鼻骨骨折螺旋CT3D成像与X线片对比研究

目的 评价螺旋CT扫描三维重建成像与X线摄片对比对鼻骨骨折法医学鉴定的价值。方法 使用SOMATOM BALANCE 1s螺旋CT机，对32例复杂鼻部外伤者2mm／2mm扫描，常规进行最大密度投影法(MIP)、多平面重建(MPR)、表面覆盖法(SSD)、容积成像(VR)方式。全貌显示受伤鼻骨骨折影像，并与常规鼻骨摄片比较。结果 螺旋CT三维成像纠正3例X线照片的假阳性和6例诊断骨折类型不准确。结论 螺旋CT三维重建对诊断复杂鼻骨骨折块数目、移位，以及骨折类型优于X线摄片。     

81例外伤性鼻部骨折的特点及其法医学鉴定分析

研究鼻部损伤后骨折的特点、确诊的方法及法医学鉴定的相关问题。 81例以鼻部外伤为主诉 ,经鼻骨拍摄X线侧位片 ( 62例加做鼻部CT扫描 )检见有鼻骨骨折的患者 ,进行法医临床学鉴定分析。单纯性线性骨折 19例 ,骨折移位者 11例 ,粉碎性、多发性骨折 4 0例 ,鼻骨骨折伴上颌骨额突骨折或 (及 )伴眶骨骨折 11例 ;轻伤 58例 ( 72 % ) ,未构成轻伤 2 3例 ( 2 8% )。多数鼻骨骨折为粉碎性、多发性 ,且可伴有其它部位骨折。鼻骨X线侧位片只能明确部分粉碎性骨折及部分移位明显的骨折 ,CT扫描能确定鼻部骨折形态。     

From chronic rhinitis to death: Fatal outcome of nasal polyposis treatment

Introduction

Nasal polyposis (NP) is considered to be the state of chronic inflammation of nasal mucosa and sinuses presenting with various nasal symptomatology. In most cases, it is treated conservatively. Recently, functional endoscopic sinus surgery (FESS) was developed as the valuable and advantageous surgical procedure to treat NP. Despite the inherited risks of this procedure, its complication rate is considered to be acceptable compared to potential benefits for the patient.

Case

Fifty-five-year-old man was admitted to the hospital for surgical removal of the nasal polypus. After the usual pre-surgery procedures, the patient underwent FESS. Under general anesthesia, left sphenoid sinus was opened and cleaned from the imflammatory discharge, polypus was excised, and following the trepanation the left maxillary sinus was left to drain out. Polypus and pieces of sinonasal mucosa were sent to pathohistological analysis, which yielded in diagnosis of inverted sinonasal papilloma.The early postoperative recovery was regular, but 2 h upon the surgery, the patient started to lose consciousness gradually falling into the state of coma. CT scan and angiography of the head revealed pneumocranium, defect of the left ethmoidal sinus, hematoma in the left frontal cerebral lobe, as well as the hemorrhage in all four cerebral ventricles. A series of neurosurgical procedures followed in the next 8 days. Despite the attempts to resolve above complications, the patient remained comatous and died 16 days after the polypectomy.Autopsy revealed the extensive oval-shaped defect on the skull base in the left posterior part of cribrous plate of the left ethmoid bone. The brain appeared swollen and heavily congested, showing the zone of subarachnoidal hemorrhage in basal face of left frontal lobe. Frontal serial sections revealed large intracerebral haematoma in basal periventricular structures of left frontal lobe extending to the whole ventricular system. Apart from the above, most prominent finding was bilateral bronchopneumonia. The cause of death was attributed to bronchopneumonia following the brain trauma, manner of death ruled as violent.

Conclusion

Although majority of the patients suffering from chronic rhinosinusitis or NP recover well after the endoscopic surgery, the possibility of undesirable outcome must not be ignored. This case calls for assessment of potential medical liability caused by malpractice. Having in mind rather high prevalence of chronic rhinosinusitis and NP, legal aspects of postoperative death should be carefully analyzed.     

新鲜鼻骨骨折CT诊断指标探讨

法医鉴定工作中,需要明确判断鼻骨骨折为新鲜形成,方可作为人体损伤鉴定的依据.通过案例追踪复查与已知陈旧鼻骨骨折对照及临床表现等方法,依据骨折断端锐利、骨折部位粘膜肿胀、软组织内有小片状低密度影等CT影像表现,结合伤后鼻面部肿胀、鼻出血、鼻腔通气不畅等临床表现作为新鲜鼻骨骨折的影像诊断指标.工作中,须重视鼻骨骨折新旧伤的...     

