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.