右股骨骨折钢板内固定术致血管损伤尸检1例

骨折并发血管损伤可以是原发外伤或是手法复位中引起骨折断端刺破邻近血管。切开复位内固定手术损伤血管 ,鲜有产生严重不良后果的报道。其原因是骨折手术中损伤常被归为骨折本身的并发症 ,或术中致血管损伤大多可在手术当时发现 ,并且及时采取补救措施 ,即或遗留后遗症 ,亦被开脱为骨折本身所致。本文报道一例手术损伤血管引起患者死亡的病例 ,复习有关文献 ,对内固定术致血管损伤的特点进行阐述。案例资料患者 ,男 ,3 5岁。车祸伤后 5 + 小时入院。查体 :T 3 6.6℃ ,P 88次 /分 ,R 2 0次 /分 ,BP 12 0 /70mmHg ,神清合作。右下肢肿胀明…     

右下肢血管损伤致功能障碍1例

单纯性肢体重要血管损伤,引起血液循环障碍,严重影响肢体功能的情况在法医临床工作中实属罕见,现报道1例。1案例某男,34岁。2002年9月2日被他人的摩托车挤压右大腿致伤,伤时无昏迷,伤后20min急诊住院。体检:神志清,右侧腹股沟处软组织挫裂伤严重,创口约8.0cm×3.0cm、有轻度污染,有明显的活动性出血。X线片示:未见明显骨折。急诊清创中见右股动脉起始段破裂,局部组织呈粉碎状,右股动脉损伤约2.5cm,切除损伤的右股动脉再将右股动脉断端与右髂外动脉作端端吻合。术后给予对症治疗至9月24日好转出院。出院时患者述右下肢麻木。检见:右足背动脉…     

桡骨骨折内固定术后钢板断裂医疗纠纷司法鉴定1例

通过对本例桡骨骨折内固定术后钢板断裂、骨折不愈合医疗纠纷司法鉴定案例的回顾性分析,提出此类医疗纠纷司法鉴定中应当注意的鉴定要点,如骨折内固定术后钢板断裂的常见因素、鉴定时应当参考的鉴定标准以及医疗过错参与度中应当注意的问题,以期为客观、公正鉴定此类医疗纠纷提供思路和方法。     

家庭暴力致骨折损伤机制分析1例(英文)

本文报道了一名37岁女性遭受丈夫殴打,造成下肢受伤。医院诊断为右髌骨和左胫骨骨折,伤者遂接受了切开复位内固定术。由于丈夫否认对其实施家庭暴力,声称其下肢骨折系交通事故坠落伤。警方遂委托对该女性的损伤进行法医学鉴定。经过审阅X线和CT检查资料,结果为伤者右侧髌骨骨折、左胫骨骨折,以及左眶内侧壁骨折。鉴定意见为髌骨的横向骨折系由肌肉的牵拉暴力引起,左胫骨损伤符合直接和间接外力所致,左眶内侧壁骨折在施暴期间形成的可能性较大。本文阐述了运用影像学技术对家庭暴力案件与交通事故损伤进行鉴别,强调了影像学技术在法医临床鉴定中的应用价值。     

股骨骨折致脂肪栓塞死亡1例

股骨骨折致脂肪栓塞死亡１例王英元，秦小兵（山西医学院法医系，太原０３０００１）１案情摘要梁某，男，６５岁，农民。１９９０年吕月２日１０点，梁某因他人的纠纷，被村委会叫去后发生争执，被人踢伤左大腿，并致不省人事．乡卫生院治疗无效，于８月３日转县医院骨科...     

