柔道事故にみる繰り返し脳損傷

Repeated Head Injury during Judo Practice

Ⅰ．はじめに

　中学・高校生の学校柔道による死亡事故が29年間（1983～2011年度）に118例あり，死因に占める重症頭部外傷の割合が極めて高いという実態がある²²⁾．その主たる急性硬膜下血腫は，加速損傷によって架橋静脈に亀裂や切断が起こることで多く発症する．初心者に事故が多く，投げ技が危険であることは周知で，受傷時の技・受傷後の経過の報告は多い^14,22,23)．

　しかし，事故が起こるまでの詳細な経過や背景に関して言えば，脳神経外科医が個別に経験する柔道事故数は少なく，頭部外傷データバンクに登録された資料ではスポーツ事故の分析は困難であること，および個人情報保護の観点から，未着手の分野であった²⁾．中学生の授業に武道が必修化され，重症でない外傷で脳神経外科外来を受診する人の数も増えることが予想され，脳神経外科医の日常診療の観点で，事故予防につながる注意点がないかどうかを検討した．

　Mild traumatic brain injuries, if repeated, can cause permanent brain damage, or even death. I examined five published documents（three judicial decisions, one official injury report, and one book）to analyze incidents in which high school students who, while practicing judo, experienced acute subdural hematoma（ASDH）with grave outcomes, despite the fact that they had been examined by neurosurgeons.

　The five students, first-grade boy and girl of junior high school and two first-grade boys and one second-grade girl of senior high school, were hit on the head during extracurricular judo practice and were taken to the neurosurgery department of different hospitals. They were all novices or unskilled players. The initial diagnoses were ASDH in three cases, concussion in one, and headache in one. Although the surgeons, except in one case, prohibited the students from returning to play, the juveniles resumed judo practice soon. Some of them complained of continued headaches, but they kept practicing. Between 17 and 82 days after the first injury, they received the fateful hits to their heads, and they were brought to the emergency rooms. MRI and CT revealed ASDH in all;two of them died, and the other three remain in persistent vegetative state.

　Neurosurgeons should take the initiative to prevent severe brain injury of young athletes through collaborations with the athletes themselves, fellow athletes, family members, coaches, teachers, athletic directors, and other physicians. They should pay close attention to headaches and other signs and symptoms of concussion and prohibit the athletes from returning to play until they are confirmed to be symptom free for recommended periods, insisting that safety comes first.