In the handling of traffic accidents, most involve the problem of disability assessment, in which the calculation of limb loss is a necessary step. As a professional traffic accident handling platform, the following will give you a general knowledge of this aspect.
First, the structure diagram of the human skeleton system is introduced
The human body has a total of 206 bones, divided into three parts: skull, trunk and limbs. They are distributed in various parts of the body, supporting the body, protecting the internal organs, and at the same time being helped by muscles to carry out various activities. Among them, there are 29 skulls, 51 trunk bones, and 126 limb bones.
1. 29 skulls
Includes 8 skulls, 15 facial skulls, and 6 ossicles
There are 6 kinds of skulls: forehead, apex, temporal, butterfly, sieve, pillow. There is 1 piece each of the frontal bone, sphenoid bone, sieve bone, and occipital bone, and 1 pair of parietal bone and temporal bone, a total of 8 pieces.
There are 9 kinds of facial skulls: maxilla, cheekbones, nasal bones, tear bones, palate bones, lower turbinates (1 pair each), mandible, hyoid bone, and plough bone (1 piece each), a total of 15 pieces.
There are also 6 ossicles, namely hammer bones, anvil bones and stirrup bones (1 pair on the left and right)
2. 51 pieces of trunk bone
Includes 26 vertebrae, 1 sternum, and 24 ribs
Vertebrae: In early childhood, the total number of vertebrae is 33 to 34, which are divided into cervical vertebrae (7 pieces), thoracic vertebrae (12 pieces), lumbar vertebrae (5 pieces), sacral vertebrae 1 (5 pieces), and tail vertebrae 1 (4 to 5 pieces) according to their locations. By adulthood, 5 sacral vertebrae have healed into one sacral bone, and 4 to 5 tail vertebrae have healed into one coccyx, so the total number of adult vertebrae is generally 26.
Sternum: 1 piece.
Ribs: 12 pairs in total, consisting of ribs and rib cartilage.
3. 126 limb bones
Divided into 64 upper limb bones (divided into upper limb bone and free upper limb bone) and 62 lower limb bones (divided into lower limb bone and free lower limb bone)
Upper extremity with bones: shoulder blade 2, collarbone 2
Free upper limb bones:
Humerus 2, radius 2, ulna 2, carpal bone 16, metacarpal bone 10, phalangeal bone 28 (1) Wrist bone (16 pieces in total) include: hand scaphoke bone, lunar bone, triangular bone, bean bone, most horn bone, small polyangular bone, skull, hook bone, left and right pairs, a total of 16 pieces. (2) Metacarpal bone (10 pieces in total) (3) Phalangeal bone (28 pieces in total, except for 2 pieces of the thumb, each finger is 3 pieces, left and right pairs)
Lower extremity bone: sciatic bone 2, pubic bone 2 (also called hip bone)
Free lower limb bones:
Femur 2, tibia 2, fibula 2, tarsal 14, metatarsal 10, phalangeal 28 (1) Metatarsal (14 pieces in total) include: talus, calcane, scaphoid bone, dice bone (1 piece each), left and right pairs, a total of 8 pieces. 3 wedge bones, left and right pairs, a total of 6 pieces (2) metatarsal bones (10 pieces in total) (3) phalanges (28 pieces in total, except for 2 toes of the thumb each other are 3 pieces, left and right pairs)
2. Calculation of limb loss of function
The proportion of the degree of loss of function of the three major joints of the limb is multiplied by the corresponding weight index of the three major joints of the limb.
3. Activity reference value
The reason why it is said to be the reference value of joint mobility, but not the normal value, is because the degree of joint range of motion varies too much between individuals, and it is difficult to unify the so-called normal value. The following data is for reference only, whether the individual's joint range of motion is normal, the simplest and most accurate way is to compare with the injured person's healthy limb.
(1) The reference value of the hip range of motion
Flexion: Flexion is bending, and the knee touching the chest is the flexion of the hip joint. It is about 130°, but it is also believed that the flexion of the hip joint is only 90°, and after 90° to a greater angle, it is not the activity of the hip itself, but the participation of the lower waist.
Back stretch or stretch: it is a back kick movement, about 10-15 degrees, some people will feel that the angle is larger than this, like martial arts and dancers can kick very high, acrobatic jiu-jitsu actors can even step on the top of their heads. This is also done with the help of the extension of the lower back, and the hip itself is only at a posterior extension angle within 20°.
Adduction: When the right leg steps to the left when the cross step, the left leg step to the right is the adduction of the hip joint, about 20-30 °.
Abduction: The spread of the legs is the abduction of the hip joint. Approximately 30-45°. After the system training, the angle can be increased a lot, and the ability to "split fork (horizontal fork)" is the embodiment of the practice effect.
Outer rotation: "Cocked legs" and kicking shuttlecocks, the movement of the calf flipping inside is the external rotation. Approximately 30-40°.
Internal rotation: Flipping the calf in the opposite direction of external rotation is internal rotation. Approximately 40-50°.
(2) The reference value of the range of motion of the knee joint
Flexion: Flexion is bending, and when squatting is when the knee flexion angle is close to the maximum. Approximately 135-150°.
Stretching: Stretching is stretching the legs, and showing a straight line is 0°. Most people have overextension, which is a little longer than 0°, about 5-10°.
