根据长骨线性骨折愈合X线表现与骨折时间推算

在法医临床学鉴定中，因车祸、高坠及伤害等导致的肢体骨折日渐增多，都涉及到对骨折时间的法医学鉴定。本研究选择不同年龄人体长骨线性骨折的X线片进行观察和分析，得到不同年龄人体长骨愈合的影像数据并进行统计学处理，为根据长骨线性骨折X片表现推断骨折时间的法医学鉴定提供数据支持，初步探讨根据骨折X片表现推断骨折时间的方法。     

基于双能X线骨密度仪的骨折形成时间推断研究

目的 研究人体骨折部位骨矿物密度值(bone mineral density,BMD)在骨折愈合过程中的变化规律，分析其与骨折形成时间的关系。方法 共收集451例外伤性股骨骨折患者样本，其中男性233例，女性218例，年龄范围为20～79岁；采用双能X线吸收测量法，在骨折当时及骨折后2、4、6、8、10周分别对患者骨折区域R1和健侧对照区域R2进行BMD检测；应用SPSS22.0软件对数据进行统计学分析。结果 骨折患者的BMD值与年龄呈负相关，骨折区的BMD值低于正常人群，但会随着骨折时间的延长而升高，男性患者的BMD值大于女性患者，利用BMD值推断骨折时间的方程为：Y=(X₁-0.714+0.069×X₂+0.111×X₃)/0.036(X₁代表BMD值，X₂代表性别，X₃代表年龄分组，Y代表骨折时间)。结论 利用双能X线测量骨折区域的BMD值可以推断骨折形成时间，在人体损伤程度鉴定、损伤形成时间推断以及三期评定等法医临床学鉴定实践中有应用价值。     

法医学鉴定中影像资料的应用

随着科技水平的提高,法医学鉴定的范围也日益拓宽,涉及到影像学资料的法医学鉴定案件日趋增多,合理有效地应用影像学资料来还原案件的真实情况是法医学鉴定应引起重视的问题,本文试从X线片及CT片的有关应用及注意事项等方面作一探讨。1利用骨折愈合过程推断受伤时间骨折愈合过程在X线的表现征象可以分为4个阶段犤1犦,即骨痂形成期、骨痂连接期、骨痂成熟期及骨痂塑型期。其中骨痂形成期在法医检案中的应用价值颇大。此时常常需要鉴别受伤时间与X线片征象改变提示的时间是否相符的问题。学术界通常认为[1,2,3]骨痂形成期的时间为2～4周,但…     

X线计测法推断骨龄的研究进展

利用计测法推断年龄是指应用X线摄片技术,测量不同年龄人群全身不同部位骨骼相关数据,如四肢长骨、短骨及椎骨的长度、宽度、厚度,骨化中心面积、干骺端横径、骨骺端横径、骺线宽度、干骺比值等,经过统计学分析探讨这些测量数据与真实年龄（即生活年龄）之间的相关性,并据此推断活体年龄（即骨龄）。本文对有关掌指骨、腕骨、肱骨、股骨及颈椎骨推断骨龄的计测方法和骨龄推断结果进行回顾性分析和总结,并对其应用价值和应用前景进行了初步探讨。     

骨折延迟愈合或骨不连接伤残等级评定66例分析

目的探讨骨折延迟愈合、骨折不连接伤残等级评定条款的适用。方法从患者的性别、年龄、骨折部位/种类、合并疾病情况、治疗方式、骨折愈合时间、伤残等级等资料分析66例骨折延迟愈合、骨折不连接的评残案件。结果进行伤残等级鉴定60例,其中八级2例,九级11例,十级28例,未构成伤残19例,还有6例未申请伤残鉴定。结论现行国家鉴定标准尚无骨折延迟愈合、骨折不连接的明确条款,故有一定的不适应性,在实践中可比照最相类似条款进行评残。     

外伤后肘关节骨化性肌炎鉴定1例

1案例资料1.1简要案情及病历资料张某,男,17岁,学生。2010年6月8日在学校被他人打伤左上肢,随即送往A医院住院治疗。检查:X线片见左肱骨髁间粉碎性骨折,远端向后移位。入院后行手术内固定治疗,术中见肱骨髁间劈裂有碎骨块,部分缺损,旋转移位,取右髂骨3cm×3cm×1cm修整骨折,放置于骨折端。术后石膏托屈肘90°位固定。诊断为左肱骨髁间粉碎性骨折。一年后左前臂旋转功能受限,遂至B医院住院治疗,X线片示左肱     

