道路交通事故致足弓结构破坏伤残评定

足弓由横弓、内侧纵弓、外侧纵弓组成。足弓测量包括内弓角、外弓角、前弓角、后弓角和跟距角五个角度的测量。《道路交通事故受伤人员伤残评定》（GB18667—2002）标准将足弓结构破坏分为破坏1／3以上和完全破坏两种情形。前者是指足三弓（内侧纵弓、外侧纵弓、横弓）的任一弓结构破坏。后者是指一足三弓结构均有损害。当伤侧内弓角或外弓角测量值超过健侧10％时，提示内侧纵弓或外侧纵弓损坏；当伤侧前弓角或后弓角测量值小于健侧3％时，提示前弓或后弓破坏。在全面了解案情、严格审查送检材料，对被鉴定人进行体格检查和影像学检查后，可以做出最终判定。     

172例采用横仓氏法测量足弓角的伤残评定

正司法实践中,因鉴定人对足弓结构破坏的理解不一,同一案件出现多种鉴定结果。本文对172例有伤足不适主诉、伤者或鉴定人员发现伤侧足弓扁平或高弓,采用横仓氏法测量足弓角进行分析,拟定足弓结构破坏的量化基线,与同道商榷。1案例资料收集172例采用横仓氏法测量足弓角的法医学鉴定资料,进行归类并按统一表格进行登记和分析     

172例采用横仓氏法测量足弓角的伤残评定

司法实践中,因鉴定人对足弓结构破坏的理解不一,同一案件出现多种鉴定结果。本文对172例有伤足不适主诉、伤者或鉴定人员发现伤侧足弓扁平或高弓,采用横仓氏法测量足弓角进行分析,拟定足弓结构破坏的量化基线,与同道商榷。1案例资料收集172例采用横仓氏法测量足弓角的法医学鉴定资料,进行归类并按统一表格进行登记和分析     

《人体损伤致残程度分级》与GEPI对足踝伤残评定的比较

目的本文通过对《人体损伤致残程度分级》和GEPI有关下肢足踝评定的内容进行比较研究,为《人体损伤致残程度分级》的修订提供建议。方法从条款分布、两个标准适用时的具体评定方法等方面对二者进行比较,并以GEPI足踝评定的残损值为参照,计算、分析《人体损伤致残程度分级》下肢条款致残率合理性。结果在跟骨骨折和踝关节创伤性关节炎评定方面,两个标准存在良好的对应性;在踝关节功能评定方面,除关节强直固定于非功能位的致残率略高于GEPI外,《人体损伤致残程度分级》其他条款与GEPI均具有良好的对应性。而在足弓结构破坏和足趾功能评定方面,两个标准对应性差,《人体损伤致残程度分级》评定的致残率明显高于GEPI。结论通过两个标准下肢足踝评定的比较,可以发现目前《人体损伤致残程度分级》的不足之处,提示在足弓结构破坏和足趾功能评定方面可能存在问题,需要进一步完善。     

鞋内底不同部位接触DNA提取初探

目的探讨鞋内底不同部位接触DNA提取检出率。方法取100名20-30岁的志愿者，将其穿用过的运动鞋和皮鞋鞋垫设置成不同穿用时间组、不同材料鞋垫组、穿用后不同放置时间组，根据脚的形态学及运动力学特点，将鞋垫分成8个区域进行脱落细胞提取，并进行DNA进行检验。结果鞋垫上8个不同区域提取到的脱落细胞DNA分型检验效果不同。足弓外侧区（足引折弓除外）的接触DNA检出率最高；足弓内侧、第1趾骨区、第1跖骨区及足跟区次之；第2～5趾骨区、第2～3跖骨区、第4～5跖骨区不容易成功提取到接触DNA。结论鞋内底接触DNA检出率与接触时间、放置时间、鞋垫材质均相关，分区提取检验DNA更有针对性。     

