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11.
Nihal Apaydin Murat Bozkurt Marios Loukas R. Shane Tubbs Ali F. Esmer 《Surgical and radiologic anatomy : SRA》2009,31(6):415-418
The position of the inferior gluteal nerve (IGN) makes it vulnerable to iatrogenic injury during posterior and posterolateral
approaches to the hip. Although the posterior approach has been reported to be the most frequently used technique, it is most
likely to be associated with damage to the IGN. As there is scant information in the literature regarding the course and the
anatomic relationships of the IGN, we aimed to investigate the anatomic course of the IGN and define the anatomical landmarks
that can be used by surgeons during posterior approaches to the hip. Thirty-six gluteal regions from adult fixed cadavers
were used for this study. A triangular-shaped anatomic area that contains the IGN was defined. This geometric area was formed
by connecting the following points: posterior inferior iliac spine (PIIS) (apex), ischial tuberosity (IT) and greater trochanter
(GT). This triangle can further be divided into two, the upper triangle being the “danger zone” since it contains the IGN
and its branches. The closest mean distance between the point of IGN origin and the PIIS, IT and the GT was 3.2, 4.8 and 5.4 cm,
respectively. In all specimens, the nerve entered the deep surface of the gluteus maximus approximately 5.4 cm from the apex
of the GT and approached the GT as close as 0.8 cm, on average. Based on our study, dividing the gluteus maximus with standard
techniques may damage the IGN. Posterior minimally invasive approaches to the hip should take into account the point of entry
of the IGN into the gluteus maximus. Localization of the IGN by using the anatomic triangle defined in this study may decrease
surgical morbidity. 相似文献
12.
Novel surgical repair with bilateral
gluteus muscle patching for intractable rectovaginal
fistula 总被引:4,自引:1,他引:3
Abstract.
We created a novel surgical repair for intractable
rectovaginal fistula and treated four patients who had
previously undergone unsuccessful surgery. An X-shaped skin
incision was made on the perineum, and then the rectum was
carefully divided from the vagina. Defects of both the rectum
and the vagina were closed with vertical mattress sutures. The
external sphincter muscle also was approximated. The gluteus
muscle was identified through another skin incision to the
buttock, and cut at the attachment to the femur. Bilateral
gluteus muscles were approximated at the midline of the perineum
so that the vagina was sufficiently separated from the rectum.
Established anorectal angle was 92.5° (SD=6.4°). Mean resting
pressure was 101.3 cm H2O (SD=13.1). All
patients retained complete anal function without soiling. The
unusual problem of erosion of the posterior vaginal wall with
fistulation in a sexually active woman justifies greater
efforts, and this surgical technique offers good prospects in
this small group of patients. 相似文献
13.
目的探讨臀大肌止点上移松解术治疗重型臀肌挛缩症的临床价值。方法重型臀肌挛缩症患者38例行臀大肌止点上移松解术,观察临床效果。结果平均随访29个月,38例患者术后功能改善满意;驼背与骨盆后倾消失35例(97.2%),步态基本恢复正常31例(86.1%),轻度摇摆步态4例(11.1%),1例仍有明显跛行(2.8%);与术前相比,中立位平均屈髋改善94°;在屈髋90°时,髋内收功能平均改善75;°双髋外展肌力正常者32例(88.9%),单侧外展肌力较差者3例(8.3%),双侧外展肌力较差者1例(2.8%)。结论臀大肌止点上移松解术治疗重型臀肌挛缩症,疗效满意。 相似文献
14.
臀中肌的解剖学观测及其临床意义 总被引:1,自引:0,他引:1
目的:为临床臀部疼痛的定位及治疗提供解剖学依据。方法:以两侧髂后上棘连线为A线,从四个水平,即C水平(A线下1.5cm)、D水平(A线下3.5cm)、E水平(A线下5.5cm)、F水平(A线下7.0cm),并以通过左右髂嵴最高点的垂线B线为外侧界,对12具成人防腐尸体的臀大肌、臀中肌、梨状肌的解剖位置进行观测。结果:在四个水平上均可见臀大肌与臀中肌,梨状肌多数见于E和F两个水平上。结论:临床上臀部疼痛大多可能是臀中肌肌筋膜痛,而并非梨状肌。 相似文献
15.
