MSCT及图像后处理在鼻骨骨折法医鉴定中的应用

目的探讨多层螺旋CT(MSCT)及图像后处理在鼻骨骨折法医学鉴定中的应用价值。方法采用MSCT对134例被鉴定人进行薄层扫描并行多平面重建(MPR)和表面遮盖成像(SSD)。比较MSCT与常规X线诊断结果。结果线型骨折55(41.04%)例,粉碎型骨折46例(34.33%),凹陷型骨折27例(20.15%),未见骨折6例(4.48%)。X线平片及CR片漏、误诊48例(35.82%)。MSCT正确诊断133例(99.25%)。两者诊断结果存在显著差异(χ2=45.0816,P<0.001)。结论MSCT及后处理图像应作为鼻骨骨折法医鉴定的主要依据。     

CT在肋骨骨折认定中的价值及骨折的力学分析

目的探讨在法医学鉴定中普通X线片难以确定的肋骨骨折,以CT技术加以显示的方法,并阐明肋骨骨折的力学原理。方法对17例普通X线技术显示困难的肋骨骨折行CT扫描,采用薄层平滑和高分辨率重建、表面遮盖法和多平面重建观察,确定肋骨骨折的部位、数量、形态、移位和骨痂形成情况等信息。结果17例X线平片难以确定的骨折,通过上述CT扫描和后处理重建技术,均得到满意的结果。通过骨折力学分析和影像观察,将间接暴力导致肋骨骨折的力矩分成垂直和旋转两类,从而提出垂直型和旋转型肋骨骨折的分类。结论对普通X线平片难以确定的肋骨骨折,建议采用薄层CT扫描,沿肋骨长轴多平面重建观察,结合肋骨骨折的力学原理,有助于避免将急性旋转型肋骨骨折误诊为陈旧骨折。     

An unusual case of sudden unexpected death: postmortem investigation and biomechanical analysis of the cervical spine

A naked man died under peculiar circumstances and the postmortem examination revealed unexpected lesions in the cervical spine. Investigations of the cervical spine (computed tomography, magnetic resonance imaging, and histological examination) showed that a piece of bone was torn of the anterior part of vertebra C6 and that there was fresh bleeding in the surrounding tissue. The cause of death remained unclear but was most likely cardiac arrhythmia initiated by beta-2 agonist inhalation due to an acute asthmatic attack. Data from biomechanical investigation using finite element analysis supported the conclusion that the cervical spine injury was secondary to impact during falling as a consequence of the cardiac arrhythmia.     

CT技术的应用对鼻区骨折法医学鉴定意见的影响

目的 探讨CT技术的应用对鼻区骨折法医学鉴定的影响,发现现行鉴定标准存在的问题提出修订意见.方法 运用x2检验比较两个不同时期分别以X线和CT为主要鉴定依据评定为轻伤的案件,探究医学放射影像检查技术对鼻区骨折鉴定意见的影响程度.结果 发现CT技术对鼻区骨折的鉴定结果的影响,与X线比较,其差异有统计学意义,并暴露出基于X线影像技术的鼻骨损伤鉴定标准条款不再适应目前鉴定实践状况的问题.结论 在CT技术广泛应用后,现行的鼻骨损伤鉴定标准条款不能很好地适应医学发展,有必要重新制定基于CT技术的鼻区骨折鉴定标准.     

利用放射性核素骨显像检查鉴别鼻部骨折新旧程度回顾性法医学分析

目的 利用放射性核素骨显像检查鉴别鼻部骨折的新旧程度.方法 对48例疑似陈旧性鼻部骨折伤者放射性核素全身骨显像、局部断层骨显像及CT融合图像在鼻部骨折处放射性分布、浓聚情况的分析,鉴别鼻部骨折的新旧程度.结果 48例中8例放射性核素全身骨显像、局部断层骨显像及CT融合图像在鼻部骨折处显示放射性分布增高、浓聚区,诊为新鲜骨折,评定为轻伤;40例在鼻部骨折处未见明显异常放射性分布增高、浓聚区,诊为陈旧骨折,与本次外伤无因果关系.结论 放射性核素骨显像检查在鉴别鼻部骨折新旧程度方面可得到满意结果.     