三分髌骨误诊为髌骨骨折1例

1案例材料曹某,男,42岁,某日驾驶自行车时与他人发生碰撞,右膝部着地,当时感疼痛伴活动受限。至医院就诊,右膝部表皮破损,摄X线片报告髌骨可疑骨折(照片1),行石膏外固定。一周后复查,病历记载患者已下地行走,石膏已断裂,摄片报告髌骨骨折断端未见错位,更换石膏外固定并于4周后拆除。因赔偿问题未能达成一致,伤者起诉到法院,被告则要求鉴定有无髌骨骨折。鉴定过程中请专家会诊,重摄右膝关节正位片显示髌骨内透亮影清晰,但边缘欠锐利,呈小波浪形,未见骨痂生长(照片2),阅伤时侧位片亦未见异常(照片3),摄髌骨轴位片示“三分髌骨”(照片4),从而…     

运用螺旋CT技术对骨折进行法医学鉴定2例

单纯运用X线和CT平扫技术在针对一些形态特殊、结构复杂的骨损伤情况时,常显得较为困难。利用螺旋CT技术能有效鉴别骨折,弥补上述手段的缺憾。1案例案例1:某男,30岁,2003年6月被他人石块投掷致右小腿受伤。临床检验:右胫前局部红肿3cm×2cm,右侧踝关节、膝关节活动无障碍。X线正位片见右侧胫骨中下段有一斜行密度增高影,皮质完整;侧位片未见异常;临床诊断:右侧胫骨骨折。医院予石膏外固定处理。后经螺旋CT对可疑骨折区域进行了扫描,在横断面上仍可以见到一连续的斜行密度增高影,但是在三维重建中发现此处骨皮质完整,推断该斜行透亮影是线条状的滋养血管沟,排除了右侧胫骨骨折的诊断。     

青少年颌面部X线影像测量数据在年龄推断中的应用

目的建立依据青少年颌面部X线影像测量数据推断其年龄的方法。方法收集273名于山西医科大学口腔医院就诊儿童、青少年患者的头颅侧位X线像。测量SNA角、SNB角、ANB角、NP-FH面角、Y轴角、NA-PA（颌凸角）、MP-FH（下颌平面角）、SN-MP角、1-SN角、1-MP角、1-NA角、1-NB角和1-T角、1-NA距和1-NB距等15个影像数据,使用SPSS 11.5统计分析软件建立数据库,多元逐步回归分析,建立年龄推断公式。结果年龄推断的回归方程为：Y=16.402-0.024（1-1角）＋0.039（ANB角）和Y=17.575＋0.897（ln[1-NB角]）-1.237（ln[NP-FH面角]）。结果说明,青少年的年龄与ANB角呈正相关,与1-1角呈负相关,ANB角的作用大于1-1角的作用;与1-NB角的自然对数值呈正相关,与NP-FH面角的自然对数值呈负相关,NP-FH面角的作用大于1-NB角的作用。结论本研究根据颌面部X线影像测量数据建立的青少年年龄推断方法,可在相关研究和实践中选择使用。     

判别中国人腕关节性别的研究

<正> 本研究试图使用X线片照相技术,使骨骼成像,研究不同性别之间的差异。通过对腕关节X线解剖标志的测量,建立了用X线照相法推断性别的方法。全部过程10min内即可完成,对软组织无任何损伤。     

Bilateral First Rib Anomalous Articulations with Pseudarthroses Mimicking Healing Fractures in an Infant with Abusive Head Injury

Bilateral symmetric bone nodules were observed in the anterolateral first ribs of an infant with shaking injuries at autopsy. The location prompted diagnostic considerations of healing fractures versus anomalous articulations with pseudarthroses. The forensic pathologist worked with forensic anthropologists and pediatric radiologists to evaluate autopsy findings and compare premortem and postmortem X‐rays. Gross examination of the bones by the pathologist and anthropologists confirmed bilateral, callus‐like bone nodules in first‐rib locations associated with pseudarthroses. Histologic examination of one of the bones further showed features most consistent with pseudarthrosis, not a healing fracture. Radiologists then compared multiple premortem and postmortem radiographs that showed no remodeling of the bone over a 2‐week interval between the time of injury and death, which would be unexpected for a healing fracture in an infant. This multidisciplinary approach resulted in the appropriate diagnosis of pseudarthroses due to anomalous articulations, an uncommon finding in forensic pathology.     

