道路交通事故胸腹部损伤机制与临床法医学应用研究

发布时间：2019-01-07 18:58

【摘要】： 目的：研究道路交通事故胸腹部伤亡的流行病学特点和人体胸腹部损伤机制；探讨道路交通事故胸腹部受伤人员的伤残发生、分布特点及合理的评定时限，为预防、控制道路交通事故和临床法医学应用提供依据；探讨交通事故胸腹部受伤人员后期医疗费用的影响因素，并为此类案例后期医疗费用的法医学评估积累经验。方法：应用统计学方法和法医学技术对2004年和2005年昆明地区道路交通事故死亡210例胸腹部损伤法医病理鉴定资料和247例胸腹部损伤法医临床检验鉴定资料进行系统性分析研究。结果：本组457例交通事故胸腹部伤亡案例男性297例(65.0％)，女性160例(35.0％)，年龄分布呈偏态分布，18～59岁占事故人数的74.4％。职业分布以农民所占比例最高。事故发生的时间分布以9～12时最高，占22.8％，少年儿童(1-17岁)事故时间以16—19时最高，占27.1％；老年人(60岁以上)事故时间以9—12时最高，占33.3％。肇事车辆在死亡分组中以大型机动车肇事为主，伤残分组则以微型车肇事最多。死亡原因以胸部损伤为主，行人和非机动车驾驶员占事故损伤人员总数的60.7％。摔跌伤以摩托车驾驶员和乘客最为多见，碾压伤以车外人员多于车内人员，车外人员之间无差异。合并伤中，会阴部损伤在摩托车驾驶员和非机动车驾驶员的构成比最高。乘客和非机动车驾驶员发生椎体损伤比例高。247例交通事故胸腹部损伤伤残评定中Ⅷ—ⅹ级占总数的94.4％，行人和非机动车驾驶员伤残人数最多且伤残级别较高。伤残人员以青中年为主，占总数的75.1％。胸腹部伤残后遗症以活动障碍最为多见，且以非机动车驾驶员最易发生。后期伤残评定时间伤后3-6个月进行伤残评定的例数最多，占总数的66.8％，后期医疗费用多集中在2-4千，占63.4％。在3-4个月进行后期医疗费用评估的例数最多，占总数的34.0％。结论：道路交通事故胸腹部伤亡年龄分布以18-59岁人群事故发生率最高，少年儿童事故时间以16—19时最高，老年人事故时间以9—12时最高；胸腹部损伤类型包括碰撞伤、碾压伤、拖擦伤、摔跌伤、挤压伤及砸压伤；不同车辆造成损伤的形成机制中，伤亡人员以碰撞伤为主。胸腹部伤残椎体损伤例数最多，，且大型机动车造成椎体损伤例数多且损伤最为严重。伤残等级分布以轻度伤残为主，后期伤残评定时间和后期医疗费用评估均需要考虑多种影响因素综合判断。交通事故伤后3—6个月进行评定较合适。
[Abstract]:Objective: to study the epidemiological characteristics of thoracic and abdominal injuries in road traffic accidents and the mechanism of human thoracoabdominal injuries. To explore the occurrence, distribution characteristics and reasonable evaluation time limit of injury in chest and abdomen of road traffic accident, to provide basis for prevention and control of road traffic accident and application of clinical forensic medicine. To explore the influencing factors of the late medical expenses of the injured persons in the chest and abdomen of traffic accident and to accumulate experience for the forensic evaluation of the late medical expenses in this kind of cases. Methods: the forensic pathological data of 210 cases of road traffic accidents in Kunming in 2004 and 2005 and 247 cases of chest and abdomen injuries were analyzed and analyzed systematically by using statistical method and forensic techniques. Results: there were 297 cases (65.0%) in males and 160 cases (35.0%) in females in 457 traffic accidents. The age distribution was skewed, and 1859 years old accounted for 74.4% of the total number of accidents. Occupation distribution is the highest proportion of farmers. The distribution of the time of the accident was the highest from 9 to 12:00, accounting for 22.8. the time of the accident for the children (1-17 years old) was the highest at 16-19 hours, accounting for 27.1 hours. The accident time of the elderly (over 60 years old) was the highest at 9-12, accounting for 33. 3%. In the death group, large vehicles were the main cause of accidents, and minor vehicles were the most frequent ones in the disability group. Chest injury was the leading cause of death, and pedestrian and non-motor vehicle drivers accounted for 60.7% of the total number of injuries. Motorcycle drivers and passengers were the most common injuries, and crush injuries were more than those inside the vehicle, but there was no difference between them. Among the combined injuries, the ratio of perineum injury was the highest among motorcycle drivers and non-motor vehicle drivers. The ratio of vertebral body injury to passengers and non-motor vehicle drivers was high. In 247 cases of traffic accidents, 鈪

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