基于CT检测探析眶壁骨折伴眼球内陷的鉴定难点

Forensic challenges in the CT-based identification of orbital fractures and enophthalmos

目的探究CT检验应用于眶壁骨折鉴定的要素与眼球内陷的测量及其法医学问题。方法对146例涉及眶壁骨折的法医临床学鉴定案例进行回顾性分析,筛选眼球内陷案例予以测量并行两种方法的比较。结果致伤方式以徒手伤和交通事故损伤为主的眶壁骨折案例,其中复合型眶壁骨折以内下壁联合骨折最常见且眼球内陷发生率最高,再逐一比较11个眼球内陷案例经Hertel突眼度计和CT法所测眼球突出度,伤健双眼的相对差值无明显差异。结论高分辨CT检查及三维重建等呈现细微损伤的技术对眶壁骨折致眼球位置异常的鉴定有重要价值;眼球内陷最易发生于眶内下壁联合骨折,其内陷程度适用Hertel突眼度计和CT法测量且具有较好一致性,眼球内陷鉴定时机和双侧内壁骨折鉴定案例需进一步研究。

Objective This study investigates the application of CT examination in identifying orbital wall fractures,measuring enophthalmos,and addressing related forensic issues,with a focus on the presenting statistical results.Methods A retrospective analysis was conducted on 146 clinical forensic cases of orbital wall fractures.11 cases of enophthalmos were selected for comparison between two measurement methods.Results The most common causes of orbital wall fractures were unarmed injuries and traffic accidents.Compound fractures of the inner and lower walls were the most common,with a high incidence of enophthalmos.The degree of exophthalmos measured by Hertel exophthalmometer and CT showed good consistency in 11 cases.Conclusion High resolution CT examination and 3D reconstruction techniques that present subtle injuries have important value in identifying the abnormal position of the eyeball caused by orbital wall fractures.Entrapment of the eyeball is most likely to occur in the combined fracture of the lower orbital wall,and its degree of retraction can be measured using Hertel exophthalmometer and CT methods and has good consistency.Further research is needed on the time of enophthalmos identification and the identification of bilateral inner wall fractures.