A pilot study of total pelvic floor repair or gluteus maximus transposition for postobstetric neuropathic fecal incontinence 总被引:1,自引:1,他引:0
PURPOSE: The aim of this study was to report pilot data comparing the morbidity and functional outcome of total pelvic floor repair with gluteus maximus transposition for women with postobstetric fecal incontinence. METHODS: This is a prospective, randomized trial of two surgical procedures in 24 women so far. Functional assessment was performed with use of a 20-point clinical incontinence score and patient questionnaire before and after operation. The physiologic parameters, before and after operation, included resting and squeeze anal pressures, length of the high pressure zone, anal and rectal mucosal sensitivity, and pudendal nerve latency. RESULTS: So far, 12 patients have been treated by total pelvic floor repair and 12 by gluteus maximus transposition. Of these, three patients developed wound complications after gluteus maximus transposition compared with none after total pelvic floor repair. Among these cases there was a significant overall improvement in functional score (given as mean ± standard deviation) after both total pelvic floor repair (13.1±2.7vs. 6.6±4.5;P<0.001) and gluteus maximus transposition (13.8±3.8vs. 7.7±6.1;P<0.01), although no difference existed between the groups. There was no change in any of the physiologic measurements after either operation, and preoperative measurements did not identify patients likely to do badly. CONCLUSIONS: We conclude from these preliminary data that both total pelvic floor repair and gluteus maximus transposition significantly improve continence in women with postobstetric neuropathic fecal incontinence. Gluteus maximus transposition gives equivalent results to total pelvic floor repair. Neither procedure has any influence on anorectal physiologic parameters.Preliminary results presented at the Association of Surgeons of Great Britain and Ireland, Glasgow, Scotland, April 9 to 11, 1997. 相似文献
16.
我科于1985年至1986年收治成人双侧臀大肌挛缩症3例。均系成年始发病,有臀部注射或外伤史;以双侧臀部皮沟为其显著特点兼有挛缩引起继发症状。病变以肌肉变性、瘢痕化为主,主要累及臀大肌、筋膜、髂胫束后缘。手术切除条索、瘢痕,效果较好。 相似文献
17.
18.
Makhsous M Lin F Cichowski A Cheng I Fasanati C Grant T Hendrix RW 《Clinical anatomy (New York, N.Y.)》2011,24(5):638-645
The goal of this experiment was to investigate changes in the thickness of the soft tissue overlying the ischial tuberosity (IT) due to changes in hip flexion angle and the addition of a sitting load. Eleven healthy subjects were tested. An apparatus constructed from foam blocks and an air bladder was used to position the subjects in different postures within an MRI tube. MRI images of the buttocks and thigh were obtained for four postures: Supine, 45° Hip Flexion, Non-Weight-Bearing 90° Hip-Flexion, and Weight-Bearing 90° Hip-Flexion. The thickness of muscle, adipose tissue, and skin was measured between the IT tip and skin surface, perpendicular to the cushion placed beneath the thighs. The tissue overlying the IT was found to be significantly (P < 0.001) thinner in 90° Hip-Flexion (73.8 ± 9.0 mm) than in the supine position (135.9 ± 8.1 mm). Muscle thickness decreased significantly from Supine to Non-Weight-Bearing 90° Hip-Flexion (59.1 ± 8.5%, P < 0.001), and further decreased from Non-Weight-Bearing to Weight-Bearing 90° Hip-Flexion (46.2 ± 7.9%, P < 0.001). Under Weight-Bearing 90° Hip-Flexion, the muscle tissue deformed significantly (P < 0.001) more than the adipose tissue and skin. We concluded that the tissue thickness covering the IT significantly decreased with hip flexion, and further decreased by nearly half during loading caused by sitting. In addition, the muscle tissue experienced the largest deformation during sitting. The results of this study may improve our understanding of risk factors for pressure ulcer development due to changes in tissue padding over the IT in different postures. 相似文献
19.
Manouras A Lagoudianakis EE Markogiannakis H Larentzakis A Kekis P Filis K Bramis C Katergiannakis V 《Irish journal of medical science》2009,178(3):359-362
Background Hydatid disease caused by the tapeworm Echinococcus granulosus is a worldwide problem especially in sheep and cattle raising countries.
Aims Muscle involvement is most commonly encountered as recurrence of previously treated disease or concurrently with primary lesions
of the liver or lung. Furthermore, the rarity of muscle hydatidosis has unique implications in diagnosis and management.
Methods We report on three cases of primary echinococcus of the gluteus muscles presented in our clinic during a 10-year period.
Results We have administered albendazole for one cycle of 28 days in two of our patients based on the size and appearance of the cyst.
All patients underwent total pericystectomy without cyst rupture. We have not found any recurrences after minimum follow up
of 12 months.
Conclusions Muscle echinococciasis respond well to surgical intervention. Complete and intact removal of the cyst in primary muscular
hydatidosis should be considered curative. 相似文献
20.
Greater trochanteric pain syndrome is commonly due to gluteus minimus or medius injury rather than trochanteric bursitis.
Gluteal tendinopathy most frequently occurs in late-middle aged females. In this pictorial review the pertinent MRI and US
anatomy of the gluteal tendon insertions on the greater trochanter and the adjacent bursae are reviewed. The direct (peritendinitis,
tendinosis, partial and complete tear) and indirect (bursal fluid, bony changes and fatty atrophy) MRI signs of gluteal tendon
injury are illustrated. The key sonographic findings of gluteal tendinopathy are also discussed. 相似文献