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目的:比较胸腰椎损伤分类及损伤程度评分系统（TLICS）评分≤4分的中青年胸腰椎骨折患者行经椎旁肌间隙入路椎弓根螺钉内固定治疗与保守治疗的疗效。方法:回顾性分析2014年1月至2018年12月山西医科大学第二医院骨科收治且获得随访的219例TLICS评分≤4分的胸腰椎骨折中青年患者资料。根据治疗方法不同分为手术组（126例，行经椎旁肌间隙椎弓根螺钉内固定术）和保守组（93例，保守治疗）。手术组：男65例，女61例；年龄18~37岁；TLICS评分：1分38例，2~4分88例。保守组：男48例，女45例；年龄19~38岁；TLICS评分：1分29例，2~4分64例。两组患者在治疗前均进行胸腰椎X线、CT及MRI检查，治疗后均定期复查胸腰椎X线。分别计算两组患者治疗后的下腰痛视觉模拟评分（VAS）较术前的改善情况，比较两组患者治疗前、治疗后1个月、末次随访时的VAS、伤椎前缘高度及后凸cobb角。结果:手术组和保守组患者治疗前一般资料比较差异均无统计学意义（n P>0.05），具有可比性。手术组随访24~72个月；治疗后1个月、末次随访时的VAS评分[（2.5±1.2）分、（2.3±0.8分）]较术前[（6.8±2.1）分]显著改善，差异均有统计学意义（n P< 0.05）；治疗后未发生严重的手术并发症。保守组随访30~65个月；治疗后1个月、末次随访时的VAS评分[（3.9±1.9）分、（3.5±0.9分）]较术前[（6.2±2.0）分]显著改善，差异均有统计学意义（n P< 0.05）；出现下肢神经症状3例，发生褥疮4例，肺部感染4例，并发症发生率为11.8%（11/93）。手术组术后1个月、末次随访时的VAS评分、伤椎前缘高度、后凸cobb角均优于保守组，差异有统计学意义（n P0.05). In the surgery group, patients were followed up for 24 to 72 months, the average VAS scores at one month post-treatment (2.5±1.2) and the last follow-up (2.3±0.8) were significantly improved compared to the pre-treatment value (6.8±2.1) (n P<0.05), and no serious surgical complications occurred. In the conservative group, patients were followed up for 30 to 65 months, the average VAS scores at one month post-treatment (3.9±1.9) and the last follow-up (3.5±0.9) were significantly improved compared to the pre-treatment value (6.2±2.0) (n P<0.05), and the rate of complications was 11.8% (11/93, including 3 cases of neural symptoms of the lower limb, 4 cases of bedsore and 4 cases of pulmonary infection). The VAS, anterior height of the injured vertebra and kyphosis cobb angle at one month post-treatment and the last follow-up in the surgery group were all significantly better than in the conservative group (n P<0.05).n Conclusion:In young patients with thoracolumbar fracture with TLICS ≤ 4 points, pedicle screw internal fixation via the Wiltse approach can lead to better therapeutic outcomes than conservative treatment, especially in relief of postoperative low back pain.