耳廓缺损百分比计算法浅议

在法医学损伤鉴定中，常遇到耳廓缺损面积计算问题，由于表面不平整，形成缺损部位形态各异，如何正确计算其缺损面积，到目前为止，法医学界尚无一种和人体轻、重伤鉴定标准相配套的统一方法，而耳廓缺损面积的计算又直接涉及人体轻、重伤的评定。选择一种有效而简便的计算方法，就成了法医同行们都在不断摸索的问题之一。笔者现就３种耳廓缺损面积百分比的计算方法作一浅议，以供同道商讨。１计算方法１．１摄影法取标准侧位，放好标尺，以等焦距分别垂直于左、右耳廓平面摄影，等倍放大为照片，然后将照片上伤耳廓描于市售透明计算用方格…     

不规则损伤长度及面积的测量方法

我国《人体损伤程度鉴定标准》已于2014年1月1日正式实施。标准中有多款关于体表损伤长度、损伤面积的条款,但由于损伤长度及面积的测量工具及计算方法不统一,不规则损伤长度及面积测量的准确性难以把握。作者在工作中,探索出能更准确测量方法,于本文介绍给大家,以便共同探讨。1不规则损伤长度的测量传统方法 目前国内对于体表损伤长度常用钢直尺、软尺或棉线测量,测量后加比例尺拍照。但对     

不规则损伤长度及面积的测量方法

我国《人体损伤程度鉴定标准》已于2014年1月1日正式实施。标准中有多款关于体表损伤长度、损伤面积的条款,但由于损伤长度及面积的测量工具及计算方法不统一,不规则损伤长度及面积测量的准确性难以把握。作者在工作中,探索出能更准确测量方法,于本文介绍给大家,以便共同探讨。1不规则损伤长度的测量传统方法 目前国内对于体表损伤长度常用钢直尺、软尺或棉线测量,测量后加比例尺拍照。但对     

三种不规则体表损伤面积测量法的比较

正《人体损伤程度鉴定标准》中有很多涉及损伤面积的条款,如皮肤缺损、色素异常以及烧烫伤、擦挫伤等面积,而很多分布在体表上的损伤形态极不规则,如何精确测量其面积是评定损伤程度的关键。笔者认为,利用计算机图形处理软件测量不规则损伤面积结果较为准确,目前广泛应用的软件有Photoshop、AutoCAD等,还有一款是公安业务软件图像浏览编辑器,本研究用这三种软件对同一损伤处面积进行测量并比较。     

鼻缺损伤残等级鉴定

鼻损伤（injury of the external nose）的致伤方式包括切割伤、挫裂伤、咬伤、枪弹伤、烧伤、冻伤等。损伤类型包括单纯软组织损伤、鼻骨骨折、鼻中隔损伤、鼻缺损等。各种外伤如绞轧伤、压砸伤、电刨伤、电烧伤、挫裂伤及烧伤、冻伤、感染或肿瘤切除可以引起鼻缺损。损伤累及范围分表浅缺损、结构部分缺损及完全缺损．     

人咬伤法医学鉴定2例

1案例资料1.1案例1王某,男。某日因纠纷与他人在农田的地上抱在一起滚打互殴,出现面部流血被人拉开后发现王某鼻尖部缺损,在现场未发现缺损的组织。医院检查：鼻尖部缺损,累及鼻小柱（图1）。王某自诉是被嫌疑人咬掉,当地鉴定机构两次鉴定均定为重伤;嫌疑人不服,同时对伤者鼻部损伤形成原因提出质疑,认为可能是被农田地面上的玉米茬割伤。     

结构光三维扫描技术测量损伤瘢痕的法医学应用

目的验证结构光三维扫描技术测量体表规则或不规则损伤瘢痕的长度和面积的准确性与可靠性,探讨其法医学应用价值。方法采用软尺、游标卡尺+细线法、结构光三维扫描法分别对30例模拟条状瘢痕与50例伤后条状瘢痕的长度进行测量,以长×宽、薄膜描记结合坐标纸法、像素法、结构光三维扫描法分别测量35例模拟片状瘢痕及15例伤后片状瘢痕的面积,并进行统计学分析。结果结构光三维扫描法测量的模拟条状瘢痕长度与标准长度差异无统计学意义;对表面曲率较大且大面积不规则模拟片状瘢痕和伤后片状瘢痕进行测量时,结构光三维扫描法测量结果与标准面积差异无统计学意义。使用结构光三维扫描法对50例伤后条状瘢痕长度进行测量时,两名操作人员测量结果的相关系数为0.998,同一操作者两次测量结果的相关系数为1.000,与游标卡尺+细线法测量结果的相关系数为0.996。结论采用结构光三维扫描技术测量可获取体表瘢痕的立体信息,对瘢痕长度和面积的测量不受部位、体表曲率及人为因素的影响,测量结果准确可靠,具有独特的优势。     

