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Original Article

By 博安 牧野, 研一 植村, 晶 山浦, 浩志 劉, 紀彰 忍頂寺, 英夫 高橋, 治夫 大川, HIROYASU MAKINO, KENICHI UEMURA, AKIRA YAMAURA, NORIAKI NINCHOJI, HIROSHI RYU, HIDEO TAKAHASHI and HARUO OKAWA

Abstract

頭部外傷は交通機関の発達にともなつて,人類におそいかかってきている大きなThreatとなっているが,小児の頭部外傷は交通事故災害のほかに,その原因としては墜落事故が多く見られることから,日常生活に密接に関連していることが多い。しかも小児の他の疾患と同じような特異性をこの場合も有して,完全に治癒しやすい反面,非常に死亡する症例も多く見られている。われわれの一連の臨床研究はこの特異性を十分に理解し,小児外科医との強力な協力のもとに,万全と思われる手術法およびその他の治療法をほどこしてみた。これらの治療法は従来報告されている方法より,より積極的でかつ,拡大されたものと考える。過去数年のこの療法をふりかえってみると,われわれの行なった一つの方針は確かに有用であったと思いここに発表して諸兄の批判を仰ぐ次第である。これをさらにまとまったものとして発表して行くつもりである。Head injury in childhood is never considered to be the same with head injury in adults. Acute subdural hematoma is much frequently seen in children, accompanied by cerebral contusion, even if no skull fracture is found. This is probably because skull of children is very thin and flexible, so small traumatic energy would give considerable damage on the cerebral tisssue without marked skull fracture. Also it is one of the characteristics of head injury in children that, if prompt and adequate management had been given, unexpectedly remarkable improvement would be seen even in very severe cases, which is impossible in adults. Many conservative managements have been developed for these severe head injury, however, our policy to severe cerebral contusion is always as follows ; as long as the total intracranial space is limited, it is surgical enlargement of the intracranial cavity that could protect the brain stem against compression. For this purpose, we have performed unilateral, or bilateral, if indicated even in small children, large decompressive craniotomy in many cases, using fascia or silicone gauze for dural complete relaxation. At the same time, it must be emphasized that following procedures should be done promptly preceding the operation; namely, to keep air way with or without tracheostomy and to keep intravenous route. And enough dose of steroid hormone may be given. In patients with prolonged unconsciousness, we perform gastrostomy for the purpose of satisfactory nutrition and protection from pulmonary complication which frequently seen during prolonged tube feeding. No improvement is expected without good nutrition in prolonged cases. We have experienced 19 cases of severe head injury in children for the last 3 years. Among them, tracheostomy done in 9 cases, and gastrostomy in 7 cases. With these intensive care, satisfactory improvement seen in 11 cases and death in only 1 case

Topics: 脳挫傷, 頭部外傷
Publisher: 千葉医学会
Year: 1969
OAI identifier: oai:opac.ll.chiba-u.jp:900114940
Journal:

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