性别不匹配不影响膝关节骨软骨同种异体移植术后疗效及移植物存活率：一项系统综述
简介
这项系统综述纳入4项III-IV级研究共973例患者，评估膝关节同种异体骨软骨移植中供体-受体性别不匹配对预后的影响。结果显示，性别不匹配并未一致性地影响移植物存活率或功能结果，仅一项研究报道男性供体-女性受体组失败率较高（21.2% vs. 6.9%）。临床提示，常规进行性别匹配可能并非必要。
英文摘要
PURPOSE: To investigate the effect of donor-recipient sex mismatch on outcomes following osteochondral allograft transplantation (OCAT) of the knee, with a focus on graft survivorship, complications, and patient-reported outcome measures. METHODS: A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed, Embase, and Scopus were searched through March 2025 for Level I-IV studies comparing sex-matched versus sex-mismatched OCAT for knee cartilage defects with a minimum follow-up of 2 years. Cadaveric, in vitro, and revision studies were excluded. Data extracted included patient demographics, lesion characteristics, graft type, surgical technique, patient-reported outcome measures, and postoperative complications. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies. RESULTS: A total of 973 patients were included across 4 Level III or IV studies, with 613 receiving sex-matched and 360 receiving sex-mismatched grafts. Follow-up ranged from 3.3 to 5.4 years, with consistent use of fresh, press-fit osteochondral allografts across studies. Three studies found no significant differences in failure, reoperation, or patient-reported outcomes between matched and mismatched cohorts. One study reported a higher failure rate in the sex-mismatched group (21.2% vs. 6.9%, P = .02), particularly in male-donor-to-female-recipient cases. However, sex mismatch was not a consistent predictor of failure across studies. CONCLUSIONS: Donor-recipient sex mismatch in patients undergoing OCAT of the knee does not consistently affect graft survival or functional outcomes. Reported failure rates ranged from 5.2% to 21.2% across studies, with bipolar grafts being the most reliable predictor of failure. Given the absence of consistent differences in outcomes, routine sex matching does not appear necessary. LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.