眶壁爆裂性骨折法医学鉴定相关问题探讨(附21例分析)

眶壁爆裂性骨折在眼损伤鉴定中占有相当的比重，有关其法医学鉴定相关的问题，在法医临床学方面少见分析报告。本文对21例眶部爆裂性骨折案例进行统计分析，对其致伤方式，眼部X光片与头颅CT及眶部CT片比较，眶壁骨折伴有眼球结构的损伤情况，眶壁骨折部位及复视情况，鼻眼相关损伤等问题分别进行了统计分析；进一步阐述了眶壁爆裂性骨折是一种人体保护机制的理由；提出了眶部爆裂性骨折早期易于漏诊、眶部X光片显示率低易造成眼损伤鉴定失误的临床特征，以及鼻眼相关损伤的问题。同时，提出了作者就此类损伤法医学鉴定的一些建议，以资法医同仁共同探讨。

Diagnosis and analysis of blowout fravture of the Orbit with 21 cases

The blowout fracture of the orbit has a important position in eye damages. However,study on blowout fracture of the orbit in clincal medicolegal expertise are few. ln this paper, 21 cases of blowout fracture of the orbit(BFO) were statistically analysed. There were significant difference bstween BFO with eyeball damage (BFO with ED) group and BFO without eyeball damage (BFO without ED) group (BFO with ED = 62%, BFO without ED = 38%, p < 0. 01. ). The traumatic material was largely blunt force such as cuff and kick(72 % ). Due to lower positive rate of the X -ray image, the miss -diagnosed of BFO was as higher as 33 %. However,the positive rate of cerebral CT examination with BFO was up to 5O%, and orbital CT examination with BFO was l00%. The characteristics of BFO in orbital CT examination showed breaking continuity of orbital wal1, abnormal curved surface of orbital wall and orbital bone collapsed. There were direct correlation between severity of BFO and double vision, the Kappa = 0.80, p<0.05. These findings suggests that orbital CTexamination with BFO have the advantage of X-ray,and BFO should be full attention in clinical forensic medicine.