卡车与卡车前部碰撞驾驶员与前排乘车人损伤特征的研究

目的：研究道路交通事故卡车与卡车前部碰撞驾乘人员损伤特征,分析比较驾乘人员的损伤及损伤分布特点。方法：应用统计学方法对2001年-2010年昆明地区卡车与卡车200例前部碰撞人员损伤的法医学鉴定资料进行系统分析性研究。结果：1.驾驶员易发生损伤的部位是下肢、头颈部,其次为胸、腹部损伤。驾驶员易发生右下肢的损伤及骨折。驾驶员易发生颅骨骨折和肋骨骨折。2.前排乘车人员易发生损伤的部位是上肢、头颈部,其次为下肢,而胸腹部损伤较少见。前排乘车人员易发生上肢的损伤及双侧尺桡骨的骨折。前排乘车人员左侧头颈部受伤的几率大于驾驶员的相对部位。前排乘车人员易发生右肱骨骨折。结论：1.与前排乘车人相比,驾驶员易造成胸部、腹部及盆部、右侧下肢的损伤及右股骨胫腓骨的骨折,发生双侧上肢的体表损伤及尺桡骨骨折均明显少。在身体体表出现胸部、腹部及盆部多部位连续的损伤,有助于提高认定卡车驾驶员的准确性。2.与驾驶员相比,前排乘车人易形成左侧头颈部的损伤,上肢双侧尺桡骨骨折,右侧肱骨的骨折。当损伤位于身体左侧头颈部且有右侧肱骨的骨折,有助于提高认定卡车前排乘车人的准确性。     

道路交通事故致胫腓骨骨折的特点及救治

目的：总结交通事故伤中胫腓骨骨折的流行病学分类、特点及救治注意事项。方法：对136例交通事故伤中胫腓骨骨折患者的临床资料进行回顾性分析。结果：交通事故致胫腓骨骨折以多发伤及复合伤多见,经早期彻底清创、恰当的骨折固定、抗生素应用等,治愈77例,截肢2例,伤口浅表感染6例,骨髓炎1例。结论：交通事故伤中胫腓骨骨折大多伤情严重,感染率高,且开放性居多,早期及时选择合适的治疗方法是取得良好预后的关键。     

道路交通事故致胫腓骨骨折的特点及救治

目的:总结交通事故伤中胫腓骨骨折的流行病学分类、特点及救治注意事项。方法:对136例交通事故伤中胫腓骨骨折患者的临床资料进行回顾性分析。结果:交通事故致胫腓骨骨折以多发伤及复合伤多见,经早期彻底清创、恰当的骨折固定、抗生素应用等,治愈77例,截肢2例,伤口浅表感染6例,骨髓炎1例。结论:交通事故伤中胫腓骨骨折大多伤情严重,感染率高,且开放性居多,早期及时选择合适的治疗方法是取得良好预后的关键。     

道路交通事故的法医学鉴定

本文结合相关专业及多年的工作经验,通过对交通事故的案例分析对道路交通事故的概念、道路交通中尸体检验与司法鉴定的内容和方法,以及法医学尸体检验与法医学鉴定在道路交通事故中的重要作用等问题展开分析与讨论,为交通事故的调查和处理以及相关的尸体检验工作提供指导.     

225例髁突骨折病例的回顾性研究

目的:总结髁突骨折治疗方法选择的原则和适应征,为髁突骨折的治疗提供参考依据.方法:对225例髁突骨折住院病例进行回顾性分析,对患者的受伤年龄、性别、受伤原因、部位、合并损伤、治疗方法、疗效等方面进行分析.结果:髁突骨折多见于20-49岁男性,交通伤害的成年患者的常见病因,跌落损伤是小孩和老人患者的常见病因.骨折常发生在髁突颈,多合并颌面部其他部位骨折.高位骨折和(或)没有明显移位的骨折常采用保守治疗,中低位骨折和(或)有明显移位的骨折常采用手术治疗.结论:髁突骨折的高发人群是青壮年,最常见的致病因素为交通伤;现阶段髁突骨折的治疗方法主要有保守治疗和手术治疗,治疗方法的选择跟患者年龄、骨折部位和移位程度相关.     

