[目的]通过对39例接受外科治疗的股骨近端骨纤维结构不良病例进行回顾性分析,提出用于指导外科治疗的分区方法,并根据分区方法探讨股骨近端骨纤维结构不良的外科治疗策略.[方法]对1998～2009年收治的39例股骨近端骨纤维结构不良症病例进行回顾性分析,根据患者术前X线平片判断病变范围,并根据股骨近端受累范围提出分区方法.分析分区类型与外科治疗方案的关系.并通过对患者术后局部病灶控制情况及术后功能(MSTS 93评分)评价外科治疗的效果.[结果]根据39例病变范围,并结合股骨近端解剖特点,将股骨近端分为四个区:Ⅰ区,股骨干(小粗隆以下);Ⅱ区,粗隆间(小转子至股骨颈基底部);Ⅲ区,股骨颈;Ⅳ区,股骨头.根据上述分区,病变分为7种类型,Ⅰ型9例,Ⅱ型12例,Ⅲ型3例,Ⅰ+Ⅱ型6例,Ⅱ+Ⅲ型5例,Ⅱ+Ⅲ+Ⅳ型2例,Ⅰ+Ⅱ+Ⅲ型2例,Ⅰ+Ⅱ+Ⅲ+Ⅳ型1例.手术主要采用病变刮除植骨+内固定.内固定方式有DHS,髓内钉及人工关节置换,其中DHS最常见于Ⅱ区受累(57.58%),其次为Ⅲ区受累(24.24%);髓内针固定见于Ⅰ区受累(64.70%)及Ⅱ区受累(35.30%).病变累及三区及三区以上的病例,采用关节置换.本组39例均得到随访,中位随访时间为6.3年(0.5～11年).MSTS 93评分:(91.70±9.64)%.局部复发率12.82%(5/39),均未发现局部畸形加重.本组病例随访结果满意,选取的治疗方法较为合理.[结论]制订股骨近端骨纤维结构不良外科治疗方案时,应先考虑病变部位特点,从而选用合理的内固定方式,达到较好的外科治疗效果;本文提出的分区方法町以作为术前制订外科治疗方案的参考.“,”[Objective]To retrospectively analyze 39 cases of surgical treatment of fibrous dysplasia of proximal femur, in order to propose a partition method which can be used to guide the surgical treatment, and probe the surgical treatment strategy according to the partition method of fibrous dysplasia of proximal femur. [Methods]The data on 39 cases of fibrous dysplasia of proximal femoral from 1998 to 2009 were retrospectively analyzed. The study determined extent of the lesion according to preoperative X-ray film and proposed partitioning method in accordance with the scope of proximal femoral involvement, analyzed the relation of partition type and surgical treatment , and evaluated the effect of surgical treatment through the postoperative localized lesions control and functional score (MSTS 93 ). [Results]According to the scope of 39 cases of lesions, combined with characteristics of proximal femoral anatomy , proximal femur was divided into four zones: area Ⅰ, femoral shaft ( below small protuberance) ; area Ⅱ, intertrochanteric ( small rotor to the neck base division); area Ⅲ, femoral neck; area Ⅳ, the femoral head. Based on the above partition, lesions were divided into 7 types, type Ⅰ , type Ⅱ , type Ⅲ , type Ⅰ + Ⅱ , type Ⅱ + Ⅲ , type Ⅱ +Ⅲ + Ⅳ , type Ⅰ +Ⅱ + Ⅲ , type Ⅰ +Ⅱ + Ⅲ +Ⅳ. Surgical treatment was performed mainly with curettage of bone lesions,bone grafting and fixation.Internal fixation included DHS, intramedullary nails, and artificial joint replacement, DHS was most common in area Ⅱ involvement (57.58% ) , followed by area Ⅲ involvement (24.24% ) . Intramedullary nail was most common in area Ⅰ involvement (64.70% ) and area Ⅱ involvement (35.30% ) . For lesions involving ≥ 3 zones, joint replacement was carried out. The patients were all followed up, with a median time of 6. 3 years (0. 5 - 11 years) . Local recurrence rate was 12. 82% (5 / 39) , local deformity was not found deterious. The followed up results were satisfactory. The selected treatment was reasonable. [Conclusion]When making a surgical treatment regimen for fibrous dysplasia of the proximal femur, Surgeons should consider lesion characteristics, and choose a reasonable internal fixation to achieve better surgical results. Partition method proposed in this paper can be formulated as one of preoperative surgical treatment options.