VDT작업자에서 어깨 근육장애와 혈청 CPK의 관련성

정해관,김수근 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.2

VDT workers are often exposed to static load in the shoulder stabilizing muscle due to repetitive work over long periods. Many investigations were reported the relationships between static load due to repetitive work and regional muscle disorder. However, diagnostic approach to work-related muscle disorder is difficult due to the absence of objective dignostic tools. This study was performed to investigate the relationship between the serum CPK(creatine phosphokinase) concentrations and the shoulder muscle disorders. Results are as follow. 1. Mean serum CPK in total VDT workers was 67.6±28.4 IU/l and workers with abnormal serum CPK were 35(21.5%). 2. Comparison between cases and controls did not show significant difference in the serum CPK level and the distribution of abnormal findings. 3. Sensitivity and sepcificity of the CPK test was 23.0% and 82.0%, respectively. Above results, in accordance with literatures, show that while serum CPK measurement can be useful for the diagnosis of acute muscle injury, it does not adequately reflect the muscle disorders developed by the repetitive work of low tension over long time, such as VDT works.

망간노출로 인한 신경장해의 임상적 양상

정해관,마샤 라트너,로버트 펠드만 東國大學校醫學硏究所 2002 東國醫學 Vol.9 No.1

망간의 신경독성은 19세기 초 이래 널리 알려져 왔다. 고전적 망간중독은 파킨스증후 군을 유발하나 그 임상적 양상이 파킨슨병과는 명확하게 구별된다는 점이 인정되고 있다. 그러나 최근 들어 망간 노출 농도가 낮아지는 반면 노출인구는 증가하면서 저농도 노출에 의한 신경장해의 범위에 대해서 논란이 있어왔다. 특히 인구 노령화에 따른 각종 신경퇴행성 질환과는 구별도 필요하게 되었다. 저자들은 최근까지 보고된 직업적, 비직업적 망간 노출인구에서의 건강장해에 대한 임상적, 역학적 연구들을 비교 분석하여 망간 노출에 따른 신경장해를 다음과 같은 5가지 범주로 구분하였는데, 이들은 만성 망간중독, 파킨슨병, 추체외로증후군, 임상전 단계 및 변형증후군 등이다. 이와 같은 임상적 구분은 망간 독성의 병태생리를 이해하는데 도움을 줄뿐 아니라 직업적 및 비직업적 망간노출을 평가하는데도 유용한 도구로 사용될 수 있을 것이다. Neurotoxicity of manganese is known since the report of manganism in early 19th century. However, there are controversies on the range of the clinical manifestation of manganese exposure, especially after the introduction of magnetic resonance imaging on the exposure assessment of manganese exposure. The authors categorized various clinical syndromes of neurologic disorders, which are suggested to be related to occupational or non-occupational manganese exposure, into five stages; chronic manganism, Parkinson's disease, extrapyramidal syndrome, subclinical stage, and variant cases. This categorization will be useful in understanding the pathophysiology of the manganese toxicity and could be utilized in assessment of occupational and non-occupational manganese exposure.

채용시 건강진단 운영 현황에 대한 조사

정해관,임현술 大韓産業醫學會 1995 대한직업환경의학회지 Vol.7 No.2

Preemployment health examination, stipulated by the Occupational Safety and Health Regulations, plays an important role in workers health management. Recently, employers are getting more aware of the importance of screening recruits before employment to decrease the development of occupational disorders and work loss due to health problems. Accordingly, additional test items are being included and selection criteria for preemployment health examination is getting more strict. However, studies and data on preemployment health examination are scarce until now. Authors reviewed preemployment health certificates of 3,261 recruits issued by a university hospital in Pohang from January 3 to December 31, 1993, analyzed regulations on preemployment health examination of 16 companies in the Pohang area, and surveyed 80 health and safety personnel with questionnaire to evaluate the present status of preemployment health examination. Of 3,261 recruits 125(3.8%) failed to recruit. Main causes of failure were chronic liver disease, tuberculosis of undetermined activity. The regulations of 16 companies on preemployment health examination were reviewed. Most companies adopted additional test items in addition to basic test items listed on th Regulation; test of physical strength, pulmonary function test, pure tone audiometer(2000 Hz and 4000 Hz in addition to 1000Hz), exercise provocation test, urine erythrocyte and urobilinogen, complete blood count, stool examination, VDRL, and sputum examination for acid fast bacilli. In most companies, obesity, hearing disturbance, color vision disturbance was included in the selection criteria. Hepatitis B carrier was not accepted in 4 companies, accepted conditionally in 2, and accepted in 5 companies. Of 80 health and safety personnel of companies in the Pohang area, 56(70.0%) perceived preemployment health examination as a tool for selection of recruits and 14(17.5%) as a procedure for job fitting. Most of them were against the acceptance of recruits with hepatitis B carrier, lumbar spine deformity, and hearing disturbance. In conclusion, preemployment health examination is performed mainly for the purpose of selection of healthier employee, but test items and selection criteria is not seem to be adequate. Authors suggest that further studies are needed to select the test items for specific job, and application of selection criteria be restricted only to some specified jobs. Consecutive filing of preemployment health examination to the periodic health examination was also suggested.

