05-2_紹介_原田氏.indd

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1 12 特集交通事故と法医学 / 紹介交通事故による人体の損傷頭部外傷を中心に Traffic Accident Injury with a Focus on Head Injury Kazuki HARADA Traffic accidents are one of the most significant topics in forensic practice. Forensic pathologists must inspect and record each injury caused by traffic accidents to determine how those injuries were inflicted. This article describes traffic accident injuries of each body part, with a special emphasis on head injury, as it has a significant impact on the victimʼs prognosis. Airbag injuries will be discussed in a separate chapter. 1. はじめに ( ) ( ) Associate Professor, Department of Forensic Medicine, National Defense Medical College ( ) ( ) ( ) ( ) ( ) ( 12 )

2 ~ ~ 13 (Quality of Life: QOL) 2. 頭部外傷 (Traumatic Brain Injury: TBI) ) ( ) ) TBI TBI 頭部外傷を生じる交通事故状況 ( ) 2 1 頭皮の損傷 Scalp Injury ( Table 1 ) Table 1 損傷に関する用語の説明鈍器損傷両方の特徴を持つ鋭器損傷表皮剥脱皮下出血挫創裂創挫裂創切創刺創 *1 鈍体が皮膚の表面に作用して表皮が剥離あるいは剥離欠損し真皮を露出した状態 ( いわゆる擦り傷は表皮剥脱の一型である ) 皮膚に鈍体が打撲あるいは圧迫的に作用して皮膚組織の離開を伴わずに皮下の血管が破綻して皮下組織内に出血した状態 ( いわゆる青あざ ) 鈍体の打撲作用によって皮膚が挫滅されて裂けた ( 離開した ) 状態皮膚が過度に牽引されて裂けた ( 離開した ) 状態挫創と異なり皮膚の離開部と外力が作用した部位とは異なる鈍体による打撲と牽引との同時的作用によって生じた皮膚の離開挫創と裂創の刃器あるいは鋭利な辺縁を人体表面に押しあて刃の長軸方向に引いてあるいは押してできた創先端が尖った刃器をその長軸方向に刺入してできた創 ( 13 )

3 14 ( ) dicing injury ( ) ) 2 2 頭蓋骨骨折 Skull Fracture 2 3 硬膜外血腫 Epidural Hematoma(EDH) ( ) (Fig.1) (EDH) ( ) ( lucid interval) 2 4 硬膜下血腫 Subdural Hematoma(SDH) (SDH) ~ bridging vein cortical artery/ vein ( ) SDH 43 ) Matsuda Fig. 1 脳を包む髄膜 ( 14 )

4 ~ ~ 15 SDH ) talk & deteriorate( ) talk & die( ) SDH ) ) SDH EDH SDH acute spontaneous subdural hematoma of arterial origin( ) 9 10) 11 12) SDH ( ) EDH 2 5 クモ膜下出血 Subarachnoid Hemorrhage(SAH) (SAH) SAH SAH 2 6 脳挫傷 Cerebral Contusion ( ) ( ) ( ) 48 13) SAH ( ) ( 15 )

5 びまん性軸索損傷 Diffuse Axonal Injury (DAI) (DAI) ( ) (shearing forces: ) CT DAI ( ) DAI 2 8 脳浮腫 Cerebral Edema 脳ヘルニア Cerebral Herniation 3. 頸部外傷 ( 頸髄損傷 ) whiplash injury QOL 4. 体幹外傷 (linear acceleration) (impact deceleration) 46 14) 15) ( ) (independent predictor) 16) ( 16 )

6 ~ ~ 17 1,500 ~ 2,000mL ( ) ( ) 外傷性窒息 Traumatic Asphyxia (mechanical asphyxia) ( ) 5. 四肢外傷 ( ) ( ) ( ) ( ) ( ) 300 ~ 500mL 1,000 ~ 2,000mL 500 ~ 1,000mL 6. エアバッグ損傷 Airbag Injury ) Table 2 17 ~ 19) Table 2 エアバッグ損傷部位頭部頸部体幹上肢下肢その他損傷顔面損傷顎関節損傷眼部損傷 ( 眼窩骨折網膜剥離水晶体破裂 ) 頭蓋底骨折脳挫傷頸椎脱臼骨折肋骨骨折気胸大動脈離断心臓弁損傷心臓破裂腹部臓器損傷脱臼骨折手指の完全不完全離断エアバッグによる重大な損傷の報告はない熱傷音響性外傷妊娠時の前期破水 ( 17 )

