480例活体损伤的法医学鉴定分析

目的分析活体损伤的特征,探讨其损伤类型与损伤程度的关系,以及法医学鉴定的有关问题。方法随机抽取1998-2001年间活体损伤的鉴定资料,对伤者的损伤及其法医学鉴定进行回顾性分析。结果男性伤者居多;多发伤高于任何单一部位损伤;致伤方式以钝器致伤为主;重伤以颅内血肿和腹腔脏器破裂最多,轻伤以四肢骨折居首。结论损伤程度与损伤部位及类型有一定的关系。     

156例道路交通事故活体损伤分析

１５６例道路交通事故活体损伤分析陈新山（武汉同济医科大学法医病理学教研室；武汉４３００３０）ＡＮＡＬＹＳＩＳＯＦ１５６ＣＡＳＥＳＯＦＮＯＮ－ＦＡＴＡＬＩＮＪＵＲＹＩＮＲＯＡＤＴＲＡＦＦＩＣＡＣＣＩＤＥＮＴ￥ＣｈｅｎＸｉｎｓｈａｎ（Ｄｅｐａｒｔｍｅｎｔ...     

外伤在与疾病共同存在的案件中参与度的评判标准（草案）

在刑事和民事审判中，经常遇到一些损伤与疾病共同存在的案件，审判人员要求法医工作者分析二者在案件中所起的作用。目前国内尚无评定这二者关系的参考标准，为解决这一问题，我们以实际检案、审判实践和医学理论为基础，制定了本标准。根据损伤与疾病的作用大小不同，将外伤参与因果关系的程度划分了若干等级（０％～１００％），就涉及死亡、刑事案件的损伤程度评定（重伤、轻伤、轻微伤）和损害赔偿问题（医疗费、营养费、误工费、伤残者生活补助费、死者丧葬费等）提出了具体的外伤参与度评判方法和量化意见。     

创伤的AIS评分与损伤程度评定对比分析的研究

ＡＩＳ评分法是国际医学临床上公认的创伤严重度评价方法之一。作者收集了本室５４６例伤害案件，分别给予损伤程度评定及ＡＩＳ评分，设为损伤程度组和ＡＩＳ组。两组比较，经Ｘ２检验，Ｐ＜０．００１；经Ｓｐｅａｒｍａｎ等级相关检验ｒｓ＝０，９４０，Ｐ＜０．００１，均有高度显著性，反映两组之间有密切关系而且损伤程度组的程度变化与ＡＩＳ组分级变化有关系。提示：轻伤、重伤可以参照ＡＩＳ严重度分级、编码，由此为轻、重伤分级、标准的计算机化及国际间的交流提供新方法。     

骨盆损伤鉴定的影像学检查方法选择探讨

目的通过研究骨盆结构和常用影像学检查方法,对骨盆损伤的影像学检查方法的选择提出建议。方法研究数例法医学鉴定中骨盆损伤的案例,结合骨盆环的生物力学和骨盆损伤分型,并对X线透视、X线摄片检查、CT等检查方法进行比较。结果四个骨盆损伤案例都是多发损伤,通过X线和CT检查均能满意地确认。结论结合骨盆致伤方式和生物力学,注意被鉴定人是否存在多发伤,来选择适合的影像学检查方法以正确评价骨盆损伤。     

Fatal child abuse-maltreatment syndrome. A retrospective study in Ontario,Canada, 1990-1995

