Nikolić Slobodan
Srp Arh Celok Lek. 2009 Nov-Dec;137(11-12):627-31. doi: 10.2298/sarh0912627n.
Forensic expertise has not specified with certainty any specific injury among fatally injured frontal car-occupants in frontal car collisions.
To establish if blunt injuries of thoracic aorta, heart, and pericardium could be used as predictors where the fatally injured car-occupant was at the moment of car-collision.
A retrospective autopsy study was performed. The subjects were fatally injured car-drivers, front-seat and rear-seat passengers in head-on car collisions. In each of them we analyzed the injuries of thoracic aorta, heart and pericardium.
492 subjects were analysed (378 male and 104 female): 239 car-drivers, 194 front-seat and 49 rear-seat passengers. The isthmus of aorta was the commonest site of simple blunt rupture among car-drivers and front-seat passengers. Among more than half of the observed subject, there was aortic blunt rupture as concomitant injury with heart and pericardium injuries. Heart and pericardium ruptures were most common among fatally injured car-drivers. Most frequently injured part of the heart was the right atrium. Injuries of thoracic aorta, heart and pericardium indicated a higher probability that the fatally injured would be the car-driver (lambda = 0.818; df = 2; p = 0.011, lambda = 0.906; df = 2; p = 0.000, and lambda = 0.951; df = 2; p =0.000); this was also pointed out by the rupture of the right atrium and multiple ruptures of the thoracic aorta (lambda = 0.966; df = 2; p = 0.000 and lambda = 0.918; df = 2; p = 0.009). The concomitant injuries of the thoracic aorta with thoracic spine, sternum and heart pointed out that the injured person was the car-driver (lambda = 0.971; df = 4; p = 0.007, lambda = 0.974; df = 4; p = 0.013 and lambda = 0.958; df = 4; p = 0.000), as well as the concomitant injuries of heart and sternal fracture (lambda = 0.960; df = 4; p = 0.001). The probability of about 80% that the fatally injured person in head-on collisions was a car-driver was pointed out by concomitant blunt thoracic aorta rupture with fractured sternum and ribs (Wald. coeff. = 8.611; df = 1; p = 0.003, and Wald. coeff. = 3.875; df = 1; p = 0.049).
The basic mechanism of the injury of thoracic organs is deceleration, as well as anteroposterior compression with caudorostral hyperextension. That is why thoracic organ injuries are mostly concomitant. Fatally injured car-drivers suffered more often of these injuries than other car-occupants. The probability that the fatally injured was the car-driver rises with the number of concomitant injuries of thoracic aorta, heart and pericardium, as well as with the fractured thoracic-cage bones.
法医鉴定尚未明确指出在正面汽车碰撞中受致命伤的前排汽车驾乘人员身上的任何特定损伤。
确定胸主动脉、心脏和心包的钝性损伤是否可作为预测受致命伤的汽车驾乘人员在汽车碰撞瞬间所处位置的指标。
进行了一项回顾性尸检研究。研究对象为在正面汽车碰撞中受致命伤的汽车驾驶员、前排乘客和后排乘客。对他们每一个人，我们都分析了胸主动脉、心脏和心包的损伤情况。
共分析了492名受试者（378名男性和104名女性）：239名汽车驾驶员、194名前排乘客和49名后排乘客。主动脉峡部是汽车驾驶员和前排乘客中单纯钝性破裂最常见的部位。在超过半数的观察对象中，主动脉钝性破裂与心脏和心包损伤同时存在。心脏和心包破裂在受致命伤的汽车驾驶员中最为常见。心脏最常受伤的部位是右心房。胸主动脉、心脏和心包的损伤表明受致命伤的更有可能是汽车驾驶员（λ = 0.818；自由度 = 2；p = 0.011，λ = 0.906；自由度 = 2；p = 0.000，以及λ = 0.951；自由度 = 2；p = 0.000）；右心房破裂和胸主动脉多处破裂也表明了这一点（λ = 0.966；自由度 = 2；p = 0.000和λ = 0.918；自由度 = 2；p = 0.009）。胸主动脉与胸椎、胸骨和心脏的合并损伤表明受伤者是汽车驾驶员（λ = 0.971；自由度 = 4；p = 0.007，λ = 0.974；自由度 = 4；p = 0.013和λ = 0.958；自由度 = 4；p = 0.000），心脏和胸骨骨折的合并损伤也是如此（λ = 0.960；自由度 = 4；p = 0.001）。胸主动脉钝性破裂合并胸骨和肋骨骨折表明在正面碰撞中受致命伤的人约80%是汽车驾驶员（Wald系数 = 8.611；自由度 = 1；p = 0.003，以及Wald系数 = 3.875；自由度 = 1；p = 0.049）。
胸部器官损伤的基本机制是减速，以及伴有尾头过度伸展的前后挤压。这就是为什么胸部器官损伤大多是合并存在的。受致命伤的汽车驾驶员比其他汽车驾乘人员更容易遭受这些损伤。受致命伤的是汽车驾驶员的可能性随着胸主动脉、心脏和心包合并损伤的数量以及胸廓骨骼骨折情况而增加。
