法医学杂志

法医学杂志 ›› 2019, Vol. 35 ›› Issue (2): 234-239.DOI: 10.12116/j.issn.1004-5619.2019.02.019

• 标准论坛 • 上一篇    下一篇

四肢长骨骨折不同伤残标准评定结果的比较

高娟， 沛臻彦， 陆晓明   

  1. 无锡中诚司法鉴定所，江苏 无锡 214000
  • 发布日期:2019-04-25 出版日期:2019-04-28
  • 作者简介:高娟（1983—），女，主检法医师，主要从事法医临床学和司法精神病学鉴定；E-mail：gaojuan83711@126.com

Comparison of Evaluation Results of Different Disability Standards of Long Bone Fracture

GAO Juan, PEI Zhen-yan, LU Xiao-ming   

  1. Wuxi Zhongcheng Institute of Forensic Science, Wuxi 214000, Jiangsu Province, China
  • Online:2019-04-25 Published:2019-04-28

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摘要： 目的 通过比较四肢长骨骨折不同伤残标准的评定结果，为进一步完善和修订肢体损伤相关标准提供参考。 方法 选取本鉴定机构2018年受理的四肢长骨骨折案件30例，包括肩、肘、腕、髋、膝、踝关节各5例，分别统计四肢长骨骨折后遗关节功能丧失程度，并依照《人体损伤致残程度分级》（以下简称《分级》）、《道路交通事故受伤人员伤残评定》（已废止，以下简称“原《道标》”）、《劳动能力鉴定 职工工伤与职业病致残等级》（以下简称《工标》）进行伤残评定，参照《永久性残损评定指南》（Guides to the Evaluation of Permanent Impairment，GEPI）关节残损率，对国内各标准定残结果进行比较。 结果 四肢大关节（踝关节除外）功能丧失率为26%~48%、踝关节功能丧失率为51%~64%，对应GEPI的关节残损率均值为13%~22%，区间波动小于10%。《分级》评定为十级残疾的比例为100%。原《道标》评定为十级残疾的比例为27%，评定为九级残疾的比例为6%，未达残疾的比例为67%。《工标》评定为十级残疾的比例为10%，残疾等级高于十级的比例为90%（其中评定为七级残疾的比例为47%）。 结论 本研究的肢体关节功能障碍者，按照《分级》和GEPI评定伤残的结果波动范围小、一致性较好，而原《道标》和《工标》评定伤残的结果与GEPI一致性较差，说明《分级》与GEPI更接近、更合理。

关键词: 法医学, 骨折, 标准, 伤残评定, 残疾等级, 对比研究

Abstract: Objective To provide reference for further perfection and revision of standards relevant to limb injury by comparing the evaluation results of different disability standards of long bone fracture. Methods Thirty cases were selected from the long bone fracture cases accepted by our institution in 2018. These cases include 5 cases of shoulder, elbow, wrist, hip, knee, ankle joints, respectively, to investigate the degree of loss of function of joints after long bone fracture. Disability evaluation was made according to Classification of the Impairment Related To Injury （hereinafter referred to as Classification）, Assessment for Body Impairment of the injured in road traffic accidents （now repealed, hereinafter referred to as original Road Standard） and Identifying Work Ability-Gradation of Disability Caused by Work-related Injuries and Occupational Diseases （hereinafter referred to as Work Standard）. The disability evaluation results of every domestic standard were compared with the joint damage rate of Guides to the Evaluation of Permanent Impairment （hereinafter referred to as GEPI）. Results The functional loss rate of joints （except ankle） was 26%-48%，and the ankle functional loss rate was 51%-64%. The mean value of GEPI joint impairment rate of the joints was 13%-22%, with the fluctuation range less than 10%. The rate of level 10 disability was 100% according to the Classification. The rate of level 10 disability was 27%, the rate of level 9 disability was 6% and 67% were not disabled according to the original Road Standard. The rate of level 10 disability was 10% according to the Work Standard and 90% had a disability above level 10 （47% were classified as level 7 disability）. Conclusion The people with limb joint dysfunction in this study had evaluation results with a smaller fluctuation range and better consistency according to the Classification and GEPI. The evaluation results according to the original Road Standard and the Work Standard has a less consistency. The Classification is more similar to GEPI and is more reasonable.

Key words: forensic medicine, fractures, bone, standard, disability evaluation, disability degree, comparative study