交通事故伤残等级鉴定356例分析

目的探讨我市交通事故伤残等级鉴定的特点。方法对长治市人民医院人身伤害司法鉴定中心2014年度356例交通事故伤残等级鉴定案例进行回顾性分析。结果 356例伤残鉴定案例中,男性比例明显高于女性,40-50岁年龄段伤残人员最多,从季节来看,第一、四季度高于二、三季度的鉴定数量。损伤以四肢骨折、颅脑损伤最为多见,达到四级以上的伤残的人员不足5%,八级以下的占据了70%以上,从委托单位的主体来看,法院委托153例,其中132例属于重新鉴定,交警队及保险公司委托198例,5例为其他单位委托。结论我市交通事故伤残等级鉴定存在一定的内在规律。     

新疆垦区607例颌面部骨折临床病例回顾性研究

目的:研究发生在新疆垦区颌面部创伤患者的损伤特点及诊治方法状况.方法:通过病案资料对新疆垦区五家医院收治的607例颌面部骨折患者性别、年龄、原因、全身损伤、骨折类型、治疗方法及术后疗效进行调查分析.结果:本组病例颌面部骨折男性占85.83%,20-40岁年龄段占68.04%,交通事故伤占54.04%,发生下颌骨骨折占75.45%,伴有全身损伤占18.62%和外伤性昏迷占20.76%;下颌运动受限(51.07%)、咬合紊乱(38.22%)和颜面畸形(40.69%)是颌骨骨折的三个主要体征;349例的骨折行手术复位和钛板坚固内固定(57.50%),均获满意疗效.结论:颌面部骨折中年轻男性多见,交通事故伤是其最主要原因,直接复位和固定是骨折治疗的有效方法,颌间牵引在新疆各垦区的颌面部骨折患者治疗中作用不可忽视,坚固内固定技术促进了颌骨骨折的治疗发展.     

脐带间充质干细胞治疗粉碎性骨折1例并文献复习

目的:观察脐带间充质干细胞治疗粉碎性骨折的疗效和安全性。方法:将脐带间充质干细胞通静脉输注和局部多点注射到常规治疗效果欠佳自愿接受干细胞移植的1例粉碎性骨折患者,4次为一个疗程,每周间隔1次,每次治疗细胞总数(3~7)×107。术后1、3、6月定期观察患者临床症状及影像学的变化并进行动态观察。结果:脐带间充质干细胞治疗后一月,患者在不帮助的情况下可独立缓慢行走,复查X线提示骨折部位有新生骨形成;干细胞治疗后三月,复查X线提示骨折愈合较前好转;半年后,患者右下肢受力明显好转,可以独立自由行走,复查X线提示右下肢骨折部位有连续性骨痂形成,骨折部位愈合良好。结论:脐带间充质干细胞移植治疗粉碎性骨折是一种安全、有效的手段,可促进粉碎性骨折的愈合,改善其生活质量。     

235例颅脑外伤致精神障碍的司法鉴定回顾分析

目的分析司法鉴定中交通事故颅脑外伤所致精神障碍的特点及有关因素。方法对235例交通事故颅脑外伤致精神障碍患者实施成人韦氏智力和脑电地形图司法鉴定检测,并进行分析。结果本组病例中最多见的是智能损害(65.5%),其次是神经症样综合症(18.7%)和人格改变(10.6%),并且IQ<70组伤前文化程度低于IQ≥70组(P<0.05),前者脑外伤程度则明显重于后者(P<0.01)。结论重型颅脑损伤所致精神障碍者常合并多种症状,且以智能损害最多见;轻型颅脑损伤所致精神障碍以神经症样综合症最多见。     

