The invention provides a sacrum nerve puncture path simulation planning system and device, and relates to puncture operation simulation. The sacrum nerve puncture path simulation planning system comprises an image obtaining module and a path simulation planning module, and the image obtaining module is configured to obtain scanning images of sacrum, sacral foramen and a positioning grid located at a lumbosacral part; and the path simulation planning module is configured to establish a three-dimensional model of the sacrum, the sacral foramen and the positioning grid according to the scanned image, and acquire a virtual puncture path penetrating through the positioning grid to reach a sacrum set position and an intersection point of the positioning grid and the virtual puncture path according to the three-dimensional model. The problems that at present, sacral nerve holes are directly punctured for many times, and pain of patients is large are solved. By acquiring the scanning images of the positioning grid, sacrum and sacral foramen, taking the positioning grid as a positioning reference, reconstructing the three-dimensional model of the sacrum, the sacral foramen and the positioning grid, taking a reference of penetrating through the positioning grid to reach a sacrum set position, and establishing a plurality of virtual puncture paths, a human organ state and an actual puncture process are simulated.