眼球突出度测量方法的比较及其法医学意义

目的比较Hertel突眼度计及CT测量两种眼球突出度测量方法的差异,探讨其法医学应用价值。方法选取56例眼部无损伤及疾病的正常人作为正常组,在确定规范的CT影像工作站上测量眼球突出度绝对值,并比较双眼眼球突出度有无差异。选取47例单侧眼眶骨折的伤者,根据两眼有无眼眶骨折,将其分为伤眼组及健眼组,分析Hertel突眼度计及CT测量两种方法测得同一眼眼球突出度绝对值的差异以及同一受检者双眼眼球突出度相对差值的差异。结果 CT法测量正常人双眼间眼球突出度差异无统计学意义。健眼组CT法测得眼球突出度绝对值为(16.66±5.41)mm,Hertel突眼度计测得眼球突出度绝对值为(16.16±4.45)mm,两组测量结果之间差异无统计学意义(P0.05)。伤眼组应用两种方法测量的眼球突出度绝对值之间差异具有统计学意义(P0.05)。两种测量方法测得的眼球突出度相对差值在伤眼和健眼组之间差异无统计学意义(P0.05)。结论 CT法与突眼度计法具有较好的一致性,可以运用于法医学鉴定实践。     

163处肋骨骨折的影像学分析

目的：探讨影像学检查方法在不同区段肋骨骨折法医学鉴定中的应用。方法回顾性分析56例被鉴定人共计163处肋骨骨折的骨折部位、影像学检查次数及其首次检出的影像学技术等资料。结果在损伤后早期（≤14 d）的检出率为65.6%。 X线对肋骨前段骨折的首次检出率76.2%，两次内检出率90.5%；CT首次检出率66.7%，两次内检出率80.0%。 X线对肋骨腋段骨折的首次检出率仅27.6%，两次内检出率58.6%；CT首次检出率54.3%，两次内检出率80.4%。X线对肋骨背段骨折的首次检出率63.6%，两次内检出率81.8%；CT首次检出率50.0%，两次内检出率70.0%。结论在肋骨骨折的鉴定中，应注意影像学检查的随访，综合运用不同技术手段，尤其在疑有肋骨腋段骨折的案例中，单纯X线摄片可能造成漏检，建议选择CT扫描。     

二分髌骨法医学鉴定1例

正1案例资料1.1简要案情某女,40岁。2010年5月10日因纠纷被人打伤,先后于县市两级医院就医,均诊断为右髌骨骨折。当地鉴定结论为右髌骨骨折,轻伤。后被告方对鉴定结论提出异议,要求市局重新鉴定。1.2病历摘要2010年5月10日至县医院住院治疗,查体见右侧膝部肿胀,可见擦挫伤痕迹,压痛,右膝关节     

4种影像学检查方法应用于肩关节损伤法医学鉴定的比较

目的 评价X线、CT、MRI及CT气-碘双对比造影4种方法在肩关节损伤法医学鉴定中的应用价值.方法通过对肩关节损伤患者行X线摄片、CT扫描、MRI成像与CT气-碘双对比造影检查,观察、分析4种方法所得的影像学资料.结果 X线摄片对骨折的诊断率为52.8%,对软组织损伤的诊断率为0%;CT对骨折的诊断率为72.0%.对软...     

二分髌骨误诊为髌骨骨折1例

1案例资料 董某,女,45岁,某年5月24日因纠纷打架致腹部、右膝疼痛。伤后入当地县医院治疗,查体：右侧膝部稍肿胀,可见擦挫伤,压痛,伤后第2天DR片显示右髌骨骨质连续性中断、两断端稍显分离,诊断为右髌骨骨折,治疗不愈。7月29日到县公安局法医室验伤,诉膝关节疼痛,查体见：持双拐步入检查室,右膝屈曲功能部分受限。鉴定结论：右髌骨骨折。     

二分髌骨误诊为髌骨骨折1例

1案例某女,38岁,农民。5月19日因纠纷被人钝物打伤左下肢,5月26日到某县法医室验伤。法医检验见:伤者步入检查室,左大腿上段见一30cm×10cm的皮肤青紫,左膝前见5cm×7cm的皮肤青紫。X线报告:左膝髌骨骨折。鉴定结论:某女左膝髌骨骨折,其损伤程度根据《人体轻伤鉴定标准(试行)》第三章第二十五条之规定构成轻伤。当地派出所接法医鉴定书后,以“故意伤害罪”将犯罪嫌疑人刑事拘留。因犯罪嫌疑人亲属认为髌骨骨折应该不能行走,要求重新鉴定。8月10日组织重新鉴定。鉴定时,重新摄了双膝X线片,加摄了双膝CT片,并与受伤当日左膝X线片进行比较,结…     

肋骨骨折的B超检查及法医学意义

对 36例肋骨骨折的 B超检查与 X线检查结果进行对比分析,显示对临床症状体征明显而早期 X线检查漏诊或诊断不明确的肋骨骨折伤者 ,应用 B超检查可以弥补 X线检查的不足 ,提高其诊断正确率 ,为法医临床学鉴定提供科学依据。     

