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51.
Ran Wei Chiao Yee Lim Yi Yang Xiaodong Tang Taiqiang Yan Rongli Yang Wei Guo 《Orthopaedic Surgery》2021,13(2):553
ObjectivesThis study aims to: (i) evaluate the outcome of patients with Harrington class III lesions who were treated according to Harrington classification; (ii) propose a modified surgical classification for Harrington class III lesions; and (iii) assess the efficiency of the proposed modified classification.MethodsThis study composes two phases. During phase 1 (2006 to 2011), the clinical data of 16 patients with Harrington class III lesions who were treated by intralesional excision followed by reconstruction of antegrade/retrograde Steinmann pins/screws with cemented total hip arthroplasty (Harrington/modified Harrington procedure) were retrospectively reviewed and further analyzed synthetically to design a modified surgical classification system. In phase 2 (2013 to 2019), 62 patients with Harrington class III lesions were classified and surgically treated according to our modified classification. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) 93 scoring system. The outcome of local control was described using 2‐year recurrence‐free survival (RFS). Owing to the limited sample size, we considered P < 0.1 as significant.ResultsIn phase 1, the mean surgical time was 273.1 (180 to 390) min and the mean intraoperative hemorrhage was 2425.0 (400.0 to 8000.0) mL, respectively. The mean follow‐up time was 18.5 (2 to 54) months. Recurrence was found in 4 patients and the 2‐year RFS rate was 62.4% (95% confidence interval [CI] 31.6% to 93.2%). The mean postoperative MSTS93 score was 56.5% (20% to 90%). Based on the periacetabular bone destruction, we categorized the lesions into two subgroups: with the bone destruction distal to or around the inferior border of the sacroiliac joint (IIIa) and the bone destruction extended proximal to inferior border of the sacroiliac joint (IIIb). Six patients with IIIb lesions had significant prolonged surgical time (313.3 vs 249.0 min, P = 0.022), massive intraoperative hemorrhage (3533.3 vs 1760.0 mL, P = 0.093), poor functional outcome (46.7% vs 62.3%, P = 0.093), and unfavorable local control (31.3% vs 80.0%, P = 0.037) compared to the 10 patients with IIIa lesions. We then modified the surgical strategy for two subgroup of class III lesions: Harrington/modified Harrington procedure for IIIa lesions and en bloc resection followed by modular hemipelvic endoprosthesis replacement for IIIb lesions. Using the proposed modified surgical classification, 62 patients in the phase 2 study demonstrated improved surgical time (245.3 min, P = 0.086), intraoperative hemorrhage (1466.0 mL, P = 0.092), postoperative MSTS 93 scores (65.3%, P = 0.067), and 2‐year RFS rate (91.3%, P = 0.002) during a mean follow‐up time of 19.9 (1 to 60) months compared to those in the phase 1 study.ConclusionThe Harrington surgical classification is insufficient for class III lesions. We proposed modification of the classification for Harrington class III lesions by adding two subgroups and corresponding surgical strategies according to the involvement of bone destruction. Our proposed modified classification showed significant improvement in functional outcome and local control, along with acceptable surgical complexity in surgical management for Harrington class III lesions. 相似文献
52.
ObjectiveTo report our experience in the reconstruction of soft tissue defects in the hand with a free anterolateral thigh deep fascia flap and describe the clinical outcomes.MethodsThis study was a retrospective trial. From November 2016 to January 2020, six patients (four men and two women) with soft tissue defects in the hand were included in this study. The average age of the patients was 33.7 ± 12.7 years (range, 20 to 50 years). All patients underwent reconstructions with free anterolateral thigh deep fascia flaps. Relevant clinical characteristics were recorded prior to surgery. The size and thickness of the deep fascia flap and the thickness of the skin were measured intraoperatively. The survival of the flaps and skin grafts and the occurrence of infection were recorded after the operation. At follow‐up, donor site complications and postoperative effects were evaluated according to the outcome satisfaction scale. The pain in the injured hand was assessed using the visual analog scale.ResultsThe average body mass index (BMI) was 26.6 ± 1.7 kg/m2 (range, 23.9 to 28.7 kg/m2). The defect sizes ranged from 5 cm × 5 cm to 13 cm × 8 cm (average, 53.1 ± 27.9 cm2). The six anterolateral thigh deep fascia flaps ranged from 7 cm × 6 cm to 14 cm × 9 cm in size (average, 71.8 ± 29.1 cm2). The thicknesses of skin ranged from 25 mm to 40 mm (average, 32.5 ± 4.8 mm), and the thicknesses of the deep fascia flaps ranged from 2 mm to 3 mm (average, 2.5 ± 0.5 mm). After the operation, the blood supply of the deep fascia flap was normal in all cases. The second‐stage skin grafts of most patients survived completely. The skin graft in one case was partially necrotic and healed after a dressing change. No infection occurred. At follow‐up (average, 16.3 ± 6.9 months), there was only a linear scar and no loss of sensation at the donor site of each patient. According to the outcome satisfaction scale, the outcome satisfaction score ranged from 6 to 8 (average, 7.2 ± 0.9), all of which were satisfactory. Apart from one patient who reported mild pain, all the other patients reported no pain. Three typical cases are presented in this article.ConclusionsThe free anterolateral thigh deep fascia flap, which is suitable for reconstruction of soft tissue defects in the hand, can provide very good outcomes both functionally and aesthetically. 相似文献
53.
