Objective To compare the safety and curative effect of video-assisted thoracoscopic surgery (VATS) and traditional thoracotomy in treatment of traumatic hemothorax. Methods The clinical data of 91 patients with hemothorax (received VATS) and 131 patients (received thoracotomy) in the Second Affiliated Hospital of PLA Air Force Military Medical University from January 2012 to December 2018 were retrospectively case-control analyzed. The curative effects between the two groups were compared by propensity score matching (PSM) method, and the risk factors of complications were predicted with multivariate logistic analysis. Results The total incidence of complications in the 222 patients was 22.1%. One patient died in thoracotomy group, whereas no patient died in VATS group. Before PSM, the numbers of fractured ribs, proportions of ribs fixation surgery and blunt injuries were lower (P<0.001) with lower incidence of complications (P=0.008) and shorter hospital length of stay (LOS) (P<0.001) in VATS group than those in thoracotomy group. After 1:1 PSM, 120 patients (60 patients in each group) were selected for further statistical analysis, and no significant difference was then identified between the two groups in the rate of complications and the hospital LOS (P>0.05). Significant statistical differences existed between the two groups in postoperative volume of drainage (P=0.006), drainage time (P=0.008), as well as postoperative hospital LOS (P=0.022) and ICU length of stay (P=0.010). Multivariate logistic analysis showed that the operation mode was not the independent risk factor for postoperative complications of traumatic hemothorax operation (OR=0.848, P=0.755). Conclusions VATS is safe and effective for hemodynamically stable patients with traumatic hemothorax since it can avoid the huge trauma of traditional thoracotomy,accelerate postoperative recovery of patients and shorten their postoperative hospital stay.