法医学杂志

法医学杂志 ›› 2026, Vol. 42 ›› Issue (4): 336-344.DOI: 10.12116/j.issn.1004-5619.2024.240913

• 案例分析 • 上一篇    

创伤性硬脑膜下积液致精神伤残的影响因素分析

许亚军1(), 李光建1, 戴晓英2, 刘伟3, 李红妍4, 姚献虎5, 王强6()   

  1. 1.皖南医科大学心理学系，安徽 芜湖 241002
    2.皖南医科大学第一附属医院弋矶山医院，安徽 芜湖 241001
    3.芜湖市第四人民医院精神病科，安徽 芜湖 241002
    4.南京医科大学基础医学院，江苏 南京 211166
    5.马鞍山第四人民医院，安徽 马鞍山 243000
    6.安徽医科大学法学院，安徽 合肥 231200
  • 收稿日期:2024-09-12 发布日期:2026-10-28 出版日期:2026-08-25
  • 通讯作者: 王强
  • 作者简介:许亚军（1980—），男，副主任法医师，副教授，硕士研究生导师，主要从事法医精神病鉴定理论与实务研究；E-mail：xuyajun@wnmc.edu.cn
  • 基金资助:
    安徽省新时代育人质量工程项目(2022zyxwjxalk168);2022年度校科学研究“揭榜挂帅”专项(WKS2022J01)

Analysis of Factors Associated with Mental Disability Caused by Traumatic Subdural Hydroma

Yajun Xu1(), Guangjian Li1, Xiaoying Dai2, Wei Liu3, Hongyan Li4, Xianhu Yao5, Qiang Wang6()   

  1. 1.Department of Psychology, Wannan Medical University, Wuhu 241002, Anhui Province, China
    2.Yiji-shan Hospital, The First Affiliated Hospital of Wannan Medical University, Wuhu 241001, Anhui Province, China
    3.Department of Psychiatry, The Fourth People’s Hospital of Wuhu, Wuhu 241002, Anhui Province, China
    4.School of Basic Medical Sciences, Nanjing Medical University, Nanjing 211166, China
    5.The Fourth People’s Hospital of Maanshan, Maanshan 243000, Anhui Province, China
    6.School of Law, Anhui Medical University, Hefei 231200, China
  • Received:2024-09-12 Online:2026-10-28 Published:2026-08-25
  • Contact: Qiang Wang

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摘要：

目的 探究创伤性硬脑膜下积液（traumatic subdural hydroma，TSH）致精神伤残的相关风险因素。 方法 回顾性分析安徽皖医司法鉴定中心和安徽华泰司法鉴定所2007—2023年进行法医学鉴定的162例单纯性TSH案例资料，依据《人体损伤致残程度分级》评估精神伤残。按照性别、年龄、文化程度、积液范围、积液部位及积液时间进行分组，采用t检验或单因素方差分析比较各组TSH伤残评分差异，采用Spearman相关分析评估伤残评分与各变量之间的相关性，并采用多元线性回归分析筛选影响因素，同时构建受试者操作特征（receiver operating characteristic，ROC）曲线分析影响因素对精神伤残的预测效能。 结果 （1）TSH伤残评分与年龄、积液范围及积液时间呈负相关；（2）多元线性回归分析结果显示积液时间对TSH伤残评分影响最大，其次是积液范围；（3）当TSH伤残评分≤10分时，ROC曲线分析显示积液范围的临界值为>2个部位，积液时间的临界值为>51 d；当TSH伤残评分≤9分时，积液范围的临界值为>2个部位，积液时间的临界值为>78 d；当TSH伤残评分≤8分时，积液范围的临界值为>2个部位，积液时间的临界值为>97 d。 结论 单纯性TSH后果的危险因素是积液时间和积液范围。积液时间对TSH所致精神伤残的影响高于积液范围，且预测稳定性优于积液范围；积液时间>51 d和积液范围>2个部位的TSH多构成精神伤残。

关键词: 法医精神病学, 创伤性硬脑膜下积液, 精神伤残, 危险因素, 案例分析

Abstract:

Objective To investigate the risk factors associated with mental disability caused by traumatic subdural hydroma （TSH）. Methods A retrospective analysis was conducted on 162 cases of isolated TSH that underwent forensic evaluation at Anhui Wanyi Forensic Appraisal Center and Anhui Huatai Forensic Appraisal Institute from 2007 to 2023. Mental disability was assessed according to the Classification of the Degree of Disability Caused by Human Injury. The cases were grouped according to sex, age, educational level, extent of fluid collection, location of fluid collection, and duration of fluid collection. Differences in mental disability scores among groups were compared using the t test or one-way analysis of variance （ANOVA）. Spearman correlation analysis was performed to evaluate the associations between mental disability scores and the relevant variables, and multiple linear regression analysis was used to identify influencing factors associated with the mental disability scores. Receiver operating characteristic （ROC） curve analysis was performed to evaluate the predictive performance of the influencing factors. Results （1） The TSH disability scores were negatively correlated with age, extent of fluid collection, and duration of fluid collection. （2） Multiple linear regression analysis showed that the duration of fluid collection had the strongest association with TSH mental disability scores, followed by the extent of fluid collection. （3） For a mental disability score ≤10, ROC curve analysis identified an extent of fluid collection involving >2 sites and a duration >51 days as the optimal cutoff values. For a mental disability score ≤9, the corresponding cutoff values were >2 sites and >78 days, respectively. For a mental disability score ≤8, the corresponding cutoff values were >2 sites and >97 days, respectively. Conclusion The risk factors associated with adverse outcomes following isolated TSH are the duration and extent of fluid collection. The duration of fluid collection has a stronger association with mental disability and better predictive performance than the extent of fluid collection. TSH with a duration of >51 days and involving >2 sites is more likely to be associated with mental disability.

Key words: forensic psychiatry, traumatic subdural hydroma, mental disability, risk factors, case analysis

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