Abstract: Objective To compare the clinical efficacy between percutaneous pedicle screw fixation and pedicle screw fixation through Wiltse approach in treatment of patients with thoracolumbar fractures. Methods Totally 30 patients with thoracolumbar fractures were randomly divided into percutaneous group(n=14)and Wiltse group(n=16). The operation related indexes were compared between the two groups. The scores of Visual Analogue Scale(VAS)before operation, on the first day after operation, 6 months after operation and 1 year after operation as well as scores of waist and back Oswestry disability index(ODI)at 3, 6 months and 1 year after operation were compared between the two groups. The relative height of anterior edge of injured vertebral body and kyphosis angle of injured vertebrae were compared between the two groups before operation, on the first day after operation, 6 months after operation and 1 year after operation. The complications were compared between the two groups. Results All the patients completed the operation successfully and were followed up for at least 1 year. The operation time, intra-operative fluoroscopy times in the percutaneous group was significantly longer and more than those in the Wiltse group, and intra-operative blood loss was significantly less than that in the Wiltse group(P<0.05). The VAS scores of the two groups were significantly decreased at 1 day, 6 months and 1 year after operation(P<0.05), and the VAS score at 1 d after operation of the percutaneous group was significantly lower than that of the Wiltse - group(P<0.05). There was no significant difference in ODI scores between the two groups at 3, 6 months and 1 year after operation(P>0.05). After operation, the relative height of the anterior edge of injured vertebrae in the two groups returned to normal, and the kyphosis angle of injured vertebrae was significantly improved compared with operation before(P<0.05), but there was no significant difference between the two groups at each time point(P>0.05). Wound infection occurred in 1 case(6.3%)in the Wiltse group and 1 case with subcutaneous hematoma(7.1%)in the percutaneous group, and there was no significant difference in the incidence of complications between the two groups(P>0.05). Conclusion Both internal fixation by percutaneous pedicle screw and pedicle fixation by the Wiltse approach can achieve satisfactory clinical effects in the treatment of thoracolumbar fractures, and have lower incidence of complication. Internal fixation by percutaneous pedicle screw should be given for single-segment fracture patients without spinal canal decompressive operation, while pedicle fixation by the Wiltse approach should be given for multiple-segment fracture patients without spinal canal decompressive operation.