7 ) (thermal burn) (chemical burn) (friction burn) 21 22) 23) Buckley 24) ~ 170 ( 120 ) Buckley 7. おわりに参考文献 ) Peden M., Scurfield R., Sleet D., et al. : World report on road traffic injury prevention, World Health Organization 2004( int/violence_injury_prevention/publications/ road_traffic/world_report/en/) ) : 2009 Vol.36 No.1 pp ) Spitz W.(ed.): Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation, 4th ed., Charles C. Thomas, 2006 ) Wind J. J., Leiphart J. K. : Bilateral subacute subdural hematomas, N England J Med, Vol.360, No.17, p.e23, 2009 ) Bordes J., Goutorbe P., Lacroix G., et al. : A case of massive delayed acute subdural hematoma, J Emerg Med, Vol.42, No.4, pp , 2012 ) Matsuda W., Sugimoto K., Sato N., et al. : Delayed onset of posttraumatic acute subdural hematoma after mild head injury with normal computed tomography: a case report and brief review, J Trauma, Vol.65, No.2, pp , 2008 ) Kim J., Kemp S., Kullas K., et al. : Injury patterns in patients who talk and die, J Clin Neurosci, Vol.20, No.12, pp , 2013 ) Kibayashi K., Ngʼwalali P. M., Hamada K., et al. : Discrepancy of clinical symptoms and prognosis of a patient forensic significance of talk and die head injury, Leg Med(Tokyo), Vol.2, No.3, pp , 2000 ) Matsuyama T., Shimomura T., Okumura Y., et al. : Acute subdural hematomas due to rupture of cortical arteries: a study of the points of rupture in 19 cases, Surg Neurol, Vol.47, No.5, pp , ) Chhiber S. S., Singh J. P. : Acute spontaneous subdural hematoma of arterial origin: a report of four cases and review of literature, Neurol India, Vol.58, No.4, pp , ) ( 18 )

8 ~ ~ 19 Vol.4 No.2 pp ) Takeuchi S., Takasato Y., Miyawaki H., et al. : Subacute subdural hematoma, Acta Neurochir Suppl, No.118, pp , ) Whitwell H. L.: Forensic Neuropathology, 1st ed., Hodder Arnold, London, ) Viano D. : Effectiveness of Safety Belts and Airbags in Preventing Fatal Injury, SAE Technical Paper , doi: /910901, ) Chen R., Gabler H. C. : Risk of thoracic injury from direct steering wheel impact in frontal crashes, J Trauma Acute Care Surg, Vol.76, No6, pp , ) Newgard C. D., Lewis R. J., Kraus J. F. : Steering wheel deformity and serious thoracic or abdominal injury among drivers and passengers involved in motor vehicle crashes, Ann Emerg Med, Vol.45, No.1, pp.43-45, ) DiMaio V. J., DiMaio D. : Forensic Pathology, 2nd ed, CRC Press, ) Saukko P., Knight B. : Knightʼs Forensic Pathology, 3rd ed, Arnold, ) Wallis L. A., Greaves I. : Injuries associated with airbag deployment, Emerg Med J, Vol.19, No.6, pp , ) Jernigan M. V., Rath A. L., Duma S. M. : Analysis of burn injuries in frontal automobile crashes, J Burn Care Rehabil, Vol.25, No.4, pp , ) De Salvia A., Sergolini L., Pescarolo D. : An atypical air bag injury?, J Forens Odontostomatol, Vol.25, No.2, pp.57-60, ) Shinha V. K., MacGill K. A. : Air bag-associated burn, Emerg Med Australas, Vol.19, No.5, pp , ) Monkhouse S. J., Kelly M. D. : Airbag-related chest wall burn as a marker of underlying injury: a case report, J Med Case Rep, Vol.2, No.91, doi: / , ) Buckley G., Setchfield N., Frampton R. : Two case reports of possible noise trauma after inflation of air bags in low speed car crashes, BMJ, Vol.318, No.7182, pp , 1999 ( 19 )

佐賀大学附属病院　高度救命救急センター　　　　　　　　　　　　　　　　阪本雄一郎

佐賀大学附属病院　高度救命救急センター　　　　　　　　　　　　　　　　阪本雄一郎 AIS コーディング 1.Abbreviated Injury Scale (AIS) 2. Injury Severity Score (ISS) Saga university Hospital Trauma and Resuscitation 基本的な心構え医師以外がコーディングを行なう前提でルールがつくられています専門的医学知識は避ける診断基準には言及しないカルテの記載事項をもとに行なう