies. Future epidemiology research should be based on prospective cohort studies because the design characteristics of such studies permit the study of cause-effect relationships and the formulation of etiologic hypotheses.
在接触振动的工人上肢出现的血管、神经和骨关节炎紊乱的综合症状被称为手臂振动综合征。有流行病学证据表明，使用振动工具的职业群体中周围感觉神经紊乱的发生率增加。据报道，接触冲击工具产生的高强度冲击和低频振动的工人患腕关节骨关节炎、肘关节关节炎和骨赘的风险增加。然而，关于手部传递振动引起的感觉神经障碍以及骨骼和关节疾病的暴露-反应关系，流行病学数据太少，无法得出可靠结论。横断面和纵向流行病学研究表明，职业性接触各种手持工具传递的手部振动与称为振动性白指（VWF）的手指血管痉挛性疾病发生率增加显著相关。VWF的暴露-反应关系提案已被纳入国际标准ISO 5349的附件中。多项流行病学研究结果表明，不同职业群体中观察到的VWF风险与ISO 5349模型预测的风险之间一致性较差。研究人员报告了对VWF发生率的高估和低估情况。有人认为，当前手部传递振动的ISO频率加权曲线可能不适用于评估振动引起的不良血管效应。近期流行病学研究提出了VWF的替代暴露-反应关系。用于构建当前振动性损伤暴露-反应关系的流行病学数据主要来自横断面研究。未来的流行病学研究应基于前瞻性队列研究，因为此类研究的设计特点允许研究因果关系并提出病因假设。