Child death due to repeated episodes of physical assault or neglect has been termed the child abuse-maltreatment syndrome (CAMS). We characterized the injuries in a series of fatally abused or maltreated child to delineate objective diagnostic criteria for the CAMS for use by clinicians and pathologists. All deaths (age <17 years) investigated by the Office of the Chief Coroner for Ontario, Canada during the time period 1990-1995 were reviewed. Cases of CAMS were defined as death due to lethal recent injury or malnutrition in the presence of significant old (healing or healed) injuries indicative of repeated episode of inflicted trauma. The nature and frequency of the various injuries was determined. The frequency of the shaken baby syndrome, and the types and frequency of ano-genital injuries were also studied. Twenty-one cases of fatal CAMS were found in the study period. Most cases had significant recent head injury with intra-cranial hemorrhage (71%). Other significant recent injuries commonly observed included blunt injuries of the skin and soft tissues (67%), blunt abdominal trauma with visceral injuries (14%), and fractures (18%). Eight cases (38%) fulfilled accepted criteria for the shaken baby syndrome. Many children with fatal head injuries had evidence of older head trauma (38% of all cases). A significant minority of cases had evidence of malnutrition due to neglect (10%) or ongoing ano-genital injuries (10%). Most cases of child homicides due to repeated episodes of abuse or maltreatment involve head trauma including shaken baby syndrome. Fractures of long bone and ribs, the classical markers of child abuse, were relatively infrequent compared with head injury. A proportion of cases had ano-genital injuries due to repeated sexual abuse or punitive maltreatment. All clinicians and pathologists must recognize the wide spectrum of injuries in child abuse to ultimate protect the victim or other children in an at-risk situation.     

眼部损伤程度法医学鉴定60例分析

目的探讨眼外伤的特点及其损伤程度法医学鉴定要点。方法对60例眼外伤的法医学鉴定案例进行回顾性分析,对所有案例按照性别、年龄、职业、致伤物及损伤类型进行分类研究。结果眼外伤中农民、工人占61.7%,钝性损伤达85.0%,且大多属单纯挫伤,占63.3%。结论眼外伤大多属钝性外力所致,眼底病变是影响视力的重要原因,对外力与视力受损关系的评价要充分考虑致伤物种类、打击部位及伤前眼病史等诸多因素的影响。     

Criteria for homicide and suicide on victims of extended suicide due to sharp force injury

This report is about the findings in association with the extended suicides of nine victims killed by sharp force. All victims were killed by sharp force. The perpetrators were predominantly the parents, the victims their children. Regarding the criteria for differentiating self-inflicted injuries from injuries inflicted by another person, the victims' injuries presented patterns usually found solely in suicides. Thus eight of nine cases presented tentative and hesitation injuries, in three of five cases areas of injury covered by clothing had been exposed beforehand. Despite extremely narrow intercostal spaces in children, injuries to the bones in thoracic stabbing were avoided more often than not (four of seven cases). Only the criterion "defence injury" occurred nearly as often as in homicide victims (three of nine cases). The psychopathology of extended suicide can explain this pattern. The perpetrator's motive is characterised by his pseudoaltruistic belief to save the loved ones from a world that is in his opinion unacceptable. A fusion or integration of the victim into the perpetrator's own self is based on an identity problem. Physical interrelation of forces between perpetrator and victim restricts the victim in his defence and presents an important prerequisite for acquiring the patterns of described injuries.     

134例眼损伤法医学鉴定统计分析

眼损伤在活体法医学鉴定中比较常见,居第4位鉴于国内眼损伤法医学鉴定文献较少,现将我室几年来所鉴定的134例眼损伤的统计资料报告如下:材料和方法本文所报告的134例眼损伤,为1984年11月至1988年10月我室受理的眼损伤鉴定案例.全部材料均根据伤后病志和鉴定时的检查所见及鉴定结论列表,进行统计分析.     

69例男性阴部损伤分析

从致伤原因、致伤工具、损伤类型等方面对69例男性阴部损伤案进行了统计分析．     

腹部穿透伤剖腹探查57例法医学鉴定分析

目的 探讨经临床行剖腹探查术的腹部穿透伤的损伤特征,归纳其损伤程度的鉴定要点,为法医临床学鉴定实践及修改相关鉴定标准提供科学、合理的参考依据.方法 对笔者于1990年7月-2011年2月受理的57例腹部穿透伤后行剖腹探查术的损伤案例,根据致伤物、腹腔积血、器官损伤、鉴定结论等方面进行分析总结.结果 对于腹部穿透伤行剖腹...     

