職業性腕隧道症候群

Occupational Carpal Tunnel Syndrome

洪怡珣(Yi-Shiung Horng) ； 謝仕福(Shih-Fu Hsieh) ； 洪于琇(Yu-Shiow Horng) ； 林銘川(Ming-Chuan Lin)

《台灣公共衛生雜誌》 28卷2期 (2009/04) Pp. 85-92

https://doi.org/10.6288/TJPH2009-28-02-01

摘要

職業性腕隧道症候群盛行於諸多須使用震動性手工具、手腕部重複性動作或過度用力的行業，許多國家包括台灣已將其列為職業病。近年來諸多研究致力於各種手腕部動作及角度對腕隧道壓力的影響，以期找出職業性腕隧道症候群的危險因子。
神經傳導速度檢查常被用來診斷腕隧道症候群，但其有偽陰性及偽陽性之可能。近年來超音波亦被嘗試用來診斷腕隧道症候群，然而其診斷標準尚未有共識。未來若能建立腕隧道症候群之超音波診斷標準，當可彌補神經傳導速度檢查之不足。
職業性腕隧道症候群之治療，除了可以藉由配戴副木、藥物、物理治療、局部類固醇注射或手術治療以減輕症狀之外，若能於高危險的職場進行人因工程評估，藉由改善工作流程、姿勢或器具等方法，減少危害因子的暴露，將可達到預防的目的。
總而言之，本篇文章擬由危險因子、致病機轉、臨床診斷以及治療等方面進行文獻回顧，並針對目前臨床診斷治療可能遭遇之問題進行探討及建議。

關鍵字

腕隧道症候群 ； 神經傳導速度檢查 ； 超音波檢查 ； 人因工程危險因子

並列摘要

Occupational carpal tunnel syndrome is common in occupations that involve the use of vibrating manual tools or tasks with highly repetitive and forceful manual exertion. Carpal tunnel syndrome has been recognized as an occupational disease in many countries, including Taiwan. In recent years, many studies have evaluated the effects of hand/wrist posture and repetitive motion on carpal tunnel pressure. The purpose of these studies has been to identify risk factors for occupational carpal tunnel syndrome and to identify innovative approaches to the management of these risk factors. Nerve conduction velocity studies have been used as a diagnostic tool for carpal tunnel syndrome. However, false positive and false negative results have been reported. Ultrasonography has been applied to evaluating carpal tunnel syndrome, but there is still a lack of consensus regarding its diagnostic criteria. With more effort on the establishment of accurate diagnostic criteria, ultrasonography could be used as an alternative diagnostic method for carpal tunnel syndrome. Treatment of carpal tunnel syndrome includes the use of splints, physiotherapy, drug therapy, local steroid injection, and surgery. Secondary prevention could be achieved through implementation of ergonomic programs and in providing sound ergonomic working areas to reduce injury in high-risk groups. In this review, we highlight difficulties in the clinical diagnosis of occupational carpal tunnel syndrome and suggest strategies for its management. We also review risk factors, pathogenesis, diagnosis, and treatment of occupational carpal tunnel syndrome.

並列關鍵字

carpal tunnel syndrome ； nerve conduction velocity study ； ultrasonography ； ergonomic risk factor

參考文獻

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