The medical image registration between preoperative three-dimensional (3D) scan data and intraoperative two-dimensional (2D) image is a key technology in the surgical navigation. Most previous methods need to generate 2D digitally reconstructed radiographs (DRR) images from the 3D scan volume data, then use conventional image similarity function for comparison. This procedure includes a large amount of calculation and is difficult to archive real-time processing. In this paper, with using geometric feature and image density mixed characteristics, we proposed a new similarity measure function for fast 2D-3D registration of preoperative CT and intraoperative X-ray images. This algorithm is easy to implement, and the calculation process is very short, while the resulting registration accuracy can meet the clinical use. In addition, the entire calculation process is very suitable for highly parallel numerical calculation by using the algorithm based on CUDA hardware acceleration to satisfy the requirement of real-time application in surgery.