Universität zu Köln

Krane, Felix ORCID: 0009-0000-6001-5747 (2023). Zytokindiagnostik bei der Implantation von Ellenbogen-Prothesen. PhD thesis, Universität zu Köln.

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Abstract

Der Ellenbogen stellt mit seinen anspruchsvollen biomechanischen Anforderungen ein sehr komplexes Gelenk dar. Bei großer Gelenkdestruktion aufgrund von Rheuma oder nach Frakturen kommt als ultima ratio die Implantation einer Totalen Ellenbogenprothese zum Einsatz. Die Operation wird insgesamt selten und in der Regel in spezialisierten Zentren durchgeführt. Komplikationen wie Infektionen nach einer prothetischen Versorgung am Ellenbogen kommen selten vor, sind jedoch bei den dünnen Knochen- und Weichteilverhältnissen oft verheerend. Das Immunsystem des Körpers steht im ständigen Austausch. Um lokale Entzündungsreaktionen zu regulieren und die Migration von Immunzellen zu steuern nutzt der Körper Zytokine, die Signale übertragen und Zellproliferation steuern. Die große Gruppe der Zytokine ist anhaltend Gegenstand von intensiver Forschung. Das Verständnis über Zusammenhänge von zugrundeliegenden Pathologien wie Rheuma und die Nutzung von Zytokinen für diagnostische Zwecke erhalten gerade erst Einzug in die Chirurgie und könnten in den kommenden Jahren viele Bereiche der Therapie und Diagnostik revolutionieren. Diese Arbeit befasst sich erstmals mit der lokalen und systemischen Ausschüttung von Zytokinen nach dem Einbau von Ellenbogenprothesen und dem möglichen Nutzen für die Diagnostik von Komplikationen. Dafür wurden in dieser klinischen Fall-Kontroll-Studie bei 22 Patienten präoperative und intraoperative Serumproben und intraoperativ gewonnene Synovialflüssigkeit asserviert. Postoperativ wurden nach 3 Tagen erneut Serumproben gewonnen. Im Anschluss wurden die Konzentrationen von 17 Standard-Zytokinen mittels Immunoassay bestimmt und im Anschluss statistisch ausgewertet. Der Nachweis einer regelhaften Zytokinreaktion auf die implantierte Prothese im Serum blieb aus. Die Ergebnisse geben jedoch Hinweise, dass Interleukin-6, Interleukin-8 und das Macrophage Inflammatory Protein-1b Potential als mögliche Laborwerte für den Nachweis einer Infektion bei Ellenbogenprothesen haben. Hierfür müssen weitere Studien mit größeren Fallzahlen durchgeführt werden. Die klassischen Laborparameter im peripheren Blut sind hingegen allein keine verlässlichen Werte für den Nachweis einer Infektion.

Item Type:	Thesis (PhD thesis)
Translated title:	Title Language UNSPECIFIED German
Creators:	Creators Email ORCID ORCID Put Code Krane, Felix felixkrane@web.de orcid.org/0009-0000-6001-5747 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-702222
Date:	2023
Language:	German
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Orthopädie > Klinik und Poliklinik für Orthopädie und Unfallchirurgie
Subjects:	Natural sciences and mathematics Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language Ellenbogen German Ellenbogenprothese German Zytokindiagnostik German
Date of oral exam:	27 April 2023
Referee:	Name Academic Title Wegmann, Kilian Prof. Dr. med. Lemberg, Marius Univ. Prof. Dr.
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Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/70222