전화번호안내원의 누적외상성 장애

정해관,최병순,김지용,유선희,임현술,김용민,어경윤,권용욱 大韓産業醫學會 1997 대한직업환경의학회지 Vol.9 No.1

To evaluate the prevalence of cumulative trauma disorders in relation to ergonomic evaluation of their work, 260 female directory assistance operators employed in three branch facilities of the nation-wide telecommunication company. Ergonomic evaluation of the work status was done by two industrial hygienists through inspection. Workers were surveyed with standardized self-administered questionnaire and examined by family physicians and an orthopaedician for cumulative trauma disorders. Laboratory examination of serum aspartate aminotransferase(AST), creatinine phosphokinase(CPK), aldolase and rheumatoid factor was done and X-ray of cervical spine and both shoulders was taken from all subjects and nerve conduction velocity test was done on 57 subjects with suspected nerve entrapment cases. Cumulative trauma disorders were categorized into 3 category according to work-relatedness of the disorders. On ergonomic evaluation of the working posture and work environment, improvement of work posture revealed inappropriate postures and devices. Mean age of the subjects were 39 years old and more than 80% graduated high school or above. Ninety-eight percent of the workers employed in the company for more than 15 years and 74.6% of the workers worked at the VDT job for more than 4 years. Mean daily work hours was 8.0 hours per day and mean break hours was 90.5 minutes per day with mean extra work hours of 10.7 hours per month. Mean daily calls were 1128.6 calls in maximum and 864-8 calls in minimum. On laboratory examination, 13.(5.0%) workers had abnormal AST, 53(20.4%) had abnormal CPK, and 1(0.4%) had abnormal aldolase level. On x-ray examination of cervical spine, 111(42.7%) had loss of or reversed normal cervical lordosis, 10(3.8%) had narrowing of intervertebral space. Nerve conduction velocity test was abnormal in 11(19.2%) among 57 workers. Among disorders categorized as work-related, 131(50.4%) were diagnosed to have fatigue myalgia of levator scapulae, 108(41.5%) had cervical strain or sprain, 47(18.1%) had fatigue arthralgia of phalangeal joints, and 47(18.1%) had probable carpal tunnel syndrome, in 10(3.8%) of those diagnosis was confirmed electrophysiologically. Age, seniority, work duration at present job, workload nor location of facilities were associated with the prevalence of symptoms nor specific diagnoses on simple statistical analysis and multiple logistic regression, which seems to be due to highly selected and homogeneous characteristics of the study subjects. Above results shows that cumulative trauma disorders are very prevalent among directory assistance operators and elaborate effort is needed to reduce the cumulative trauma disorders among the operators.

