[Objective]To evaluate the accuracy and significance of 3D printed guide assisted pedicle screw placement for fixation of the upper and middle thoracic spine fractures.[Methods]A retrospective study was performed on 50 patients who underwent surgical treat-ment for upper and middle thoracic spine fractures from December 2019 to December 2022.According to preoperative doctor-patient com-munication,25 patients had screw placed by the 3D printed guides(the guide group),while the remaining 25 patients were managed by tradi-tional freehand technique(the freehand group).The perioperative,follow-up and imaging data of the two groups were compared.[Results]All the 50 patients were successfully operated without injuries to aorta,thoracic pulp and nerve root.The guide group proved significantly su-perior to the freehand group in terms of intraoperative fluoroscopy times[(2.8±1.2)times vs(9.5±2.7)times,P＜0.001],time of single screw placement[(2.2±0.5)min vs(3.5±0.7)min,P＜0.001],success rate of first time screw placement(100.0％vs 90.7％,P＜0.001),whereas the former consumed significantly higher medical fee than the latter[(35 221.4±423.2)yuan vs(34 358.5±442.9)yuan,P＜0.001].However,there were no significant differences in operation time,total incision length,intraoperative blood loss and hospital stay between the two groups(P＞0.05).As time went on in follow-up period lasted for(16.8±3.4)months,the VAS,ODI and JOA scores,as well as ASIA neurologi-cal function classification significantly improved in both groups(P＜0.05),whereas which were not statistically significant between the two groups at any time points accordingly(P＞0.05).As result of postoperative imaging evaluation,the guide group was also proved significantly superior to the freehand group regarding screw placement accuracy[(0/Ⅰ/Ⅱ),(146/4/0)vs(122/23/5),P＜0.001].At the last follow-up,all pa-tients in both groups got fracture healing without loosening of internal implants.[Conclusion]The 3D printed guide assisted pedicle screw placement for fixation of the upper and middle thoracic spine fractures does improves the accuracy with less radiation exposure and higher safety.
upper and middle thoracic spine fracturespedicle screw fixation3D printingguide
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