颈外部与内部所见在致死性勒颈中的诊断价值：法医病理学文献的范围综述

文献信息

中文摘要

本范围综述梳理了法医病理学文献中关于颈外部与内部所见在致死性徒手勒颈和绳索勒颈中的诊断价值，以及用于区分勒颈与缢死、他杀与自杀死亡方式的所见。按照Joanna Briggs Institute方法学[1]开展范围综述，并遵循PRISMA-ScR[2]进行报告。于2026年4月检索PubMed/MEDLINE和Europe PMC；由一名评价者进行标题/摘要和全文筛选，并咨询导师。采用三个预先设定的推断类别报告结果：已确认、有争议和产生假设。共16项研究符合纳入标准，报告约1,500例病例，覆盖全球八个地区。在全国性系列中，徒手勒颈造成的喉舌骨骨折负担高于绳索勒颈。来自柏林研究所Maxeiner和Bockholdt队列的两项所见——喉肌出血和超过一个甲状腺上角骨折——在自杀性绳索勒颈中患病率为0%，为他杀方式提供了一个高特异性指标组合，但仍为单队列结果，有待重复验证。各研究中瘀点患病率的表观差异可归因于确定方法学而非生物学差异。纳入的两项中国省级系列报告舌骨骨折比甲状腺软骨骨折更常见，比例约为3:1和4:1，这与西方和北欧系列以甲状腺为主型的模式相反。这一两篇论文、单一国家的观察结果被报告为产生假设，而非已确立的地区差异。软骨内喉出血作为勒颈特异性标志物的经典主张被认定为有争议，且未得到当代对照证据的支持。该综合支持绳索勒颈中他杀方式的高特异性指标组合，并将瘀点患病率差异阐明为确定偏倚所致。它确定了三项研究优先事项。第一是在Maxeiner和Bockholdt报告的自杀性绳索勒颈中患病率为0%的两项标志物所在柏林研究所队列之外，并针对表4所列所见，对这些标志物进行重复验证。第二是对该地区异常进行死后CT检测，第三是对颈部淋巴结出血这一观察结果进行当代检测。

英文摘要

This scoping review maps the forensic-pathology literature on the diagnostic value of external and internal neck findings in fatal manual and ligature strangulation, and on findings used to differentiate strangulation from hanging and homicidal from suicidal manner of death. A scoping review was conducted in accordance with Joanna Briggs Institute methodology [1] and reported following PRISMA-ScR [2]. PubMed/MEDLINE and Europe PMC were searched in April 2026; title/abstract and full-text screening were performed by a single reviewer with supervisor consultation. Findings were reported using three pre-specified inference categories: confirmed, contested, and hypothesis-generating. Sixteen studies reporting on approximately 1,500 cases across eight world regions met eligibility criteria. Manual strangulation produced a higher laryngohyoid fracture burden than ligature strangulation across nationwide series. Two findings from the Berlin institute cohort of Maxeiner and Bockholdt - laryngeal muscle hemorrhage and fractures of more than one thyroid superior horn - reached 0% prevalence in suicidal ligature strangulation, providing a high-specificity indicator panel for homicidal manner that remains single-cohort and awaiting replication. Apparent variation in petechiae prevalence across studies was attributable to ascertainment methodology rather than biological difference. The two included Chinese provincial series reported hyoid fractures more frequently than thyroid cartilage fractures, at ratios of approximately 3:1 and 4:1, which reverses the thyroid-predominant pattern of the Western and Nordic series. This two-paper, single-country observation is reported as hypothesis-generating rather than as an established regional difference. The classic claim of intracartilaginous laryngeal hemorrhage as a strangulation-specific marker emerged as contested and unsupported by contemporary controlled evidence. The synthesis supports a high-specificity indicator panel for homicidal manner in ligature strangulation and clarifies the petechiae prevalence variation as an ascertainment artifact. It identifies three research priorities. The first is replication of the two markers reaching 0% prevalence in suicidal ligature strangulation reported by Maxeiner and Bockholdt, outside the Berlin institute cohort in which they were established and against the findings set out in Table 4. The second is post-mortem CT testing of the regional anomaly, and the third is contemporary testing of the cervical lymph node hemorrhage observation.