スノーボードによる急性硬膜下血腫—自験79例の臨床的検討

Acute Subdural Hematoma in Snowboarders:A Multivariate Analysis of 79 Cases

Ⅰ．はじめに

　1970年代に開発されたスノーボードは1990年代に爆発的ブームとなり，1998年には長野冬季オリンピックで正式種目になった．しかし，その後2002年をピークにスノーボード人口は減少し，スキー人口の減少も相まって，スキー場の経営は厳しい現状を迎えている¹⁶⁾．

　スノーボード人口の減少に伴って，当院（齋藤記念病院）に搬送されるスノーボード頭部外傷例も減少している．しかし，スノーボード外傷に伴う急性硬膜下血腫（acute subdural hematoma：ASDH）の発生がなくなったわけではない．今回われわれは，当院に搬送されたスノーボード頭部外傷によるASDH症例をまとめ臨床的に検討し，文献的考察を行った．

　Snowboarding-related head injuries have become less common as the number of snowboarders has decreased;however, severe head injuries, such as acute subdural hematomas, occur every snowboarding season. We investigated the characteristics of cases of snowboarding-related acute subdural hematoma treated at our hospital.

　A total of 3,632 patients with snowboarding-related head injuries seen at our hospital between the 1995/96 and 2012/13 snowboarding seasons were enrolled in this study. Seventy-nine（2.2%）patients were diagnosed with acute subdural hematomas using computed tomography. We statistically analyzed the patient questionnaire responses, clinical records, and radiological findings.

　We compared the findings of the acute subdural hematoma（ASDH）group with those of the non-ASDH group. Among beginners, falling on a slope, incidents involving gentle slopes, and injuries of unknown origin were significantly more common in the ASDH group. On the other hand, among the intermediate snowboarders, incidents involving jumps, jump failure, and collisions with other snowboarders were more common in the non-ASDH group. Secondly, in an analysis involving subjects who had an ASDH, we compared the beginner group with the intermediate/advanced group. Falling on a slope, incidents involving gentle slopes, pure ASDH, diffuse brain swelling, and death were more common in the beginner group, and ASDH combined with contusions or subarachnoid hemorrhaging and incidents involving a jump were more common in the intermediate/advanced group. Finally, we summarized the cases of 10 subjects with an ASDH as well as diffuse brain swelling. Nine of the 10 patients died, 8 were first-timers or beginners, 6 had incidents involving flat or gentle slopes, and 5 had fallen on a slope.

　Snowboarding is a recreational sport;therefore, snowboarders must take responsibility for their actions. However, snowboarders, especially beginners, could decrease their risk of ASDH if they are informed about ASDH and take precautions to reduce their risk of falling on gentle slopes. Educational activities related to this topic should continue.