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81.
目的 探讨应用骨水泥型双极人工股骨头置换治疗高龄股骨颈骨折患者的临床疗效.方法 对38例高龄股骨颈骨折患者行骨水泥型双极人工股骨头置换治疗,根据Harris评分法评定术后疗效.结果 38例均获得随访,时间1~3年.髋关节功能根据Harris评分:优14例,良19例(其中1例随访至第14个月死亡),中5例,优良率为84.2%.结论 应用骨水泥型双极人工股骨头置换治疗高龄患者股骨颈骨折手术风险小、费用低、疗效满意,患者可早期下床活动,提高患者生存质量. 相似文献
82.
Jia-Qi Wang You-Shui Gao Jiong Mei Zhi-Tao Rao Shu-Qing Wang 《Indian Journal of Orthopaedics》2013,47(5):449-453
Background:
It is conventionally considered that bone grafting is mandatory for Vancouver B3 periprosthetic femoral fractures (PFF) although few clinical studies have challenged the concept previously. The aim of the current study was to investigate the radiographic and functional results of Vancouver B3 PFF treated by revision total hip or hemiarthroplasty (HA) in combination with appropriate internal fixation without bone grafting.Materials and Methods:
12 patients with Vancouver B3 PFF were treated by revision THA/HA without bone grafting between March 2004 and May 2008. There were nine females and three males, with an average age of 76 years. PFFs were following primary THA/HA in nine patients and following revision THA/HA in three. Postoperative followup was 5.5 years on average (range, 3.5-6.5 years). At the final followup, radiographic results were evaluated with Beals and Tower''s criteria and functional outcomes were evaluated using the Merle d’Aubigné scoring system.Results:
All fractures healed within an average of 20 weeks (range, 12-28 weeks). There was no significant deformity and shortening of the affected limb and the implant was stable. The average Merle d’Aubigné score was 15.8. Walking ability was regained in 10 patients without additional assistance, while 2 patients had to use crutches. There were 2 patients with numbness of lateral thigh, possibly due to injury to the lateral femoral cutaneous nerve. There were no implant failures, dislocation and refractures.Conclusions:
Revision THA/HA in combination with appropriate internal fixation without bone grafting is a good option for treatment of Vancouver B3 periprosthetic femoral fractures in the elderly. 相似文献83.
目的探讨双极股骨头半髋置换治疗老年不稳定粗隆间骨折的预后并分析其影响因素。方法回顾性分析对2005年3月至2009年10月收治的双极股骨头半髋置换治疗老年不稳定粗隆间骨折的86例患者临床资料,男32例,女54例;年龄71~98岁,平均83.4岁。Evens-JensenⅢ型50例,Ⅳ型36例。57例患者伴有严重骨质疏松。受伤至入院时间1h-8d,平均1.5d,人院至手术时间3-9d,平均4.2d。骨水泥型股骨柄假体置换65例,生物型股骨柄假体置换21例;术中重建股骨距52例,未重建股骨距34例。结果最终68例患者均获得随访,随访时间为12~60个月,平均38个月。单因素与多因素分析均显示骨折分型及是否重建股骨距对股骨柄假体稳定性有显著影响(P〈0.05)。髋关节Harris评分优良率82.4%,单因素分析显示骨折分型及是否重建股骨距对术后髋关节功能恢复有显著影响(P〈0.05),多因素分析显示是否重建股骨距是影响术后髋关节功能恢复的主要因素。25例患者死亡,死亡率为32.1%,其中死于心肺疾患占56.O%。单因素与多因素均分析显示患者性别、年龄及是否重建股骨距对术后死亡率有显著影响(P〈0.05)。结论老年股骨粗隆间骨折可以通过双极人工股骨头半髋置换治疗获得良好疗效。骨折分型及术中是否重建股骨距是影响术后假体稳定性和髋关节功能的主要因素,高龄及合并心肺疾患患者死亡风险更大。 相似文献
84.
目的探讨氨甲环酸对骨水泥型人工半髋置换术治疗股骨颈骨折患者术中、术后出血量的影响。方法选取医院2018年2月至2019年2月行骨水泥型人工半髋置换术治疗的股骨颈骨折患者112例,按随机数字表法分为对照组和观察组,各56例。研究组患者分别于切皮前及关闭切口时静脉滴注氨甲环酸注射液15 mg/kg,对照组患者同时点静脉滴注0.9%氯化钠注射液100 mL。结果观察组患者术中出血量、输血量、术后24 h出血量显著少于对照组,输血率显著低于对照组(P<0.05);术后24 h,观察组患者血红蛋白(Hb)和红细胞比容(PCV)显著高于对照组(P<0.05);观察组不良事件发生率为7.14%,与对照组的10.71%相当(P>0.05)。结论应用骨水泥型人工半髋置换术治疗股骨颈骨折时静脉滴注氨甲环酸,能显著减少患者术中和术后出血量,降低输血率。 相似文献
85.