应用Pixel法测量不规则体表瘢痕面积

正体表瘢痕在法医鉴定中很常见,由于瘢痕形态多为不规则,用一般测量面积的方法会产生较大误差。本文介绍一种应用薄膜描记+图像处理软件PhotoShop测量体表瘢痕的方法—Pixel法(本文称像素法),该方法不但可较精确计算瘢痕面积,同样也适用于器官缺损面积(如耳廓缺损)、皮肤色素面     

122例鼻部骨折X线和CT诊断的法医学分析

目的　探讨CT在鼻部骨折诊断中的优点。方法　观察 12 2例鼻损伤伤者的鼻部CT和普通X线片 ,对鼻部诸骨骨折进行对比分析。结果　 12 2例鼻部骨折 (鼻骨骨折 3 2例 ,上颌骨额突骨折 3 3例 ,鼻中隔骨折 9例 ,多发性骨折 48例 )均经CT认定。其中 40例因X线片漏诊直接通过高分辨率鼻骨CT薄层扫描认定 ;82例通过鼻骨侧位X线片显示有鼻部骨折 ,因存在骨折类型认定不准确和 /或有漏诊鼻部其它部位骨折可能 ,通过鼻骨CT认定。结论　鼻骨侧位X线片易漏诊、误诊鼻部骨折 ;鼻骨CT能避免鼻部诸骨骨折的漏诊及误诊 ,且骨折认定准确。     

86例鼻部复合性骨折的法医鉴定

目的探讨鼻部复合性骨折的认定、分型和损伤程度的法医学鉴定。方法对86例鼻部复合性骨折鼻骨CT片(轴扫 冠扫)和有关病历资料进行观察分析。结果将86例伤者按骨折种类分成鼻骨并发鼻部非鼻骨骨折(81例)和鼻部非鼻骨复合性骨折(5例)两类,然后再进一步细分。结论86例伤者中轻伤80例(93%),轻微伤6例(7%)。鼻部复合性骨折的损伤程度评定关键在于应按照《人体轻微伤的鉴定》(GA/T146-1996)和《人体轻伤的鉴定(试行)》的有关规定或标准认定和分型,这样鉴定结论才会准确可靠。     

道路交通事故眼损伤伤残评定的标准化和规范化

GB18667-2002《道路交通事故受伤人员伤残评定》标准（以下简称“标准”）中有关眼损伤的条款较为原则和笼统。随着“标准”的广泛应用,加之法医学和临床眼科学技术的不断进步,对眼损伤后遗症的检验技术和认识水平已有较大的提高。建议采用视力表投影仪代替国际视力表进行行为视力检查,存在屈光不正的应了解屈光度后再检查其矫正视力;疑有伪盲或伪装视力降低时,可行伪盲试验或伪装视力降低的检验,视觉电生理技术是测试伪盲或伪装视力降低的有效方法。运用电脑视野计可进行视野检查,动态视野检查结果可通过视野有效值换算为残存视野半径（或直径）;视野检查存在一定的干扰因素,分析时应密切结合原发损伤及其他检查结果。对于遗留复视等双眼视障碍的,可采用同视机等检查方法,检验结果应考察功能障碍与眼肌等原发性损伤的符合性。泪器损伤后遗留溢泪症状的,应采用相应的检查方法证实泪道狭窄或梗阻。眼睑下垂及眼睑畸形分为轻度及重度;眼睑畸形包括闭合不全、眼睑缺损及眼睑外翻等情形。影响视力的外伤性白内障符合“标准”相关条款的规定。根据现行“标准”对道路交通事故所致眼损伤进行伤残评定,应进行视觉功能检测、眼球结构检查、伪盲试验及视觉电生理检测,最后综合病史材料及既往情况综合分析,得出评定结果。统一对现行“标准”的理解,规范检测手段和结果评价原则,有助于道路交通事故眼损伤伤残评定的标准化和规范化。     