일부 지역 도로관리 종사자에서 발견된 흉부 X선상 소음영 소견에 관한 조사

정해관,임현술,최익한,이원재,이현경 동국대학교 경주대학 1993 東國論集 Vol.12 No.-

Authors examined 135 workers(133 males and 2 females) employed in a local road construction and maintenance office lacated in the Pohang area to investigate the presence of pneumoconiosis cases among them. Examination consisted of questionnaire survey, physical examination and chest radiograph. Results are as follows ; 1. Of 135 workers, 8 cases(5.9%) were found to have small opacities of category 0/1 or more on chest radiogtaph. These cases were all males and prevalence was highest in group with age 50 or more(11.1% 3 out of 27 workers) and in froup with 5 to 9 years of employment(9.5%, 4 out of 42 workers). Small Opacities were found only in field workers(8.9%, 8 out of 90 workers) and prevalence of small opacities by job title was 8.8% in overload watchmen(3 out of 34 workers), 8.2% in road sweepers, road repair and maintenance workers(5 out of 56 workers). 2. Prevalence of small opacities on chest radiograph was higher in dusty, outdoor jobs than non-dusty jobs and the difference was statistically significant(P<0.05) 3. There was no statistically significant difference between those with radiological appearance of small opacities and normal subjects in age, educational level, duration of employment, previous dust exposure, past history of respiratory illness and clinical symptoms(P>0.05). 4. Of 8 cases with small opacities on chest radiograph, 1 case had small opacity of category 1/0(s/s) and the other 7 cases had small opacities of category 0/1. Two cases had past history of pulmonary tuberculosis, but radiologic findings were not consistent with tuberculosis. Two cases with less than 5 years of employment had previous history of dust exposure. Although specific etiologic factors were not clear with this study alone, authors suspected that specific geological factors in the Pohang area(soils rich in diatomaceous earth, bentonite and fullers' earth etc.) may have some role in development of small opacities. Above results suggests that follow up investigation for further development and progression of pneumoconiosis and effective measures to prevent dust exposure of road workers are needed.

복합유기용제 장기 노출자들의 골수충실도 평가를 위한 자기공명영상의 계량적 활용

정해관,최대섭,박건욱,윤환중,김정란,하경임,양승오,김양호 大韓産業醫學會 2002 대한직업환경의학회지 Vol.14 No.2

목 적 : 자기공명영상은 골수의 지방세포와 조혈세포간의 분퐁 차이를 신호강도 차이로 구분할 수 있어 골수 충성도에 대한 평가가 가능하다. 저자들은 유기용제에 장기간 노출된 조선업체 도장공 및 대조군을 대상으로 비참습적인 방법으로 골수 충실도를 평가하는 도구를 개발하기위하여 본 연구를 시행하였다. 방 법 : 1998녀 8월부터 2000년 1월까지 조선소 도장공 중 1개 대학병원에서 유기용제 장기간 사용으로 인한 골수검사 결과 저세포성 골수로 진단 받은 환자 6명(남자 5명, 여자 1명; 평균연령 환자군 46.5세)을 대상으로 말초혈액이 혈액학적 검사, 골수검사 및 요추부 자기공명영상을 실시하였다. 대조군으로는 동일 병원에서 요추부 자기공명영상을 촬영한 환자 132명(남 67명, 여자 65명, 연령 평균 42.5세, 범위 30-59세)을 선정하였다. 요추부 자기공명영상은 T1 및 T2 강조영상의 시상 단면에서 제 12 흉추부터 제 1 천추사이의 추체에서 각반드시 신호강도를 기록하였다. 기준 부위로는 동일 단면의 척추주위근 및 지방조직의 산호강도를 이용하여 각 부위에서 측정한 신호강도를 나누어 골수 신호강도지표를 구하였다. 결 과 : 환자군의 골수 충실도는 20.33-33.6 %이었고 혈액검사상 백혈구수는 2,100-7,600/㎣이었다. 환자군과 대조군 모두에서 각 지표는 제 12흉추에서 아래로 내려갈수록 점차 감소하였다가 제 4 요추 이후 다시 증가하는 양상을 보였다. 환자군과 대조군간의 골수 신호강도지표를 비교하였을 때 T1 강조영상에서 척추주위근을 기준으로 한 골수 신호강도지표가 환자군과 대조군간의 차이를 가장 잘 반영하였으며 환자군이 모든 추체에서 유의하게 높았다. (p<0.05, p<0.01). 대조군의 골수 신호강도지표는 T1 강조영상이 척추주위근을 기준으로 측정하였을 때 여성에서 연령 증가에 따라 모든 측정점에서 골수 신호강도지표는 증가하는 양상을 보였으며 30대와 50대간의 차이는 유의하였다. (p<0.05, p<0.01). 성별에 따른 골수 신호강도지표는 근육을 기준으로 한 골수 신호강도지표에서는 보이지 않았으나 비장을 기준으로 한 골수 신호강도지표는 남녀간에 유의한 차이를 보였다. (p<0.05). 다변량 선형회귀분석에서 연령 및 성별을 보정하였을 때 T1 강조영상의 근육을 기준으로 한 골수 신호강도지표는 환자군에서 대조군에 비하여 제 1 천추에서 0.364 더 높았다. 제 1 천추의 T1 근육을 기준으로 한 골수 신호강도지표의 연령 성별 평균+1 표준편차를 기준으로 하였을 때 6명 중 5명이 그 이상이 분포를 보여 두 군간의 차이가 가장 뚜렷하였다. 결 론 : 저자들은 자기공명영상을 이용하여 골수 충실도를 평가하기 위한 지표를 개발하였고 정상 참고치를 제시하였다. 골수 신호강도지표는 지방조직 함량, 골밀도함께 칼슘 등의 영향을 동시에 반영하지만 이러한 영향을 적절히 보정할 경우 고위험집단에서 골수 충실도를 평가하는데 활용할 수 있음을 확인하였다. 보다 좋은 지표의 개발을 위하여 충분한 표본수를 가진 저세포성 골수 환자집단을 대상으로 후속연구를 수행할 필요가 있다. Objectives : To develop a quantitative and noninvasive method of bone marrow cellularity evaluation in solvent exposed painters. Methods : Six painters (mean 46.5 years, 5 males and one female with hypocellular marrow, and 132 controls were examined using magnetic resonance imaging (MRI). A full examination of the peripheral blood and a bone marrow biopsy was done on each patient. Signal intensities were measured at the vertebral bodies from T12 to S1 on both the T1 and the T2-weighted image (T1WI and T2WI). Signal indices were calculated by dividing the signal indeces of the vertebral bodies by that of the paraspinal muscle and the subcutaneous fat in the same view. Results : The Bone marrow cellularities of the cases painters were between 20.3 % and 33.6 %. Signal indices based on the muscle at T1WI were greater in the cases of the painters compared to those of the controls (p<0.05, p<0.01). Signal indices based on the muscle at T1WI were significantly higher in older women compared with men (p<0.05). After adjusting for age and gender, the signal index of cases at S1 based on muscle of T1WI was higher than that of the controls by 0.364. Five of the six cases had a muscle signal index at S1 of T1WI higher than the mean + 1 standard deviation for the same age group and gender. Conclusions : MR signal indices are influenced by constitutional factors such as fat content. bone density, and the presence of other pathology. However, after adequate adjustment, it can be used as a useful indicator of bone marrow cellularity in a high-risk population.

