Musculoskeletal ultrasound combined with multislice CT 3D reconstruction in the positioning of rib fracture fixation surgery

Li Qiangsheng; Wan Xudong; Zhang Jing; Zhang Song; Huang Ting; Hong Haining; Liu Jun

doi:10.3969/j.issn.1009-4237.2025.05.009

Abstract：Objective To explore the application value of musculoskeletal ultrasound combined with multi-slice CT(MSCT)3D reconstruction in positioning the rib fracture ends during fixation surgery.Methods A retro-spective analysis was conducted on patients who underwent internal fixation surgery for rib fractures at the Third Peo-ple's Hospital of Bengbu Medical University from Jan.2022 to Dec.2023.A total of 60 patients were enrolled,with 44 males and 16 females aged 35-69(mean 54.7)years.The causes of injury were falls in 34 cases,road traf-fic accidents in 21,and falls from height in 5.Patients were allocated into two groups based on the method of rib fracture end positioning:the experimental group and the control group(n=30 for each).In the experimental group,MSCT 3D reconstruction was first used to locate the most obvious fractures,which were then confirmed and marked by musculoskeletal ultrasound;thereafter musculoskeletal ultrasound was re-conducted to locate the rest fracture ends based on the surrounding relations present on MSCT images.In the control group,the traditional MSCT 3D recon-struction and palpation were adopted for positioning.The accuracy of fracture end positioning,positioning time,inci-sion length and surgery exposure time of a single fracture end,as well as NRS scores for pain 48 h postoperatively,were recorded and compared between the two groups.Results The experimental group fixed 117 rib fractures with 127 ends,of which 120 were accurately positioned,with an accuracy rate of 94.5%.The control group fixed 95 rib fractures with 106 ends,of which 82 were accurately positioned,with an accuracy rate of 77.4%.Statistically signifi-cant difference was observed in the accuracy of fracture end positioning between the two groups(P＜0.05).Com-pared with the control groups,the experimental group showed much shorter positioning time(s,38.60±3.47 vs.46.97±3.88),incision length(cm,1.96±0.57 vs.2.80±0.90)and surgery exposure time(min,4.83±1.12 vs.7.17±1.07)for a single fracture end,and the NRS score 48 h postoperatively were much lower(2.93±1.08 vs.3.87±1.11),with statistically significant differences(all P＜0.01).Conclusion The combined use of musculo-skeletal ultrasound and MSCT 3D reconstruction for rib fracture end positioning can significantly improve speed and accuracy,reduce surgical incision length,facilitate fracture end exposure during surgery,and effectively alleviate postoperative pain.