Nail-Gunによる穿通性脳損傷の1例

A Case of Penetrating Head Injury Caused by Nail-Gun

I．はじめに

　頭蓋内への穿通性損傷の報告は，経鼻的^16）あるいは経眼窩的^15）なものがほとんどであり，脳内異物も種々のものが報告されている^7,15,16）．しかし，頭蓋骨を貫通するようなものはGunshot injury^7,12）や戦争に関係したものなど特殊なものに限られていた．一方，Nail-gunは建築用の強力な工具として，外国では広く普及している．しかし，Nail-gunの本邦での使用頻度はまだ低く，その性能および危険性については，あまりよく知られていない．したがって，本邦におけるNail-gunによる事故もまだ少なく，散見される程度と考えられる．現在，著者らの調べ得た範た範囲では，Nail-gunによる頭蓋内損傷の報告例は，本邦では文献上まだみられていない．今回著者らは，まれなNail-gunによる頭蓋内損傷の1例を経験したので，その診断，治療法につき，若干の文献的考察を加え報告する．

A rare case of penetrating head injury caused by a nail-gun was described. A 24-year-old male was admit-ted to our hospital due to head injury. He had handled a nail-gun at a construction site. On admission the patientwas fully conscious with no neurological defects. A small wound was observed at the left front-temporal region. Skull films showed a large nail embedded in the skull cavity. A computed tomographic (CT) scan, changing level of window, demonstrated intracerebral hematoma, fragment of skull bone and nail. Cerebral angiography (CAG) showed extravasation at the left frontal region. Emergency operation was performed and his recovery was uneventful. Twenty-two craniocerebral injuries caused by nail-guns have been reported in world medic-al literature but this was the first report in Japan. The characteristics of craniocerebral nail-gun injuries were less damage and better prognosis compared with gun-shot injuries. However intracranial infection and vascular injury were possible lethal complications. In this case, preoperative examination, such as CT scan and CAG was valuable and the early operation for the sake of safe-ty was very effective.