交通事故致弥漫性轴索损伤伤残等级鉴定89例分析

目的研究交通事故致弥漫性轴索损伤（diffuseaxonalinjury，DAI）的患者伤残等级鉴定结果，并探讨DAI对鉴定结果可能产生的影响。方法收集556例本鉴定中心2011年1月-2012年12月受理的交通事故致颅脑损伤案例，其中单纯性脑挫（裂）伤467例，临床诊断为DAI89例。再重新审阅被鉴定人颅脑CT及MRI检查结果，分为单纯DAI组、DAI合并脑挫（裂）伤组、无DAI脑挫（裂）伤组3组颅脑损伤，并对鉴定结果进行比较和统计学分析。结果单纯DAI组（20例）的伤残等级为7．72±1．09，DAI合并脑挫（裂）伤组（69例）的伤残等级为7．78±1．11，无DAI的脑挫（裂）伤组（467例）的伤残等级为8．86±0．66，前两组的伤残等级均高于无DAI的脑挫（裂）伤组（P〈0．05）。结论患有DAI的被鉴定人可能存在更为严重的脑功能损害．鉴定时应注意临床的漏诊和误诊，避免过于依赖CT、MRI等影像学表现。

Disability Identification for Cases with Clinical Diagnosis of Diffuse Axonal Injury due to Traffic Accidents： A Study of 89 Cases

Objective To study the disability identification for cases with clinical diagnosis of diffuse ax- onal injury （DAI） due to traffic accidents, and to explore the possible effects of DAI on identification results. Methods Five hundred and fifty-six cases of cerebral injury due to traffic accidents were collect- ed, including 457 cases diagnosed with cerebral contusion or laceration and 89 cases diagnosed with DAI. The identification results of different groups with diagnosis of DAI diagnosis, diagnosis of DAI with cerebral contusion （laceration）, and diagnosis of cerebral contusion or laceration without DAI were compared and statistically analyzed, based on the results of CT and MRI re-review. Results The disabil- ity identification levels in DAI group （20 cases）, DAI group （69 cases） with cerebral contusion （lacera- tion） and DAI group （467 cases） not complicated by cerebral contusion （laceration） were 7.72±1.09, 7.78±1.11, and 8.86＋0.66, respectively. The disability levels of the two groups diagnosed with DAI were higher than those of the group without DAI diagnosis （P〈0.05）. Conclusion Patients with DAI diagnosis might have more severe cerebral injury. In the identification process, one should pay attention to the possible missed diagnosis and misdiagnosis, and meanwhile avoid relying on those evidences provided only by CT and MRI.