钝性椎动脉损伤的特点及法医学鉴定

Characteristics and Forensic Identification of Blunt Vertebral Artery Injury

钝性椎动脉损伤在法医学实践中时有发生,但因椎动脉大部分区域走行位置较深,容易出现漏检甚至错检。本文通过文献综述,发现其致伤方式多样,可由一种或多种成伤机制同时作用,伤者常因直接损伤或继发性动脉瘤、夹层等病变,引起即刻或迟发性脑卒中以及压迫损伤周围结构,轻者致残,重者致死。当合并椎动脉粥样硬化、发育异常等疾病时,将增加致残或死亡的风险以及法医学鉴定的难度。法医学鉴定时须详细了解案情,对疑似椎动脉损伤的案例,除常规检查颅内段外,还应注意检查颅外段。若条件允许,可在解剖前或解剖时辅以血管造影,提高鉴定效率和意见的准确性。

Blunt vertebral artery injury occurs frequently in forensic practice.However,injuries of the vertebral artery are easily ignored or overlooked because of its relatively deep location.Through litera-tures review,this paper finds that the manners of blunt vertebral artery injury are varied and one or more injury mechanisms may be involved simultaneously.Patients often undergo immediate or delayed cerebral apoplexy as well as compression and injury of surrounding structures,due to direct injury or secondary aneurysm or dissection,resulting in disability or death.Diseases such as,vertebral atheroscle-rosis and dysplasia can increase the disability and death risk and the difficulty of forensic identifica-tion.In forensic identification,the details of the case should be considered.For cases of suspected ver-tebral artery injury,in addition to routine examination of intracranial segment,attention should be paid to the examination of extracranial segment.If conditions permit,angiography can be used prior to or during the autopsy to improve the identification efficiency and accuracy of opinions.