肱骨骨折内固定术后内固定物移行入胸腔1例

<正>临床上,上肢骨折采用克氏针内固定术后发生克氏针移行入胸腔的案例极为罕见,类似案例亦鲜见报道。笔者通过1例肱骨骨折内固定术后内固定物移行入肺的案例,从司法鉴定角度探讨治疗方案选择与告知、术后病情观察及鉴定评价等相关问题。     

多源性损伤致颈内动脉假性动脉瘤形成尸检1例

1案例资料1.1病历资料徐××,男,27岁,于2003年8月25日因车祸致右眼周软组织挫裂、右额叶脑挫伤,右额骨、右颅前窝、右视N管骨折、筛窦及蝶窦多发骨折。因右侧视神经管骨折压迫右侧视N,右眼无光感,而于9月9日行鼻内窥镜右侧视神经管减压术术中见筛窦、蝶窦内有血痂,右侧筛窦、蝶窦及左侧蝶窦后壁、上壁粉碎性骨折,去除骨碎片,右颈内动脉管壁上有凝血块粘附,予剥离凝血块后见动脉管壁尚完整、形态正常,有渗血,沿骨折线剥离右视N管内侧骨壁并切开视N鞘膜减压。术后反复流鼻血,内窥镜见蝶筛隐窝搏动性出血,予黎氏区射频止血、明胶海绵填塞等…     

跳水致颈髓损伤存活1例

跳水致颈髓损伤往往伤势严重,头部向下入水致颈髓损伤者伤势更为凶险,常难以存活。笔者在实践中遇见1例,报道如下。1案例某男,17岁,2002年8月5日和同学一起在游泳池游泳,头向下自岸边跳入1.2m深泳池受伤,救起后送至省人民医院住院治疗。8月7日MRI示:C6椎体骨折且向后明显错位,C     

枪击致弹头血管内游走1例

1案例资料2006年1月3日接报案,在某宾馆后河内发现一男尸,并在河边发现有砍刀、双截棍等物品。经初步勘查,认为溺死。但因头部有损伤,请法医检验。尸检未见明显刀、双截棍等工具损伤。前额有细小皮肤擦伤,鼻右侧有2.0cm×0.3cm挫伤;右胸锁关节处见1.5cm类圆形创口,边缘有挫伤轮,中央皮肤缺损。解剖见右胸壁软组织大片出血,锁骨内侧端部分粉碎,左胸腔少量积血,纵隔广泛血肿,心外膜少量出血点。创道方向纵隔及胸腹腔脏器搜索检验未见弹头。根据创口特征及损伤深度、程度严重,高度怀疑枪弹盲管创,其弹头必存留体内,有可能移行到了胸腹腔以外的…     

拳击颈部致甲状软骨骨折1例

20 0 0年 9月 12日早上 9时 ,马某 (男 ,40岁 )颈部被他人拳击后 (一拳 )当即感到声音嘶哑。伤后 8小时到某医院住院治疗。入院检查 :生命体征平稳 ,颈正中红肿 ,于甲状软骨向左侧推动时可闻及骨擦感 ,向右侧推动略受限 ,喉咽部急性弥漫性充血 ,会厌舌面、喉面均充血 ,无明显肿胀 ,双侧声带运动对称。次日ＣＴ检查示 :甲状软骨左前端线形骨折 ,伴披裂及声带增厚肿胀 (以右声带增厚最显著 )。临床诊断 :外伤性甲状软骨骨折 ,喉挫伤。当天法医学检验 :喉结部位见皮下出血一处 ,大小 3ｃｍ× 4ｃｍ ,声嘶 ,未见呼吸困难。半月后复检 :声音恢复…     

拳击颈部致甲状软骨骨折1例

2000年9月12日早上9时,马某(男,40岁)颈部被他人拳击后(一拳)当即感到声音嘶哑.伤后 8小时到某医院住院治疗.入院检查:生命体征平稳,颈正中红肿,于甲状软骨向左侧推动时可闻及骨擦感,向右侧推动略受限,喉咽部急性弥漫性充血,会厌舌面、喉面均充血,无明显肿胀,双侧声带运动对称.次日CT检查示:甲状软骨左前端线形骨折,伴披裂及声带增厚肿胀(以右声带增厚最显著).临床诊断:外伤性甲状软骨骨折,喉挫伤.当天法医学检验 :喉结部位见皮下出血一处,大小3 cm × 4 cm ,声嘶,未见呼吸困难.半月后复检:声音恢复正常.     