鼻骨骨折影像学检查方法与法医学鉴定

本文从影像学检查方法的不同，重点对鼻骨骨折的影像学特点进行论述，比较了各种影像学检查方法的优劣。在法医学鉴定中，应根据实际情况，选择更优质的影像学检查，注意与正常的解剖变异相区别．并提出根据鼻骨骨折的影像分型进行法医学伤情鉴定的依据。     

鼻骨骨折影像学检查方法与法医学鉴定

本文从影像学检查方法的不同,重点对鼻骨骨折的影像学特点进行论述,比较了各种影像学检查方法的优劣。在法医学鉴定中,应根据实际情况,选择更优质的影像学检查,注意与正常的解剖变异相区别,并提出根据鼻骨骨折的影像分型进行法医学伤情鉴定的依据。     

骨折法医鉴定中常规X线与CT漏诊、误诊的技术因素分析

目的 探讨X线平片和常规CT检查技术对骨折漏、误诊的影响。方法 对366例已接受普通X线或常规CT检查的骨折法医鉴定者行MSCT扫描并行对照性研究。结果 骨折法医鉴定中普通X线、常规CT漏、误诊率分别为40.83%和29.73%，存在显著统计学差异（x^2=4.69，P＜0.05）。二者漏、误诊病例中与技术因素相关者分别占66.29%和88.63%，亦存在显著统计学差异（x^2=7.58，P＜0.01）。结论 普通X线与常规CT的设备和技术缺陷与失误是造成漏、误诊的重要因素。     

Forensic Identification of Bipartite Patella Misdiagnosed as Patella Fracture

Bipartite patella is recognized as a developmental anomaly of ossification. Most of them are asymptomatic and are discovered incidentally. Bipartite patella is sometimes misdiagnosed as a patella fracture, because the x‐ray images of both these conditions may appear very similar. In this case, the patient complained of left knee pain after x‐ray films revealed a fracture‐like line in the left patella. The patient was then diagnosed as having a patella fracture. In China, the injury degree is categorized as serious injury, minor injury, and trivial injury. As the injury degree of patellar fracture is identified as minor injury, the defendant who injured the patient will be sentenced to prison for ≤3 years. However, the defendant objected to this judgment and applied for the second evaluation of injury degree. On the basis of the site of injury, clinical manifestations, and imaging findings, we diagnosed the patient with bipartite patella which belongs to normal anatomic variant. Therefore, the injury degree of the patient was not minor injury.     

Contributions from Forensic Imaging to the Investigation of Upper Cervical Fractures

Abstract: Injuries to the upper cervical spine (UCS) are common in traumatic deaths and postmortem computed tomography (PMCT) may contribute to the forensic investigation. This study presents PMCT in comparison with autopsy in the examination of UCS injury. Thirteen consecutive cases with UCS fracture and/or cranio‐cervical dislocation were examined with PMCT and autopsy, and the findings were correlated. Neither of the techniques identified all UCS injuries. Fractures of atlas and axis were best visualized with PMCT whereas cranio‐cervical dislocation was better identified during autopsy. Serious injuries were present after both high‐ and low‐energy trauma. Medico‐legal autopsy in combination with PMCT produced a thorough evaluation of UCS injuries. By combining these procedures detailed investigations, including accident reconstruction and injury pattern analysis, can be performed. This study supports the routine application of PMCT, as a supplement to the medico‐legal autopsy of deaths with UCS injuries.     

Postmortem Computed Tomography in Firearm Homicides: A Retrospective Case Series,

Postmortem computed tomography (PMCT) is integrated into the evaluation of decedents in several American medical examiner offices and medicolegal death investigative centers in many other countries. We retrospectively investigated the value of PMCT in a series of firearm homicide cases from a statewide centralized medical examiner’s office that occurred during 2016. Autopsies were performed or supervised by board-certified forensic pathologists who reviewed the PMCT scans prior to autopsy. PMCT scans were re-evaluated by a forensic radiologist blinded to the autopsy findings and scored by body region (head–neck, thoracoabdominal, and extremities). Injury discrepancies were scored using a modified Goldman classification and analyzed with McNemar’s test. We included 60 males and 20 females (median age 31 years, range 3–73). Based on PMCT, 56 (79.1%) cases had injuries relevant to the cause of death in a single body region (24 head–neck region, 32 thoracoabdominal region). Out of these 56 cases, 9 had a missed major diagnosis by PMCT outside that region, including 6 extremity injuries visible during standard external examination. Yet all had evident lethal firearm injury. We showed that PMCT identifies major firearm injuries in homicide victims and excludes injuries related to the cause of death in other regions when a single body region is injured. Although PMCT has a known limited sensitivity for soft tissue and vascular pathology, it can be combined with external examination to potentially reduce or focus dissections in some of these cases depending on the circumstances and medicolegal needs.     

