无骨折脱位型颈髓损伤35例法医学鉴定分析

Analysis of forensic identification in 35 cases of cervical spinal cord injury without fracture and dislocation

目的对35例无骨折脱位型颈髓损伤的法医学鉴定案例进行分析,探讨其法医鉴定要点。方法收集35例无骨折脱位型颈髓损伤案例,对法医临床检查、影像检查及鉴定结果进行回顾性分析。结果 32例X线检查结果中,颈椎生理曲度变直30例,椎体退行性改变26例;35例CT检查结果中,后纵韧带钙化18例,椎间盘突出31例。MRI检查结果中,损伤位于颈髓中央部位19例,外层6例,中央和外层均涉及者10例。35例中,感觉及运动功能障碍涉及四肢10例,双上肢及双手19例,双下肢6例。31例进行道路交通事故评残,3例进行工伤评残,1例进行损伤程度鉴定。结论无骨折脱位型颈髓损伤需根据头颈部外伤史、临床症状及影像学检查综合诊断,MRI检查结果是重要依据,伤残和损伤程度鉴定宜在受伤12个月后进行。

Objective This paper aims at exploring forensic point of cervical spinal cord injury without fracture and dislocation by analyzing the 35 cases of forensic identification. Methods There are 35 cases materials of cervical spinal cord injury without fracture and dislocation collected in this paper. A retrospective analysis was performed based on the forensic clinical examination ,medical imaging examinations and forensic identification results. Results There are 30 cases of cervical curvature straightening and 26 cases of spinal degenerative changes in the 32 cases examined by X-ray. There are 18 cases of calcification of posterior longitudinal ligament and 31 cases of cervical disc herniation in the CT examinations. There are 19 cases of cervical spinal cord injuries in the central position, 6 Cases in the peripheral position and 10 cases in both positions in the MRI examinations. In the 35 cases of movement and sensory dysfunctions, there are 10 cases of the four limbs dysfunction, 19 cases of double upper limbs and hands dysfunction, and 6 cases of double lower limbs dysfunction. There are 31 cases identified according to the standard of road traffic accident disability assessment, 3 eases identified according to standard of work-related injuries disability identification, and 1 case identified according to standard of degree of injury. Conclusion The diagnosis of cervical spinal cord injury without fracture and dislocation should be based on the comprehensive analysis of the traumatic history of head and neck, clinical symptoms and medical imaging examinations in which the result of MRI examination plays an important role. h is better to take the disability identification and degree of injury identification after 12 months of injury.