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