颅脑外伤致运动和感觉障碍的评残时机

目的研究颅脑外伤致运动、感觉障碍相对合理准确的最佳鉴定时机。方法分别收集108例交通事故颅脑外伤患者伤后不同时间段（3、6、9、12、15、18月）的病史、影像学及电生理检查资料,并对患者家属进行随访调查,进行法医学检验,据此做出诊断并进行伤残等级评定;同时分别应用脑卒中残损评价表（Stroke Impairment Assessment Set,SIAS）、日常生活能力量表（Activity of Daily Living Scale,ADL）和Fugl-Meyer评定表（Fugl-Meyer assessment,FMA）对患者进行测验。结果SIAS、ADL、FMA对不同等级伤残及不同时间段区分良好,整体样本显示患者SIAS、ADL、FMA平均值9月至18月变化无差别,轻度伤残SIAS、ADL、FMA平均值6月至18月变化无差别,中度伤残SIAS、ADL、FMA平均值9月至18月变化无差别,重度伤残SIAS、ADL、FMA平均值12月至18月变化无差别。结论颅脑外伤所致运动、感觉障碍评残时机应在医疗终结以后,轻度伤残（7～10级）最佳评残时机为颅脑外伤后6个月,中度伤残（4～6级）评残时机以颅脑外伤后9个月为宜,重度伤残（1～3级）评残时机不应短于伤后12个月,视具体情况可以适当延后评残。

Study on Optimal Assessment Time of Motor and Sensory Disability due to Traumatic Brain Injury

Objective To determine the optimal assessment time for motor and sensory disability due to traumatic brain injury （TBI）.Methods 108 cases involving traumatic brain injuries in traffic accidents with different injury time（3,6,9,12,15,18 months）,were collected,including medical history,radiology and electricphsiology materials.Patient families were interviewed; forensic examination and medical diagnosis were made;and disability degrees were determined.Patients were examined using Stroke Impairment Assessment Set（SIAS）,Activity of Daily Living Scale（ADL）,and Fugl-Meyer Assessment（FMA）.Diagnosis and disability assessments were based on all of the above information.Results SIAS,ADL and FMA showed good distinction between different levels of disability and different injury time.The complete samples demonstrated that there was no statistically significant difference for SIAS,ADL and FMA.The average values in SIAS,ADL and FMA showed no difference for injuries from 6 to 18 months in light disability.The average values in SIAS,ADL and FMA from 9 to 18 months showed no difference in mild disability.For severe disability,there was no statistically significant difference of the average value for SIAS,ADL and FMA from 12 to 18 months.Conclusion Motor and sensory disability should be assessed after medical treatment is finished.For mild disability（grades 7-10）,the best time is 6 months after injury.For moderate disability（grades 4-6）,the best time is 9 months.For severe disability（grades 1-3）,the best time is more than 12 months after injury,and can be delayed according to specific clinical situations.