女性腕隧道症候群非職業性危險因子之探討

Non-occupational Risk Factors of Carpal Tunnel Syndrome

背景：腕隧道症候群，是正中神經在手腕處穿過「腕隧道」遭受壓迫時所造成的臨床症狀，常發生在需重複手腕動作的人身上，除了職業性因素外，尚有肥胖、女性、糖尿病、甲狀腺功能低下、自體免疫性疾病、過去曾有腕隧道症候群、過去曾有手部手術等非職業性因素。本研究的目的主要為探討女性腕隧道症候群的各項危險因子。方法：本研究個案來源為因上肢麻痛或無力至本院門診求診後，安排神經電生理上肢檢查之女性，共收案3個月，以問卷之型式詢問個案基本資料、工作的型態、過去病史、是否停經等，取用該次神經電生理檢查結果，以正中神經遠端運動延遲超過4.2毫秒作為CTS診斷標準。以SPSS統計軟體進行分析，類別變項使用卡方檢定，並利用邏輯式迴歸分析病例組與對照組間之危險性對比值（odds ratio, OR）。結果：問卷回收共160份，60位為停經前女性，100位為停經後女性，腕隧道症候群的盛行率為45.6%。以邏輯斯迴歸分析後之結果，在所有檢查之女性，各危險因子與腕隧道症候群之OR大於2者有糖尿病、工作危險因子、過去曾有腕隧道症候群、停經，其中糖尿病及工作危險因子具有顯著差異；停經前女性此一族群，OR大於2者有糖尿病、自體免疫性疾病、過去曾有腕隧道症候群，其中糖尿病具有顯著差異；停經後女性此一族群，OR大於2者有工作危險因子、糖尿病，其中工作危險因子具有顯著差異。結論：在有症狀而安排神經電生理上肢檢查之女性，糖尿病及工作危險因子明顯增加腕隧道症候群之風險。其中停經前女性之糖尿病及停經後女性之工作危險因子明顯增加腕隧道症候群之風險。 Background: Carpal tunnel syndrome (CTS) emerges due to compression of the median nerve when passing through the wrist at carpal tunnel. It is usually found in people whose works require repetitive hand and risk movements. In addition to occupational factors, obesity, female sex, diabetes mellitus, hypothyroidism, autoimmune diseases, previous history of CTS or hand operation and other non-occupational factors may also lead to CTS. The main purpose of this study is to explore and discuss the non-occupational risk factors of CTS in women. Methods: The study recruited women who received neuroelectric examination of their upper limbs due to numbness or weakness during a period of 3 months. A questionnaire was designed and used to collect the participants' basic information, work type, past medical history, and menopausal status. CTS was diagnosed with a distal motor latency of median nerve exceeding 4.2 millisecond. Categorical variables were compared using the Chi-square test, and logistic regression model was adopted to calculate the odds ratio (OR). All statistical analyses were performed using SPSS version 17.0. Results: Of the 160 effective questionnaires collected, 60 were from premenopausal participants and 100 were from postmenopausal ones. CTS was diagnosed in 45.6% of the participants. Statistical analyses revealed that, among all patients recruited, diabetes mellitus, high-risk work type, previous history of CTS and menopause had an odds ratio over 2 with diabetes mellitus and high-risk work style reaching statistical significance. In premenopausal participants, diabetes mellitus, autoimmune disease, previous history of CTS had an odds ratio over 2 with statistical significance observed in diabetes mellitus and high-risk work style. In postmenopausal participants, diabetes mellitus and high-risk work style had an odds ratio over 2, and high-risk work style reached statistical significance. Conclusion: As indicated by the findings of the study, female workers undergoing neuroelectric examination of their upper limbs due to associated symptoms, diabetes mellitus and high-risk work type significantly increase the risk of CTS. Diabetes mellitus in premenopausal women and highrisk work type style in postmenopausal women appear to be statistically significant risk factors of CTS.