Death caused by a signal rocket--not an isolated case*

Fatalities related to sporting events are predominantly caused by blunt force injuries especially due to the emotional involvement of crowd, but occasionally other types of trauma are reported as well. A case of very rare trauma caused by shooting with a hand-held parachute signal rocket during a football match is presented. A 17-year-old football fan sustained fatal injuries, a combination of mechanical trauma caused by rocket penetration, as well as extensive thermal burning of the thoracic viscera. Analysis of the event was based on autopsy findings and evidence produced by medicolegal and ballistic experts. Improper use of a hand-held signal rocket, designed for marine distress signals, may cause serious injuries either mechanically, due to explosion, or as a result of thermal discharge. In the reported case, pattern of injuries is discussed, and medical finding corroborated to other available evidence. The presented case is a reminder that the forensic pathologist should be informed accordingly on the type and features of weapon suspected to produce injury, to be able to understand traumatic changes, and look for potential presence of foreign bodies at postmortem examination.     

Death caused by ingestion of endosulfan

This paper reports the autopsy and toxicological findings of a death caused by ingestion of endosulfan dispersed in a colorless liquid containing about 55% of xylene (w/v). For isolation of endosulfan, the biological material was homogenized and the drug was isolated by extraction with ether. Quantitative determinations were carried out by gas chromatography. The following concentrations of endosulfan were found: Blood 30 mg/L Gastric contents 0.5 g in the total 50 mL Liver 20 mg/kg Kidney 2.0 mg/kg Brain 0.3 mg/kg Xylene (solvent) was detected only in stomach contents (0.4 g in the total 50 mL).     

Death and injury caused by land mines in Burma

One hundred and eighty-eight Burmese refugees in Thailand were interviewed. One hundred and five of those interviewed had knowledge of a total of 313 persons who had been exposed to land mine explosions. Twenty-three of the interviewed were land mine survivors. They were all male, aged between eight and 68 years, and all except one had been injured between 1986 and 1997. Fifteen of the 23 were civilians, eight were guerilla soldiers who were injured either in battle or while deploying or disarming land mines. Those who had stepped on land mines were all crus or femur amputated and had several scars on the lower limbs, abdomen and some also on the forearms. Those who had handled a land mine had lost either fingers or hands and one also lost both eyes. This study shows that the frequency of land mine accidents in Burma has been underestimated and that the mortality is high. The study also supports the general impression that many victims are civilians.     

Death caused by sharp injury. Criminologic and criminalistic aspects

From 3497 obductions during the ten years between 1979 and 1988 100 homicides and 18 suicides were caused by sharp trauma. Homicide by sharp trauma is the most frequent method for killing. These 100 homicides were analysed in relation to the age and nationality of victims and perpetrators, place of action, number and localisation of wounds, cause of death. The main results are discussed, particularly those which vary from the results of other authors.     

Death caused by cardioinhibitory reflex cardiac arrest--a systematic review of cases

Forensic pathologists often refer to the cardioinhibitory reflex cardiac arrest (CiRCA) following short neck trauma as a mechanism of death. We sought via a systematic review of the literature to identify circumstances under which carotid bifurcation stimulation could lead to death. Two independent reviewers selected case studies or reports from Medline, ISI Web of Knowledge, and Embase. Circumstances and contributory factors were extracted for each case. From the available data, authors independently assessed whether CiRCA was highly probable (no alternative explanation possible), probable (alternative explanation possible), or unlikely (alternative explanation highly probable). A narrative approach was used to define circumstances in which CiRCA remained possible. From the 48 published cases evoking CiRCA as a possible cause of death between 1881 and 2009, 28 were most likely to result of other mechanism of death (i.e., cerebral hypoxia due to carotid compression, mechanical asphyxia, myocardial infarction). CiRCA remained possible for 20 cases (including five based on anecdotal evidence only) with only one case with no alternative explanation other than CiRCA. Our findings support the presumption that reflex cardiac arrhythmia due to carotid bifurcation stimulation cannot provoke death alone. Actual state of knowledge suggests CiRCA might be contributory to death in the presence of drug abuse and/or cardiac pathology, often associated with physical and/or mental excitation.