171例脑干颅神经损伤

目的　观察头部受力致脑干颅神经损伤的形态学改变 ,探讨脑干颅神经损伤形成机制及其与头受力部位和方式的关系。方法　 171例脑干标本 ,于双侧第 3～ 12对颅神经的根部水平横切取组织块 ,常规固定、脱水、包埋、切片、HE染色 ,光镜检查。结果　所有标本均见颅神经损伤。有动眼神经损伤 ( 12 0例 ,70 2 % ) ,面听神经损伤( 92例 ,5 3 8% ) ,三叉神经损伤 ( 85例 ,49 7% ) ,外展神经损伤 ( 4 5例 ,2 6 3 % ) ,舌下神经损伤 ( 3 1例 ,18 1% ) ,迷走神经损伤 ( 2 7例 15 8% ) ,舌咽神经损伤 ( 2 4例 ,14 0 % )及滑车神经和副神经损伤 (各 10例 ,5 8% )。损伤可为单侧或双侧 ,累及单条或多条。病理形态学改变有出血 ( 4 2例 ,2 4 6% ) ,水肿 ( 2 6例 ,15 2 % ) ,神经根部组织结构变形 ( 71例 ,41 5 % ) ,根部撕裂 ( 3 2例 ,18 7% )等。结论　脑干颅神经损伤是脑干损伤的并存病变 ;位脑干高位的颅神经损伤比位低位的多 ,粗的神经损伤比细的多而严重 ;动眼、面、听神经损伤的发生率较高。     

意外摔跌致颅脑损伤21例尸体检验分析

通过对21例意外摔跌伤所致颅脑损伤的法医学检验资料进行统计分析,探讨意外摔跌伤的损伤特点、发生原因,以及与高处跌倒、交通事故及打斗中摔跌形成的损伤特点进行比较。结果表明意外摔跌饬有其独特的特点。     

道路交通事故颅脑损伤的法医学鉴定

目的　研究道路交通事故中颅脑损伤的类型、特点、主要并发症及其受伤人员的伤残评定。方法　 862例道路交通事故颅脑损伤的案例资料 ,按伤者受伤的不同部位、有无并发症、并发症的类型及伤残程度进行统计分析。结果　复合性颅脑损伤 2 76例 ,脑挫伤 192例 ,颅骨骨折 79例 ,颅内出血 91例 ,头皮外伤 2 2 4例 ;主要并发症为脑积水 ( 19例 ,2 2 0 % )、癫痫 ( 16例 ,1 86% )、偏瘫 ( 14例 ,1 62 % )、植物人状态 ( 12例 ,1 3 9% )。结论　道路交通事故中颅脑损伤 ,以头部复合性损伤最多见 ,严重的脑挫伤为最常见的损伤类型 ,并发症的诊断应掌握诊断标准 ,并注意与相关疾病鉴别。     

Forensic medical expert evaluation of gunshot injuries of brain skull

Forensic medical experts are offered a set of morphological signs which help identify the gunshot origin of a skull injury, identify which of the injuries is the inlet and which is the outlet, specify the direction of the shot and succession of formation of injuries in cases with several shots. The author suggests evaluating a gunshot wound in the head with due consideration for the mechanisms of its formation. From a complex of signs of a gunshot injury to the brain skull he singles out the tissue defect with a conical channel and the edge of bone defect, additional injury to the external compact plate near the inlet, and type, number, and location of the radial and concentric cracks. Analysis of the morphology of the above listed signs of gunshot injuries to the skull notable extends the potentialities of forensic medical expert evaluation in cases with gunshot injuries.     

