骨愈合中的性别差异：近期临床前文献综述
Sex-Based Difference in Bone Healing: A Review of Recent Pre-clinical Literature.
作者信息
Kurapaty Steven S, Hsu Wellington K
机构信息
Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 6061, USA.
Simpson Querrey Institute, Center for Regenerative Nanomedicine, Northwestern University, Chicago, IL, USA.
出版信息
Curr Rev Musculoskelet Med. 2022 Dec;15(6):651-658. doi: 10.1007/s12178-022-09803-1. Epub 2022 Nov 15.
PURPOSE OF REVIEW
Recent literature has sought to understand differences in fusion failure, specifically considering how patient sex may play a role. Overall, there exists inconclusive data regarding any sex-based differences in bone healing.
RECENT FINDINGS
In vitro studies examining the roles of sex hormones, 5-LO, IGF-1, VEGF, osteoclasts, and OPCs seem to show sexually dimorphic actions. Additionally, donor characteristics and stem cell environment seem to also determine osteogenic potential. Building on this biomolecular basis, in vivo work investigates the aforementioned elements. Broadly, males tend to have a more robust healing compared to females. Taking these findings together, differences in sex hormones levels, their timing and action, and composition of the inflammatory milieu underlie variations in bone healing by sex. Clinically, a robust understanding of bone healing mechanics can inform care of the transgender patient. Transgender patients undergoing hormone therapy present a clinically nuanced scenario for which limited long-term data exist. Such advances would help inform treatment for sports-related injury due to hormonal changes in biomechanics and treatment of transgender youth. While recent advances provide more clarity, conclusive answers remain elusive.
综述目的
近期文献试图了解融合失败的差异，特别是考虑患者性别可能发挥的作用。总体而言，关于骨愈合中任何基于性别的差异的数据尚无定论。
最新发现
研究性激素、5-脂氧合酶、胰岛素样生长因子-1、血管内皮生长因子、破骨细胞和成骨前体细胞作用的体外研究似乎显示出性别二态性作用。此外，供体特征和干细胞环境似乎也决定成骨潜能。基于这一生物分子基础，体内研究对上述因素进行了调查。总体而言，与女性相比，男性的愈合往往更强健。综合这些发现，性激素水平、其时间和作用以及炎症环境的组成差异是导致骨愈合性别差异的基础。临床上，对骨愈合机制的深入理解可为跨性别患者的护理提供参考。接受激素治疗的跨性别患者呈现出一种临床细微差别情况，目前长期数据有限。这些进展将有助于为因生物力学激素变化导致的运动相关损伤以及跨性别青少年的治疗提供参考。虽然近期进展提供了更多清晰度，但确凿答案仍然难以捉摸。
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