柔道における重症頭部外傷

Severe Head Injury during Judo Practice

Ⅰ．はじめに

　スポーツによる頭部外傷は，日本においては柔道やボクシングなどの格闘技，ラグビーやアメリカンフットボールなどのコンタクトスポーツ，スノーボードなどで頻度が高い^{1-3,6,8,10-13)}．近年，柔道練習中の頭部外傷による死亡事故が，マスコミなどで相次いで報道されており，社会的にも注目されている¹²⁾．柔道による頭部外傷が重症化する原因は，ほかのスポーツ外傷と同様に急性硬膜下血腫による場合が多いとされている^{1,2,6,8,12,13)}が，その発生頻度や発生状況，治療と転帰の詳細や対応マニュアルなどに関しては，これまで詳細には報告されていない．2012年度から，中学体育への武道（柔道・剣道・相撲）の必修化に伴い，さらに頭部外傷事故の増加が懸念されており¹²⁾，今回，全日本柔道連盟（全柔連）の要請を受け，全柔連の「損害補償・見舞金制度」に報告された事故例を解析する機会を得たので，柔道による重症頭部外傷の特徴と対策について検討した．

　The goal of this study is to elucidate the characteristic features of Judo head injuries and to propose safety measures and a reaction manual on how to prevent and to deal with such accidents in Japan. Thirty cases of severe head injuries suffered during Judo practice were enrolled in this study. They have made insurance claims for damage compensation and inquiries about Judo accidents attributed to the All Japan Judo Federation,from 2003 to 2010. The average age of the patients was 16.5 year old. The incidence of injury showed 2 peaks in different academic grade levels; one is in the first year of junior high-school (30.0%,n＝9) and the other is in senior high school (26.7%,n＝8). Around half of them were beginners. Four cases (13.3%) had past history of head trauma or headache and dizziness before a catastrophic accident,suggesting the presence of a second impact. Lucid interval was observed in 25 cases (83.3%). Most patients (93.3%) suffered acute subdural hematoma associated with avulsion of a cerebral bridging vein. Of patients who underwent emergency removal of the hematoma,15 patients (50%) died and 7 patients (23.3%) entered a persistent vegetative state. Based on these findings,we propose an emergency manual with safety measures for effectively preventing and treating Judo head injuries in an appropriate manner. To reduce the disastrous head injuries in Judo,the safety measures and an optimal action manual should be reconsidered and widely spread and accepted by society.