38例单纯型脑干损伤法医学尸检的回顾性研究

Retrospective study of 38 autopsied cases of primary simple brainstem injury

目的报道38例原发性单纯型脑干损伤致死案例法医学尸检所见的脑干损伤、致伤方式和致伤物等特点,并探讨在法医学鉴定中的意义。方法从208例脑干损伤死亡法医学尸检案例中,挑选出38例符合单纯型脑干损伤的案例,分析单纯型脑干损伤发生的案情、损伤的部位和类型等特点。结果38例中男性占绝大多数,农民明显多于其它人员;大多发生于纠纷斗殴中;头部拳击伤18例(47.4%);头皮挫伤19例(50.0%);头皮挫裂创9例(23.7%);未见头皮损伤7例(18.4%);受伤当时昏迷并很快死亡者34例(89.5%);其损伤为局灶性挫伤出血,有32例(84.2%)肉眼未能辨认出,镜检见小灶性出血:其中,桥脑18例(47.4%)、延脑10例(26.3%)、中脑4例(10.5%)、桥脑和延脑均有出血6例(15.8%)。结论原发性单纯型脑干损伤不仅存在,而且能致人死亡;应引起同行的重视。

Objective To study the characteristics of the brainstem injury and manner of the injury of the 38 autopsied cases of primary simple brainstem injury （PSBSI） and its significance in forensic medicine. Methods Thirty-eight autopsied cases of PSBSI were selected from 208 cases of the brainstem injury, which autopsied in Department of Forensic Pathology, Tongji Medical College from 1978 to 2004. Retrospective study was used to analyze the position and patterns of injury of the PSBSI. Results Of 38 cases, men occupied a dominant position and farmer was more than other people. Most cases took place in the contradictory dispute or tangle; 18 cases （47.4%） were harmed by fist; the half of the cases had scalp contusion; 9 cases （23.7%） had scalp contused-lacerated wound; and 7 cases （18.4%） had no scalp injury. 34 cases had coma at the time of injury and then died. The localized bruise and hemorrhage were observed by microscope, of which, 18 （47.4%） cases located in pons ; 10 （26.3%） cases, in medulla oblongata; 4 （10.5%）cases, in mesencephalon and 6 （15.8%） cases, in both of pons and medulla oblongata. However, there were 32 （84.2%） cases of the brainstem hemorrhage which couldn＇ t be found by unaided eye. Conclusion The PSBSI not only was found in the case of mechanical injury, but also could be fatal, to which should be paid more attention by medicolegal workers.