직업적 아크릴아미드 폭로에 의한 다발성 신경병증

정해관,권용욱,어경윤,김병준,양정선,정철,진영우,이미영,강성규 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.3

Authors report a first Korean case of polyneuropathy in an acrylamide producing factory together with an environmental and epidemiologic survey for the ten workers of the same workplace and 46 workers in the production and manufacturing acrylamide in Ulsan, Korea. The case is 30 years old man who worked in the production of the acrylamide for two years. In August, 1997, he had a weakness of the lower extremity with loss of body weight of 15 Kg which progressed to paresthesia of the limbs, the loss of vibration sense, difficulty in walking, speech disturbance, dysuria, constipation, difficulty in erection and swallowing difficulty. Neurologic examination showed a complete loss of vibration and position sense, and loss of deep tendon reflex in all the limbs. There was a contact dermatitis-like skin lesion on the feet. Electrodiagnostic test showed a generalized polyneuropathy of moderate degree involving motor and sensory component of peripheral and cranial nerves. After 8 months' cessation from exposure and supportive care, his symptoms were completely resolved, but abnormality in electrodiagnostic test and vibrotactile perception threshold still persisted, although much improved than before. There were 11 workers in the same workplace of the case, producing acrylamide by microorganism as a catalyst. Environmental monitoring of the workplace revealed air borne concentration of the acrylamide to be from 0.05 to 0.23 mg/m3 by personal sampling and from 7.65 to 11.65 mg/m3 by area sampling during filter exchanging process, which far exceeds TLV-TWA of 0.03 mg/m3. However, acrylamide was not detected from the plasma of the workers. Symptom questionnaire showed a markedly higher complain of neurologic symptoms, compared to the workers of the other acrylamide producing companies. Electrodiagnostic test showed a several workers are in the lower normal range without definite abnormality. Vibrotactile perception threshold by Vibratron Ⅱ showed a significantly increased threshold in the workers of the same workplace compared to the other acrylamide workers and significantly decreased test score of color vision compared to normal controls. After improvement of the production process and strict wearing of the protective device, most workers reported the improvement of clinical symptoms, but vibrotactile perception threshold was not improved. These result suggests the need for the effective environmental monitoring together with a periodic biological monitoring. Development of effective screening test is urgently needed to control and assess the skin absorption of acrylamide.