目的 :探讨先天性髋脱位治疗优化方法 ,减少并发症。方法 :自 1 986~ 1 998年应用改进Zahradnicek手术治疗先天性髋脱位 1 0 3例、1 36个关节 ,用特制的小儿髋臼钻有限切削臼软骨 ,重建髋臼孤形结构 ,恢复其头臼同心圆关系 ,同时矫正前倾角至 5°~ 1 0°,颈干角至1 2 0° ,用专用的 1 2 0°鹅颈钢板固定。结果 :术后疗效评定 :优 76髋 ,为 5 3% ,良 45髋 ,为 33% ,可 9髋 ,为 6 6 % ,差 6髋 ,为 4 4% ,优良率占 89%。结论 :此种手术在一次手术中使股骨头、髋臼、股骨颈及股骨干恢复或接近恢复正常解剖和功能的方法 相似文献
54.
55.
We have developed a breast-conserving surgery consisting of quadrantectomy and regional lymph node dissection and immediate
volume replacement using lateral tissue flap (LTF). The quadrantectomy was employed on the basis of segmental anatomy of the
duct lobular system in which breast carcinoma originates. Lateral skin incision was performed from the apex of mid-axillary
line to the inframammary fold, without removing the skin overlying the tumor. In the early period of breast reconstruction
embraced latissmus dorsi flap (LDF) for 10 patients (reconstruction was not performed on 35 patients), but in the late period
we employed LTF for 56 patients. Four of the 101 patients developed ipsilateral breast cancer during a mean follow-up period
of 48 months, but none died of breast cancer. Among the 56 patients with LTF replacement no patient developed ipsilateral
breast cancer. Fairly good cosmetic outcome was obtained in the patients who underwent the immediate volume replacement. Breast-conserving
surgeries are reviewed, and the surgical procedure using LTF for immediate volume replacement is described. 相似文献
56.
Porous Polyethylene Implants for Nasal Reconstruction: Clinical and Histologic Studies 总被引:2,自引:0,他引:2
Niechajev I 《Aesthetic plastic surgery》1999,23(6):395-402
This paper describes a technique of using Medpor porous high-density polyethylene implants for nasal reconstruction and chin
augmentation. This biocompatible material has been used successfully during the last decade for various applications in the
reconstruction of the facial skeleton. Among its most frequent uses are repair of the orbital floor and reconstruction of
the burned ear, which became standard methods at many centers. Relatively little experience is, at present, on hand concerning
the use of porous polyethylene in reconstruction of the nasal framework. Twenty-three consecutive, difficult nasal reconstructions
were performed using this method since 1996. Patients were followed up for from 1 to 3 years (mean, 2 years). The results
were durable and stable over the time. Eight patients had saddle nose deformity and 15 had catastrophe noses, mostly referrals,
previously operated on from one to four times. My aesthetic goals were correction of the depressed nasal dorsum, creation
of an acceptable nasal dorsum in the thick and/or twisted noses, and tip elevation. For nasal applications Medpor is available
as a strut or sheet. Its body, once implanted, becomes rapidly vascularized and both soft tissue ingrowth and collagen deposition
occur. This was confirmed by the microscopic investigation of biopsies. One patient of Vietnamese origin had an aesthetically
pleasing result, but her family refused to accept her westernized nose. This gave me a unique opportunity to study the whole
Medpor implant 6 months after implantation. There were two complications, one small implant exposure and one low-virulent
infection involving the nasal tip. Following revision and antibiotic treatment, both patients healed without sequel. All reconstructions
were successful in restoring nasal aesthetics and function. Four patients underwent chin augmentations with an uneventful
clinical course. 相似文献
57.
The authors review several proposed approaches to neoomphaloplasty, with emphasis on the use of three flaps anchored to the
fascia, allowing the exposed central area to heal unaided. The procedure is straightforward and can be performed singly or
during abdominoplasty. Results are both cosmetic and natural-looking. 相似文献
58.
目的对78例不同类型眼睑缺损修复与重建回顾性总结,了解显微手术应用的必要性。方法43例采用眼科显微手术器械,部分在手术显微镜下操作。35例采用普通手术器械在肉眼下操作。结果显微手术组创面全部I期愈合,眼睑外形良好。普通手术组1例延期愈合,7例遗留肉眼可见细小瘢痕。两组癫痕形成率P<0.01。结论证明了显微手术在眼睑缺损的修复与重建中必要和可行。 相似文献
59.
A novel method for "ghost" artifact suppression is introduced. It suppresses ghosts induced by motion in any direction, as well as other types of quasi-periodic signal modulation. Because it requires neither special hardware nor intensive data processing, it can be easily implemented on conventional magnetic resonance (MR) imagers. The method is based on the concept of decomposition of a ghosted complex image into a ghost mask and ideal image. A set of deliberately designed acquisitions are used to generate a set of ghosted complex images in which the ghost components are related in a simple manner. With use of equations describing image decomposition and ghost correlation, the ideal image can be calculated pixel by pixel. The ideal image obtained (representing the time-averaged spin-density distribution) is shown to be a truer representation of physical reality than the ghost-free image obtained with ordered phase encoding. In this technique, both interview and intraview effects are taken into account. The technique is also useful in simultaneously suppressing ghosts from multifrequency signal modulations such as respiratory and cardiac motions. The method was successfully tested with three time-interleaved, phase-encoding-order-shifted acquisitions. Experimental results have shown that it is a simple but effective technique. 相似文献
60.
指尖离断再植的血运重建 总被引:6,自引:0,他引:6
目的 探讨指尖离断再植时血运重建的方式。方法 临床上采用4种血运重建的万式对352例401指尖离断进行再植:①吻合指动脉与静脉的断指再植;②动-静脉转流方式的断指再植;③只吻合指动脉的断指再植;④静脉动脉化的断指再植。结果 352例401指,成活381指,成活率95%,手指外形和长度与健指相似,两点辨别觉2~6mm,指甲生长良好。结论 依据显微镜下清创所见离断指尖动静脉损伤状况,选用不同的血运重建方式,有助于扩大指尖再植适应证,提高再植成功率。 相似文献