122例鼻部骨折X线和CT诊断的法医学分析

目的　探讨CT在鼻部骨折诊断中的优点。方法　观察 12 2例鼻损伤伤者的鼻部CT和普通X线片 ,对鼻部诸骨骨折进行对比分析。结果　 12 2例鼻部骨折 (鼻骨骨折 3 2例 ,上颌骨额突骨折 3 3例 ,鼻中隔骨折 9例 ,多发性骨折 48例 )均经CT认定。其中 40例因X线片漏诊直接通过高分辨率鼻骨CT薄层扫描认定 ;82例通过鼻骨侧位X线片显示有鼻部骨折 ,因存在骨折类型认定不准确和 /或有漏诊鼻部其它部位骨折可能 ,通过鼻骨CT认定。结论　鼻骨侧位X线片易漏诊、误诊鼻部骨折 ;鼻骨CT能避免鼻部诸骨骨折的漏诊及误诊 ,且骨折认定准确。     

苍耳子水提取物对变应性鼻炎豚鼠鼻黏膜病变和血清炎症细胞因子的影响

目的 观察苍耳子水提取物对变应性鼻炎豚鼠鼻部行为学症状、鼻黏膜组织病理变化和血清炎症细胞因子的影响。方法 将SPF级豚鼠随机分成正常组,模型组,氯雷他定组,玉屏风散组,苍耳子水提取物高剂量（4 g/kg）、中剂量（2 g/kg）、低剂量（1 g/kg）组。除正常组豚鼠外,其余各组豚鼠采用卵蛋白和氢氧化铝腹腔注射并局部刺激的方法复制变应性鼻炎豚鼠模型。模型复制成功后,给药14 d,5%卵蛋白隔日滴鼻1次。观察各组豚鼠鼻部行为学症状评分,光学显微镜下观察鼻黏膜组织病理变化,采用酶联免疫吸附法检测血清免疫球蛋白E（immunoglobulin E, IgE）、白细胞介素-4（interleukin-4, IL-4）和干扰素-γ（interferon-γ,IFN-γ）水平。结果 与模型组相比,苍耳子水提取物高、中、低剂量组均可不同程度降低变应性鼻炎豚鼠鼻部行为学症状积分（P＞0.05）;高、中、低剂量苍耳子水提取物改善鼻黏膜病理变化;苍耳子水提取物呈剂量依赖性地降低血清IgE、IL-4水平（P＜0.05）,升高IFN-γ水平（P＜0.05）。结论 不同浓度苍耳子水提取物均可改善变应性鼻炎豚鼠鼻部行为学症状,减轻鼻黏膜病理变化,调节血清炎症细胞因子水平。     

86例鼻部复合性骨折的法医鉴定

目的探讨鼻部复合性骨折的认定、分型和损伤程度的法医学鉴定。方法对86例鼻部复合性骨折鼻骨CT片(轴扫 冠扫)和有关病历资料进行观察分析。结果将86例伤者按骨折种类分成鼻骨并发鼻部非鼻骨骨折(81例)和鼻部非鼻骨复合性骨折(5例)两类,然后再进一步细分。结论86例伤者中轻伤80例(93%),轻微伤6例(7%)。鼻部复合性骨折的损伤程度评定关键在于应按照《人体轻微伤的鉴定》(GA/T146-1996)和《人体轻伤的鉴定(试行)》的有关规定或标准认定和分型,这样鉴定结论才会准确可靠。     

Photoshop软件在法医临床学鼻面积测量中的应用初探

在鼻部损伤的法医临床学鉴定中,由于鼻的形态不规则,法医学界对鼻部缺损范围的测量和计算尚无一种统一的、精确的方法。本文利用Photoshop软件与传统的薄膜覆盖法分别对鼻面积进行测量,分析两种测量方法所得结果无统计学差异,因此通过软件法可以简便准确的计算鼻部面积。在伤者受伤前与伤后眼裂等器官长度不变的条件下,将伤者眼裂长度作为伤前照片的"比例尺",根据伤前照片推算其伤前鼻部面积,从而计算出鼻缺损比例,为鼻损伤程度的判定提供了更科学的方法。