일개 자동차 부품공장 근로자에서 초음파로 측정한 수근관 형태와 수근관증후군 위험도

김덕수,정해관,임현술,권용욱,이종민,조대현,최대섭 大韓産業醫學會 2002 대한직업환경의학회지 Vol.14 No.3

목적 : 일개 사업장의 생산직 근로자를 대상으로 손목 계측치 및 초음파를 이용한 수근관 계측치의 상관성 분석을 통하여 수근관증후군 발생에 관여하는 개인의 감수성 및 위험요인을 파악하여 생산직 근로자들의 수근관증후군 예방에 활용하고자 본 연구를 수행하였다. 방법 : 경주시에 위치한 자동차 방음재를 생산하는 사업장에 생산직 근로자 남자 24명, 여자 11명 등 총 35명을 대상으로 2000녀 4월과 2000년 10월 반드시 각 설문조사, 이학적검사, 전기진단검사를 실시하였으며, 2000년 10월에는 초음파를 이용한 수근관계측도 실시하였다. 결과 : 수근관증후군의 신체계측 요인에 따른 분석에서는 수근관 전치/폭 비가 0.17 미만인 군에 비하여 0.17 이상인 군에서 통계적으로 유의하게 높았다(p<0.05). 총 수근관 면적(두께×폭)은 300 ㎟이상인 군에 비하여 300㎟ 미만인 군에서 통계적으로 유의하게 높았다(p<0.05). 성별을 통제변수로 처리한 신체 계측치간 상간 분석에서는 수근관폭은 전기진단 검사와 음의 상관성을 보였으며, 수근관 두께는 전기진단 검사와 양의 상관성을 보였다. 수근관 두께/폭 비는 전기진단 검사와 양이 상관성을 보였으며, 수근관비 전치/두께 비는 전기진단 검사 결과와 음의 상관성을 보였다. 하부 수근관 면적[폭×(두께-전치)]은 전기진단 검사와 양의 상관성을 보였으며, 상부 수근관 면적(폭×전치)은 전기진단 검사와 음의 상관성을 보였다. 또한 수근관 전치의 상대적 비가 클수록 수근관증후군의 회복이 유의하게 좋았다. 결론 : 수근관증후군은 수근관 폭이 좁을수록, 수근관 두께가 두꺼울수록, 수근관 전치가 작을수록 수근관증후군 위험도가 증가한다. 저자들은 초음파를 이용한 수근관 형태의 측정은 수근관증후군의 발생의 내적 요인에 대한 중요한 정보를 제공하면 수근관증후군 발생 및 회복의 개별적 위험요인을 예측하는데 중요한 근거를 제공하는 것으로 판단하였다. Objectives: This study was conducted to evaluate individual susceptibility to carpal tunnel syndrome (CTS) by ultrasonographic measurement of the carpal tunnel configuration in workers doing repetitive work. Methods: The study subjects consisted of 24 male and 11 female workers in a soundproof material manufacturing company in Gyeongju. We conducted a self-reported questionnaire survey, a physical examination and an electrodiagnostic study (EDS) in April 2000. After the examination, jobs were rearranged for workers with CTS. A follow up physical examination. EDS, and measurement of the carpal tunnel by ultrasonography was done six monsths later. Results: Of those studied. prevalence or CTS was 63.6/100 persons among women and 29.2/100 persons among men. Mean depth and width of wrist was shorter in those with CTS compareal to the controls (p<0.05). The risk of CTS was higher in workers whose carpal tunnel ratio (displacement/width) was 0.17 or higher (OR 7.13, 95% confidence interval 1.18-43.1), and in workers whose carpal tunnel area was less than 300 ㎟ (OR 8.00, 95% confidence interval 1.18-68.5). Carpal tunnel depth and depth/width ratio had a positive correlation with motor latency of the median nerve and median-ulnar sensory latency difference (p<0.05). whereas the carpal tunnel width. displacement/depth ratio, and area (width×displacement) had a negative correlation with median nerve latencies after adjusting for gender. Workers who showed an improvement in the clinical stage of CTS after job rearrangement had a significantly lower carpal tunnel displacement/width ratio and displacement/depth ratio. They also had smaller upper carpal tunnel area (width×displacement) and larger upper carpal tunner\l area [(depth-displacement)×width] than the controls (p<0.05). Conclusions:Ultrasonographic measurement of the carpal tunnel is a good predictor of susceptibility and prognosis of CTS in workers doing repetivive work.

