椎弓崩裂与外伤伤病关系法医学鉴定26例分析

目的阐述椎弓崩裂与外伤之间伤病关系的法医学鉴定要点。方法收集26例椎弓崩裂案例,从年龄、伴随症状、治疗方式、致伤方式等方面讨论此类病例的特点。结果认定外伤与损伤后果之间存在一定因果关系的2例被鉴定人年龄均在50岁以下,致伤方式均为高能量损伤,且均伴有合并伤,2例患者均接受了手术治疗。结论应关注50岁以下中青年外伤后椎弓崩裂与外伤之间的伤病关系分析。对于选择手术治疗者,更需分析两者之间的伤病关系。     

A Comparison of Coronary Artery Stenosis Estimates Made by Forensic Pathologists and Medical Students

Previous studies suggest cardiovascular pathologists are less accurate than noncardiovascular pathologists (e.g., clinical pathologists) in estimating the degree of coronary artery stenosis. To further investigate the effect of training on accurate estimation of coronary artery stenosis, we designed a study to compare the accuracy of estimates made by forensic pathologists versus medical students. Six forensic pathologists and twelve medical students each independently examined 24 images of coronary artery cross sections and gave an estimate of the degree of stenosis. When comparing all 24 images, the forensic pathologists had a median difference between the estimated percentage of stenosis and actual percentage of stenosis of −12.380 and the medical students had a median difference of −16.50 (p-value of 0.08542). In estimating the percentage of stenosis, training in forensic pathology does not guarantee significantly improved accuracy compared with medical students. Our study showed no consistent statistically significant difference between estimates given by forensic pathologists and by medical students.     

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.     

无骨折脱位型颈脊髓损伤法医学鉴定25例分析

目的 探讨无骨折脱位型颈脊髓损伤案例中外伤与损害后果因果关系法医学鉴定的要点.方法 收集25例无骨折脱位型颈脊髓损伤的法医学鉴定案例资料,总结被鉴定人的年龄、致伤方式、影像学检查结果、自身颈椎退变情况、临床表现、主要诊疗情况、预后情况等,按照损伤与损害后果相关程度分为直接原因、主要原因、同等原因、次要原因、无原因进行伤...     

电针治疗不完全性脊髓损伤神经源性膀胱23例

目的 观察电针治疗不完全性脊髓损伤神经源性膀胱的疗效。方法 将43例脊髓损伤性神经源性膀胱患者按照入院顺序随机分为治疗组（23例）和对照组（20例）,对照组患者给予膀胱训练4周,治疗组患者加用电针治疗。治疗前后观察两组24 h排尿次数、每次尿量、每周尿失禁次数、膀胱容量和残余尿量的变化。结果 治疗后两组患者的24 h排尿次数、每周尿失禁次数、残余尿量均较治疗前显著下降(P<0.01),膀胱容量和每次尿量显著增加(P<0.01);治疗组在降低膀胱残余尿量和升高膀胱容量方面显著优于对照组（P<0.01）。结论 电针结合膀胱训练可明显改善脊髓损伤性神经源性膀胱患者的膀胱功能。     

益气活血方对脊髓型颈椎病患者术后脊髓功能的影响

目的 观察自拟益气活血方对脊髓型颈椎病(cervical spondylotic myelopathy,CSM)术后脊髓功能状态的影响。方法 将72例术后CSM患者分为中药组（43例）和对照组（29例）,对照组患者接受西医常规治疗及康复治疗,中药组患者加服益气活血方1个月。采用脊髓功能状态评定法(40分法)分别于术前及术后1、4、8、12、24周评定脊髓功能。结果 术后24周,中药组临床疗效显著优于对照组（P<0.05）;两组术后1、4、8、12、24周脊髓功能评分均较术前显著升高（P<0.01）;中药组术后4周与术前差值、术后24周与术前差值均显著大于对照组（P<0.05）。结论 在西医常规治疗及康复治疗的基础上,给予益气活血方内服,能有效改善CSM患者术后脊髓功能。     

超声引导下针刀联合神经触激治疗腰椎间盘突出症临床观察

目的 探讨超声引导下针刀联合神经触激治疗腰椎间盘突出症（lumbar disc herniation,LDH）的临床价值。方法 将60例LDH患者分为试验组与对照组,每组30例,对照组采用超声引导下针刀治疗,试验组采用超声引导下针刀联合神经触激治疗,每周1次,连续4周。采用疼痛视觉模拟评分法（visual analogue score,VAS）评价患者疼痛程度,采用日本骨科协会（Japanese Orthopaedic Association,JOA）评分标准评价患者腰椎功能,采用直腿抬高试验角度观察患者下肢活动度,比较两组疗效并进行统计分析。结果 与治疗前比较,治疗后两组患者VAS评分显著降低,JOA评分、直腿抬高角度显著升高,差异均有统计学意义（P＜0.05）;且试验组VAS评分、JOA评分、直腿抬高角度改善程度均显著优于对照组（P＜0.05）。试验组综合疗效优于对照组（P＜0.05）。结论 超声引导下针刀联合神经触激疗法能够更加精准有效地缓解LDH的临床症状,疗效优于超声引导下针刀松解术。     

交通事故致胸、腰椎损伤致残等级评定447例分析

目的探讨车祸致胸、腰椎损伤程度与伤残程度的关系,总结伤残评定经验,探寻其规律性。方法选择胸、腰椎损伤的鉴定447例,重新审查诊断,分析治疗措施,评价胸腰部活动度丧失程度及神经功能障碍情况,分析损伤程度与后遗障碍之间的关系,综合评定伤残。结果胸、腰椎损伤类型及数量并不决定其胸、腰部活动障碍程度及神经损伤后遗症严重程度;椎体损伤的部位与胸腰部活动度障碍关系密切;神经损伤主要集中在T1至L2段脊柱损伤;椎体损伤医院误诊率较高。结论伤残评定应分析损伤与后遗症严重程度的因果关系,以损伤所致后遗症为评残依据,重点关注脊柱功能的丧失程度。     

腰椎间盘突出症综合康复治疗初探

将80例腰椎间盘突出症患者分别用传统康复和综合康复手段进行治疗，并作疗效及治疗时间观察对照，结果表明两种方法在疗效和治疗时间上后者均优于前者。