肱骨滋养管误诊骨折1例

高某，男，58岁，农民。1997年8月29日被张某用铁锨击伤左上臂部，伤后3小时住进医院。临床检查：左上臂外侧中上段有一长2cm，深达骨质的裂创，无功能障碍，x线片报告：左肱骨内侧中下段线状骨折。公安机关法医鉴定认为左肱骨内侧中下段线状骨折，损伤属于轻伤。审判中被告人提出异议，进行复核鉴定。法医学书证审查：①审阅原始肱骨X线片，肱骨内侧中下段可见一由皮质斜贯髓腔的线状低密度影。②审阅病历，无局部肿胀、骨擦音及功能障碍等骨折体征。③1998年3月10日X线片复查，肢骨内侧中下段线状影像消失，骨质结构来见异常改变。鉴定结…     

损伤与疾病共存时的职工工伤伤残评定

新的《劳动能力鉴定职工工伤与职业病致残等级》关于"对原有伤残及合并症的处理"的规定较旧标准更为清晰、明确,在实践中便于把握,且符合职工工伤处理的基本原则。新标准规定,对损伤并发症、损伤加重原有伤残情形的,均需按照最终致残结局评定伤残等级;但对于本次工伤伤情显著轻于原有伤残的,则应以本次工伤所致残情为评定依据。与道路交通事故受伤人员伤残评定相比,新标准规定的伤病关系处理原则有相当的差异,主要在于交通事故伤残评定往往强调按照最终致残结局评定伤残等级,并需说明损伤与伤残的因果关系。虽然职工工伤伤残评定并不属于一般意义上的司法鉴定范畴,但参照新标准进行伤残鉴定仍将是司法鉴定机构在诸如人身伤害的刑事案件以及侵权赔偿民事案件中需要进行的重要工作,司法鉴定人应根据不同情况,准确把握鉴定中的伤病关系处理原则。     

350例道路交通事故膝关节损伤伤残评定分析

道路交通事故中膝关节损伤较常见,损伤导致的膝关节功能障碍是伤残评定的重要内容.本文对350例道路交通事故致膝关节损伤人员的相关资料进行回顾性分析,并探讨膝关节损伤后功能评定及相应的伤残等级. 1 案例资料 1.1一般资料 350例被鉴定人资料来自新乡医学院司法鉴定中心(2004年1月至2010年12月)受理的道路交通事故鉴定案例.其中男性219人(62.6％),女性131人(37.4％),年龄10 ～78岁,平均40岁.纳入标准:①道路交通事故致膝关节创伤,治疗终结;②伤前无膝关节疾病或损伤史;③病历、手术及影像学资料(X线、CT、MRI)明确损伤类型及治疗方法;④各种检查及辅助检查资料完备;⑤伤残评定时机为受伤后3～6个月以上.     

论法医学鉴定“一鉴多果”的原因与对策

由于各种生物性、化学性、机械性因素作用,可导致人体精神的、生理功能的和解剖结构的异常,以及生活、工作和社会活动能力的不同程度的丧失,因此,人体损伤的法医学鉴定就成了涉及审理刑事、民事案件中人体损伤与残疾程度的评定,公正确定侵权行为人所应承担合理赔偿的法律责任的重要依据。研究人体损伤与残疾程度的评定是法医学、伤残赔偿学的迫切需要,并且对人身损伤与伤残赔偿立法和司法实践具有重要意义。刑事技术2003年第1我国人体损伤与伤残程度鉴定的现状当前,人体损伤与伤残评级鉴定人员分专业司法鉴定人员和未实行司法鉴定人资格制度…     

足舟骨变异误诊骨折1例

1案例资料1.1简要案情刘某,男,24岁。2004年11月13日下午5时许因车祸受伤,到医院就诊。左足X线片示左舟状骨骨折,予以左足石膏托外固定治疗。同年11月16日,法医对刘某的损伤进行鉴定。1.2法医学检查损伤检查双上肢及右下肢活动自如,左小腿及左足石膏托功能位外固定。打开石膏托未见其左小腿及左足皮肤明显外伤,但主诉左足内侧疼痛,压之疼痛较剧烈。X线检查对其左足进行X线拍片检查,结果显示:左舟骨旁有一小骨块(照片1)。将其右足进行对比摄片,结果显示:在右舟骨旁同样有2个类圆形骨块(照片2)。CT扫描对伤者双足进行CT扫描检查,结果显示:…     

