头皮混合裂创的鉴定探讨

头皮裂创在法医临床中常见。当头皮既有锐器创又有钝器创时，如何进行鉴定的问题，众说不一，没有一个很好的方法来解决。运用头皮混合裂创中锐、钝器创各自长度与《人体轻伤鉴定标准 (试行 )》第六条的标准长度相比的比值之和进行计算，并总结为一个公式，借助这个公式，就能较好地解决这个问题。     

体表创口与愈后瘢痕长度的法医学分析

皮肤、软组织损伤在法医学活体损伤程度鉴定或评定中较常见。在我国轻伤鉴定标准中，对面部创口、瘢痕的长度做了明确规定，头部、躯干、四肢等部位，只规定创口长度，未规定瘢痕的长度，给司法实践带来一定的困难。为此，我们对1995～2000年的400例伤者不同部位创口及愈合后的瘢痕进行测量，以此来探讨体表创口收缩情况与愈合后瘢痕长度的关系。1一般资料1.1性别、年龄状况400例伤者中，男342例（85.5%），女58例（14.5%），年龄最大55岁，最小者16岁，平均年龄35.5岁。1.2创口部位400例伤者中有的为一处创口，有的则为多处创口，其中头皮…     

捅创论(附尸检例报告)

无尖无刃的细长钝器,沿其长轴戳入人体形成的创伤应命名为捅创。国内外现有的法医学书籍很少甚至没有描述过此创,个别作者将其归入锐器刺创。本文作者通过案例研究发现:不仅该创的致伤物为无刃无尖的棍棒类钝器(如木棍、木桩、手杖、擀面棍、铁锹把、竹竿、筷子、钢筋)而且成伤机制、形态学变化也与锐器刺创不同,应属于钝器伤。     

几种特殊损伤损伤程度评定的量化处理

在《人体轻伤鉴定标准(试行)》中,对于头部、面部及躯干等处的软组织损伤的损伤程度评定都有具体的量的规定,但对于以下几种特殊的损伤在具体损伤程度评定时却缺乏具体的规定。一、特殊损伤案例1人体交界部位损伤例1　某男,23岁,1996年9月被他人用砖头砸伤头面部,查体见:左额顶部发际处见一条长55ｃｍ创口,其中创口在头部长25ｃｍ,创口在面部长30ｃｍ。例2　某男,26岁,1993年3月被人因故用木棍砸伤头面部,查体见:右额顶部发际处见一长80ｃｍ创口,其中头顶部创口50ｃｍ,额面部创口30ｃｍ,其他部位未见损伤。2锐器钝器混合损伤例3　某男,32岁,…     

创口和瘢痕损伤程度鉴定相关问题探讨

正1《人体损伤程度鉴定标准》中涉及"创口或者瘢痕"的条款《人体损伤程度鉴定标准》(以下简称《标准》)中有多条关于"创口或者瘢痕"的条款,但在学习和宣贯的过程中我们发现对于这些条款的理解还存在差异,在实际操作过程中也可能会出现争议。除了轻微伤之外,《标准》中有关"创口或者瘢痕"的条款共有12处(表1),分列于头面部(包括头皮、面部和耳郭)、颈前部、肢体和体表等不同条款中。     

18例玻璃致伤探析

玻璃品整体为钝器，分离的碎片为锐器，其作用于人体时具钝、锐器伤特征。现将本人近年来对玻璃损伤的案例观察报告于下。损伤检验资料玻璃器（如酒瓶、花瓶、烟灰缸等）打击头面部致伤6例，玻璃器未碎。检见损伤：（1）片状皮下出血，其边缘清楚；（2）圆形、类图形及片状表皮剥脱，剥脱面光滑，无点、线状擦划痕，有两例见大片表皮附着于剥脱面一侧；(3)条、弧形挫裂创，创周见条、片状表皮剥脱，其面光滑，创壁间有组织间桥，创底不平整；（4）有一例检见颅骨线状骨拆。玻璃碎片致伤3例。一例吻须自杀未死者，颈部见多道线状表皮剥脱，多…     

