Objective To provide a theoretical basis for the clinical treatment of vertebral compression fractures, finite element method was used to analyze the stress distribution of vertebral implants with chiral honeycomb sandwich structure. Methods A trichiral honeycomb sandwich structure was constructed as the 3-D finite element model of the vertebral implant.The structural parameters was optimized by combining orthogonal experiment with the size effect in-plane and out-of plane,and the stress of the five different loadings was analyzed. Results The combination of structural parameters with the minimum stress peak value was as follows: cell wall thickness 0.28mm, panel thickness 0.8mm, cell height 0.2mm, ligament length 0.6mm.The stress peak occurs at the edge of the honeycomb core near the upper and lower panels, and the maximum strain is located at the edge of the upper panel which is not supported by the honeycomb core. Conclusions After optimized design, the chiral honeycomb sandwich structure can meet the physiological load of human body, and the stress peak value after implantation is smaller than that of the regular hexagonal honeycomb sandwich structure, and the stress distribution is more uniform, which is suitable for the basic structure of vertebral implant.