Abstract: Objective To explore the advantages of high-frequency ultrasound-guided “cross-shaped” positioning method in accurate positioning and surgical effect in open reduction and internal fixation of rib fractures.Methods Retrospective analysis of 97 cases of multiple rib fractures treated surgically in our department from october 2019 to october 2024.Patients were divided into three groups based on different localization methods.The control group designed the surgical incision according to the results of chest three-dimensional reconstruction,the ultrasound group determined the incision based on the control group combined with high-frequency ultrasound,and Based on the method used in the ultrasound group,the “cross-localization” technique was combined to determine the incision in the cross-shaped group.The comparison of surgical-related data included fracture positioning accuracy,incision length of per singer rib,postoperative drainage volume,duration of drainage tube retention,postoperative pain score,operative time,intraoperative blood loss,length of hospital stay and incision infection rate.Additionally,commonly used inflammatory markers (white blood cell count,neutrophil percentage,CRP,IL-6,NF-κB) and pain-related biomarkers (PGE2,5-HT) were also included in the comparative analysis.Results In the control group,ultrasound group,and crossover group,aside from wound infections,the respective accuracies of fracture localization were 68.97% vs 87.50% vs 97.22%,the length of single rib incision was (3.50±1.23) cm vs (2.70±0.62) cm vs (2.45±0.58) cm,the volume of drainage on the day of surgery was (170.55±27.85) ml vs (150.69±24.67) ml vs (120.34±18.45) ml,the duration of drainage tube retention was (4.17±1.12) days vs (3.67±0.95) days vs (3.12±0.65) days,the postoperative pain scores were (6.86±2.15) vs (5.54±1.15) vs (4.89±1.53),the operation times were (75.84±15.62) minutes vs (67.74±11.85) minutes vs (57.35±9.36) minutes,the intraoperative blood loss was (85.78±11.78) ml vs (72.65±8.92) ml vs (62.23±9.63) ml,and the length of hospital stay was (8.42±1.47) days vs (7.12±1.14) days vs (6.56±1.32) days.The crossover group showed superior results in all metrics compared to the other two groups,with statistically significant differences (P<0.05).The inflammatory and pain stress indicators for the control,ultrasound,and crossover groups were as follows:white blood cell counts [(16.39±4.15)×109/L vs (13.25±2.45)×109/L vs (12.02±2.77)×109/L],neutrophil percentages [(80.14±12.21) vs (72.36±10.34) vs (65.73±8.83)],CRP [(31.86±6.87) mg/L vs (27.72±5.65) mg/L vs (24.69±4.11) mg/L],IL-6 [(46.35±11.42) pg/L vs (41.42±8.75) pg/L vs (35.53±9.51) pg/L],NF-B [(22.55±4.98) pg/L vs (17.34±3.62) pg/L vs (15.91±3.84) pg/L],PGE2 [(240.37±21.65) ng/L vs (209.45±23.24) ng/L vs (180.21±18.72) ng/L],and 5-HT [(290.62±34.37) ng/L vs (270.85±26.98) ng/L vs (210.62±19.64) ng/L].The crossover group demonstrated statistically significant differences compared to both the control and ultrasound groups (P<0.05).There was no statistically significant difference in incision infection among the three groups (P > 0.05).Conclusion The ultrasound-guided “cross” positioning method for rib fracture open reduction and internal fixation can more accurately locate the incision,shorten the incision length and hospitalization time,reduce postoperative inflammatory response and patient pain,and facilitate rapid recovery after surgery.

Key words: rib fracture, flail chest, CT three-dimensional reconstruction, ultrasound, localization