Multiple rib fractures (shackle thorax) are more serious chest injuries in which paradoxical whistling occurs due to loss of chest wall stability, resulting in severe whistling and circulatory dysfunction. Early and proper treatment of shackle thorax can significantly improve the early whistling function of patients, ensure the blood oxygen supply to the heart, brain, liver, kidney and other important organs, significantly reduce the related complications caused by hypoxemia, and reduce the occurrence of ARDS/MODS, which is crucial to improve the cure rate and reduce the mortality rate of patients. The traditional methods of treatment of shackled chest are: ① external fixation with cotton pad pressure can be used in most cases; ② suspension traction of floating injured ribs; ③ external fixation traction of chest wall; ④ endotracheal chest wall fixation, i.e. endotracheal intubation, whistle machine to maintain artificial ventilation, applicable to severe chest trauma, combined with floating chest wall, this method should be used with caution. The traditional method has more complications and a longer duration of illness. In order to achieve the elimination of chest wall floating and shackle chest, minimize the risk and relieve the patient’s pain, it has become a trend to use internal fixation devices for surgical internal fixation to correct shackle chest. There are various implantation materials, such as steel wire, Kirschner’s pin, thin steel plate, ring hugger, etc. Steel wire and Kirschner’s pin do not fix the ribs firmly, the patient’s pain lasts long after surgery, affects early coughing and sputum, and the fracture is easily displaced after activity; steel wire and Kirschner’s pin are prone to electrolytic reaction, slow recovery, and often need to be removed. Nickel-titanium alloy ring holding apparatus has various advantages that traditional fixation methods do not have, such as easy operation, safety, reliable fixation, good histocompatibility and less complications. The patient’s shackle chest and mediastinal sway disappeared after surgery, and the early whistling function was significantly improved; therefore, the application of nickel-titanium alloy ring holder internal fixation method in the plateau area is a more ideal treatment method to improve the early whistling function of patients with shackle chest. Surgical method The corresponding position and incision can be made according to the rib fracture. Since rib fractures are mostly multiple, the length of the incision depends on the number of rib fractures and the fracture site. The fracture end is revealed by incision layer by layer, the soft tissue at the fracture end is removed, and the distal and proximal ends of the ribs ready for fixation are peeled back 3 cm from the periosteum to give anatomical repositioning, and the fracture fragments are returned to their original position. Take the nickel-titanium alloy ring hugger and soak it in sterile ice saline at 0-5℃ for 3-5 minutes, then use the spreader to open the tooth arms separately so that the opening of each pair of tooth arms is slightly larger than the transverse diameter of the rib, and quickly set it on the rib from above or below the fracture, and flush its surface with warm saline at 40-45℃ to speed up the closure of the tooth arms and move both ends of the fracture to observe whether the fracture is fixed satisfactorily and to confirm whether the tooth arms of the ring hugger hold the rib The ring was fixed without loosening. The same method was used to fix the rest of the rib fractures in turn.