20181216运医学习笔记Biceps Detachment 

BACKGROUND:: Lesions of the long head of the biceps tendon are often associated with massive rotator cuff tears (MRCTs), and biceps tenotomy is frequently performed for pain relief and functional reservation. However, the efficacy and safety of biceps tenotomy regarding the effects on the surrounding tissues in chronic MRCT are unclear.巨大肩袖缺损常合并二头肌损伤。长头腱切除会缓解疼痛保留功能。对周围组织的影响不清楚。

HYPOTHESIS:: Biceps tenotomy would result in improved mechanical and histological properties of the intact subscapularis tendon and improved in vivo shoulder function while not compromising glenoid cartilage properties.

假设切断后改善了肩胛下肌功能发挥和组织结构，增强肩关节功能同时不损伤软骨。

STUDY DESIGN:: Controlled laboratory study.

METHODS:: Right supraspinatus and infraspinatus tendons were detached in 25 male Sprague-Dawley rats, followed by 4 weeks of cage activity to create a chronic MRCT condition. Animals were randomly divided into 2 groups and received either biceps tenotomy (n = 11) or sham surgery (n = 14) and were sacrificed 4 weeks thereafter. Forelimb gait and ground-reaction forces were recorded 1 day before the tendon detachment (baseline), 1 day before the surgical intervention (biceps tenotomy or sham), and 3, 7, 10, 14, 21, and 28 days after the intervention to assess in vivo shoulder joint function. The subscapularis tendon and glenoid cartilage were randomly allocated for mechanical testing or histologic assessment after the sacrifice.

方法，做大鼠模型，雄性，25只，右侧冈上肌和冈下肌切断，运动四周后分组。切断组和假手术组。4周后处死。前足步态和地面反应力分别在不同时间记录，切断前一天为基线值，术后3，7，10，14，21，28天。处死后行肩胛下肌和关节软骨的机械检测和组织学评估。

RESULTS:: Compared with sham surgery, biceps tenotomy partially restored the in vivo shoulder joint function, with several gait and ground-reaction force parameters returning closer to preinjury baseline values at 4 weeks. With biceps tenotomy, mechanical properties of the subscapularis tendons were improved, while mechanical properties and histological Mankin scores of the glenoid cartilage were not diminished when compared with the sham group.

切断组可以部分恢复肩袖功能。小鼠表现为4周后检测指标恢复至基线水平。肩胛下肌机械强度增大，组织学Mankin评分与对照组比未见差异。

CONCLUSION:: Biceps tenotomy in the presence of chronic MRCT partially preserves overall shoulder function and potentially restores subscapularis tendon health without causing detrimental effects to joint cartilage. This laboratory study adds to the growing literature regarding the protective effects of biceps tenotomy on the shoulder joint in a chronic MRCT model.

结论就是切了更好。

CLINICAL RELEVANCE:: This study provides important basic science evidence supporting the use of biceps tenotomy in patients with massive rotator cuff tears.

为临床决策提供了基础科研证据。

所以说二头腱，留还是不留，这是个问题。回顾性研究可以会从临床角度提供证据。