胸部损伤死因鉴定审查在诉讼中的应用

人身伤害案件被害人的死因鉴定,轻则涉及被告人的量刑,重则事关案件的定性。而司法实践中,经常遇到一些刑事被害人的死因鉴定意见是建立在推断的基础之上,且其推断不具有排他性,经不起推敲,往往直接影响到案件的定性与处理。针对这一问题,结合司法案例进行分析,以期提升死因鉴定的证明力和法医学鉴定意见的公信力。     

CT测量在眶内壁骨折损伤程度鉴定中的应用

目的 利用CT测量眶内壁骨折案件中伤者眶容积扩大率及眶内壁骨质缺损面积,探讨两种CT测量值用于评估眶内壁骨折范围的可行性.方法 选取20例无眼眶骨折案件作为对照组,使用CT测量双侧眶容积,并比较两例是否存在差异.选取本院2018-2020年间受理的眶内壁骨折案件39例作为实验组,并根据鉴定意见分为轻伤组与轻微伤组.分别...     

Characteristics and Prediction of Cranial Crush Injuries in Children*†

Abstract: This study documents four clinical cases of fatal crush injuries to children between 1.5 and 6 years of age with correlations between modeled stress and clinically observed fracture patterns. The clinical case fractures were concentrated in the basicranium, bridged the impact sites, and traversed the middle cranial fossa in the area of the spheno‐occipital synchondrosis. The crushing forces from these cases were recreated on a simplified finite element model of a cranium by applying bilateral pressures to corresponding regions. Numerous trials were run to develop a representative pattern of principal stress directions. In all cases, the highest tensile stresses were located on the basicranium and corresponded to the observed fracture path(s). These results suggest that prefailure stress field diagrams may predict fracture propagation paths, although these will not be exact. Also, these analyses indicate that quasi‐static bilateral loading of the cranium may lead to predictable fracture of the basicranium.     

骨折延迟愈合或骨不连接伤残等级评定66例分析

目的探讨骨折延迟愈合、骨折不连接伤残等级评定条款的适用。方法从患者的性别、年龄、骨折部位/种类、合并疾病情况、治疗方式、骨折愈合时间、伤残等级等资料分析66例骨折延迟愈合、骨折不连接的评残案件。结果进行伤残等级鉴定60例,其中八级2例,九级11例,十级28例,未构成伤残19例,还有6例未申请伤残鉴定。结论现行国家鉴定标准尚无骨折延迟愈合、骨折不连接的明确条款,故有一定的不适应性,在实践中可比照最相类似条款进行评残。     

A Fatal Mediastinitis Due to a Neck Trauma from an Undeclared Assault

History of neck trauma should be promptly investigated in patients with severe infections of the chest as mediastinitis. We present a forensic case of a death due to a mediastinitis in a patient with an undetected fracture of the superior horn of the thyroid cartilage that was exclusively revealed at autopsy examination. Histological analyses of the neck tissues showed signs of pharyngeal mucosal microperforation caused by the fracture and surrounded by an inflammatory reaction. The fracture was caused by a not declared manual strangulation attempt, happened several days before medical evaluations. We share our experience to emphasize the importance of revealing the etiologies of fatal infections of the mediastinum both for clinical and forensic purposes.     

Skeletal Trauma Resulting From Fatal Low (≤3 m) Free Falls: An Analysis of Fracture Patterns and Morphologies

The skeletal trauma resulting from fatal low (≤3 m) free falls is poorly researched and understood by forensic practitioners. The aim of this study was to identify the types of skeletal trauma resulting from low falls through investigating fracture patterns and morphologies. Skeletal trauma was analyzed using full‐body postmortem computed tomography scans of 145 individuals who died from a low free fall. Trauma was then contextualized to the variables that influence how a person falls using multiple logistic regression. Results showed fracture patterning primarily involved the axial skeleton and that there were a number of patterns significantly associated with the height fallen, pre‐existing health conditions, and age. Analysis of fracture morphologies showed 108 possible fracture types, six of which were significantly associated with the height fallen. Understanding the skeletal trauma characteristic of low free falls will further inform anthropological interpretations of trauma in cases where a fall may be considered the possible mechanism.     

Skull Fracture with Brain Expulsion in a One-Level Jumping-Fall

Abstract:  Here presented is the case of a one-level jumping-fall with extensive skull fractures and brain expulsion. The body was found on the basement floor at the foot of the stairs. At the autopsy, the skull was extensively fractured, with about half of the brain expulsed several feet away from the body. The cause of death was established as a craniocerebral trauma with brain expulsion. The circumstances and manner of death were still unclear at that time. A low fall seemed very unlikely considering the severity of the skull and brain damage. The police investigation clearly revealed that the man, in a paranoid psychotic state, attacked his wife with a knife and then was witnessed by his children to have hit his head several times with a hammer. Afterwards, they saw him running to the top of the basement stairs and jumping to the bottom of the stairs head first.     

闭合复位中空螺钉内固定结合中药内服治疗股骨颈骨折36例

目的 观察闭合复位中空螺钉内固定结合中药内服治疗股骨颈骨折的临床疗效。方法 将72例患者随机分为对照组、治疗组,每组各36例,两组均行中空加压螺钉内固定,治疗组依据辨证分期同时予中药内服,对照组常规预防处理。结果 治疗组总优良率显著优于对照组(94.44% vs 72.22%,P<0.05);两组术后1、3、6个月Harris评分比较,差异均有统计学意义(P<0.01)。结论 闭合复位中空螺钉内固定结合中药内服治疗股骨颈骨折临床疗效显著,值得临床推广应用。