目的 比较四轴定位3D打印导板辅助穿刺与徒手穿刺经皮椎体成形术的差异，明确3D打印导板辅助经皮椎体成形术临床疗效，探讨其临床应用价值。 方法 纳入广东省中医院珠海医院因骨质疏松性椎体压缩性骨折行单节段椎体成形术治疗患者70例，随机分为徒手组（对照组）、导板组（观察组）。对照组35例患者在传统徒手穿刺下行PVP术，观察组35例患者在四轴定位3D打印导板辅助穿刺下行PVP术，收集两组患者一般资料、围手术期资料、影像学资料、术前术后的功能评分，进行对比分析。 结果 在术中透视次数、手术时间、术后不良反应方面，观察组明显低于对照组，且差异有统计学意义（P < 0.05）。但两组在术中出血量、骨水泥渗漏、骨水泥灌注是否包含骨折部位方面，差异无统计学意义。临床疗效方面，两组患者术后伤椎前缘高度比、术后VAS评分、术后JOA评分均明显优于术前，差异有统计学意义（P < 0.05）。而术前、术后同一时间点，两组患者伤椎前缘高度比、VAS评分和JOA评分对比，差异无统计学意义（P > 0.05）。 结论 四轴定位3D打印导板辅助穿刺与经验丰富的临床医生徒手穿刺行PVP的临床疗效相同，都能迅速缓解疼痛和改善功能障碍。但导板辅助可缩短手术时间，减少透视次数和术后不良反应，使椎体成形手术更快速、更安全。

Objective To compare the difference between four-axis positioning 3D printing guide assisted puncture and manual puncture percutaneous vertebroplasty， to clarify the clinical efficacy of 3D printing guide assisted percutaneous vertebroplasty， and to explore its clinical application value. Methods A total of 70 patients who underwent single-segment vertebroplasty for osteoporotic vertebral compression fractures in our hospital were randomly divided into a manual group （control group） and a guide plate group （observation group）. Thirty-five patients in the control group underwent PVP under the traditional manual puncture， and 35 patients in the observation group underwent PVP under the four-axis positioning 3D printing guide assisted puncture. The general data， perioperative data， imaging data， preoperative and postoperative functional scores of the two groups were collected and compared. Results In terms of intraoperative fluoroscopy times， operation time， and postoperative adverse reactions， the observation group was significantly lower than the control group， and the difference was statistically significant（P < 0.05）. However， there was no significant difference between the two groups in intraoperative blood loss， bone cement leakage， and whether bone cement perfusion included fracture sites. In terms of clinical efficacy， the ratio of anterior vertebral height， postoperative VAS score and postoperative JOA score of the two groups were significantly better than those before operation， and the difference was statistically significant（P < 0.05）. At the same time point before and after operation， there was no significant difference in the height ratio of the anterior edge of the injured vertebra， VAS score and JOA score between the two groups （P > 0.05）. Conclusion The clinical efficacy of four-axis positioning 3D printing guide plate-assisted puncture is the same as that of experienced clinicians with free hand puncture for PVP， which can quickly relieve pain and improve dysfunction. However， guide plate assistance can shorten the operation time， reduce the number of fluoroscopy and postoperative adverse reactions， and make vertebroplasty faster and safer.