Twenty male chain saw operators between the ages of 46-60 working in -5° to 10℃ were studied. Fifteen of them had white finger. The frequency and acceleration level of chain saw was 65-160 Hz and 124 dB respectively. Thirty-four age and sex matched forest workers who had never used vibrating tools were also examined as control group. The research program was comprised of :(1) case history, physical, laboratory and radiographic examinations, (2) electrophysiological and motor function examinations, (3) peripheral circulatory function tests and (4) skin pathological and electronmicroscopic studies.
Our results illustrated the broad spectrum of pathologic abnormalities associated with the vibration syndrome. It is a multisystem discorder of the peripheral circulation, nerves, muscles, bones and joints of the hand and arm. Its pathogenesis is unclear but it is possibly related to direct microtrauma to the tissues as well as to secondary trauma to blood vessels after long term exposure to vibration, cold and noise which results in circulatory insufficiency. Muscle weakness and bone degeneration also develop as a result of the heavy and strenuous work of lumbering. 長期使用振動工具會傷害上肢之血管、神經、肌肉及骨骼，同時也可能影響到中樞神經及自主神經。本研究之目的是在探討在低溫下長期使用鏈鋸對工人所造成之傷害及其可能之致病機轉。研究對象為20位在5～10℃下長期使用鏈鋸 (頻率為65～160Hz)之男性鏈鋸工人，平均年齡為54歲 (46～60歲)。本研究計劃包括：(一)個人病歷、理學及實驗室檢查，(二)神經生理學及運動機能檢查，(三)末梢循環機能檢查，(四)皮膚切片之病理及電子顯微鏡檢查。同時34位年齡及性別相配對之健康工人亦接受檢查，作為對照組。
病患主要之臨床症狀為手麻、白指及上肢疼痛，其中有15位有白指，平均之潛伏期為8.9年(2～19年)。手部X光顯示一半以上之病患有腕骨囊腫病變，尤其以左右手之頭狀骨為最厲害。神經傳導速度之檢查，發現其振幅有下降及潛伏期有延長之情形，尤其以運動神經部份更為明顯；双手握力測定顯示病患之握力比對照組有顯著之下降 (p<0.001)；皮膚溫之測定，病患手指指端之皮膚溫度於冷浸前、冷浸中及冷浸後皆比對照組有意義之下降 (p<0.001)，且冷浸後皮膚溫之回升亦較媛慢。電子顯微鏡觀察下，發現真皮之血管內皮細胞腫漲，管腔變小及基底層有重層化，部份神經之髓鞘破裂形成螺旋狀構造向軸突侵入，部份髓鞘有裂開，以及軸突分離，史郞二氏切痕開離，軸突及舒旺細胞呈現變性，而無髓鞘神經則以透明式退化為主要病變。此微細構造之變化與臨床上表現之手麻和白指以及神經傳導之異常和皮膚溫之下降可互相吻合。
本研究結果顯示振動症候群為一多器官受損之疾患，包括神經、血管、肌肉、骨骼及關節之損傷。其致病機轉尚不清楚，但可能由於振動直接對於各組織所造成之慢性傷害，再者長期暴露於振動、寒冷及噪音之下，血管一方面受破壞，另一方面造成異常收縮而致血流下降，間接地導致其他組織之進一步傷害；又因伐木本身為一十分吃力之工作，亦是肌肉無力及骨骼變性之一因素。
關聯:
嘉南學報 15 : p.A89-A101 轉載 The Kaohsiung Journal of Medical Sciences 2(12),p.732-744 (1986)
