Artificial intelligence (AI)-native three-dimensional (3D) spectrum maps are crucial in spectrum monitoring for intelligent communication networks. However, it is challenging to obtain and transmit 3D spectrum maps in a spectrum-efficient, computation-efficient, and AI-driven manner, especially under complex communication environments and sparse sampling data. In this paper, we consider practical air-to-ground semantic communications for spectrum map completion, where the unmanned aerial vehicle (UAV) measures the spectrum at spatial points and extracts the spectrum semantics, which are then utilized to complete spectrum maps at the ground device. Since statistical machine learning can easily be misled by superficial data correlations with the lack of interpretability, we propose a novel knowledge-enhanced semantic spectrum map completion framework with two expert knowledge-driven constraints from physical signal propagation models. This framework can capture the real-world physics and avoid getting stuck in the mindset of superficial data distributions. Furthermore, a knowledge-enhanced vector-quantized Transformer (KE-VQ-Transformer) based multi-scale low-complex intelligent completion approach is proposed, where the sparse window is applied to avoid ultra-large 3D attention computation, and the multi-scale design improves the completion performance. The knowledge-enhanced mean square error (KMSE) and root KMSE (RKMSE) are introduced as novel metrics for semantic spectrum map completion that jointly consider the numerical precision and physical consistency with the signal propagation model, based on which a joint offline and online training method is developed with supervised and unsupervised knowledge loss. The simulation demonstrates that our proposed scheme outperforms the state-of-the-art benchmark schemes in terms of RKMSE.