自動釘打ち機による穿通性多発臓器損傷の1例—頭蓋内損傷を中心に

Penetrating Injury of the Head, Neck and Chest by a Nail-Gun:a case report

I．はじめに

　頭蓋内への穿通性異物損傷としては，経眼窩的^{1,2,7,9,16）}あるいは経鼻的^3）な損傷が大半を占め，また異物の種類としては銃弾^14），ガラス^1,16），木片^3,9,18），刃物^7）がほとんどである．今回われわれは，建設用工具として最近日本にも普及しつつあるnail-gunによる頭蓋内穿通性損傷，頸椎脊椎管穿通性損傷ならびに胸腔内損傷の稀な症例を経験し，その臨床的特徴ならびに治療につき文献的考察を加え報告する．

A very rare case of directly penetrating injury of the head, neck and chest caused by a nail-gun was re-ported. A 56-year-old male was admitted to our critical care center due to chest injury.

On admission, he showed numbness of the hand & leg, left hemiparesis and hypalgesia. Physical examina-tion disclosed three nails on the left anterior chest, but other wounds or nails were not found. Chest films showed three nails penetrating the lung without reaching the heart, but other nails were found by skull and neck films. One nail had penetrated the cervical canal at the C1 level through the posterolateral cervical region. Two other nails were demonstrated at the right temporal and the left frontal region. Computed tomography revealed no massive cerebral hemorrhage and cerebral angiography showed no extravasation and no passage through main vessels. Emergency surgery was performed uneventfully and the nails in the chest, neck and head were totally removed. He was dis-charged one month after surgery.

Some injuries caused by a nail-gun have been re-ported in the world literature but in Japan this multiple injury case was the first reported. Since nail-gun in-juries can cause multiple damage, systemic X-ray ex-amination was very important.