아크릴아마이드에 의한 신경병증 조기발견을 위한 선별검사의 평가

김성순,정해관,권용욱 大韓産業醫學會 2000 대한직업환경의학회지 Vol.12 No.3

목 적 : 아크릴아마이드에 직업적으로 노출되는 근로자들의 신경병증을 조기에 발견하기 위하여 사용될 수 있는 선별검사를 평가하기 위하여 본 연구를 진행하였다. 방 법 : 울산지역에서 아크릴아마이드 단량체를 제조하거나 취급하는 전체 근로자 52 명 중 아크릴 아마이드에 의한 신경병증 사례가 발생하고 작업환경노출이 많은 것으로 평가된 근로자 10명(평균연령 30.4세)을 고노출군으로, 나머지 근로자 42명(평균 연령 28.9세)을 저노출군으로 하였고, 의사 및 의대생 23명(평균 29.4세)을 대조군으로 선정하였다. 이들에 대하여 말초신경 증상설문지와 신경학적 진찰, 전기진단학적 검사, 진동감각역치검사 및 색도분별 검사를 시행하였다. 결 과 : 증상 설문지에서 고노출군은 말초신경에 특이한 증상을 저노출군 및 대조군에 비하여 더 많이 호소하였으며 신경학적 진찰소견상 이점분별력이 다른 집단에 비하여 유의하게 떨어져 있었다. 전기 진단학적 검사에서는 운동신경의 경우 정중신경 전도속도와 비골신경 잠시가, 감각신경의 경우 정중신경 진폭과 비복신경 잠시가 유의한 차이를 보였다.고노출군은 상지 및 하지의 진동감각역치가 저노출군 및 대조군에 비하여 유의하게 증가하였다. 색혼동지수로 측정한 색도분별력은 고노출군에서 대조군에 비하여 유의하게 떨어져 있었다. 이들 검사의 양성소견은 다른 변수를 제어하였을 때 아크릴아마이드 노출과 유의한 연관관계를 보였으며 각 검사의 양성 소견은 상호 중복이 많지 않고 이들 검사를 동시에 적용하였을 때 가장 많은 양성 소견을 보였다. 결 론 : 말초신경증상설문지, 진동감각역치검사 및 색도분별검사는 말초신경장해를 조기에 발견하는데 민감하였으며 이들 검사를 동시에 사용할 경우 말초신경장해의 조기 발견을 가장 효과적으로 수행할 수 있었다. Objectives : Acrylamide is a neurotoxin inducing central-peripheral distal axonopathy. The authors evaluated several neurologic tests to screen the early effect of occupational acrylamide exposure. Methods : Fifty-two males working either in the production of acrylamide monomer or in the handling of acrylamide in Ulsan, Korea, were selected and subcategorized into the hlgh-exposure group (n=10, mean age of 30.4 years) and the low-exposure group (n=42, mean age of 28.9 years). Twenty-three males (mean age 29.4 years) from medical professionals and students were chosen as a non-exposed reference group. Symptom questionnaire, neurologic examination, electrodiagnostic test, vibrotactile threshold test, and Lanthony desaturated 15 panel test (LD-l5D) were done. Results : The high-exposure group shewed more number of specific symptoms on questionnaire and more abnormal two point discrimination test. High-exposure group showed a significant difference in the median motor conduction velocity, peroneal nerve motor laten cy, sensory amplitude of median nerve action potential, and sensory latency of aural nerve. The vibrotactile threshold of the high-exposure group was significantly higher in both hands and feet than that of the low-exposure group and the reference group. Average color confusion index on the LD-l5D was significantly higher In the high-exposure group (median 22.7, range 0-135.7) than in the reference group (median 2.4, range 0-33.2) . Conclusions : The symptom questionnaire, vibrotactile threshold test, and color dis crimination test are sensitive in detection of the early acrylamide-induced neuropathy, and the combination of these tests would further facilitate the effectiveness of the screening.

