鉄筋圧着機の爆発により受傷した穿通性頭部外傷の1例

A Case of a Penetrating Brain Injury due to an Explosion of a Construction Machine

Ⅰ．はじめに

　非銃社会である本邦において，銃創を含めた穿通性頭部外傷を経験する機会は少ない．穿通性頭部外傷の症例は，異物の進入経路により，副鼻腔損傷や脳血管損傷を合併することもあり，その治療方針は症例ごとに十分な検討を要する．今回われわれは，油圧式鉄筋圧着機の爆発による穿通性頭部外傷の1例を経験したため，文献的考察を加えて報告する．

　Penetrating brain injury caused by a high speed projectile is rather rare in Japan,known for its strict gun-control laws.

　We report a case of a 55-year-old male, who was transferred to our hospital with a foreign body in the brain due to penetrating head injury, which was caused by an explosion of a construction machine. Neurological examination demonstrated severe motor aphagia with no apparent motor paresis. The patient had a scalp laceration on his left forehead with exposed cerebral tissue and CSF leakage.

　Head CT scan and plain skull X-ray revealed a 20 mm×25 mm bolt which had penetrated due to the explosion of the machine. The anterior wall of the left frontal sinus was fractured resulting in dural laceration, and scattered bone fragments were seen along the trajectory of the bolt. Digital subtraction angiography showed no significant vascular injuries including superior sagittal sinus.

　We performed open surgery, and successfully removed the bolt along with the damaged frontal lobe. The patient had no infection or seizure after the surgery, and was transferred for further rehabilitation therapy. We performed a cosmetic cranioplasty six months later.

　Surgical debridement of the damaged cerebral tissue along the trajectory led to successful removal of the bolt with no further neurological deficit.