日本全国および東京都における頭部外傷の統計的観察

STATISTICAL SURVEY OF THE HEAD INJURY IN JAPAN

I．緒言

　医学の全面的な顕著な進歩によつて，伝染病や感染性疾患による死亡が激減し，悪性新生物や老人病においても，その克服の曙光がみえる現在，これらと正反対に近年急増しつつあるのが外因性疾患であり，なかんづく外傷である。科学文明の発達に伴ない，人間関係は複雑の度を加え，エネルギー革命の進展のため，昔時には想像もできなかつた高エネルギーの外力がたえず人間を襲わんとしているのが現状である。

　しかも外傷の中でも頭部外傷の占める比は大きい。第1,2,3表でみるように，救急車を必要とする急患や，事故死の約四分の一は頭部外傷によって占められているのである。

In the last 5 years the traffic death toll has been doubled parallel to the duplication of the National Income of Japan. Metropolitan City of Tokyo now stands at the top of the world cities in traffic accidents as well as in her population of 10,000,000. While various legislative measures and regulations are taken by the authorities, we, neurosurgeons, feel ob-liged to encounter the increase of death tolls, especially because approximately 70% of the traffic death tolls are owing to head injury. In order to emphasize the need of specified neurosurgical treatment and of such Centers as appropriate therapeutics and treatment can be given to these patients without delay, we surveyed the head injury statistically and discussed the probability of saving lives which have so far been lost in vain being treated by non-speciallists.

According to our investigation, the total incidence of head injury in Japan amounts to half a million presumably, of which 20,000 die. As more than 40% die within half an hour and 90% within a day, no delay in neurosurgical treatment is allowed to rescue the lives.

After our re-examination from neurosurgi-cal standpoint of 500 cases autopsied by the Tokyo Medical Examiner Office, we found 34% died due to operable epidural and sub-dural hematomas without noticeable cerebral contusions, and that 22% died of intracranial hematomas with considerable contusions in which cases surgical intervention is indicated, though with little hope. Deaths due to inope-rable lesions such as acute cerebral swelling, contusions or lacerations occupied 27% of these 500 cases.

Putting into consideration the fact that these 500 cases have been so selected as to be autopsied, we tried to evaluate the true operability of the whole head injury death in Japan and estimated it to be about a quarter, because the instant deaths and the deaths within 1 hour after the injury amount to approximately 50% of the whole. If we can rescue 5,000 lives a year by appropriate neuro-surgical techniques, this is highly apprecia-ble, since the complete recovery from stomach cancer which is the most popular malignancy in the Japanese people is inferred to be no more than 5,000 a year.

The posttraumatic disorders take place in 50% of the injured (including 20% of organic neurological disorders& 30% of posttrauma-tic neurosis).

The age-grouping shows that half of the head injury deaths belongs to 16-44 years of age.