Estimation of length of calcaneum and talus from their bony markers

Since hardly a report is available on estimation of length of calcaneum and talus from a fragment of them, a fresh study was made on a present day south Indian population. A total of 110 calcanei (55 right and 55 left), and 70 tali (35 right and 35 left), all unpaired, dry, and devoid of gross pathology, were used. Maximum anteroposterior length of the bone was measured in millimeter using an anthropometric board, and linear measurements of the other bony markers were measured in millimeter using a sliding caliper. Bony markers of calcaneum were maximum anteroposterior length, maximum transverse width, length, width and depth of groove on the sustentaculum tali, and length, width, and depth of the sulcus calcanei. Bony markers of talus were maximum anteroposterior length, maximum transverse width, length and width of articular surface for the lateral malleolus, length and width of articular surface for the medial malleolus, vertical width and transverse width of articular surface of the head, width and depth of groove for tendon of the flexor hallucis longus, and length, width, and depth of the sulcus tali. Simple regression suggested that maximum length of the calcaneum regressed significantly with maximum transverse width, length, width and depth of groove on the sustentaculum tali, and length, width, and depth of the sulcus calcanei and that maximum length of the talus regressed significantly with maximum transverse width, length and width of the lateral articular surface, length of the medial articular surface, vertical and transverse diameters of the head, and depth of the sulcus tali. Maximum length of calcaneum and talus is derived from the regression values, to predict the stature of the person from available stature equations in the literature.     

The diagnosis of the mechanisms of bone tissue destruction from the surface of the break]

Data on bone tissue fractography are summarized and systematized. Possibilities of a microscopic fractography method in analysis of skeletal bone fractures in order to determine conditions of traumatic exposure were shown. Destruction of bone tissue is considered from the point of view of fragile and tough destruction using as a model solid body with crack at the top of which deformations of detachment, lateral and longitudinal shifts are acting. Morphologic features for different types of destruction were singled out. Use of these features may help to determine character and type of deformation at concrete areas of fracture during all destruction process.     

Fractures of the arches of the atlas: a study of their causation

The autopsy findings in 32 accidental deaths which showed fracture(s) of the arches of the atlas have been correlated to reconstructions of the course of events in the accidents. Flexion of the head causing fracture(s) of the neural arch or odontoid process of the axis also resulted in fracture(s) of the posterior arch due to downward traction. Extension of the head causing fracture of the odontoid process of the axis gave rise to fractures of the posterior arch due to pressure from below. Tilting of the head caused marginal fractures of the anterior arch due to oblique traction. Tilting of the head also caused fracture(s) of the anterior and/or posterior arch due to transverse extension of the atlas ring and/or superior dislocation of one lateral mass in relation to the other. Oblique flexion or extension of the head resulted in similar fractures. Flexion of the head with some rotation combined with compression of the neck can cause the anterior margin of one upper joint surface of the axis to act as a wedge separating the anterior arch of the atlas from below. Extension of the head with some rotation combined with compression of the neck can lead to a fracture running through one lateral mass due to its tilting-dislocation in posterior direction. It is striking that there was no fracture of the atlas which could be ascribed to a simple and symmetric compression of the neck (classical Jefferson's fracture).     

Course of the meatus acusticus internus as criterion for sex differentiation

The importance of features that allow the determination of an individual's gender even with skulls that have been largely destroyed is undisputed in archaeological and anthropological practice. Due to its extreme mechanical strength, the pars petrosa ossis temporalis is usually preserved in skulls and the sex dimorphisms of this skeletal part are therefore of particular significance. In the present study, we aimed at clarifying the controversial question whether the course of the meatus acusticus internus (M.a.i.) beneath the superior surface also reveals sex-specific differences. Using 410 forensically modern petrous portions, the course of the canal was examined and the respective angles determined using a specifically developed casting and cutting technique. The median values certainly reveal sex differences: the lateral angle on the male petrous portions is 10 degrees smaller than that of females; the medial angles on female petrous portions are approximately 5 degrees smaller than those of male skulls. Using discriminant analysis, approximately 66% of the specimens can be determined accurately.     

