Dubrovin I A, Chauhan M, Dubrovina I A, Kislov M A
Tver State Medical University, Ministry of Health of Russia, Tver, Russia.
Department of Forensic Medicine & Toxicology, Room No 212, Level II, E-Block, Government Medical College & Hospital, Sector-32, Chandigarh, 160030, India.
J Forensic Leg Med. 2022 Oct;91:102422. doi: 10.1016/j.jflm.2022.102422. Epub 2022 Aug 17.
Liver is the most common organ to get injured in cases of blunt force trauma to the abdomen (BFTA). It is the 2nd commonest organ after brain to sustain injuries out of all the trauma related fatalities. However, the literature about contre-coup injuries to the liver due to BFTA is scarce in-spite of the high mortality rates seen out of injury to this particular organ.
The authors intended to systematize the characteristic morphogenesis of the contre-coup injuries of the liver on the basis of the patho-mechanics involved in various types of BFTA.
One hundred and sixty three cases of BFTA were identified, and interpretation was attempted for the contre-coup rupture of the liver seen in twenty out of all the trauma related fatalities that presented for post-mortem examination during the study period. However, the mechanics of the pattern of the rupture injuries to the liver were indiscernible. This motivated the authors to conduct the comparative characterization of injuries to the liver by experimental simulation of BFTA after necessary permission via inflicting pre-calculated forces on unclaimed cadavers.
The patterns of contre-coup rupture/s of liver were established in all the twenty out of one sixty-three cases of BFTA. The rupture depicted patterns of injury in the situations of - 1) strong hits with a limited surface trauma, 2) very strong hits with a generalized surface trauma, 3) and collision with a solid surface resulting due to fall onto the side of the abdomen. The causative mechanism discerned was deformation of the liver, followed by its parenchymal rupture due to the shear and strain types of force/s consequent upon tissue compression. The minimum force and energy of impact required for the liver to rupture was estimated to be 2000 N and 141.5 J.
This series of the simulation experiments revealed two variants of liver rupture in the contre-coup impact zone. The pattern of injury was maintained in cases, those studied at post-mortem examinations, but the relief ruptures were found to vary depending upon the overall mechanics of the traumatic forces involved in the simulation experiments performed on the cadavers. The anti-shock ruptures were formed during shock trauma, and shockproof ruptures were not seen in cases of underlying compressive forces. The morphogenetic characterization of the relief rupture surface of the liver was also delineated in relation to its surface orientation to the spine on the basis of the terms "large" and "very large" depicting the quantum of force/s delivered out of an impact or blow.
肝脏是腹部钝性暴力创伤（BFTA）中最常受伤的器官。在所有创伤相关死亡案例中，肝脏是仅次于脑的第二大易受伤器官。然而，尽管肝脏损伤导致的死亡率很高，但关于BFTA所致肝脏对冲伤的文献却很匮乏。
作者旨在根据各种类型BFTA所涉及的病理力学，系统阐述肝脏对冲伤的特征性形态发生过程。
确定了163例BFTA病例，并试图对研究期间进行尸检的所有创伤相关死亡案例中20例出现的肝脏对冲性破裂进行解读。然而，肝脏破裂伤的模式机制难以辨认。这促使作者在获得必要许可后，通过对无人认领的尸体施加预先计算好的力来模拟BFTA，对肝脏损伤进行比较特征分析。
在163例BFTA病例中的20例均确定了肝脏对冲性破裂的模式。破裂呈现出以下几种损伤情况：1）表面创伤有限的强力撞击；2）表面创伤广泛的极强撞击；3）因腹部侧面着地而与固体表面碰撞。所识别出的致病机制是肝脏变形，随后由于组织压缩产生的剪切力和应变力导致肝实质破裂。肝脏破裂所需的最小冲击力和能量估计分别为2000牛和141.5焦耳。
这一系列模拟实验揭示了肝脏对冲撞击区域破裂的两种变体。在尸检研究的案例中，损伤模式得以保留，但发现缓解性破裂因尸体模拟实验中所涉及的创伤力的整体力学情况而异。抗休克性破裂在休克创伤期间形成，而在存在潜在压缩力的情况下未见到防震性破裂。还根据描述撞击或打击所施加力的大小的“大”和“非常大”等术语，描绘了肝脏缓解性破裂表面的形态发生特征与其相对于脊柱的表面方向的关系。
