Nail-gunによる頭部顔面穿通性外傷:釘抜去に骨螺子ドライバーが有用であった1例

A penetrating cranio-facial injury due to a nail-gun accident

I．はじめに

　Nail-gunは建築用工具として広く世界中で用いられており，諸外国では以前よりその使用に伴った脳損傷例が報告されている^1,3,6,10）．近年，本邦でもその普及に伴ってnail-gunによる穿通性脳損傷例の報告が散見されるようになってきた^2,8,9）．われわれはnail-gunによる穿通性頭部顔面外傷を経験し，釘の抜去において整形外科用骨螺子ドライバーが非常に有用であった．これに診断・治療法についての若干の文献的考察を加え報告する．

We report a case of a penetrating cranio-facial injury due to a nail-gun accident. An 18-year-old worker was admitted to our hospital as an emergency patient. He was working using a nail-gun when a nail ricocheted off a wall and pierced the right side of his face. Skull X-rays and a CT scan showed that a 9 cm nail had pierced his right frontal lobe through the right maxil-lary bone via the orbital space. The patient was alertwithout any neurologically abnormal findings. A small stab wound was recognized on his face. The nail was removed six hours after the injury through a sublabial approach and a fronto-temporal craniotomy. The nail was very tightly fixed in the maxillary bone and skull base bones, and a screw driver normally used inorthopedic surgery proved to be very useful for remov-ing the nail. The patient returned home 14 days later without any neurological deficits. The technical prob-lems associated with such a nail-gun injury in the face and skull are also discussed.