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目的:探讨载距突轴位和正位X线成像技术在跟骨关节内骨折手术中的应用价值。方法:回顾性研究。纳入2015年1月—2020年1月徐州医科大学附属宿迁医院SandersⅡ～Ⅳ型跟骨关节内骨折患者82例(92足)，其中男47例、女35例，年龄18～71岁，均采用接骨板-螺钉内固定术治疗，按照术中不同的X线透视方法分组：常规组45例(50足)，男25例、女20例，年龄(39.65±9.28)岁，采用跟骨侧位和轴位X线透视；观察组37例(42足)，男22例、女15例，年龄(41.22±8.65)岁，在跟骨侧位X线透视基础上，采用载距突轴位和正位X线透视。术后行足踝多层螺旋CT(MSCT)扫描和Mimics建模，评价载距突置钉质量，对比分析两组载距突置钉数和置钉优良率的差异。结果:两组患者术前一般资料比较差异均无统计学意义(n P值均>0.05)。常规组(50足)载距突置钉(1.22±0.43)枚(共60枚)，观察组(42足)载距突置钉(1.61±0.53)枚(共67枚)，两组置钉数差异有统计学意义(n t＝4.521, n P<0.05)。观察组置钉优良率97.01%(65/67)，高于常规组的85.00%(51/60)，差异有统计学意义(χn 2＝5.776, n P0.05). Sixty screws were placed into the sustentaculum tali for 50 feet with an average screw placement for each foot (1.22±0.43) in the routine group. In the observation group, 67 screws were placed into the sustentaculum tali for 42 feet with an average for each foot (1.61±0.53); the difference was statistically significant (n t=4.521, n P<0.05). Compared with the routine group, the observation group had a higher excellent rate of screw placement into the sustentaculum tali (97.01% [65/67]n vs. 85.00% [51/60]), showing a statistical difference (χn 2=5.776, n P<0.05).n Conclusions:On the basis of lateral X-ray fluoroscopy of calcaneus, the application of the axial and frontal fluoroscopy of sustentaculum tali to aid intraoperative X-ray fluoroscopy of intra-articular calcaneal fractures to guide the screw placement is helpful to increase the number of screw placed, improve the accuracy of the screw placement.