Winkler H, Kelaridis T
Orthopädische Abteilung am Pulmologischen Zentrum der Stadt Wien.
Z Orthop Ihre Grenzgeb. 1989 Sep-Oct;127(5):556-60. doi: 10.1055/s-2008-1040290.
Metatarsal osteotomy according to Helal is a successful method of treating metatarsalgia. Using this method, 72% of our patients, followed up between 1974 and 1986, (114 patients with a total of 336 osteotomies) were relieved of pain, the result depending on the patients' age. On reviewing the unsuccessful results using pedobarographic measuring, the major part of failures was due to an unequal distribution of weight on the forefoot. Two main types of faulty weight-bearing were stated: 1. Excessive weight-bearing on non-osteotomized adjacent metatarsals (domino-effect). In concern of the overall-result no difference could be found between cases with routine osteotomy II-IV and ones with single or double osteotomy. 2. Excessive weight-bearing on the complete fore-foot as a consequence of missing support by contracted metatarsophalangeal joints. When planning an operation, the length of all metatarsals in relation to each other, as well as the mobility of the toes should therefore be taken into consideration.
根据赫拉尔方法进行的跖骨截骨术是治疗跖痛症的一种成功方法。采用这种方法，在1974年至1986年间接受随访的患者中，有72%（114例患者，共进行了336次截骨术）的疼痛得到缓解，结果取决于患者的年龄。在使用足压力测量法评估未成功的结果时，大部分失败原因是前足负重分布不均。指出了两种主要的负重错误类型：1. 未进行截骨术的相邻跖骨负重过多（多米诺效应）。就总体结果而言，常规II-IV跖骨截骨术病例与单根或双根跖骨截骨术病例之间未发现差异。2. 由于跖趾关节挛缩缺乏支撑，整个前足负重过多。因此，在计划手术时，应考虑所有跖骨彼此之间的长度以及脚趾的活动度。
