Herron M L, Kar S, Beard D, Binfield P
Department of Orthopaedic and Trauma Surgery, Warwick District General Hospital, Lakin Road, Warwick CV34 5BW, UK.
J Bone Joint Surg Br. 2004 Jan;86(1):54-7.
Injury to the dorsomedial cutaneous nerve in the foot may occur after operations for hallux valgus. Pressure neuropathy before operation is also described but remains largely unexplored. We have investigated the incidence of sensory deficit in the great toe before operating for hallux valgus and examined to what extent any deficit was related to the degree of angulation of the joint. Forty-three patients with a total of 61 great toes with hallux valgus presenting for consideration of surgical correction had their sensation tested in pre-designated zones using a five-filament set of Semmes-Weinstein monofilaments. These allowed good inter-observer reliability with an intra-class correlation coefficient of 0.84. Sensory symptoms were noted by only 21% of the patients, a measurable reduction in sensation by one monofilament grade or more was found in an additional 44%. No relationship was found between the degree of sensory loss and the degree of angulation. Patients with symptomatic hallux valgus may have sensory loss in the toe without being aware of it. Normal subjective sensation does not reliably predict normal sensory function. Given the potentially high rates of nerve damage following operations for hallux valgus, we recommend objective sensory testing as part of routine assessment before surgery.
拇外翻手术后可能会发生足部足背内侧皮神经损伤。术前的压迫性神经病变也有描述，但在很大程度上仍未得到充分研究。我们调查了拇外翻手术前拇趾感觉缺失的发生率，并研究了任何感觉缺失与关节成角程度的相关程度。43例共61个拇外翻拇趾拟行手术矫正的患者，使用五丝组的Semmes-Weinstein单丝在预先指定的区域进行感觉测试。这些单丝在观察者之间具有良好的可靠性，组内相关系数为0.84。仅21%的患者有感觉症状，另外44%的患者发现感觉有一个单丝等级或更多等级的可测量降低。感觉丧失程度与成角程度之间未发现相关性。有症状的拇外翻患者可能在拇趾存在感觉丧失而未意识到。正常的主观感觉并不能可靠地预测正常的感觉功能。鉴于拇外翻手术后神经损伤的潜在高发生率，我们建议在手术前进行客观感觉测试作为常规评估的一部分。
