成人无骨折脱位颈脊髓损伤18例法医临床学鉴定分析

目的了解成人无骨折脱位颈脊髓损伤的临床特征及法医学鉴定原则。方法自2012年12月～2016年12月共受理此类案例18例。对法医临床学鉴定(包括损伤程度、伤残等级)进行分析。结果对18例被检者中15例进行伤病关系分析,参与度以同等作用最多,占33.33%,其次为主要作用、次要作用,分别占22.22%,3例未进行伤病关系分析。结论成人无骨折脱位型颈脊髓损伤是以颈椎退行性改变为基础的疾病,大部分均涉及伤病关系分析,必要时给出伤病参与度。     

儿童无骨折脱位胸脊髓损伤因果关系鉴定分析

<正>无骨折脱位脊髓损伤或称无放射学影像异常的脊髓损伤,是指损伤暴力造成脊髓损伤而经X线及CT等影像学检查未见脊柱骨折、脱位等异常,属于脊髓损伤的一种特殊类型[1]。成人多见于颈段脊髓损伤,儿童胸段无骨折脱位型脊髓损伤则明显高于成人[2-3]。本文报道1例相关案例,并就其损伤因果关系鉴定进行分析。1案例资料1.1临床资料女童,7岁,某年7月15日,在练习下腰动作后     

骶尾部骨折及脱位的影像学诊断和法医学鉴定2例

骶尾部损伤在临床上及法医学鉴定中均较常见,对骶尾部骨折及脱位的诊断主要靠影像学资料。但骶尾骨作为人体退化器官,个体差异较大,在影像学上对骶尾骨变异与骶尾骨骨折及脱位的鉴别点较难区分。笔者通过对法医案检中遇到的两例骶尾部损伤鉴定案例的分析,对骶尾骨变异的类型、特点及其与骶尾部骨折与脱位的鉴别点进行简要阐述。     

18例输卵管妊娠相关医疗损害法医学鉴定分析

目的 分析输卵管妊娠误诊后发生医疗损害的案例,探讨发生医疗损害的原因,过错行为与损害后果的因果关系以及原因力大小,为此类案件的法医学鉴定提供评价思路。方法 收集18例输卵管妊娠相关医疗损害的法医学鉴定案件,从患者年龄、孕产史、生育需求、危险因素、诊疗情况、医疗过错、损害后果、原因力大小等方面进行回顾性分析。结果 18例均为输卵管妊娠,其中17例医疗行为存在过错,导致14例患侧输卵管切除,2例失血性休克死亡,1例宫内胎儿停止发育并患侧输卵管切除。另1例虽有输卵管切除的损害后果,但医疗行为无过错。结论 正确的诊断有助于制定合理的治疗方案,防止病情进展,减少严重不良后果和医患纠纷的发生。科学、合理地分析医疗过错行为与损害后果之间的因果关系及原因力大小,对此类医患纠纷的顺利解决有重要意义。     

50例男子性功能鉴定分析

对５０例男子性功能障碍法医学鉴定案例进行了分析,旨在探讨不香阴茎勃起功能障碍的发病特点及其原因。结果表明,在１６例骨盆骨折伴尿道断裂的病人中,有１０例阴茎勃起功能有不同程度的障碍,其主要原因为阴部神经和血管损伤。在６例脊柱骨折伴轻度脊髓损伤的病人中,有３例阴茎勃起功能有不同程度的障碍,其主要原因为脊髓或脊神经损伤。而在１９例睾丸损伤的病人中,除２例双侧睾丸损伤者阴茎勃起功能障碍外,其余１７例单侧睾     

临床漏诊眶骨骨折的法医学鉴定分析

<正> 在眼损伤的法医临床学鉴定实践中,有些临床漏诊的眶骨骨折的法医学鉴定案例,已被大多数法医同行所关注。本文作者对32例临床漏诊的眶骨骨折的法医学鉴定资料进行回顾性分析,并对其漏诊原因和法医学鉴定的有关问题进行讨论。     

寰枢关节损伤的法医学鉴定分析

寰枢关节的脱位及枢椎齿状突的骨折在交通事故受伤人员中比较常见,在一般伤害案件中不多见。此类损伤临床症状和体征视其是否伤及神经系统而有所不同,骨折或脱位主要通过影像资料来鉴别。笔者通过对典型案例的分析,提出此类损伤的法医学鉴定要点。1案例资料例1:某男,35岁,因故与人发生争执中,被人用手扼住颈部抵于门框上。次日因颈部疼痛去医院就诊。X线片报告“齿状突骨折、半脱位”,后在局麻下行颅骨牵引术(2kg),术中因体质较差曾发生晕厥(具体情况无记载),故停止牵引改用颈托支架固定,治疗期间多次进行X线摄片检查,诊断为齿状突半脱位或…     

