目的 从法医学角度探讨儿科医疗纠纷案件特点及成因。 方法 对四川华西法医学鉴定中心2002 年1月－2011年12月受理的184例儿童死亡并进行尸检的儿科医疗纠纷案件的法医学鉴定资料进行回顾性研究。 结果 儿科医疗纠纷呈逐年升高趋势，年龄以新生儿为主，死因以呼吸系统疾病为主；临床-尸检符合率低（55.23%），医疗过错率高（60.47%），且两者呈负相关。 结论 儿科医疗纠纷临床-尸检符合率比所有年龄段人群低，医疗过错率比所有年龄段人群高，且呈现出临床-尸检诊断符合率越低，医疗过错率越高的特征。
【摘要】 目的 探讨颅脑损伤(BI)死亡的法医病理学特点,以及继发性脑干损伤、并发症的发生与死亡之间的因果关系。方法 从性别、年龄、致伤方式、损伤类型、生存时间、死亡原因等方面,对四川大学华西法医学鉴定中心1998年1月-2008年12月127例BI死亡尸检案例进行回顾性统计研究分析。结果 127例法医病理学检案中,原发性BI死亡51例(402%),继发性脑干损伤死亡61例(480%),并发症死亡15例(118%),其中伤后12 h内死亡者直接死因均为严重原发性脑损伤,存活12 h～1周者直接死因以继发性脑干损伤居多,生存时间超过1周者约半数死于并发症。结论 在BI案例的死亡原因确定时,应在全面系统的病理学检验基础上,结合案情及临床资料进行综合分析。【Abstract】 Objective To explore the characteristics of forensic pathology in traumatic brain injury and the relationships between secondary brainstem damage, complications and the causes of death. Methods 127 cases were reviewed from gender, age, manner of injury, survival time and the direct causes of death from January 1998 to December 2008. Results Of the 127 cases, the key direct cause of death was secondary brainstem damage, followed by severe primarily brain injury and complications. For those who died within 12 hours after injury, the direct cause was severe primarily brain injury; for those who survived between 12 hours to one week, secondary brainstem damage was in the majority of the causes and for those who survive more than one week time, complication was an important cause. Conclusion In the cases of traumatic brain injury, we should take comprehensive and systematic examination of forensic pathology, and refer to clinical data at the same time to determine the direct cause of death.
【摘要】 目的 探讨颅脑损伤(BI)死亡的法医病理学特点,以及继发性脑干损伤、并发症的发生与死亡之间的因果关系。方法 从性别、年龄、致伤方式、损伤类型、生存时间、死亡原因等方面,对四川大学华西法医学鉴定中心1998年1月-2008年12月127例BI死亡尸检案例进行回顾性统计研究分析。结果 127例法医病理学检案中,原发性BI死亡51例(402%),继发性脑干损伤死亡61例(480%),并发症死亡15例(118%),其中伤后12 h内死亡者直接死因均为严重原发性脑损伤,存活12 h～1周者直接死因以继发性脑干损伤居多,生存时间超过1周者约半数死于并发症。结论 在BI案例的死亡原因确定时,应在全面系统的病理学检验基础上,结合案情及临床资料进行综合分析。【Abstract】 Objective To explore the characteristics of forensic pathology in traumatic brain injury and the relationships between secondary brainstem damage, complications and the causes of death. Methods 127 cases were reviewed from gender, age, manner of injury, survival time and the direct causes of death from January 1998 to December 2008. Results Of the 127 cases, the key direct cause of death was secondary brainstem damage, followed by severe primarily brain injury and complications. For those who died within 12 hours after injury, the direct cause was severe primarily brain injury; for those who survived between 12 hours to one week, secondary brainstem damage was in the majority of the causes and for those who survive more than one week time, complication was an important cause. Conclusion In the cases of traumatic brain injury, we should take comprehensive and systematic examination of forensic pathology, and refer to clinical data at the same time to determine the direct cause of death.
Objective To comprehend the concept， pathology， molecular mechanisms， diagnosis， and treatmentof aggressive fibromatosis （AF）， and to find a novel way to cure aggressive fibromatosis. Method The literatures about the definition， molecular mechanisms， and clinical research of AF were reviewed and analized. Results AF is rare and benign fibromatous lesion that is the result of abnormal proliferation of myofibroblasts. The pathologic features of AF isa benign disease， but it has “malignant” biological behavior. The tumor often involved the surrounding organs and bloodvessels， and caused death of patients. For patients with clinical symptoms or complications， complete excision of thetumor is the treatment of choice. Even if the operation to ensure the negative margin also has a higher recurrence rate， soits treatment requires multidisciplinary treatment. Conclusions The mechanism of AF is very complex， and it’s mecha-nism is still unclear. Clinical management of patients with AF is difficult and controversial， at present， the most effective treatment for AF is operation resection. The effects of adjuvant radiotherapy， chemotherapy， and other treatment after operation for AF still need further study.
Objective To investigate the effectiveness of lateral closing wedge osteotomy for treatment of traumatic cubitus varus deformity in children. Methods Between July 1996 and June 2010, 20 cases of traumatic cubitus varus deformity after humeral supracondylar fracture were treated by lateral closing wedge osteotomy. There were 13 boys and 7 girls, aged from 7 to 14 years (mean, 10.6 years). The left elbow was involved in 12 cases and right elbow in 8 cases. Thirteencases had received closed reduction, percutaneous Kirschner wire fixation, and external fixation in other hospital, and 7 cases misdiagnosed as elbow luxation and soft tissue injury had given external fixation. Cubitus varus deformity occurred at 2-12 years after injury. Preoperatively, the elbow range of motion (ROM) in flexion and extension was 100-150° (mean, 133.0°) and 0-24° (mean, 11.7°), respectively. The angle of cubitus varus deformity was 20-50° (mean, 32.1°). Results All incisions healed by first intention, and no related complication occurred. A total of 17 patients were followed up 1-14 years (mean, 5 years). X-ray films revealed that bone union was achieved in all cases within 5-8 weeks after operation (mean, 6 weeks). The deformity of cubitus varus was corrected in all cases. At last follow-up, the elbow ROM in flexion and extension was 110-150° (mean, 135.9°) and 0-27° (mean, 12.9°), respectively. According to Jupiter et al. elbow score system, the results were excellent in 14 cases, good in 2 cases, and fair in 1 case; the excellent and good rate was 94.1%. One patient underwent recurrence at 1 month after removal of the Kirschner wire, and lateral closing wedge osteotomy was performed again after 1 year. Conclusion Lateral closing wedge osteotomy is a safe and effective surgical procedure in correcting traumatic cubitus varus deformity in children, which is easy to operate and can be effective in reducing the complications.