Objective　To investigate the clinical effect of the Wiltse muscle gap approach combined with vertebral screw placement on treating of thoracolumbar fractures.　Methods　53 patients with thoracolumbar fractures were admitted to our department from October 2015 to October 2018, which were divided into a Wiltse muscle gap approach group (group A) and a traditional posterior median group (group B) according to the surgical approach. Based on Frankel Graded to grade E, there was no need for the patients to perform the spinal decompression and bone graft fusion. 28 patients in the group A were treated with Wiltse muscle gap approach, and 26 patients in the group B were treated with conventional posterior surgery. The operation time, intraoperative blood loss, postoperative drainage volume, postoperative ground time were observed. Visual analog scale (VAS) was used to evaluate the pain, and the height of the vertebral body leading edge and Cobb angle were measured and compared.　Results　All patients were followed up for 6 to 18 months, with an average of 12.5 months. The operation time, intraoperative blood loss, postoperative drainage volume, postoperative ground time and other indicators in the group A were better than that of the group B (P<0.05). There was statistical difference in VAS scores between 3 days and 1 month after operation of the two groups (P<0.05). There was no significant difference in the height and Cobb angle between the two groups.　Conclusions　The Wiltse muscle gap approach combined with the vertebral screw placement for the treatment of thoracolumbar fractures is simple to operate and pale the screw, which can reduce the operation time, bleeding volume and the degree of postoperative low back pain, shorten the recovery time, with little effect on the paravertebral muscles and high clinical application value.