交通事故致多发伤的院前救护体会

随着我国交通事业的高速发展,交通事故已成为威胁人类生命安全的第一公害[1]。而交通事故所致严重创伤多为多发性创伤,其具有伤情重,变化快,休克率及死亡率高等特点,若处理不及时或处理不当可危及伤员的生命,因此,及时、正确、有效的院前救护措施,是挽救伤员生命的关键。2004年6月~2007年6月,我院共出诊救护多发伤患者207例,除31例死亡外,其余176例经院前救护后均安全转运到院内进一步治疗,现将院前救护情况及体会介绍如下。1临床资料2004年6月~2007年6月,我院共出诊救护多发伤患者207例,男163例,女64例,年龄3~76岁。从患者受伤至救护车到达…     

Road Traffic Deaths and Injuries Are Under-Reported in Ethiopia: A Capture-Recapture Method

In low and middle income countries road traffic injuries are commonly under-reported. This problem is significantly higher among those less severely injured road users. The objective of this study was to determine the incidence and the level of ascertainment of road traffic injuries and deaths by traffic police and hospital registry. In this study two-sample capture-recapture method was applied using data from traffic police and hospital injury surveillance, through June 2012 to May 2013. The study was conducted on one of the busiest highways in Ethiopia, the Addis Ababa – Hawassa highway. Primary data were collected by accident investigators and hospital emergency nurses using a structured checklist. Four matching variables; name of the victim, sex, place and time of the accidents was used to get the matched cases. During the study period the police independently reported 224 deaths and 446 injuries/billion vehicle kilometer while hospitals reported 123 deaths and 1,046 injuries/billion vehicle kilometer. Both sources in common captured 73 deaths and 248 injuries/billion vehicle kilometer. Taking the two data sources into consideration, the capture-recapture model estimated the incidence of deaths and injuries ranged 368–390 and 1,869–1,895 per billion vehicle kilometer, respectively. The police source captured 57.4%–60.9% of deaths and 23.5%–23.9% of injuries while the hospital sources captured 31.5%–33.4% of deaths and 55.2%–56% of injuries. Deaths and injuries among females, younger age victims, cyclists/motorcyclists and pedestrians were under-reported by traffic police. In conclusion neither of the two sources independently provided accurate coverage of road traffic incident related deaths and injuries. Strengthening both systems is necessary to obtain accurate information on road accidents and human causalities.     

Complaints of Poor Sleep and Risk of Traffic Accidents: A Population-Based Case-Control Study

Introduction

This study aimed to determine the sleepiness-related factors associated with road traffic accidents.

Methods

A population based case-control study was conducted in 2 French agglomerations. 272 road accident cases hospitalized in emergency units and 272 control drivers matched by time of day and randomly stopped by police forces were included in the study. Odds ratios were calculated for the risk of road traffic accidents.

Results

As expected, the main predictive factor for road traffic accidents was having a sleep episode at the wheel just before the accident (OR 9.97, CI 95%: 1.57–63.50, p<0.05). The increased risk of traffic accidents was 3.35 times higher in subjects who reported very poor quality sleep during the last 3 months (CI 95%: 1.30–8.63, p<0.05), 1.69 times higher in subjects reporting sleeping 6 hours or fewer per night during the last 3 months (CI 95%: 1.00–2.85, p<0.05), 2.02 times higher in subjects reporting symptoms of anxiety or nervousness in the previous day (CI 95%: 1.03–3.97, p<0.05), and 3.29 times higher in subjects reporting taking more than 2 medications in the last 24 h (CI 95%: 1.14–9.44, p<0.05). Chronic daytime sleepiness measured by the Epworth Sleepiness Scale, expressed heavy snoring and nocturnal leg movements did not explain traffic accidents.

Conclusion

Physicians should be attentive to complaints of poor sleep quality and quantity, symptoms of anxiety-nervousness and/or drug consumption in regular car drivers.     