肩袖损伤法医学鉴定研究进展

肩袖损伤是一种临床常见的肩关节病,成因复杂且症状有时不甚明显,缺乏特征性表现,容易被漏诊及误诊。在法医学鉴定中,时常遇到肩袖损伤的案例,判定该类案例是创伤所致、自身疾病抑或属于伤病共同作用导致是目前摆在法医鉴定人面前的难点问题。但因找不到客观的鉴别指标,容易使鉴定工作进入盲区,也时常引起当事人对鉴定意见的质疑,甚至长期的上访缠诉,引发社会的不稳定。基于此,从肩袖解剖结构、损伤机制、临床表现、鉴别诊断及法医学鉴定等方面展开论述,有助于为此类案件的鉴定提供参考。     

应用Goggle-VEP客观评定视野缺损的法医学价值分析

目的以视神经损伤为研究对象,分析视野与Goggle-VEP相关性,探讨法医临床学视野的客观评定问题。方法以被检查者健眼作对照,行双眼电视野检查及Goggle-VEP检查;应用SPSS软件分析两者数据的相关性。结果80例视神经损伤眼均表现为不同程度的视野改变,其中41例为视神经完全损伤,Goggle-VEP均无波型诱出;39例为不完全视神经损伤,Goggle-VEP表现为仅诱出切迹波或者潜伏期延长、波幅降低;80例健眼,视野正常,Goggle-VEP均正常。分析视野与Goggle-VEP结果两者的相关性,R=0.911(P<0.01,n=80)。结论视神经损伤时,视野缺损程度与Goggle-VEP异常程度有较为良好的相关性,Goggle-VEP可作为视神经损伤后客观评定视野缺损的指标。     

Photogrammetry vs CT Scan: Evaluation of Accuracy of a Low-Cost Three-Dimensional Acquisition Method for Forensic Facial Approximation

Photogrammetry is a three-dimensional acquisition method potentially applicable to the forensic field. This possibility requires the verification of its accuracy. In this study, 3D volumes of skulls are generated to compare the photogrammetry versus the CT scan. In order to provide eligible material to the photogrammetric software, photographs were captured at a distance of 30 cm from the skull placed on a support 1 m in height and illuminated with diffused laboratory ceiling artificial light. A Nikon Coolpix P7100 camera was used. Photographs capture common elements with the previous and the next photograph so as to allow the photogrammetric software to recognize these common points between photographs and create a 3D puzzle. The Zephyr Lite (3DFlow©) software was employed to register the 3D volume. CT-based skulls are taken as a metric reference. The photogrammetry-based skulls are then enlarged according to the measurements of some landmarks or Zygion and Zygion, the distance between end of nasal and base of nasal pyramid for frontal projection, and minimum breadth of the mandibular ramus for the right lateral projection. The accuracy of the photogrammetry is compared to that of the CT scan by measuring the 3D volumes of the skulls studied. Specific landmarks are used as reference points for the measures in both frontal and lateral views. Bland–Altman graph shows homogeneity. The mean difference (1.28 mm) indicates that the measurements taken on the photogrammetry-based skull tend to slightly overestimate compared with the measurements taken on the CT-based skull.     

新鲜鼻骨骨折CT诊断指标探讨

法医鉴定工作中,需要明确判断鼻骨骨折为新鲜形成,方可作为人体损伤鉴定的依据。通过案例追踪复查与已知陈旧鼻骨骨折对照及临床表现等方法,依据骨折断端锐利、骨折部位粘膜肿胀、软组织内有小片状低密度影等CT影像表现,结合伤后鼻面部肿胀、鼻出血、鼻腔通气不畅等临床表现作为新鲜鼻骨骨折的影像诊断指标。工作中,须重视鼻骨骨折新旧伤的鉴别,确保鉴定意见的准确性。     

Importance of electromyography and the electrophysiological severity scale in forensic reports

Forensic reports on traumatic peripheral nerve injuries include dysfunction degrees of extremities, which are arranged according to the Turkish Penalty Code. The aim of this study is to discuss the role and importance of electromyography while preparing forensic reports in the cases of traumatic peripheral nerve injuries and the usefulness of scoring systems. A modified global scale, recommended by Mondelli et al., was used to assess the electrophysiological impairment of each peripheral nerve. Forensic reports of 106 patients, reported between 2002 and 2004, were evaluated. Thirty-four percent of the cases were reported as "total loss of function," 41.5% were reported as "functional disability," and there were no dysfunctions in the other cases in forensic reports that were prepared based on Council of Social Insurance Regulations of Health Processes and Guide prepared by the Council of Forensic Medicine and profession associations of forensic medicine. When we rearranged these forensic reports based on the electrophysiological severity scale (ESS), it was clearly found that all of the score 2 cases and 86.7% of the score 3 cases corresponded to "functional disability" and 91.4% of the score 4 cases correspond to "total loss of function." We found a significant correlation between the ESS and functional evaluation in peripheral nerve injury cases. Evaluation of functional disabilities in peripheral nerve injuries with the ESS represents a standardized and objective method used for forensic reports.     