带刃锐器砍切刺创的顺序判断

在锐器所致创伤的案件中 ,因致伤工具、作用方式和方向 ,以及加害部位的不同 ,创口形态千差万别。在法医学鉴定中 ,分析创口形成的先后顺序 ,具有一定的难度。本文作者通过创口组织结构变化和创口特征差异 ,推断创口形成的先后顺序 ,在检案中取得了良好的效果。1　判定顺序正常组织均具有一定的张力 ,当带刃锐器首次作用于人体组织后 ,由于创口组织断裂并发生回缩 ,使创壁两侧组织发生移位 ,创口中部哆开移位最大。再次作用这一区域 ,必然发生创口组织改变 ,使先后创伤特征不同。按照锐器所致创口的不同形状和创口特征差异 ,判定创口形成的…     

皮肤切创愈合过程中FoxO1表达与损伤时间关系

目的检测皮肤切创愈合过程中FoxO1的表达及其时间规律性变化。方法建立小鼠皮肤切创模型,应用免疫组织化学技术及Western印迹法检测切创后不同时间段皮肤中FoxO1的表达。结果 HE染色显示皮肤创口正常愈合。免疫组织化学结果显示,对照组FoxO1弱表达于表皮、毛囊、皮脂腺、血管内皮及真皮中少数的成纤维细胞;伤后6~12h创口周边区表皮及皮肤附件FoxO1表达增强,可见浸润的中性粒细胞和少量单核细胞表达FoxO1;伤后1~3d FoxO1以单核细胞阳性表达为主;伤后5~10d FoxO1以新生血管内皮及成纤维细胞表达为主;伤后14d仍有少量成纤维细胞表达FoxO1。Western印迹法检测显示,创伤各组创口皮肤的FoxO1表达量均高于对照组,其中伤后12h和伤后7d为FoxO1的两个表达峰值。结论 FoxO1在皮肤切创愈合过程中呈现一定的时序性变化,有望成为推断创口形成时间的生物学指标。     

颅骨内外板骨折的致伤物推断1例

1案例资料宋某,男,19岁。2008年9月11日因故被多人打致颅骨后枕部骨折。现场收集遗留物七环刀一把,该刀全长52cm,刀柄为木质(长15cm),刀体为铁质(长37cm)、重约4kg,刀背呈直线形(厚2mm),刀刃呈弧线形,较钝,刀刃前段可见数处豁口。铁质油漆桶一个,桶高31cm,桶底面直径为32cm,重约5.5kg,桶口边缘较钝,呈卷边状,桶底边缘较锐利,厚0·6cm(照片1)。当地鉴定本部门依据宋某头皮创口较明显的表皮剥脱及钝器损伤特征性的颅骨外板线状骨折认为,宋某左枕部颅骨骨折为铁质油漆桶较锐利的底边直接打击所致,头部倒“U”型创口为头皮在铁桶切线作用力下撕脱形成。因有异议,故来我处要求对后枕部损伤的机制重新鉴定。法医学检查:伤后48d进行法医学检查。左耳廓后颞枕部可见一折线状瘢痕,大小为7.0 cm×0·2 cm,瘢痕对位较齐,周围皮肤未见明显痂皮形成(照片2),与该瘢痕相连处可见一弧线状瘢痕,大小为17.0 cm×0·2 cm,部分瘢痕周围可见大量痂皮附着。两瘢痕相连呈倒“U”型(照片2)。头部CT示左枕骨内板粉碎性骨折,骨折片散在分布,左额部可见低密度颅内积气影(照片3)。骨外板呈弧线性骨折(照...     

木工手锯齿侧砍伤颅骨遗留多枚折断锯齿一例

案例头部锐器伤在司法鉴定中极为常见，但锯齿砍伤遗留颅骨内多个折断的锯齿尚未报道。笔者将所遇一例报道如下。某男，21岁。某年5月22日在工作中与他人发生争吵，被人用木工手锯齿侧将头部砍伤。砍伤当时无恶心、呕吐及意识障碍。伤后两天查体；右前额部有一5．0cm长创口，已缝合，愈合佳．但有压痛及触痛。伤后第三天X线片报告颅骨内有异物。据术后小给记载：在右前额原创口处切开长约scm头皮组织，深至骨膜，见颅骨上有折断的锯齿，用止血钳取出6个约0－scm长折断的锯齿，经止血后缝合包扎。经近1个月治疗，现右侧头痛，头皮麻木。讨论…     

体表创伤与愈合后瘢痕长度的临床法医学意义

探讨体表创口与愈后瘢痕的关系。比较创口愈合成为瘢痕的收缩率。由于现有伤残鉴定标准中未就体表创口或瘢痕的长度测量的换算作出任何规定，所以某些体表损伤的伤残评定可能有欠公允。有必要就此提出相应解决办法，供同行探讨。     

