The invention discloses a multi-angle adjustment puncture fixator based on medical image guidance. The fixator comprises a base sleeve, an adjusting plate, a gear sleeve, a rotating shaft, a gear clamping plate, a fixed seat, a screw rod, a sliding block, a positioning arc plate I, a positioning arc plate II, a sliding plate and a middle positioning plate. The invention discloses the multi-angle adjustment puncture fixator based on medical image guidance. Firstly, a combined structure is adopted, so that installation and operation are convenient; secondly, longitudinal angle and transverse angle double-adjustment guide design is adopted, rapid positioning of multiple angles and degrees of freedom can be met, puncture accuracy is improved, clinical operation is facilitated, and the problemthat an assistant is needed for fixing a puncture needle during conventional needle biopsy is solved; and finally, the distance between the positioning arc plates can be adjusted in cooperation with alead screw structure, and adaptive adjustment can be conducted according to the sizes of the head, limbs and other areas of a patient. In conclusion, the fixator is high in practicability, stable, reliable and extremely high in application and popularization value.