Abstract: [Objective] To explore the feasibility and accuracy of inserting mid upper thoracic screws with the assistance of 3D printing guides. [Method] A retrospective analysis was conducted on 50 patients who underwent upper thoracic spine surgery in our hospital from December 2019 to December 2022. Under the condition of obtaining patient consent before surgery, 25 cases were divided into two groups: 3D printed guide plate assistance (guide plate group) and 25 cases were treated with traditional barehanded nail placement (barehanded group). Compare the perioperative, follow-up, and imaging data between two groups. [Result] All 50 surgeries were successfully completed, and there were no injuries to the aorta or thoracic spinal cord during the surgery. There was no statistically significant difference in surgical time and bleeding volume between the groups (P>0.05). The fluoroscopy frequency [(2.75 ± 1.21) times vs (9.46+2.71) times, P<0.05] and single nail insertion time [(2.23 ± 0.45) minutes vs (3.46 ± 0.72) minutes, P<0.05] in the guide plate group were smaller than those in the unarmed group. The VAS scores of both groups of patients decreased (P<0.05) during follow-up, while the JOA scores of both groups increased (P<0.05). The accuracy of nail placement in the postoperative imaging evaluation guide plate group was better than that in the unarmed group (97.33% vs 81.33%, P<0.05). At the last follow-up, both groups had fractures that healed, and there were no broken nails or loose internal fixators. [Conclusion] The 3D printing guide plate assisted placement of upper and middle thoracic screws improves the safety and accuracy of placement, with minimal radiation exposure.