Analysis of fatal injuries to motorcyclists by helmet type

To clarify the characteristics of injuries of motorcyclists dying in accidents in relation to helmet type, we retrospectively analyzed forensic autopsies of 36 helmeted motorcycle riders. The presence of major injuries and injury severity were evaluated with the injury severity score and the 1990 revision of the Abbreviated Injury Scale. Persons with open-face helmets (19 cases) were significantly more likely to have sustained severe head and neck injuries, especially brain contusions, than were persons with full-face helmets (17 cases). Furthermore, major injuries of the chest or abdomen, rib fractures, lung injuries, and liver injuries were each present in more than one quarter of all cases (26.3% to 70.6%), but their prevalences did not differ significantly between riders with different types of helmet. Because many types of head and neck injuries cannot be prevented and fatal chest and abdominal injuries occur despite the use of full-face helmets, more effective helmets and devices for protecting the chest and abdomen are needed to decrease deaths from motorcycle accidents.     

道路交通事故二次损伤致死17例分析

目的探讨道路交通事故二次损伤致死的法医学鉴定思路和要点。方法收集17例道路交通事故二次损伤致死的案例,通过事故现场勘验和尸体检验收集交通事故发生的基本信息以及损伤分布、性质等资料。根据收集的信息,重建事故发生过程,明确死者的致伤过程,分析损伤的致伤方式和机制、损伤的严重程度,判断属生前伤抑或死后伤,明确死者的死亡原因。结果道路交通事故二次损伤致死案例存在损伤严重,多发伤与复合伤常见,生前伤、濒死伤与死后伤并存,致伤方式多样,致伤机制复杂,甚至多次损伤相互掩盖等特点。结论道路交通事故二次损伤致死的法医学鉴定需结合事故现场勘验、尸体检验等综合分析和判断。     

Artifactual injuries of the larynx produced by resuscitative intubation

Over a period of 9 months we examined a series of 50 deaths due to natural and unnatural causes in which there had been endotracheal intubation and chest compression during resuscitation at the scene or in the emergency department shortly before death. In 37 of 50 cases (74%) there were airway injuries directly resulting from the intubation procedure which we documented using a standardized protocol and photography. Specific airway injuries, ranging from petechiae to contusions, included oral injury (28%), posterior pharyngeal injury (16%), epiglottic injury (22%), piriform recess injury (12%), laryngeal and tracheal mucosa injury (64%), strap muscle hemorrhage (14%), and cutaneous injury of the neck (4%). In addition, we recorded the presence of facial (6%) and conjunctival petechiae (21%) and attributed these changes to resuscitative chest compression. No cases had associated fractures of the hyoid or thyroid cartilage. Based on our findings, we conclude that resuscitative intubation can cause artifactual injury that may mimic inflicted injuries caused by neck compression, including strangulation and neck holds.     

道路交通事故死亡案例驾驶员损伤特征分析

目的针对交通事故中驾驶员和乘客的损伤,辨别驾驶员损伤的特征性改变,从而为交通事故中准确认定驾驶员提供科学的证据支撑。方法对2006—2014年间,黑龙江省垦区内126例汽车交通事故死亡案例数据进行回顾性研究,分析汽车事故死亡案例驾驶员损伤特征,探讨驾乘人员损伤的法医学鉴定要点。结果驾驶员颈部、胸部、腹部的损伤多见,可检见汽车部件所致特征性损伤。乘员仅头面部及四肢与汽车接触部位有特征性损伤,其他部位未检见可明确汽车部件所致特征性损伤。结论损伤部位、类型与死亡人员的驾乘身份有关。     

几种眼外伤鉴定时机的研究

目的分析几种眼外伤的伤后视力稳定时间,研究最早且合适的鉴定时机。方法将145件案例160个伤眼按损伤类型分成5组,研究几种眼外伤后视力水平、眼外伤类型与视力稳定时间的关系。结果不同的眼外伤,其视力稳定时间有较大差异,且视力水平的高低与视力稳定时间也有明显的相关性。结论眼外伤最早的合适鉴定时机既与眼外伤的类型有关,也与伤后视力水平有关;应灵活掌握鉴定时机,以适应司法机关的需要。