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目的分析交通事故致弥漫性轴索损伤(DAI)患者的伤残等级鉴定结果,并探讨弥漫性轴索损伤对鉴定结果可能产生的影响。方法选择的研究对象为2000年1月至2016年10月阶段我所在的鉴定机构进行鉴定的交通事故致颅脑损伤案例1112例,其中934例为单纯性脑挫伤,178例被临床诊断为弥漫性轴索损伤。由正高级影像学专家和正高级神经内科专家共同对1112例被鉴定者在交通事故发生后进行的颅脑CT及MRI检查结果进行重新的诊断分析,最后按照重新诊断的诊断结果对1112例患者实施分组,其中单纯弥漫性轴索损伤患者40例,为单纯DAI组;弥漫性轴索损伤合并脑挫伤患者138例,为DAI合并脑挫伤组;无弥漫性轴索损伤脑挫伤患者934例,为无DAI脑挫伤组。同时对鉴定结果进行比较和统计学分析。结果对于弥漫性轴索损伤的诊断,临床诊断结果与专家公议结果具有高度的一致性。单纯DAI组和DAI合并脑挫伤组鉴定者的伤残等级均显著高于无DAI脑挫伤组,二者之间比较差异具有统计学意义P<0.05,但单纯DAI组和DAI合并脑挫伤组鉴定者的伤残等级之间的比较差异不具有统计学意义P>0.05。结论交通事故致弥漫性轴索损伤患者可能存在更为严重的脑功能损害,在对其进行鉴定的过程中,不可过度依赖颅脑CT和MRI影像学检查结果,避免由此造成的漏诊和误诊。
Objective To analyze the disability rating of patients with diffuse axonal injury (DAI) caused by traffic accident and to explore the possible impact of diffuse axonal injury on the identification results. Methods The subjects selected were 1112 cases of craniocerebral injury caused by traffic accidents identified by our appraisal agency from January 2000 to October 2016, of which 934 were simple brain contusion and 178 were diagnosed as diffuse Sexual axonal injury. A total of 1112 patients were diagnosed by positive imaging experts and positive neurology specialists who were diagnosed with brain CT and MRI after a traffic accident. Finally, 1112 patients were diagnosed according to the diagnostic result of re-diagnosis Group, in which simple diffuse axonal injury in 40 patients, a simple DAI group; diffuse axonal injury in 138 patients with cerebral contusion, DAI brain contusion group; diffuse axonal injury in 934 cases of brain contusion, as No DAI brain contusion group. At the same time, the identification results were compared and analyzed statistically. Results For the diagnosis of diffuse axonal injury, the results of clinical diagnosis and expert opinion have a high degree of consistency. The DAI group and the DAI combined brain contusion group were significantly higher than those with DAI brain contusion group, the difference was statistically significant (P <0.05), but DAI group and DAI combined brain contusion group identification The difference between the disability ranks was not statistically significant (P> 0.05). Conclusions In patients with diffuse axonal injury caused by traffic accidents, there may be more severe brain damage. During the process of their identification, they should not be over-relied on CT and MRI findings of the brain to avoid the misdiagnosis and misdiagnosis .