The application of prefabrication technology in underground engineering has been mostly concentrated in subway tunnels and subway stations. Research on the prefabrication technology of underground box culverts is relatively recent. There is almost no research on the improvement in structural performance of aging box culverts using prefabricated assembly technology. Traditional trenchless rehabilitation technology was developed from the rehabilitation of round pipes and was applied to underground square pipes, such as box culverts, after certain improvements. These methods produce a limited increase in the structural bearing capacity of aging underground box culverts and are time-consuming to construct. In this regard, this paper puts forward the idea of reinforcement with and a design method using prefabricated assembly technology to reinforce the interior of a box culvert with high-strength thin-walled concrete segments. A case study was analyzed and a construction simulation was verified. A full-scale prefabricated high-strength concrete segment was subsequently subjected to horizontal and vertical equal-proportion loading static bearing capacity tests. The results showed that the designed and manufactured prefabricated high-strength concrete segment can be independent of the original structural bearing capacity and without its beneficial constraints to meet the design requirements of bearing capacity. It should be noted that in this experiment, the prefabricated segments eventually suffered shear failure at the splice joints, and attention should be given to strengthening the local structure of the splice joints. The reinforcement method proposed in this paper is also applicable to other similar structures with box-shaped internal space sections.