涉及骨科医疗损害案件的法医学鉴定  

Medicolegal Identification of Medical Malpractices in Orthopaedic Surgery

作　　者：史芳 张毛影 马静媛 黄崇亚 高建辉[1,2] 顾珊智 SHI Fang;ZHANG Mao-ying;MA Jing-yuan;HUANG Chong-ya;GAO Jian-hui;GU Shan-zhi(College of Forensic Medicine,Xi’an Jiaotong University Health Science Center,Xi’an 710061,China;Medicolegal Expertise Center of Xi’an Jiaotong University,Xi’an 710061,China;Beijing Source ofJudicial Identification Center of Scientific Evidence,Beijing 100062,China;Department of Forensic Med?icine,Xuzhou Medical University,Xuzhou 221004,Jiangsu Province,China)

机构地区：[1]西安交通大学医学部法医学院,陕西西安710061 [2]西安交通大学法医学司法鉴定中心,陕西西安710061 [3]北京法源司法科学证据鉴定中心,北京100062 [4]徐州医科大学法医学教研室,江苏徐州221004

出　　处：《法医学杂志》2019年第1期52-57,共6页Journal of Forensic Medicine

摘　　要：目的分析骨科医疗损害特点,探索骨科医疗损害司法鉴定的原则和方法,为今后医疗损害司法鉴定统一标准的制定提供基础数据支撑。方法收集2002—2015年西安交通大学法医学司法鉴定中心医疗损害司法鉴定案例364例,对其中100例涉及骨科医疗损害的案例进行回顾性调查分析。结果在100例骨科医疗损害司法鉴定案例中,涉案医院104家,判定有过错的95例,无过错的9例,过错原因居前三位的分别是"对病情观察、预计不足"占27.9%"、术中操作不当"占17.3%"、误诊误治、漏诊漏治"占12.5%。诊疗后果以残疾居多,占61%;其次为病程延长,占31%;死亡较少,占8%。判定有因果关系的95例,占91.4%;无因果关系的9例,占8.6%。医方过错原因力分布在次要原因(25%)的为56例,占53.9%;主要原因(75%)的为20例,占19.2%。结论全面分析骨科损害后果的成因,区分引发医疗过错发生的主观因素和客观因素,是判定骨科医疗过错原因力的关键。Objective To analyze the characteristics of medical malpractices in orthopaedic surgeries, to explore principles and methods in medical legal identification, and to provide basic data for uniform medicolegal standard for the future medical identification. Methods A retrospective analysis was conducted on 100 cases of medical malpractices in orthopaedic surgery, among the 364 cases archived in Medicolegal Expertise Center of Xi’an Jiaotong University during 2002-2015. Results In the 100 cases of orthopedic medical malpractices, with 104 hospitals involved in, 95 cases were judged with medical errors and the other 9 cases with no error. The top 3 reasons for errors were (1) inadequate observation or estimation of diseases (27.9%),(2) intraoperative improper operation (17.3%), and (3) delayed or missed diagnosis and treatment (12.5%). The consequences of medical malpractices were mostly disability (61%), followed by prolonged diseases (31%) and death (8%). With regard to the causal relationship between medical errors and consequences, 95 cases(91.4%)were with causality and the other 9 cases (8.6%) with no causality. Specifically, 56 cases (53.9%) were with medical errors as the secondary causes accounting for 25% causative potency, and 20 cases (19.2%) were with medical errors as the major causes accounting for 75% causative potency. Conclusion It is pivotally important for determining the causative potency of medical errors to analyse the causes of damages in orthopaedic surgery and to distinguish subjective factors from objective ones of medical errors.

关 键 词：法医学 骨科 医疗损害 案例分析 

分 类 号：DF795.1[医药卫生—法医学]