작업자의 손목비와 수근관증후군 위험도

김덕수,정해관,권용욱 대한산업의학회 2001 대한직업환경의학회지 Vol.13 No.3

목적 : 손목의 반복적 동작을 해야하는 사업장에서 근무하는 근로자군에서 수근관증후군 유병률과 위험요인을 알아보고, 손목 형태와 수근관증후군과의 관련성을 알아보고자 하였다. 또한 손목 측정치가 수근관증후군 발생에 미치는 예측 정도를 확인하여 수근관증후군 예방에 도움을 주고자 본 연구를 수행하였다. 방법 : K시에 위치한 자동차 방음제를 생산하는 사업장의 근로자 남성 45명, 여성 16명, 총 61명을 대상으로 2000년 4월 설문 조사, 이학적 검사, 근전도 검사를 통하여 다음과 같은 결과를 얻었다. 결과 : 수근관증후군의 유병률은 100명당 26.2명이었다. 수근관증후군 위험요인 단변량 분석에서 연령이 증가할수록, 학력이 낮을수록 교차비가 증가하는 소견을 보였다(p<0.01). 사무직에 비하여 생산직에 근무할수록, 특히 진공작업에 근무할수록 교차비가 유의하게 높게 나타났다(p<0.01). 손목비가 0.74 이상인 군에서 0.74 미만인 군에 비하여 교차비가 유의하게 높았다(p<0.05). 수근관증후군과 관련있는 변수를 알아보기 위하여 로지스틱 회귀분석한 결과 사무직에 비하여 생산직 I (시상작업), 생산직 II (진공작업)에 근무할수록 교차비가 유의하게 높았다(p<0.01). 작업부서를 통계변수로 한 근전도 검사결과와 손목비의 편상관계수 분석에서 여성의 정중 및 척골 감각신경 전도검사의 원위잠시 차이와 손목비와는 유의한 양의 상관 관계를 보였다(p<0.05). 결론 : 손목비는 수근관증후군의 발생과 연관설이 있는 것으로 나타났으나 예측력이 높지 않아 감수성의 예측지표로 직접 이용하는 것은 무리가 있다. 이러한 문제점을 보완한 측정 방법과 예측력이 높은 지표를 개발해야 할 것이다. Objectives : To evaluate the risk factors of the cabal tunnel syndrome (CTS) and the impad of the wrist ratio on the prevalence of CTS in workers on repetitive work over a long term. Methods : Study subjects consisted of 45 mail and 15 female workers in a company that produces soundproof material in Gyeongju. We conducted a physical examination, a self-reported questionnaire survey and a nerve conduction study. CTS cases were defined as those subjects that had a positive finding in both the nerve conduction study and the physical examination done by a doctor specializing in rehabilitation medicine. Results : Prevalence of CTS among the study subjects was 26.2/100 persons. The prevalence of CTS was positively associated with increasing age (p<0.01, usiug the chi square test for trend) and female gender (OR=6.98, 95% CI=1.66-31.0), but was negatively associated with the educational level (p<0.01 by the chi-square for trend). Workers in the production area had a higher prevalence of CTS compared to those in the clerical area (OR=10.8 in the frame manufacturing process, OR=32.2 in the vacuum molding process). Patients with CTS had a narrower mean wrist width and a shorter mean hand and palm length, compared to those that had no disease (p<0.01 by the Student's t-test). The number of subjects who had a wrist ratio of 0.74 or more was significantly higher in cases of CTS (OR=4.0, 95% CI=1.01-16.3). However, a multiple logistic regression analysis showed only that the type of work was a significant variable after adjusting for the other variables. Conclusions : The writs ratio, a surrogate of carpal tunnel configuration, can represent individual susceptibility to CTS. However this study shows that the use of the wrist ratio for predicting CTS risk is not adequate. The development of a new carpal tunnel configuration index based on more direct measurements of the tunnel shape will provide a better predictor of individual susceptibility to CTS.