Measurement of arch widths in a human population: relation of anticipated bite marks

The authors compared arch width measurements of diagnostic dental models obtained from dental school patients. Arch width measurements were taken in the canine area on each dental cast in an effort to assist forensic dental investigators in matching certain classes of subjects to the bites they might possibly inflict. If any canine teeth were absent, the measurements were taken using other specified adjacent teeth which the investigators felt would be interpreted as the arch width determiners in a bite mark injury. The ages of the subjects varied from 14 to 87 years. Statistical comparison of the maxillary arch width, mandibular arch width, and the mean difference between maxillary and mandibular arch width were performed. Significant differences between the arch width measurements were found to exist between several classes of subjects based on race and sex.     

Two arch criteria of the ilium for sex determination of immature skeletal remains: A test of their accuracy and an assessment of intra- and inter-observer error

Although the assignment of sex to immature skeletal remains is considered problematic, some traits have been considered useful for both forensic and bioarchaeological applications. One such trait is the arch criterion found in subadult ilia, which is defined relative to the greater sciatic notch-auricular surface area. In adults, the composite arch has also been described in relation to this area and has proven relatively successful in sex determination. This study offers an examination of the accuracy of the arch criterion and the composite arch in determining the sex of subadult skeletal remains, and an assessment of intra- and inter-observer scoring error. A sample of 97 skeletons of known sex and age (<15 years) from the Lisbon collection (Portugal) were selected and the traits were scored by three observers on orthogonal photos of each ilium. In general the agreement within (67.7–88.5%) and between (50.5–76.3%) examiners was poor and overall accuracy (26.7–52.6%) did not meet the expectations of that reported in previous studies. The authors suggest that this derives from great variation in morphology, difficulties in interpreting criteria and possibly a lack of association between the expression of the traits and sex. Careful examination of sex-related morphology in the immature skeleton and additional blind tests of so-called useful traits should continue to be carried out.     

IMPLICATIONS OF THE DIVORCE MEDIATION ASSESSMENT INSTRUMENT FOR MEDIATION PRACTICE

The development of the Divorce Mediation Assessment Instrument (DMAI), based on six dimensions—commitment, social-psychological factors, values, understanding, skills, and conflict—was in response to the need to systematically assess clients' readiness for divorce mediation and to inform and guide intervention. Tests on DMAI showed high reliability, and reasonable instrument validity. The implication of DMAI for mediation practice is discussed in terms of the various outputs of DMAI: DMAI score, subscale score, and item score. Issues in assessment raised included highlighting strengths, working on agreements, and preventive intervention. DMAI's implication for theory building and research is also discussed. Careful assessment is needed for appropriate use of mediation, and the DMAI provides a model of assessment which has clinical, empirical, and theoretical validity.     

Determination of the mineral content and the transparency of the root dentine of human teeth

One hundred and fifty-six teeth were extracted from corpses aged between 15 and 79 years. Of these, 101 teeth were selected for measurement of the mineral content of the root by photon beam absorption. Six or seven cross-sections were measured in each root, and the mean values calculated for the apical, medial, and coronal part within each decade. Further, 20 selected teeth were embedded in methacrylate and the length of the zone of transparency determined in longitudinal sections. There was no significant age dependency of the root's mineral content. There was no correlation between the extent of transparency and the mineral content.     

The hydrodynamic effect of gunshots in cranial explosive shots

Case report on five fatal gunshot injuries in which discharge of the cranial contents had occurred owing to a skull blast. Despite an appreciable explosive action with destruction of the bony cranium, the brains were not completely destroyed. In analogy to the "Kr?nlein shot", comparative reflections were made concerning wound ballistics. The case reports show that injury patterns resembling "Kr?nlein shot" may arise in cranial blast shots in rare cases despite destroyed projectile parts and even in a mouth shot.