鼓膜外伤性穿孔特征彩照在法医学上的应用

目的:因打架斗欧,权势伤人,恶意打人等致耳鼓膜外伤性穿孔的民事纠纷中,要求鉴定者不少,有的争论还较大。为预防诈伤和造假,摄制客观.公正又具科学技术水平的鼓膜外伤穿孔特征的彩色照片和记录伤情文字资料,发挥了重要作用,并作为司法定案的重要资料.对打击犯罪,保护伤者,稳定民心有重要意义。方法:伤后尽快进行鼓膜彩色照像或摄像,重点显示鼓膜穿孔部位的特征。大多在2天内诊治。若超过7～10天诊断者,其受伤鼓膜的穿孔边缘已渐由锐变园钝,锐角已渐变钝角,鼓膜充血逐渐消退,(但血痂仍附著),诊断时会有一定难度。还需作双耳纯音听阈听力测定和病史记录。结果:自1997年10月～2006年10月,我院诊治鼓膜外伤性穿孔患者175例。其中男性73例(42.0%),女性102例(58.0%)。鼓膜外伤原因:掌拳击伤81例(46%),车禍伤85例(49%),火炮炸伤6例(3.3%),高处坠下跌碰伤3例(1.7%)。1次耳外伤致鼓膜两个穿孔者4例(2.3%),其余171例均为1个穿孔(97.7%)。鼓膜外伤穿孔作1期修补愈合者125例(71.5%),鼓膜穿孔范围过大(>2象限)者作颞筋膜鼓膜修补痊愈6例(3.5%),鼓膜穿孔小自行愈合者33例(18.8%),放棄治疗者11例(6.2%)。结论:鼓膜外伤性穿孔,作鼓膜穿孔部位彩色照像或摄像.能显示典型的鼓膜穿孔外伤特征。可杜绝诈伤和作假。专科医师提供的图文资料,在司法定案中具有重要价值。同时外伤性鼓膜穿孔1期修补者大部份均可在10～15天完全愈合,外观几乎不留痕迹.且听力也可恢复或基本恢复正常,满足了因鼓膜外伤穿孔患者,要求快速愈合和恢复正常听力的需要。

Applications of Characteristic Colour Photographs of Traumatic Perforation of Tympanic Membrane in the Forensic Science.A Treatise

Objective:There were numerous requests in civil disputes for identification of the traumatic perforation of tympanic membrane resulted from violent fighting,illegitimate assaults,malicious wounding,and etc.In some cases,the disputes are difficult to settle.It is of great importance to produce objective,impartial,and scientifically proved characteristic colour photographs of traumatic perforation of tympanic membrane and record relevant injury conditions to provide important information for the judicial decision.This had played an important role in fighting crimes,protecting the injured,and maintaining social stability.Methods:Colour photographing of the tympanum should be performed as soon as possible after the infliction of injury.The photographing emphasis should be placed on the characteristics of the perforated area of the tympanum.The injury was usually diagnosed and treated within two days.If diagnosed in longer than 7 or 10 days,the edge of perforated area of the injured tympanum would become blunt with its acute angle gradually turning into obtuse,and the blood congestion would be faded(but blood clots remain attached),making it difficult to diagnose.Binaural pure-tone auditory threshold hearing test should be performed with results recorded.Results: From Oct.1997 to Oct.2006,there had been 175 cases of patients with traumatic perforation of tympanic membrane treated in our hospital,among which,73 were male(42.0%),102 were female(58.0%).The causes of traumatic injury of the tympanum membrane: 81 injuries by palm and fist(46%),85 injuries by car accident(49%),6 injuries by firecrackers(3.3%),3 injuries by falling from high ground(1.7%).4(2.3%) of them received two traumatic perforations of tympanic membranes,with the remaining 171(97.7%) receiving only one perforation.125(71.5%) of them were cured with phase-one repair,6(3.5%) of them were cured with temporal fascia repair due to excessive perforation inflicted on the tympanic membrane(>2 quadrant),33(18.8%) were cured naturally without receiving any treatment,11(6.2%) gave up treatment.Conclusion: Traumatic perforation of tympanic membrane should be diagnosed and colour photographed as soon as possible.Typical characteristics of traumatic perforation of tympanic membrane are visible that make the authentication easy.The photographs provided by specialist physicians may play an important part in the judicial decision.Meanwhile,the patients who received phase-one repair could completely recover from traumatic perforation of tympanic membrane within 10 to 15 days,with no trace left and restoration of hearing ability at the same time.This might have met the requirements of fast injury recovery and fast restoration of hearing ability by patients with traumatic perforation of tympanic membrane