Site, number and depth of wounds of the scalp in falls and blows--a contribution to the validity of the so-called hat brim rule

The sites, numbers and lengths of wounds of the skin of the scalp and head caused by blunt injuries (falls from standing position, falls downstairs, blows) in an autopsy series. Analysis of the localization, length and number of wounds located at the head in 305 autopsy cases of falls from a standing position (203 cases), falls downstairs (51 cases) and blows with relatively long materials (51 cases). For the distinction between falls and blows, among several other aspects the so-called rule of the hat-brim-line is described: in cases of falls from a standing position down to a flat bottom, contusions can be expected in or near a line which represents the greatest horizontal circumference of the skull, whereas in cases of blows the contusions lay above this area. Although such a tendency was found in our material, a rule could not be confirmed: only approximately 55% of the wound due to blows were above this line, and in cases of falls from a standing position ca. 1/3 of the wounds were above this area. Only in the (dorso-frontal and parietal) region "top of the head" contusions due to falls from a standing position were quite uncommon. The mean length and length distribution of wounds in the hat-brim-zone was not different between the 3 causes of injuries; in positions above this, wounds due to blows were longer compared to those by falls. In falls from a standing position, only exceptionally more than 1 wound was found, whereas in cases of homicide several or many wounds were common. Single wounds due to blows were only found in cases, in which the victims were knocked down but not killed by blunt forces, and death was caused by other methods (e.g. strangulation or stabbing).     

Peculiarities of the stab and cut wounds caused by blades of combat cold weapons

Design philosophy of blades of Russia-made combat cold arms and of inflicted-by-them stab-and-cut wounds were characterized on the basis of a comparative-and-evaluation study. Stereomicroscopy, histology examinations as well as X-ray-spectral and fluorescence analyses were made use of while investigating the wounds with subsequent processing of the results by discriminative analysis. Form, skewness and a graze type of the wound tubber as well as presence of "edge cuts" and of central graze wound were found to be the main distinctive wound signs. The study results ensure a full-value differential diagnosis of a type of the used cold-arm sample.     

枪弹创后置物射出口形态学的实验研究

为建立后置物射出口与射入口的检验鉴定方法，使用国产五四式7．62mm口径手枪及五六式7．62mm口径半自动步枪，以5米的距离射击约克夏种白猪18只，同时以木板、水泥板、玻璃及衣服等作为射出口衬垫物，制成后置物射出口56例，并与对照组12例射出口进行对比观察。结果表明，射出口与后置物距离在3cm以内均可出现创缘伸展轮及皮下出血，且与后置物质地及距离成正比。根据其形态分为典型及非典型两类，并建立了此类射出口的检验方法及其与射入口鉴别的依据，有助于法医在实际检验中对射击方向的判断。     

皮肤切创愈合中caspase-3表达的免疫组化研究

目的探讨皮肤切创损伤愈合过程中,caspase-3在损伤区内的表达以及不同损伤时间caspase-3的变化规律。方法应用免疫组织化学技术对33例不同损伤时间小鼠皮肤切创组织中caspase-3的表达进行研究。同时以3例非切创小鼠皮肤组织做对照。结果伤后6h的损伤皮肤组织中可见少量中性粒细胞表达caspase-3,伤后12～24h,大部分浸润的中性粒细胞及部分单核细胞为caspase-3阳性。随伤后时间延长,caspase-3阳性细胞以单核细胞及成纤维细胞为主。伤后0～3h,caspase-3阳性细胞比率较低,为(4.53±6.53)%,12h后逐渐增加,伤后3d达高峰,为(62.66±4.84)%,其后逐渐下降。结论小鼠皮肤损伤愈合过程中,caspase-3可能在诱导损伤区内中性粒细胞、单核巨噬细胞及成纤维细胞发生凋亡过程中发挥重要作用,同时,caspase-3的规律性表达可用于损伤时间的推断。     

Concordance Rate for the Identification of Distant Entrance Gunshot Wounds of the Back by Experienced Forensic Pathologists Examining Only Images of Autopsies

The images of 66 gunshot entrance wounds with a defect on the back, a bullet in the body, hemorrhage along the wound track, and logical certainty that it was an entrance wound were collected from the files of a moderately busy medical examiner's office. Participants numbering 22 board‐certified forensic pathologists viewed a single digital archival image of each of the 66 entrance wounds randomly mixed with 74 presumptive exit wounds to determine whether they were entrance or exit wounds. The concordance rate for correctly identifying the 66 logically known entrance wounds was 82.8% with a range from 58% to 97%. This pilot study was conducted to provide an evidence‐based approach to the interpretation of the direction of gunshot wounds by reviewing pathologists with access only to archival photographs, and it is not a measure of the accuracy to distinguish entrance from exit wounds when given all of the circumstances.     