Fatal Child Abuse Presenting with Multiple Vertebral and Vascular Trauma

This case study involves the unexplained death of a previously healthy 30‐month‐old child. Reportedly, she was found unresponsive by her foster father following a 2‐hour nap. She was transported to the hospital and died in the emergency room of unknown causes. Blood drawn in the ER showed hemoglobin of 4.3 mg/dL. Postmortem skeletal survey, magnetic resonance imaging (MRI) of the brain, and retinal examinations were negative. The medical examiner assumed jurisdiction of the body. The autopsy showed massive retroperitoneal hemorrhage, transections of the abdominal aorta, and inferior vena cava, and complete tears of the anterior longitudinal ligament of the spine at C5/C6 and L1/L2 with diastases of the vertebral bodies at the corresponding intervertebral disk spaces. The case is believed to be extraordinary due to both the extent of injury that does not match the reported history and the mechanism of vertebral and vascular injuries.     

The Self-salvation of Capitalist Society——Giddens' Criticism of Historical Materialism and the Third Way

Giddens fully absorbs the Marx's capitalism critical theory of capital criticism as the core by including Marx in historical framework of late modernity. Based on fracture of modernity, Giddens criticizes historical materialism and develops structural theory of understanding of the developed capitalist society. Thereby, Giddens shows the current status of modernity: pluralistic structure and high risk of society dominated by the forces of globalization. According to the principle, Giddens proposes “the third way” as self-salvation of capitalist society: adhere to the ideals of socialism, beyond the traditional opposition of government and market, making full use of the balance between state and market to build a society of positive welfare. Laying aside political label of “the third way”, the exploration of the balance between government and market is of great practical significance for China to promote the balance between government and market, and to manage the challenge of globalization. However, the position of Postmodernism indicates that Giddens criticism of Marx's historical materialism is a failure undoubtedly.     

Ballistic impact of hollow-point ammunition on porcine bone

Identifying failure mechanisms in skeletal tissue allows a deeper understanding of the effects of specific projectile impacts on bone. While ballistic trauma in flat bones is largely researched, knowledge of how long bones react to gunshot impacts is limited in the literature. The impacts of deforming ammunition appear to produce higher levels of fragmentation; however, these have not been studied in depth. This study compares the damage to femora bone by HP 0.357 and 9 mm projectiles constructed with both full and semi-metal jackets. Impact experiments were undertaken on a single-stage light gas gun involving the use of a high-speed video camera and full reconstruction of the bones to ascertain fracture patterns occurring in the femora. Higher degrees of fragmentation are likened to the presence of semi-jacketed HP projectiles than jacketed HP projectiles. The observations of external facing beveled edges are believed to be associated with the increased separation of the jacket and lead core of projectiles. Additionally, experimentation has shown that the amount of kinetic energy lost postimpact is likely related to the presence or the absence of a metal jacket on an HP projectile. The observed data, therefore, suggest that the composition, rather than the configuration, of a projectile affects the type and extent of the damage.     

An Analysis of the Characteristics of Thoracic and Abdominal Injuries Due to Gunshot Homicides in Israel

De‐identified wound data from 197 homicidal gunshot postmortems were obtained between 2000 and 2008. Forensic ballistics data were only available for cases between 2004 and 2008. Males represent 91% of gunshot victims and were struck in the thorax/abdomen with an average of 2.3 bullets. The type of firearms involved were semi‐automatic pistols in the predominant caliber 9‐mm Luger and assault rifles in caliber 5.56 × 45 mm and caliber 7.62 × 39 mm Soviet, using full metal jacket bullets. The majority of shootings occurred at ranges of 1 m or greater. The most common bullet path was front to back in 66% of cases. Entry wounds occurred more often on the left side of the thorax, abdomen, and back. The most common critical organs/tissues to sustain bullet trauma in descending order were as follows: heart, lungs, liver, aorta, spleen, kidneys, and vena cava. Ribs were struck by most bullets that entered the thorax.     

Specific Characteristics of Injuries Inflicted by Claw Hammer

Claw hammers have the specific characteristic of having two distinct ends: one a flat head of variable form, the other bifurcated. So the use of this tool as a blunt instrument will cause varying injuries. The authors present two clinical cases of assault with a claw hammer. Examinations revealed two types of wound. A first injury composed of integumentary lacerations and underlying bone injuries in terms of “shape” suggested the use of a blunt instrument. A second injury made up of damage showing two parallel wounds or two wounds located one in the extension of the other suggested the use of an object with a bifurcated end. The combination of both types of injury should alert examiners to the possibility of the use of a claw hammer in causing the injuries in order to help direct investigators in their investigations and in the search for the weapon used.