眼眶爆裂骨折的CT表现及法医学鉴定分析

目的研究眼眶爆裂骨折的CT表现特点及其法医学鉴定问题。方法对76例眼眶爆裂骨折的临床法医学鉴定案例进行回顾性分析、总结。结果单纯头部CT以及X线检查诊断眼眶爆裂骨折漏诊率较高,其中CT诊断阳性率高于X线;眼部CT检查是诊断眼眶爆裂骨折的首选方法。76例骨折中以眶内侧壁骨折多见,其次为眶下壁骨折。CT直接征象主要表现为眶壁骨质连续性中断和眶壁移位,间接征象主要为骨折处积血和软组织增厚;临床表现以眼周瘀斑、肿胀、视力下降及复视为主。眼眶爆裂骨折对伤眼视力影响不明显,患者伤后视力多在0.8以上,但是容易出现复视;损伤程度以轻伤为主。结论单纯头部CT及X线检查诊断眶壁爆裂骨折有局限性,对眼部损伤患者,建议法医鉴定时将眶部CT检查作为常规;眶壁骨折对伤眼视力影响不明显,但是容易出现复视,法医鉴定时应引起注意。

The orbital blowout fracture CT characteristic and its forensic medicine appraisal

Objective To study the CT characteristics and the medicolegal expertise of orbital blowout fracture.Methods To review 76 cases orbital blowout fracture CT image and analyze their clinical forensic appraisal.Results The missed diagnosis of the only examination of craniocerebral CT or head X-ray was higher. The orbital CT examination has advantage in finding the orbital blowout fracture. The diagnosis rate of orbital blowout fracture with CT was higher than X-ray. The simple inside wall fracture case predominate in all 76 cases, the underside wall fracture case situated secondary. The interruption of bone continuity and displacement of bone fragments were mostly showed in CT image. Hemorrhage near the fracture and the parenchyma incrassation were indirect signs. The petechia and tumefaction around the eye, the eyesight descend and diplopia are the most common clinical symptom. The vision of the injured eye is not weakened significantly by the orbital blowout fracture,the eyesight of most patients higher than 0.8, the diplopia cases were more compared with the diminution of vision. The injury degree for most of the orbital blowout fracture is a light injury.Conclusion It is difficult to find out the orbital blowout fracture only by means of the examination of craniocerebral CT and head X-ray. The examination of orbital CT should be done once the orbital fracture was suspicious of. The orbital blowout fracture didn’t weaken the eyesight of injured eye significantly, but diplopia of the patient should be considered in the medicolegal expertise of orbital blowout fracture.