浅谈损伤参与度评定应注意的几个问题

在人身损害的案件中 ,由于损伤与疾病等诸多因素的共同存在 ,且造成机体结构破坏及功能障碍、死亡等现存后果 ,损伤或者损伤所致的继发症、并发症在现存后果的因果关系的评定中所起作用的相对比例 ,就是损伤参与度。换句话说 ,就是损伤与后果究竟有多大关系。近年来 ,损伤参与度被法医界同仁广泛研究 ,并在法医学鉴定中所应用 ,对法医学鉴定和司法工作起到了很重要的作用。但由于对损伤参与度的评定尚属尝试阶段 ,无统一标准可循 ,不同的鉴定人在评定损伤参与度时常用不同的做法而引起争议。笔者试结合实际鉴定工作 ,谈一谈损伤参与度在评定…     

外伤后流产23例法医学鉴定回顾性分析

目的分析外伤后流产案例法医学临床鉴定的特点,探究外伤与流产之间的因果关系。方法收集近年中国医科大学法医学院临床法医学教研室外伤后流产法医学鉴定共23例,总结和分析外伤后流产案例的特点。结果23例外伤后流产法医学鉴定例均为早期流产,体表损伤轻微,伤后短时间内出现阴道流血,并在较短时间内流产。高龄孕妇、农村人口和无业人员所占比例大。结论流产原因较多,对于外伤后流产的法医学鉴定案例,只有排除非外伤性因素后,才能认定为外伤性流产;对于不能排除非外伤性流产因素的案例,可根据具体情况分析损伤为流产的主要原因、次要原因或诱因。     

浅谈损伤参与度评定应注意的几个问题

在人身损害的案件中,由于损伤与疾病等诸多因素的共同存在,且造成机体结构破坏及功能障碍、死亡等现存后果,损伤或者损伤所致的继发症、并发症在现存后果的因果关系的评定中所起作用的相对比例,就是损伤参与度。换句话说,就是损伤与后果究竟有多大关系。近年来,损伤参与度被法医界同仁广泛研究,并在法医学鉴定中所应用,对法医学鉴定和司法工作起到了很重要的作用。但由于对损伤参与度的评定尚属尝试阶段,无统一标准可循,不同的鉴定人在评定损伤参与度时常用不同的做法而引起争议。笔者试结合实际鉴定工作,谈一谈损伤参与度在评定时应注意的几个问题,供同仁们参考。     

Homicide by manual occipitoatlantal dislocation

Occipitoatlantal dislocation is usually seen as a fatal injury in traffic accidents and has rarely been reported as a consequence of a homicide. The authors report the case of a women presenting a fatal occipitoatlantal dislocation, the circumstances of which pointed to a homicidal origin. Blood extravasation surrounding the muscles of the posterior part of the neck as well as abnormal mobility of the cranio-cervical joint was noted during autopsy; thus a complete dissection of this region was performed. This led to the finding of a fracture of the left occipital condyle and of the left superior articular facet of the atlas. This case clearly demonstrates the need to perform a large, systematic, posterior approach to the upper cervical spine, completed by the opening of the skull around the posterior fossa, when injury to the cranio-cervical junction is suspected. In these cases, the classic anterior approach give poor information and poor dissection possibilities.     

Analysis of 50 cases of sexual dysfunction

Fifty cases of male sexual dysfunction were analyzed in order to investigate the incidence and causes of the erectile dysfunction in the different injuries. The results showed that the incidence of erectile dysfunction of the patients with brevic fracture and urethra injury is 62.50%, main caused by the damage of pudendal nervous and arterial system. The incidence in the patients with the spinal fracture and light spinal cord injury is 50%, caused by the damage of nervous system. The erection in the 17 cases of the patients with only one testis injury is normal. Two cases with bilateral testis injury have suffered from erectile dysfunction.     

Contributions from Forensic Imaging to the Investigation of Upper Cervical Fractures

Abstract: Injuries to the upper cervical spine (UCS) are common in traumatic deaths and postmortem computed tomography (PMCT) may contribute to the forensic investigation. This study presents PMCT in comparison with autopsy in the examination of UCS injury. Thirteen consecutive cases with UCS fracture and/or cranio‐cervical dislocation were examined with PMCT and autopsy, and the findings were correlated. Neither of the techniques identified all UCS injuries. Fractures of atlas and axis were best visualized with PMCT whereas cranio‐cervical dislocation was better identified during autopsy. Serious injuries were present after both high‐ and low‐energy trauma. Medico‐legal autopsy in combination with PMCT produced a thorough evaluation of UCS injuries. By combining these procedures detailed investigations, including accident reconstruction and injury pattern analysis, can be performed. This study supports the routine application of PMCT, as a supplement to the medico‐legal autopsy of deaths with UCS injuries.     