Radiography of perforating centerfire rifle wounds of the trunk

All deaths resulting from perforating centerfire rifle wounds of the chest and abdomen, investigated by the Office of the Chief Medical Examiner for the Province of Alberta from 1988 to 1995. were reviewed retrospectively to determine whether the radiographic distribution of bullet fragments in such cases is a useful predictor of bullet trajectory. Study cases were limited to single gunshot wounds without surgical intervention or intermediate targets, and for which adequate radiography was available. Three pathologists individually viewed the radiographs on two separate occasions; wound locations were provided for the second viewing (Group 2). Differences in opinion regarding direction of fire were resolved by consensus review. A trauma radiologist independently made two sets of interpretations in the same way. Comparisons of these groups of interpretations were made with the actual bullet direction determined at autopsy. Of 21 cases included in the study, only three (14.3%) did not require consensus resolution in either group. Accuracy of pathologists' interpretation improved from 38.1% (8/21) to 76.2% (16/21) with provision of wound locations (p = 0.012). The radiologist achieved similar improvement, from 28.6% (6/21) to 47.6% (10/21). The rate of agreement between radiologist and pathologists increased from 42.9% (9/21) to 61.9% (13/21) between Groups 1 and 2. Both the pathologists and radiologist interpreted several cases the same way in both groups; of those cases interpreted differently, the second interpretation was occasionally incorrect after correct interpretation in Group 1. We conclude that bullet direction for perforating centerfire rifle wounds cannot be accurately determined from postmortem radiographs. When wound location is known, the ability to predict bullet direction improves but is still subject to error, including a lack of consistency between observers.     

Secondary combined suicide viewed by the wife]

A 47-year-old man was found dead at the bottom of a wall outward the door of the cellar of his house. Preliminary physical examination at the scene of the death revealed a laceration of the scalp, an incised wound in front of the neck and several stab wounds in the left chest penetrating through the clothing. Questioned by the police his wife told that her husband who suffered from severe depression had inflicted the incised and the stab wounds himself, had made an unsuccessful attempt at self-strangulation and had finally jumped down from the wall beside the stairs declining to the cellar of their house. As the circumstances of the scenario were suspicious and as the pattern of injuries arose doubts concerning self-infliction homicide was taken into consideration as well. Autopsy showed additional hesitation marks adjacent to the left end of the incised wound in front of the neck. The stab wounds of the chest were restricted to the region of the heart and displayed only minimal penetration of the chest-wall, findings characteristic of self-infliction. As a consequence the manner of death could be determined as prolonged suicide, and exact reconstruction was possible with the help of the wife's testimony.     

枪弹创前置物射入口形态学的实验研究

为建立前置物射入口与典型射入口的检验鉴别方法，使用国产54式7.62mm口径手枪及56式7．62mm口径半自动步枪，以3m的距离射击约克夏种白猪义3只，同时以各种玻璃、木板。汽车门、动物躯干等物质作为中间障碍物，制成前置物射入口36例，并与对照组6例射入口进行对比观察。结果显示，前置物射入口较典型射入口增大，撕裂，创线挫伤增宽，创周出现卫星创或假点彩，创道内异物及弹头严重变形。此检验诊断方法有助于法医在实际检验中对射击距离的判断和对现场环境的分析。     

Shored gunshot wound of exit. A phenomenon with identity crisis

Shored gunshot wound of exit is produced when the outstretched skin is impaled, sandwiched, and crushed between the outgoing bullet and the unyielding object over the exit site, thus leaving an abrasion collar on the wound margin. Proper coaptation of the wound margin is impossible because of the loss of skin just like those observed in entrance wounds. In contrast to the entrance wound, the supported exit wound shows a scalloped or punched-out abrasion collar and sharply contoured skin in between the radiating skin lacerations marginating the abrasion (Fig. 1). Should gunpowder be observed around the exit site, it is often unevenly distributed, and is not associated with searing, gunpowder stippled abrasion, tatooing, and deposition of soot.