膝关节骨性关节炎关节内治疗结果的性别差异：现有证据和研究差距：系统回顾和荟萃分析

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-09-23 DOI:10.1002/jeo2.70432

Gae Fattini Fellini, Giacomo A. Fumagalli, Andrea Piano, Alessandro Bensa, Giuseppe Filardo

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引用次数: 0

摘要

本系统综述和荟萃分析的目的是量化和比较膝关节骨关节炎（OA）患者关节内注射皮质类固醇（CS）、透明质酸（HA）、富血小板血浆（PRP）和细胞治疗后性别特异性结局的证据。方法根据PRISMA指南于2024年10月在PubMed、Cochrane和Web of Science上进行文献检索。纳入标准是任何证据水平的临床研究，至少6名患者，英语，无时间限制，关于使用关节内CS， HA， PRP和细胞疗法治疗膝关节OA。在短期（3个月）和中期/长期（≥3个月）随访时，对每种产品的结果进行meta分析。结果共纳入848项研究，报告了99443例患者（61.5±24.7岁，女性65.8%，男性34.2%）。其中，只有21篇文章（占总数的2.5%，2265例患者）提供了按性别分类的数据，包括4项CS治疗组的研究（占CS患者的1.9%），3项HA组的研究（占HA患者的0.2%），11项PRP组的研究（占PRP患者的5.9%）和8项细胞治疗组的研究（占细胞治疗患者的10.2%）。荟萃分析对15项研究（1387例患者）进行了分析，在分析的四种注射治疗方法的短期和中期/长期随访中，VAS和WOMAC的改善没有任何统计学上的显着差异。在评估膝关节OA最常用的关节内注射疗法的研究中，缺乏按性别分类的数据，只有2.5%的研究分析了CS、HA PRP和细胞治疗的女性和男性特异性结果。对这些数量有限的按性别分类的数据进行分析，并没有显示女性和男性在任何被调查的注射方法上有统计学上的显著差异。分解的严重缺乏阻碍了对这些治疗的潜在性别特异性效应的理解，并强调了该领域数据报告的转变，需要更可靠地设计研究，纳入性别分层分析。证据等级一级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Sex differences in intra-articular treatment outcomes for knee osteoarthritis: Current evidence and research gaps: A systematic review and meta-analysis

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Sex differences in intra-articular treatment outcomes for knee osteoarthritis: Current evidence and research gaps: A systematic review and meta-analysis

Purpose

The aim of this systematic review and meta-analysis was to quantify and compare the evidence on sex-specific outcomes following intra-articular injections of corticosteroids (CS), hyaluronic acid (HA), platelet-rich plasma (PRP) and cell-based therapies in patients affected by knee osteoarthritis (OA).

Methods

A literature search was conducted on PubMed, Cochrane and Web of Science in October 2024 according to PRISMA guidelines. Inclusion criteria were clinical studies of any level of evidence, a minimum of six patients, English language, no time limitations, on the use of intra-articular CS, HA, PRP and cell-based therapies for knee OA treatment. A meta-analysis was conducted for each product on the outcomes with sufficient data at short-term (<3 months) and mid/long-term (≥3 months) follow-ups.

Results

A total of 848 studies were included reporting on 99,443 patients (61.5 ± 24.7 years old, 65.8% women, 34.2% men). Out of these, only 21 articles (2.5% of the total, 2265 patients) presented sex-disaggregated data, including four studies with a CS treatment group (1.9% of CS patients), three with a HA group (0.2% of HA patients), 11 with a PRP group (5.9% of PRP patients) and eight with a cell-based therapy group (10.2% of cell-based therapies patients). The meta-analysis was performed on 15 studies (1387 patients) and did not show any statistically significant difference of VAS and WOMAC improvements at short- and mid/long-term follow-ups for any of the four injectable treatment approaches analysed.

Conclusion

There is a staggering lack of sex-disaggregated data in studies evaluating the most used intra-articular injective therapies for knee OA, with only 2.5% analysing women- and men-specific outcomes for CS, HA PRP and cell-based therapies. The analysis of this limited amount of sex-disaggregated data did not show statistically significant differences between women and men for any of the investigated injectable approaches. The substantial lack of disaggregation hinders the understanding of potential sex-specific effects of these treatments and underscores the need for a shift in data reporting in this field, with more robustly designed studies incorporating sex-stratified analyses.