目的 回顾性分析应用人工股骨头置换及动力髋螺钉系统(dynamic hip screw,DHS)治疗老年骨质疏松性粗隆间骨折,总结该类患者治疗经验。方法选取第四军医大学西京医院骨科2007年1月至2009年12月老年骨质疏松性粗隆间骨折病例103例,其中采用DHS术式71例;采用人工关节置换32例;记录手术时间、术中出血量,术后并发症,骨折愈合情况,术后髋关节Harris功能评分。结果DHS组平均手术时间(96.7±8.6)min,平均出血量(317.7±26.5)ml,术后Harris髋关节功能评分,优32例,良26例,可6例,差7例,优良率81.7%;人工股骨头置换组手术时间平均(107.0±12.8)min,手术出血量平均(335.34-28.1)m1,术后Harris髋关节功能评分:优10例,良14例,可2例,差1例,优良率88.9%。结论结合抗骨质疏松治疗,只要适应证选择恰当,DHS及人工股骨头置换均为老年骨质疏松性粗隆间骨折的有效治疗手段,中短期疗效满意。 相似文献
86.
目的 探讨应用人工肱骨头置换治疗肱骨近端复杂粉碎性骨折的疗效。方法采用Thompson入路行人工肱骨头置换术治疗肱骨近端复杂粉碎性骨折31例,根据美国加州洛杉矶半关节成形改良评分系统(SSMH)对患肩术后功能进行评估。结果手术时间40-90min,平均手术时间65min,出血量200-350ml,平均出血量280ml。患者早期进行功能锻炼。术后随访5-42个月,平均随访14.1个月,所有患者均无感染、神经损伤,复查X线片显示人工肱骨头位置良好,无假体松动、脱位、周围骨折等并发症发生。优13例,良14例,可3例,差1例,优良率为87.10%。结论人工肱骨头置换术是治疗肱骨近端复杂粉碎性骨折的一种较好的方法。 相似文献
87.
Cynthia A. Kahlenberg Shawn S. Richardson William W. Schairer Michael B. Cross 《The Journal of arthroplasty》2018,33(3):771-776
Background
Closed reduction with percutaneous pinning (CRPP) for nondisplaced or valgus impacted femoral neck fractures is a relatively low-risk operation that can produce excellent union rates in some patients; however, failure can occur in selected patients requiring conversion to arthroplasty. The primary aim of this study was to perform a population-level analysis to determine the rate and timeframe of conversion from CRPP to total hip arthroplasty (THA) or hemiarthroplasty.Methods
The PearlDiver database was queried from 2007-2015 for all patients who underwent CRPP for a femoral neck fracture. Survival analysis was used to evaluate the rate of conversion of CRPP to hemiarthroplasty or THA. Risk factors for conversion arthroplasty were identified using a multivariable cox proportional hazards model that included patient demographics and comorbidities.Results
There were 5122 patients in the Humana database and 4840 patients in the Medicare database that were included in analysis. At 5 years after CRPP, the conversion rate was 10.0% in the Medicare patients and 10.8% in the Humana patients. Risk factors for undergoing conversion from CRPP to arthroplasty in the Medicare cohort included preexisting diagnoses of pulmonary and/or circulatory comorbidities, peripheral vascular disease, hypertension, hypothyroidism, and metastatic cancer. In the Humana cohort, the only risk factors were male gender and acute blood loss anemia.Conclusion
Although CRPP remains a successful operation in elderly patients and patients with certain comorbidities, failure of CRPP for the treatment of a femoral neck fracture is high at approximately 10%-11%, which is much higher than reported failure rates for THA in the same population. Patients with femoral neck fractures being considered for CRPP should be counseled about the possibility of further surgery. 相似文献88.
89.
目的:探讨重建股骨距半髋置换治疗高龄股骨转子间不稳定骨折的疗效。方法对2006年1月~2013年1月我院行重建股骨距半髋置换治疗的高龄股骨转子间骨折30例患者进行回顾性随访分析,其中男性9例,女性21例;年龄70~93岁,平均78岁。采用Harris评分进行临床疗效评估,股骨近端X线片Singh分级指数判断股骨近端骨质疏松改善程度。结果随访6~72个月,平均22个月,所有患者安全度过围手术期,无感染、深静脉血栓形成、脱位、假体松动、假体周围骨折等并发症发生。 Harris髋关节功能评分由术前(21.2±5.6)提高至(86.6±3.8),Singh 分级从术前(2.3±0.7)级上升至(3±1.0)级(P<0.05),临床疗效满意。结论重建股骨距的半髋置换治疗高龄股骨转子间不稳定骨折是一种安全、有效的手术选择。 相似文献
90.