体感诱发电位检查在法医学鉴定中的应用探讨

目的探讨体感诱发电位(SEP)检查在法医学鉴定中的应用价值。方法将60例神经系统外伤(不包括周围神经损伤)并功能障碍者分为脊髓损伤组(33例)和颅脑损伤组(27例),分别进行神经系统查体及SEP检查,并对其结果进行相关分析。结果脊髓损伤组SEP结果33例均表现为异常,异常率100%,且随着功能障碍程度的加重,SEP异常的程度亦加重,两者呈正相关(R=0.72,P<0.01,n=33)。27例颅脑损伤者,仅有9例异常,异常率为33%,功能障碍程度与SEP异常相关性分析(R=0.36,P>0.05)。结论SEP检查是客观评定脊髓功能较为敏感而准确的辅助检查手段;但对颅脑损伤功能障碍的客观评价价值相对有限。     

Fatal birth trauma due to an undiagnosed abdominal teratoma: case report and review of the literature

The fetus is subjected to mechanical forces during labor and delivery, which may result in traumatic injuries. Such injuries include intracranial hemorrhage, spinal cord lesions, cephalhematoma, cranial or peripheral nerve palsies, intraabdominal organ rupture, or bony fractures. Risk for perinatal trauma and mortality is increased in primigravidas, multiple gestations, abnormal presentations, maternal-fetal disproportion, oligohydramnios, forceps or vacuum extractions, and internal version maneuvers. Very-low-birth-weight neonates (<1500 g) are at high risk due to ease of deformity of the cranium. Infants with certain congenital anomalies or pathologic processes that distort normal anatomy are also at increased risk, especially when a prenatal diagnosis is lacking. The authors present a case of a term gestation neonate who sustained a cervical spine dislocation fracture of C5-7, with subtotal transection of the spinal cord and resultant paralysis. The fetus was in vertex presentation, and a manual vaginal delivery was attempted. When the infant lodged in the birth canal following a difficult delivery of the head and arms, its enlarged abdomen was palpated, and the delivery was converted to an emergent cesarean section. The infant lived for 3 days and then expired due to neurologic complications of trauma sustained during the attempted vaginal delivery. Autopsy revealed a previously undiagnosed intraabdominal immature teratoma. The pathology of teratomas, the most common neonatal tumor and occasionally implicated in cases of birth trauma, will be addressed, followed by a review of the literature concerning birth trauma.     

Injuries to pathologically changed cervical vertebrae

Three cases of fatal injuries to the upper cervical spinal cord and underlying cervical spine pathology are presented. It is stressed that the slightest suspicion concerning injuries to the upper part of the neck must lead not only to microscopic examination of the cervical spinal cord and medulla oblongata, but also to careful preparation (or maceration) of the upper cervical spine, in order not to overlook fractures or misinterpret old fractures and diseases as fresh fractures.     

颈椎损伤的伤残等级及“三期”法医学评定——附64例分析

目的探讨交通事故致颈椎损伤后伤残等级和休息、护理、营养时限的法医学鉴定,以及颈部损伤、原有疾患与后遗症之间因果关系法医学鉴定的原则与方法。方法收集64例颈椎损伤的伤残等级鉴定案例,对相关资料/数据进行统计分析。收集交警部门反馈的涉及伤病关系案件的处理结果,了解案件双方当事人对鉴定结论的认可程度。结果随着对颈椎损伤后伤残评定案件中原发病的认识逐渐增加,相应颈椎损伤涉及伤病关系鉴定的案件也日益增多;在受理的颈椎损伤伤病关系案件中,均按照伤病关系理论进行鉴定,案件处理机关（交通警察）以及双方当事人对鉴定结论均表示满意。结论对于各种颈椎损伤进行伤残等级和“三期”鉴定的案例,由于损伤机制不同,自身原有颈椎健康程度不同,所造成的后果也不尽相同,鉴定中应考虑原有疾病对伤残等级的影响。     

人体损伤后医疗因素影响的有关问题探讨

人体损伤后医疗因素的影响会改变人身损害后果，加之目前我国法理及法律方面的不完善，使此类案件的审理出现一定困难，同时对法医学鉴定也有一定的影响。本文通过对８例案件的分析，讨论了人体损伤后医疗因素影响的特点，并结合法律的观点，提出法医学鉴定中需探讨的问题：１、医疗因素与人身损害之间的因果关系；２、医疗因素有无过失以及责任性过失和技术性过失的区分；３、外伤与医疗因素在人身损害中参与度的判定。从而提高法医学鉴定的科学性，为公正审判服务。     

Unusual neck lesion in a pedestrian caused by a road accident

The authors describe a road accident that occurred in the Trieste region of Italy in 1998, wherein a pedestrian experienced a mortal injury. During the on-site examination, the forensic officer in charge noticed, in addition to dispersed abrasions, bruises, and fractures, an unusual position of the head with a highly unusual motility of the cervical rachis and, above all, an apparent whitish fibrous elastic cord, 7-8 cm long, which came out of the mouth. The cord was found to be a segment of the spinal cord, expelled and driven into the mouth cavity by the impact. This represents an interesting case because of the specific dynamics of the accident and the type of lesion involved. This kind of spinal cord injury, in particular, is infrequent among pedestrians involved in road accidents in comparison with other road casualties.