Forensic Radiology Pitfalls: CT Imaging in Gunshot Wounds of the Head

Computed tomography (CT) imaging is increasingly used in emergency departments and trauma services and is being offered as a supplemental tool with autopsy in coroner's and medical examiner's offices throughout the United States. The availability of CT images in lieu of traditional X‐rays for medicolegal autopsies may lead to misinterpretation of images for forensic pathologists who are not familiar with these types of images. Forensic pathologists must become familiar with CT imaging, the basis of CT image formation and how to interpret CT images appropriately. We highlight potential pitfalls of CT image interpretation through two cases of fatal gunshot wounds of the head. Antemortem CT imaging available at the time of autopsy led to discrepancy between the initial image findings and the autopsy due to inexperienced manipulation of the images. With appropriate understanding of CT image interpretation and manipulation, forensic personnel should be able to avoid most sources of misinterpretation.     

MSCT鉴定交通事故致死2例分析

目的使用多层螺旋CT(multi-slice spiral computed tomography,MSCT)对交通事故的致伤特征进行观察和分析,探讨MSCT在分析交通事故中的应用价值。方法以2例交通事故为对象,运用MSCT平扫、三维重建技术以及心脏穿刺造影技术对尸体进行全面检查,结合尸表检查分析交通伤形成机制等特点。结果案例1 MSCT结合心脏穿刺造影,发现死者右心破裂,死亡原因为交通事故挤压胸部致右心破裂、心脏压塞。案例2 MSCT发现左侧躯干部损伤引起脾破裂、腹腔出血,死亡原因为失血合并创伤性休克。结论 MSCT对于骨骼损伤、软组织损伤、血液改变均具有良好的观察效果,MSCT平扫结合心脏造影有助于诊断心血管系统的损伤。     

足弓破坏法医临床学鉴定的影像学理论与实践

足弓破坏是现行GB18667-2002《道路交通事故受伤人员伤残评定》标准针对足损伤后伤残等级评定特别给出的命名,临床与法医学界对此问题的阐述尚较少见,有必要在实践工作的基础上加以总结。足在纵、横方向上形成凸向上方的弓形外观,分别为内侧纵弓、外侧纵弓及横弓。足弓作用主要在于吸收震荡,起到保护作用,具备静态与动态两种态势。足弓可借鉴静态体重负荷下X线摄足弓侧位片进行测量。足损伤致跗、跖骨骨折愈合后足弓X线测量值背离临床医学足弓正常参考值和/或维持足弓功能作用的肌肉、韧带严重损伤,可谓足弓破坏。足弓骨性构架的动力结构内侧纵弓或承载负重的外侧纵弓中任意一个破坏,必定影响横弓,符合一足足弓结构破坏1/3以上的限定要件;而内侧纵弓及外侧纵弓均破坏,横弓必定破坏,符合一足足弓结构破坏的限定要件。     

120例强奸案法医学回顾分析

强奸案的证据通常应具备暴力证据和性交证据,机械性损伤、使用药物和生物检材等是构成暴力证据和性交证据的重要组成部分。由于加害人实施强奸时手段的不同以及个体性行为的差异,损伤的类型、形态、部位及生物检材的种类、遗留部位、遗留客体也会呈现不同特征。如果不仔细地检查和提取,就会使这些物证灭失。本文通过对120例强奸案件的分析,总结了案件中损伤、药物、生物检材的发现、提取和检验的相关信息与技术细节问题,同时结合案情对案件发生的时段、地点、环境、区域、作案手段与方法、嫌疑人和受害人的职业特点等进行了讨论,希望对法医学鉴定工作和民警办理案件有所帮助。     

Manifestations and Medicolegal Significance of Loeys–Dietz Syndrome

Loeys–Dietz syndrome is a recently described autosomal dominant disorder with underlying vasculopathy characterized by aortic and other vascular aneurysmal dissection/rupture. A 61‐year‐old man is reported who died suddenly and unexpectedly and at autopsy was found to have a ruptured abdominal aortic aneurysm. Additional findings included dolichostenomelia, high‐arched palate, and pectus excavatum. There was a strong family history of Loeys–Dietz syndrome, although the decedent had never been tested. Death was, therefore, due to a ruptured abdominal aortic aneurysm in a case of probable Loeys–Dietz syndrome. Although Loeys–Dietz syndrome shares common characteristics with Marfan and other connective tissue syndromes, it is a distinct entity with a much more aggressive clinical course. Lethal events may not occur until later adult life; however, the identification of the syndrome and differentiation from other connective tissue disorders at autopsy is important so that genetic investigation of close relatives can be undertaken with prophylactic surgical treatment if necessary.     

MRI鉴别新鲜与陈旧性椎体压缩性骨折

目的 探讨MRI对新鲜与陈旧性椎体压缩性骨折的鉴别价值.方法 回顾性分析43例胸、腰椎椎体压缩性骨折的MRI表现,MRI检查序列主要为T1WI、T2WI和STIR.结果 本组43例共发现55处胸、腰椎椎体压缩性骨折,其中46处椎体被判定为新鲜骨折,T1WI呈低信号或低信号中混有少许高信号,T2WI呈高信号,STIR呈明...