足弓破坏法医临床学鉴定的影像学理论与实践

The Theory and Practice of Arch Destruction Imaging Examination in Clinical Forensic Medicine

足弓破坏是现行GB18667-2002《道路交通事故受伤人员伤残评定》标准针对足损伤后伤残等级评定特别给出的命名,临床与法医学界对此问题的阐述尚较少见,有必要在实践工作的基础上加以总结。足在纵、横方向上形成凸向上方的弓形外观,分别为内侧纵弓、外侧纵弓及横弓。足弓作用主要在于吸收震荡,起到保护作用,具备静态与动态两种态势。足弓可借鉴静态体重负荷下X线摄足弓侧位片进行测量。足损伤致跗、跖骨骨折愈合后足弓X线测量值背离临床医学足弓正常参考值和/或维持足弓功能作用的肌肉、韧带严重损伤,可谓足弓破坏。足弓骨性构架的动力结构内侧纵弓或承载负重的外侧纵弓中任意一个破坏,必定影响横弓,符合一足足弓结构破坏1/3以上的限定要件;而内侧纵弓及外侧纵弓均破坏,横弓必定破坏,符合一足足弓结构破坏的限定要件。

Arch destruction is specially named by the Assessment for Body Impairment of the Injured in Road Traffic Accident（GB18667-2002） for the assessment of the disability level in foot injury.It is necessary to summarize this type of impairment assessment on the basis of practical work,for it is rarely discussed by the clinical and forensic science communities.Foot forms convex bow-shaped appearance in longitudinal and transverse directions,which are named as the medial longitudinal arch,the lateral longitudinal arch and transverse arch respectively.The physiological function of the arch is to absorb shock and protect the foot.Arch has both static and dynamic postures.The arch could be measured by taking X-ray radiographs of the lateral arch in weight load.When the measured values deviate from normal clinical arch reference values,or the muscle and the ligament are serious injured,it is called arch destruction.Destruction of either the medial longitudinal arch or the lateral longitudinal arch will certainly affect the transverse arch,which reaches the condition of more than 1/3 of the arch destruction.If both the medial longitudinal arch and the lateral longitudinal arch are destroyed,the transverse arch will be destroyed,which reaches the condition of the whole arch destruction.