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致谢：该病例来自auntminnie Board Review——Musculoskeletal 翻译：赵文韬 江门市中心医院 放射科   
A 48-year-old man presents to the emergency department with right hand and thumb pain after falling off his motorcycle. Radiographs of the right hand were obtained. Frontal, oblique, and lateral views are shown below. 一名48岁男子从摩托车上摔下后右手和右手拇指疼痛，目前正在急诊科接受治疗。拍摄右手X线平片。正位、斜位和侧位平片如下所示。 What is the most likely diagnosis? A．Bennett fracture B． Rolando fracture C． Epibasal (pseudo-Bennett) fracture D． Duverney fracture 最可能的诊断是什么？ A．Bennett骨折 B． Rolando骨折 C． 上基底部骨折（伪Bennett骨折） D． Duverney骨折 Correct answer：B Explanation: A Rolando fracture is a three-part or comminuted intra-articular fracture-dislocation of the base of the first metacarpal. The fracture usually results from axial loading to a partially flexed metacarpal. The volar fragment typically remains with the trapezium via the anterior oblique ligament, while the main dorsal fragment subluxes or dislocates dorsally and radially due to unopposed pulling from the abductor pollicis longus. Inadequate reduction of this fracture leads to malunion and secondary osteoarthritis. A Bennett fracture is a two-part intra-articular fracture through the first metacarpal base. An epibasal (pseudo-Bennett) fracture is an extra-articular fracture through the first metacarpal base. Duverney fractures are isolated pelvic fractures involving only the iliac wing. They are caused by direct trauma. 正确答案：B 解释：Rolando骨折是指第一掌骨基底部骨折包括三个部分，或关节内粉碎性骨折伴脱位。Rolando骨折通常是由于轴向的冲力作用于部分弯曲的掌骨所致。掌侧骨折块通常通过前斜韧带与大多角骨保持在原位，而主要的背侧骨折块受无拮抗的拇长展肌牵拉向背侧和桡侧移位，呈半脱位或脱位改变。骨折复位不充分会导致畸形愈合和继发性骨关节炎。 Bennett骨折是指穿过第一掌骨基底的关节内骨折，分为两部分。上基底部（伪Bennett）骨折是指穿过第一掌骨基底的关节外骨折。Duverney骨折是仅累及髂骨翼的孤立性骨盆骨折。它们都是由直接创伤引起的。
上基底部（伪Bennett）骨折 图片来源：百度文库  |
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