OBJECTIVE: To observe the near- and long-term efficacy of unilateral puncture kyphoplasty for osteoporotic vertebral compression fractures. METHODS: Twenty-two patients with fresh osteoporotic vertebral compression fractures underwent unilateral puncture kyphoplasty with a mean follow-up of 2.3 years; preoperative VAS score and VAS score at discharge were performed, and preoperative vertebral body heights and Cobb angles of the anterior, middle and posterior margins of the compressed vertebral body were measured; the side of puncture, the type of instrumentation applied, the amount of bone cement injected and complications were recorded; VAS score was performed at follow-up, and Measurements were made of the anterior, middle and posterior marginal vertebral body heights and Cobb angles, cement position, adjacent vertebral body conditions, and whether other vertebral fractures occurred in the X-ray treated vertebrae at follow-up. RESULTS: The pain relief rate was 91% postoperatively and 95% at a mean of 2.3 years postoperatively; there were statistically significant differences in VAS scores between preoperative and postoperative, and postoperative to follow-up; there were no differences in VAS scores between the application of Kyphon balloon and SKY; transcatheter left and right pedicle puncture; the amount of bone cement injected, and the location of the bone cement. There was no statistically significant difference between preoperative and postoperative vertebral body anterior, middle and posterior margin height, Cobb angle; leakage rate was 23%; other vertebral body fracture incidence was 13.6%. Conclusions: 1. unilateral puncture was effective for pain relief and long-term results were positive; 2. which side of the puncture, instrument type, bone cement injection site, and injection volume were not related to pain relief; 3. for right-handed operators, left-sided puncture was easier to reach the ideal position. 4. leakage of bone cement intervertebral space did not affect long-term efficacy; 5. 1-12 months after surgery was a high incidence of re-fracture. 6. PKP overall did not achieve the purpose of partially repositioning the fracture and improving the kyphosis.