Publikationsserver der Universitätsbibliothek Marburg
Titel:Der Einfluss von Immunsuppression auf den peri- und postoperativen Verlauf in der operativen Versorgung der distalen Radiusfraktur
Autor:Dannenberg, Svea
Weitere Beteiligte: Frink, Michael (Prof. Dr. med.)
Veröffentlicht:2018
URI:https://archiv.ub.uni-marburg.de/diss/z2018/0258
DOI: https://doi.org/10.17192/z2018.0258
URN: urn:nbn:de:hebis:04-z2018-02584
DDC:610 Medizin
Titel (trans.):The impact of immunosuppression on the peri- and postoperative course in the surgical management of the distal radius fracture
Publikationsdatum:2018-06-04
Lizenz:https://rightsstatements.org/vocab/InC-NC/1.0/

Dokument

Schlagwörter:
operative Versorgung distale Radiusfraktur, distal radius fracture, immunosuppression, operative Versorgung distale Radiusfraktur, distale Radiusfraktur, surgical treatmeant distal radius fracture, Immunsuppression, fracture of the distal radius, distale Radiusfraktur, Immunsuppression

Zusammenfassung:
Die distale Radiusfraktur stellt die häufigste Fraktur des Menschen dar. Aus epidemiologischer Sicht bestehen zwei Häufigkeitsgipfel. Diese liegen im Kindesalter und im vorangeschrittenen Alter bei über 65 Jahren. Ebenso wie die distale Radiusfraktur durch die demographisch bedingte Veränderung der Altersstruktur der Bevölkerung einen immer weiter wachsenden Anteil an den operativ zu versorgenden Frakturen einnehmen wird, werden Krankheiten, deren therapeutischer Ansatz in der Verwendung immunsuppressiver Medikamente liegt, an Relevanz gewinnen. Vielfältige und für den Patienten einschränkende Konsequenzen eines supprimierten Immunsystems, sowohl als Folge einer immunsuppressiven Therapie als auch einer Einschränkung des Immunsystems aufgrund verschiedener Erkrankungen, sind bekannt und durch zahlreiche Studien belegt. Ebenso existieren Empfehlungen zum allgemeinen Umgang im peri- und postoperativen Setting. Bisher wurde jedoch unzureichend untersucht, ob ein supprimiertes Immunsystem einen Einfluss auf den peri- und postoperativen Verlauf bei der operativen Versorgung der im klinischen Alltag höchst relevanten distalen Radiusfraktur hat. Diese Studie hat sich im Rahmen eines retrospektiven Studiendesigns dieser Fragestellung angenähert. Insgesamt 38 Patientenpaare wurden dabei anhand ihrer Daten zur medizinischen Dokumentation untersucht. Die Patientenpaare wurden einander in einem Matchingvorgang zugeordnet und unterschieden sich hinsichtlich des Merkmales der Immunsuppression. Der Matchingvorgang berücksichtigte das Geschlecht, das Alter, den Zeitpunkt der Operation und den Charlson Comorbidity Score. Für die Fall- und Matchgruppe wurde eine Vielzahl von Patienteninformationen erhoben. Dazu gehörten das Geschlecht, das Alter, der Body Mass Index, der Raucherstatus, die Frage nach regelmäßigem Alkoholkonsum, dem Patienten verordnete Medikamente, die prä- und postoperativ erhobenen Laborparameter der Leukozyten und des CRP-Wertes, die Frakturklassifikation, die präklinische Zeit, die Anzahl der Tage bis zur Operation, das Anästhesie- und Operationsverfahren, die Operationsdauer, der postoperative Analgetikabedarf, die Dauer des stationären Aufenthaltes und aufgetretene Komplikationen. Für die Patienten der Fallgruppe wurde weiterhin eine genaue Dokumentation der Immunsuppression vorgenommen, die den Grund und falls ursächlich, die genaue Dosierung und Dauer verabreichter immunsuppressiver Medikamente beinhaltete. Es stellte sich heraus, dass keine signifikanten Unterschiede in der Häufigkeit postoperativ aufgetretener Komplikationen (p: ,824), in der Dauer des stationären Aufenthaltes (p: ,768), sowie hinsichtlich der präklinischen Zeit (p: ,625), in der Dauer bis zum Operationszeitpunkt (p: ,641) und in der Länge der Operation (p: ,346) bestanden. Es kann somit kein negativer Einfluss von Immunsuppression auf den peri- und postoperativen Verlauf der distalen Radiusfraktur festgestellt werden. Zusammenfassend unterstützen die vorgelegten Daten die aktuellen Empfehlungen zum perioperativen Umgang mit immunsupressiven Medikamenten, die eine Unterbrechung der Therapie für nicht notwendig halten. Weitere idealerweise prospektive Studien mit einer deutlich höheren Fallzahl sind notwendig, um spezifischere Empfehlungen geben zu können.

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