スキー滑走中受傷した頭蓋内穿通外傷の2例

Penetrating Craniocerebral Injuries during Downhill Skiing

I．はじめに

　頭蓋内穿通外傷は比較的稀であるが，今回われわれは，スキー中の事故で発症した頭蓋内穿通外傷の2例を経験したので報告する．

Two cases of penetrating craniocerebral injuries which occurred during alpine skiing were presented. The first was a 25-year-old lady whose calvarium was impaled with a ski pole in the anterior part of the orbit-al roof following an interpersonal collision. She was brought to the Critical Care and Emergency Center, Iwate Medical University. On admission, her conscious-ness was clear and a stab wound was observed in her upper eyelid. Initial CT showed bone fracture of the anterior part of the orbital roof and a small intracereb-ral hematoma associated with bone fragment was re-vealed. Immediate removal of the hematoma and fore-ign body was carried out and duralplasty was per-formed. She had a very good postoperative course but residual anosmia. The second was a 9-year-old boy who lost control and collided with a tree during downhill skiing. A twig penetrated through his left maxillary sinus. He was brought to the Critical Care and Emergency Center, Iwate Medical University. On admission, his consciousness was clear. CT showed a round low density area from his anterior lobe to the Nucleus caudatus, indicating the tract of the twig. Im-mediately, duralplasty and removal of the foreign body was performed. He had a very good postoperative course.

Though stab wound during downhill skiing was be-lieved to be rare, we noted that the rate of stab injury was much higher in Japan than in other countries for the following reasons; 1) In Japan, 24.8-30.6% of skiing injuries are caused by collision with other skiers. This comes after “falls” as a cause of injury. The rate was significantly higher in Japan than in other coun-tries. 2) In Japan, ski courses are narrow and usually constructed by deforestation. Thus, once a skier runs off the course, he runs the risk of colliding with a tree.