(3) The reference value of the ankle range of motion
Sit on the bed and straighten your legs, with your calves flat on the surface of the bed, just above the tiptoe, which is the 0° position of the ankle joint.
Dorsal extension: The upward hook tip is the dorsal extension of the ankle joint, about 20-30°.
Plantar flexion: Tiptoe down is the plantar flexion of the ankle joint, about 40-50 °.
Varus: The foot is naturally relaxed, biased in the direction of the center of the foot, so that the two centers of the foot are opposite, that is, inverted, about 30 °.
Valgus: The foot is naturally relaxed, and the direction of the instep is biased, that is, the valgus, about 30-35 °.
(4) The reference value of the range of motion of the shoulder joint
Forward bending: it is the front flat lift, the maximum can be lifted to full vertical, about 70-90 °.
Posterior extension: The action of lifting the arms back against the sides of the body is to extend backwards, about 40 degrees.
Outreach: Side flat lift is outreach, about 80-90°. But the largest angle of abduction can also be until the arm is completely erect, and the arm is close to the ear, which is 180 °. This is because the shoulder straps are involved in the movement as a whole, and the oblioflagus (narrow shoulder joint) is only about 90°.
Adduction: The action of straightening the arm and touching the opposite leg with the hand is the adduction of the shoulder joint. Approximately 20-40°.
Internal rotation: the arms are tightened on both sides of the body, the elbow joint is bent into 90 degrees, the forearm is turned inward, and the hand can touch the stomach, which is the maximum angle of the internal rotation. Approximately 70-90°.
External rotation: The action in the opposite direction of the internal rotation is the external rotation. Approximately 40-50°.
(5) The reference value of the range of motion of the elbow joint
Buckling: Flexion is bending the arm. Approximately 135-150°. Generally the arm is bent over, the fingers can be easily rested on the shoulder, and the flexion of the elbow joint is in place.
Stretching: When the arm is straightened and in a straight line, it is 0 °. Many people have overextension, that is, to stretch out more than 0 °, called overextension, about 10-15 °.
The arms are clamped against the sides of the body, the elbows are bent at 90°, and the fist is clenched to raise the thumb, and the thumb is just pointing upwards, which is the 0° position.
Before spinning: it is to rotate the forearm to make the palm of the hand down, about 80-90 °.
After-rotation: Rotate in the opposite direction from before-spinning, so that the palm of the hand is up after the rotation, about 80-90°.
(6) The reference value of wrist range of motion
The hand and forearm are straight in a straight line, and the palm of the hand is down, which is the 0° position of the wrist joint.
Flexion (palm flexion): Bend your wrist downward in the direction of the palm of your hand, about 50-60 °.
Stretch (dorsal extension): In the direction of the back of the hand, raise the wrist upwards to reach the back, about 30-60 °.
Ulnar side deviation: the wrist is straight, and the palm is biased in the direction of the little finger, which is the ulnar side deviation, about 30-40 °.
Radial side deviation: the wrist is straight, and the palm is biased in the direction of the thumb finger, that is, the radial side deviation, about 25-30 °.
(7) The reference value of the activity of the cervical spine
Flexion: Bowing your head forward and touching your chest with your chin is flexing. The upper body is straight and the head is also kept straight, the eyes are level forward is 0 °, and the maximum angle of the head is about 45 °.
Stretching: It is the action of looking up backwards and looking up at the sky. The maximum angle is about 45°.
Side flexion: Sideways flexion is to tilt the head, use the ear to reach the shoulder, but not the head. The angle of lateral flexion is about 45°. Of course, the lateral flexion is divided into left and right sides.
Rotation: Rotation is the action of turning the head and turning back. The angle of rotation is about 60°.
Circular rotation: The neck can also continue to do the front and back left and right movements, that is, the circular rotation, of course, is to turn a circle is 360 °.
(8) The reference value of the lumbar spine mobility
Flexion: Flexion is the action of bending over. Natural standing straight is 0°. The angle of bending forward is only about 40°. The lumbar spine cannot be bent above 100°, and when bending over, the hand can feel the ground and the hip joint is involved.
Stretching: It is the action of the upper body leaning back. The maximum can be about 30°. In the "lower waist" movement in martial arts dance acrobatics, people can lean back and touch their ankles from behind, and the hip joint is also participating.
Side flexion: It is the "body side" movement in broadcast gymnastics done in elementary school, but the legs cannot move with it, only the waist. The angle of lateral flexion is also limited, around 20-30°.
Rotation: The waist and cervical spine can do the same circumference, the same circle is 360 °, but the amplitude of the action is smaller.
Fourth, take a chestnut
Wrist range of motion analysis:
Healthy side values: dorsal extension 60 degrees, palm flexion 60 degrees, radius deviation 20 degrees, ruler deviation 30 degrees. Injured value: back extension 20 degrees, palm flexion 30 degrees, radius deviation of 10 degrees, ulnar deviation of 20 degrees.
The degree of loss of wrist function is calculated as follows:
[(60-20)/60+(60-30)/60+(30-20)/30+(20-10)/20] ÷4=50%
Converted into the degree of loss of an upper limb: 50% * 0.18 = 9%, which does not meet the requirements of the 10-level assessment.