Multi-Rater Agreement Using the Adapted Fracture Healing Scale (AFHS) for the Assessment of Tubular Bones on Conventional Radiographs: Preliminary Study*

Better understanding of the timing of fracture healing may help in cases of interpersonal violence but also of personal identification. The intra- and inter-rater agreement for the adapted fracture healing scale (AFHS) assessing the post-traumatic time interval on radiographs were tested. This is a preliminary study, providing essential information on method reliability for upcoming studies using the AFHS. Five raters (two radiologists, a forensic pathologist, an orthopedist, and an anthropologist) were presented with a test in three parts consisting of 85 radiographs (from 30 adults) of fractures of tubular bones in different stages of healing purposefully selected from more than 1500 radiographs. The raters were firstly asked to assess 15 features describing fracture healing as present, absent, or not assessable. Thereafter, the raters were asked to choose from the AFHS a single-stage best representing the observed healing pattern. The intra- and inter-rater agreement were assessed using single-rating, absolute agreement, two-way mixed-effects intra-class correlation (ICC) coefficients. The intra-rater ICC of radiologist 1 ranged from 0.80 to 0.94. The radiologists’ inter-rater ICC ranged from 0.68 to 0.74, while it ranged from −0.01 to 0.90 for the other raters. The good to excellent ICC among the radiologists and forensic anthropologist provides good foundation for the use of the AFHS in forensic cases of trauma dating. The poor to good results for the other physicians indicate that using the AFHS requires training in skeletal anatomy and radiology.     

A radiographic assessment of pediatric fracture healing and time since injury

Past studies and pediatric bone physiology indicate that younger individuals may heal at a faster rate. Additionally, in adults upper limb fractures heal faster than lower limb fractures; this trend is expected for pediatric fractures. This study aims to evaluate and compare rates of fracture repair in children based on age and skeletal element. Six stages are used to describe the bone repair process in 294 radiographs of tibial and radial fractures from 107 infants and young children. Healing rates are examined using ANOVA and Welch's t-test with a 95% confidence interval. Results indicate that younger individuals spend less time at stage 1, suggesting a delay in the start of healing. Furthermore, forearm fractures heal faster than leg fractures at stages 2 and 3, suggesting a role in the osseous reaction of bone healing. The healing schedule presented may allow the timing of injuries to be estimated from radiographs.     

Alcohol‐Induced Osteopenia Among In‐Custody and Homicide Deaths from the Harris County Institute of Forensic Sciences

Four cases of in‐custody or unlawful death are presented as examples of increased bone fragility with an associated increase in fracture rates due to ethanol‐induced osteopenia. In addition, one of the individuals suffered fractures several weeks premortem, allowing some healing to take place. Using radiographs and physical examination, the ribs from these individuals are compared with those retained from three individuals with no history of alcoholism to illustrate diagnostic characteristics that will be notable using standard autopsy and anthropological procedures. Trabecular bone mass is notably decreased in the alcoholic group leading to a greater chance of fracture occurring during conflict, including arrest and in‐custody situations. The average number of perimortem fractures among the alcoholic individuals is 15, while the control group is six. In the case of the individual with healing, the degree of bone repair on the ribs was less than is expected considering the interval between injury and death.     

基于深度学习的人体肋骨骨折智能检测技术

目的将人工智能中的深度学习技术应用到人体肋骨骨折识别,实现人体肋骨骨折智能检测,提高法医肋骨骨折诊断效率。方法采集3143例人体胸部X线数字影像(2602例用于训练,541例用于测试),标注肋骨骨折特征点,通过多层网络堆叠,分层、分级主动学习原始数据高度抽象的特征表述,并将此特征反馈至检测器进行骨折检测,输出骨折位置及相应置信度。结果基于深度学习的人体肋骨骨折检测准确率在90%以上。结论基于深度学习的人体肋骨骨折检测准确率较高,可用于辅助法医进行肋骨骨折识别诊断、检验鉴定等,本研究可为人体其他部位骨骼损伤智能检测提供参考。     

