De Palma L, Tulli A, Sabetta S P
Università Cattolica del S. Cuore, Roma Istituto di Clinica Ortopedica, Italia.
Acta Orthop Belg. 1994;60(3):307-14.
The authors report their experience with the operation of Heyman, i.e. complete release of the tarsometatarsal and intermetatarsal joint for the treatment of congenital metatarsus varus. This operation of Heyman is capable of meeting the requirements of correction if the indications are precise and if the surgical technique is perfect. The operation is indicated in cases of varus over 15 degrees, passively reducible, with good axes of the hindfoot and without bony alterations of the Lisfranc joint, in children between 3 and 8 years old. There should be a dorsal and medial capsulotomy, with section of the medial 2/3 of the plantar aspects of tarsometatarsal and intermetatarsal capsules; the lateral portion, the lateral 1/3 of the capsule and the insertions of the fibularis brevis and tibialis anticus should be spared. A complete capsulotomy is not indicated owing to the risk of dislocation of the tarsometatarsal joint. The correction should be stabilized during the operation by Kirschner wires to avoid a loss of correction when putting the foot in plaster.
作者报告了他们开展海曼手术（Heyman operation）的经验，即完全松解跗跖关节和跖间关节以治疗先天性马蹄内翻足。如果适应证明确且手术技术精湛，海曼手术能够满足矫正的要求。该手术适用于3至8岁儿童，内翻超过15度、可被动复位、后足轴线良好且Lisfranc关节无骨质改变的病例。应进行背侧和内侧关节囊切开术，切断跗跖关节和跖间关节跖侧2/3的内侧部分；外侧部分、关节囊外侧1/3以及腓骨短肌和胫骨前肌的附着点应予以保留。由于跗跖关节脱位的风险，不建议进行完全的关节囊切开术。手术过程中应使用克氏针固定矫正，以避免石膏固定足部时矫正丢失。
