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Purpose: To study the therapeutic effect of percutaneous pedicle screw fixation (PPSF) combined with Tongdu Huoxue decoction on thoracolumbar spine fractures. Methods: Ninety-eight patients with thoracolumbar spine fractures treated with PPSF were retrospectively enrolled and grouped into a study group (SG, n = 51, PPSF combined with THD), and a control group (CG, n = 47, PPSF). General surgical indices, postoperative pain, postoperative Oswestry dysfunction index (ODI index), preoperative and postoperative imaging indices, and postoperative hemodynamic indices were determined and recorded. Results: Patients in SG exhibited significantly lower visual analog scale (VAS) scores higher than those of CG at 3, 7 and 15 days after surgery (p < 0.05). At 15 and 30 days after surgery, patients in SG exhibited significantly lower ODI index than those in CG (p < 0.05). At day 60 after surgery, Cobb angle was lower in SG than in CG, while the injured vertebral body showed higher anterior height in SG than in CG. Furthermore, FIB and D-D were lower in SG than in CG at day 7, but exhibited higher PT than CG (p < 0.05). Conclusion: The combined application of PPSF and THD in patients with thoracolumbar fractures ameliorates postoperative pain levels, improves short-term spinal function, and significantly alters the postoperative coagulation index of patients, presumably by reducing the incidence of postoperative thrombosis. However, there is a need for further clinical trials prior to the introduction of this therapy into clinical practice.