81例外伤性鼻部骨折的特点及其法医学鉴定分析

研究鼻部损伤后骨折的特点、确诊的方法及法医学鉴定的相关问题。 81例以鼻部外伤为主诉 ,经鼻骨拍摄X线侧位片 ( 62例加做鼻部CT扫描 )检见有鼻骨骨折的患者 ,进行法医临床学鉴定分析。单纯性线性骨折 19例 ,骨折移位者 11例 ,粉碎性、多发性骨折 4 0例 ,鼻骨骨折伴上颌骨额突骨折或 (及 )伴眶骨骨折 11例 ;轻伤 58例 ( 72 % ) ,未构成轻伤 2 3例 ( 2 8% )。多数鼻骨骨折为粉碎性、多发性 ,且可伴有其它部位骨折。鼻骨X线侧位片只能明确部分粉碎性骨折及部分移位明显的骨折 ,CT扫描能确定鼻部骨折形态。     

Inadvertent clavicular fractures caused by "chiropractic" manipulations in an infant: an unusual form of pseudoabuse

A nine-month-old child was found unresponsive in his crib, five hours after his last feeding. At autopsy, there were no external or internal signs of abuse or neglect, and a few visceral pleural and epicardial petechiae were consistent with the sudden infant death syndrome (SIDS). However, postmortem total body radiographs revealed healing, symmetrical clavicular fractures and a healing left medial humeral epicondyle fracture. The parents had no explanation for these injuries and denied causing any harm to the child. The location and nature of the fractures strongly suggested abusive origin, and the case was reported to the police and the district attorney's office as child abuse. During the investigation, information from the parents indicated that the child had undergone "chiropractic" manipulations by an unlicensed therapist, between three and four weeks prior to death, to correct supposed "shoulder dislocations." This time interval correlated with the histologic age of the injuries, and the history explained their unusual bilateral location and appearance. The parents were exonerated of abuse charges, and the death was ascribed to SIDS.     

46例尺骨鹰嘴骨折法医学鉴定分析

探讨尺骨鹰嘴骨折 ,术后于功能位制动患者进行法医学鉴定的时间。对 46例尺骨鹰嘴骨折患者进行随访 ,观察在不同时期肘关节功能恢复情况。伤后 3～ 4个月 ,肘关节功能可恢复到 40°～ 90°活动范围 ;伤后 6～ 8个月 ,关节活动范围可达 70°～ 12 0° ;伤后 10～ 12个月 ,关节活动范围可达到 110°～ 14 0°。尺骨鹰嘴骨折术后于功能位制动患者 ,3个月后即可进行法医学鉴定。此期 ,肘关节功能不但有了一定程度的恢复 ,骨折亦临床愈合 ,关节较稳定有力。     

应用Young-Burgess分型推断交通事故受伤人员骨盆损伤机制

目的根据骨盆骨折X线片Young-Burgess分型推断道路交通事故致死者（roadtrafficfatalities,RTFs）骨盆损伤机制,并探讨其法医学应用价值。方法回顾性分析128例车外成人RTFs尸体骨盆X线片的Young-Burgess分型,根据分型推断骨盆损伤机制,对照真实案情进行统计分析。结果可区分APC、LC亚型的推断骨盆损伤机制正确率（94.1%、92.9%）明显高于不区分亚型的（63.6%、70.7%）（P〈0.05）;区分LC亚型还能进一步推断后侧方、前侧方或是持续、较大的前侧方外力。结论综合各种影像手段区分Young-Burgess亚型可较好地推断骨盆损伤机制,为道路交通事故现场重建提供可靠依据。     

眼眶爆裂骨折的CT表现及法医学鉴定分析

目的研究眼眶爆裂骨折的CT表现特点及其法医学鉴定问题。方法对76例眼眶爆裂骨折的临床法医学鉴定案例进行回顾性分析、总结。结果单纯头部CT以及X线检查诊断眼眶爆裂骨折漏诊率较高,其中CT诊断阳性率高于X线;眼部CT检查是诊断眼眶爆裂骨折的首选方法。76例骨折中以眶内侧壁骨折多见,其次为眶下壁骨折。CT直接征象主要表现为眶壁骨质连续性中断和眶壁移位,间接征象主要为骨折处积血和软组织增厚;临床表现以眼周瘀斑、肿胀、视力下降及复视为主。眼眶爆裂骨折对伤眼视力影响不明显,患者伤后视力多在0.8以上,但是容易出现复视;损伤程度以轻伤为主。结论单纯头部CT及X线检查诊断眶壁爆裂骨折有局限性,对眼部损伤患者,建议法医鉴定时将眶部CT检查作为常规;眶壁骨折对伤眼视力影响不明显,但是容易出现复视,法医鉴定时应引起注意。