Objective To analyze the efficacy and complications of percutaneous pedicle screw technique assisted by fluoroscopic positioning plate in the treatment of thoracolumbar vertebral fractures.Methods 110 patients with thoracolumbar vertebral fractures who were treated in the hospital were retrospectively selected between January 2021 and January 2024. According to different positioning methods, 58 patients who were assisted with fluoroscopic positioning plate were included in fluoroscopic positioning plate group (a total of 152 screws), and 52 patients who were assisted with metal positioning needles were enrolled as metal positioning needle group (a total of 139 screws). The preoperative preparation time, preoperative fluoroscopy frequency, puncture time, puncture fluoroscopy frequency, and screw placement accuracy (Rampersaud scoring standard) were recorded in the two groups. The pain degree ［Visual Analogue Scale (VAS)］ was compared between the two groups before surgery and at 3 days, 1 week and 1 month after surgery, and the lumbar function ［Oswestry dysfunction index (ODI)］ and occurrence of postoperative complications were observed before surgery and at 1 month after surgery. Results The preoperative preparation time, preoperative fluoroscopy frequency, puncture time and puncture fluoroscopy frequency in fluoroscopic positioning plate group were shorter or less than those in metal positioning needle group (P<0.05). The screw placement accuracy revealed no statistical significance between the two groups (P>0.05). At 3 days, 1 week, and 1 month after surgery, the VAS scores in both groups showed a significant downward trend (P<0.05), and the VAS scores in fluoroscopic positioning plate group at 3 days and 1 week after surgery were significantly lower than those in metal positioning needle group (P<0.05). The ODI score was significantly declined in both groups at 1 month after surgery (P<0.05), and compared with metal positioning needle group, the ODI score in fluoroscopic positioning plate group was significantly lower (P<0.05). There were no obvious complications in fluoroscopic positioning plate group after surgery, and there were 4 cases (7.69%) of complications in metal positioning needle group (P<0.05). Conclusion Compared with traditional metal positioning needle, the treatment of thoracolumbar fractures with the assistance of fluoroscopic positioning plate has the advantages of smaller trauma, better stability, higher convenience and effectiveness, milder postoperative pain and better functional recovery