Vock R
Institute of Legal Medicine, University of Leipzig, Johannisallee 28, 04103 Leipzig, Germany.
Int J Legal Med. 2001;114(4-5):244-7. doi: 10.1007/s004140000191.
A total of 5534 protocols of judicial and extrajudicial autopsies performed at the Institute of Legal Medicine of the University of Würzburg between 1974 and 1987 were examined to determine whether an isolated liver rupture can be attributed to a blow, a kick or a fall on a level plane or against a hard edge, based on the nature of the injury alone. From the 5534 autopsies examined, 293 cases of falling on level ground or down staircases were found. In 271 cases the abdomen struck against a flat surface, in 21 cases either against a post or an edge and in one case it was not possible to find out which object the abdomen struck against. A liver rupture was found in only four cases. It is highly unlikely that liver rupture will be caused by a fall on a level plane or down steps. This empirical finding is further supported by biomechanical calculations. A fall on a level plane can only cause a liver rupture if the abdomen strikes against a hard edge or a stake-like object. If such an event can be excluded, the most likely cause of the liver rupture is a blow or a kick. In all cases of liver rupture, however, the differential diagnosis must exclude extrathoracic heart massage as the cause.
对1974年至1987年间在维尔茨堡大学法医学研究所进行的5534份司法和非司法尸检报告进行了审查，以确定仅根据损伤的性质，孤立性肝破裂是否可归因于打击、踢踹或在平坦平面上摔倒或撞到硬边缘。在检查的5534例尸检中，发现293例是在平地上或下楼梯时摔倒。其中271例腹部撞到平面，21例撞到柱子或边缘，1例无法确定腹部撞到了什么物体。仅在4例中发现肝破裂。在平坦平面上摔倒或下楼梯导致肝破裂的可能性极小。这一经验性发现得到了生物力学计算的进一步支持。只有当腹部撞到硬边缘或桩状物体时，在平坦平面上摔倒才会导致肝破裂。如果可以排除这种情况，肝破裂最可能的原因是打击或踢踹。然而，在所有肝破裂病例中，鉴别诊断必须排除胸外心脏按压作为病因。
