[Objective] To explore the therapeutic effect of preoperative 3D simulation surgery on AS orthopedics. [Methods] From December 2015 to December 2020, 47 patients with ankylosing spondylitis complicated with kyphosis were selected in our hospital for posterior spinal canal decompression, bone grafting, fusion and internal fixation. According to the specific contents of the communication between doctors and patients, 19 patients were selected for pre-operative 3D assisted personalized simulation surgery, while the other 28 patients were selected for conventional surgery. During the whole diagnosis and treatment process, the perioperative, follow-up and imaging information of the two groups of patients were recorded and compared. [Results] The indexes of operation cycle, intraoperative blood loss, blood transfusion and hemoglobin level of patients in the preoperative 3D assisted personalized simulation group were significantly higher than those of patients in the conventional diagnosis and treatment group (P<0.05). The follow-up period of the two groups of patients ranged from 22 to 32 months. The average follow-up period of each patient was 27.8 ± 7.8 months in the 3D assisted personalized simulation group and 26.5 ± 7.3 months in the conventional group. With the passage of time, VAS and ODI scores of patients in the two groups decreased significantly (P<0.05), which was significant, while JOA scores of patients increased significantly (P<0.05), which was significant. From the time point perspective, there was no significant difference in VAS, ODI and JOA scores between the two groups (P>0.05). From the perspective of image, the accuracy of screw placement in preoperative 3D assisted personalized simulation patients was significantly higher than that in the conventional diagnosis and treatment group (P<0.05). Compared with that before operation, the kyphotic Cobb angle, CBD, SVA and LL of the two groups of patients in the last follow-up were significantly improved compared with that before operation (P<0.05), but there was no significant difference between TK and that before operation (P>0.05). At the corresponding time point, there was no significant difference between the two groups in the relevant indicators (P>0.05). [Conclusion] Compared with conventional surgery, preoperative 3D assisted personalized simulation surgery can complete the operation as scheduled, meet the preoperative requirements, reduce the operation time, reduce the surgical trauma, and effectively avoid postoperative complications of orthopedic surgery.