脊柱损伤的法医临床学鉴定研究进展

随着社会和现代交通、建筑事业的发展,脊柱损伤的病人发病率呈上升趋势,尤其道路交通事故为其损伤的首要原因。脊柱损伤的现场急救、临床诊断与治疗为人们所关注。然而,伴随着事件的进一步处理,对病人的损伤进行渗医学鉴定显得尤为重要。目前,有关脊柱损伤的鉴定标准仅仅是确定的标准,没有规定标准的适用条件。同时,也易导致鉴定人对标准的理解与应用存在差异,由此导致了鉴定结论的争议。本文对脊柱损伤的法医临床学应用研究进展作一综述。     

脊柱损伤的法医临床学鉴定研究进展

随着社会和现代交通、建筑事业的发展,脊柱损伤的病人发病率呈上升趋势,尤其道路交通事故为其损伤的首要原因。脊柱损伤的现场急救、临床诊断与治疗为人们所关注。然而,伴随着事件的进一步处理,对病人的损伤进行法医学鉴定显得尤为重要。目前,有关脊柱损伤的鉴定标准仅仅是确定的标准,没有规定标准的适用条件。同时,也易导致鉴定人对标准的理解与应用存在差异,由此导致了鉴定结论的争议。本文对脊柱损伤的法医临床学应用研究进展作一综述。     

A prospective study on elderly patients with facial fractures in a developing country

Background: This paper describes the incidence, aetiology, treatment and complications of facial fractures seen among the elderly in a developing country. Methods: A prospective study evaluated 85 patients over 60 years of age who were diagnosed with facial fractures over a period of 12 months in 23 public hospitals nationwide. Results: The elderly accounted for 4.5% of the total number of patients seen with facial fractures during the study period. Elderly men outnumbered women by a ratio of 4.31:1. Of the elderly patients, 35.3% had at least one medical condition, the commonest of which was hypertension. Road traffic accidents were the main cause of injury. The fractures were treated in only 26.2% of cases. Complications were uncommon. Conclusions: With a low incidence, and conservative treatment often being practised, the healthcare burden of treating facial fractures among the elderly in Malaysia is at present still low.     

Some features of traffic accidents

Some aspects of urban and rural traffic accidents have been studied at the scene of some accidents in Birmingham and the county of Worcestershire. Accidents to pedestrians are essentially an urban problem, occur mainly at low speed, and most of the serious injury comes from the initial contact with the vehicle, rather than from secondary impacts with the road surface. The characteristics of motor-cycle accidents are more varied; in urban areas there are many side impacts, with consequent injury to the lower limbs, while rural collisions are predominantly front on, with a high incidence of head injury. Accidents to car occupants vary according to the environment.     

成人胫骨平台骨折的流行病学特征及其变化趋势的回顾性研究

摘要 目的：回顾性研究成人胫骨平台骨折的流行病学特征及其变化趋势。方法：以我院2014年1月至2019年12月期间收治的1193例成人胫骨平台骨折患者为调查研究对象,根据患者收治的时间将患者分为A组(2014年1月~2015年12月收治,n=369)、B组(2016年1月~2017年12月收治,n=394)、C组(2018年1月~2019年12月收治,n=430)。对三组患者进行统一的问卷调查,并对三组患者的年龄、职业、致伤原因、骨折分型进行归纳统计,分析探讨成人胫骨平台骨折的流行病学特征及其变化趋势。结果：2014年~2019年成人胫骨平台骨折总体流行病学特征：男性患者数量多于女性患者,年龄主要在40~59岁,以从事体力劳动患者居多,骨折致伤原因中主要以交通事故和室内活动跌倒损伤为主,骨折Schatzker分型中以II型、IV型为主。三组年龄对比有差异性,年龄有逐年升高的趋势(P<0.05)。三组性别比例有显著性差异,男女性别比例差异在逐年缩小(P<0.05)。三组患者在职业类型方面也有显著性差异（P<0.05）,但均以体力劳动者居多。在致伤原因中,A组患者以交通事故致伤为主,C组患者以室内活动跌倒损伤为主,组间对比有显著差异(P<0.05)。在骨折分型中,A组以IV型为主,C组以II型为主(P<0.05)。结论：2014年至2019年成人胫骨平台骨折中男性较多,年龄以40~59岁为主,体力劳动者为高发职业,交通事故和室内活动跌倒损伤是最常见的致伤原因,好发骨折分型为Schatzker II型、IV型。变化趋势表现为骨折发病人数逐年上升,发病年龄有老龄化趋势,致伤原因和骨折分型也在逐渐变化。