Current state and progress of research on forensic biomechanics in China

Forensic biomechanics gradually has become a significant component of forensic science. Forensic biomechanics is evidence-based science that applies biomechanical principles and methods to forensic practice, which has constituted one of the most potential research areas. In this review, we introduce how finite element techniques can be used to simulate forensic cases, how injury criteria and injury scales can be used to describe injury severity, and how tests of postmortem human subjects and dummy can be used to provide essential validation data. This review also describes research progress and new applications of forensic biomechanics in China.

Key points

• The review shows the main research progress and new applications of forensic biomechanics in China.
• The review introduces eight cases about the application of forensic biomechanics, including the multiple rigid body reconstruction, the finite element applications, study of mechanical properties, traffic crash reconstruction based on multiple techniques and analysis of morphomechanical mechanism about blood dispersal.
• Though forensic biomechanics has a great advantage for the evaluation of injury mechanisms, it still has some uncertainties owing to the uniqueness of the human anatomy, the complexity of biological materials, and the uncertainty of injury-causing circumstances.

     

联合应用ERG,VEP进行眼挫伤法医学研究

本文对１１２例眼挫伤患者进行了ＥＲＧ、ＶＥＰ检查，结果证实：ＥＲＧ是一种能够客观反映视网膜功能状态的方法。其回归方程可用于评定视敏度。而联合应用ＥＲＧ、ＶＥＰ还具有损伤的定位价值。在对视网膜挫伤眼视力与ＥＲＧ、ＶＥＰ结果进行相关及回归分析时，本文应用双眼的波幅差、波幅比进行比较，结果表明：其回归方程可较准确地评定视网膜挫伤眼的客观视力。同时，本文证实：视野缺损对ＶＥＰ波形的影响不容忽视。由此提出：对较严重的视神经挫伤眼鉴定时，不宜用ＶＥＰ客观评定其视敏度、综合视力与视野的损伤程度。本文建议：以其健眼为对照，若其伤眼ＶＥＰ波消失，其损伤程度应评定为重伤。本文的研究成果可应用于法医学鉴定。     

大鼠闭合性小脑挫伤细胞凋亡研究

目的探讨闭合性小脑挫伤细胞凋亡发生发展过程。方法采用DNA缺口末端标记法比较SD大鼠闭合性小脑挫伤不同时间损伤区和正常对照组小脑神经细胞凋亡情况。结果在伤后1h发现挫伤区少数凋亡细胞,4～6h达高峰,随后下降。在挫伤缘区域伤后1h亦发现少数散在的凋亡细胞,随着损伤时间延长,凋亡细胞数量增多,在6～8h达到高峰。结论闭合性小脑挫伤不同损伤时间细胞凋亡指数变化为法医学早期损伤时间推断提供了灵敏客观的实验依据。     

Death related to nasal surgery: case report with review of therapy-related deaths

The investigation of deaths that are suspected to be related to medical therapy present several challenges for the forensic pathologist. In all such cases, it is important for the pathologist to understand the therapy/procedure that may have played a role in death. As such, review of medical records and possible consultation with various medical specialists before autopsy can provide valuable information to ensure proper evaluation in any given case.Herein, we describe a rare death occurring as a complication of septoplasty, nasal polypectomy, and intranasal endoscopic ethmoidectomy, which are common surgical procedures performed by otolaryngology/head and neck surgeons. An otherwise healthy 58-year-old woman underwent the elective surgical procedures for a deviated nasal septum, multiple nasal polyps, and chronic ethmoid sinusitis. Following surgery, the patient never awoke from general anesthesia, and further evaluation before death revealed a basilar subarachnoid hemorrhage. Autopsy disclosed basilar subarachnoid hemorrhage, a traumatic defect of the right cribiform plate, and associated anterior cerebral artery injury with frontal lobe damage. No vascular anomalies were present. The cause of death was attributed to complications related to nasal surgery, and the manner of death was ruled "accident."Following the presentation of this case, the authors discuss these common nasal surgical procedures, including a summary of their known complications. In addition, the authors address and review the topic of deaths related to medical therapy.