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Hip flexor musculature was instrumental in the evolution of hominin bipedal gait and in endurance running for hunting in the genus Homo. The iliacus and psoas major muscles were historically considered to have separate tendons with different insertions on the lesser trochanter. However, in the early 20th century, it became “common knowledge” that the two muscles insert together on the lesser trochanter as the “iliopsoas” tendon. We revisited the findings of early anatomists and tested the more recent paradigm of a common “iliopsoas” tendon based on dissections of hips and their associated musculature (n = 17). We rediscovered that the tendon of the psoas muscle inserts only into a crest running from the superior to anterior aspect of the lesser trochanter, separate from the iliacus. The iliacus inserts fleshly into the anterior portion of the lesser trochanter and into an inferior crest extending from it. We developed 3D multibody dynamics biomechanical models for: (a) the conjoint “iliopsoas” tendon hypothesis and (b) the separate insertion hypothesis. We show that the conjoint model underestimates the iliacus' capacity to generate hip flexion relative to the separate insertion model. Further work reevaluating the primate lower limb (including human) through dissection, needs to be performed to develop those datasets for reconstructing anatomy in fossil hominins using the extant phylogenetic bracket approach, which is frequently used for tetrapods clades outside of paleoanthropology.  相似文献   
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In addition to recommendations for pharmacological treatment stratified for risk and phenotype, the new 2021 edition of the Spanish COPD Guidelines (GesEPOC 2021) proposes a personalized approach to treatable traits, defined as a characteristic (clinical, physiological, or biological) that can be identified by diagnostic tests or biomarkers, for which a specific treatment is available. Some treatable traits, such as malnutrition, sedentarism, emphysema or respiratory failure, can be treated with non-pharmacological therapies, and this was not covered in detail in the guidelines. This section of GesEPOC 2021 includes a narrative update with recommendations on dietary treatment, physical activity, respiratory rehabilitation, oxygen therapy, non-invasive ventilation, volume reduction, and lung transplantation. A PICO question with recommendations on the use of supplemental oxygen during exercise in COPD patients without severe hypoxemia is also included.  相似文献   
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《Fu? & Sprunggelenk》2022,20(2):90-99
Lesser toe deformities are among the more frequent problems that need operative corrections. Common procedures are an Arthrodesis of the PIP-Joint, a flexor tendon transfer or a resection arthroplasty of the PIP-Joint. Recently, minimally invasive techniques have gained popularity. The main advantage of these techniques is that they are possible even with critical soft tissue conditions due to their less invasive character, a reduced infection rate and a reduction in operative time.Its main disadvantages are a steep learning curve and the need for special equipment like rotating burrs and image intensifiers.In this article, operative techniques are outlined and discussed. Clinical situations which can be solved with minimally invasive techniques are presented.  相似文献   
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丁涛  夏克  陈前永 《中国骨伤》2022,35(6):527-531
目的:探讨胫骨骨折患者切开复位内固定手术后血清小凹蛋白-1(caveolin-1)蛋白含量与延迟愈合的关系。方法:自2018年4月至2020年6月收治接受切开复位内固定手术的134例胫骨骨折患者,根据骨折愈合情况分为延迟愈合组和正常愈合组。比较两组患者术前及术后1、4、8、12周时血清caveolin-1蛋白含量,采用Logistic回归模型分析骨折延迟愈合的影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析血清caveolin-1蛋白对骨折延迟愈合的预测价值。结果:骨折后4个月时随访评估愈合情况,正常愈合93例,延迟愈合41例。术后1、4、8、12周时,延迟愈合组血清caveolin-1蛋白含量均低于正常愈合组(P<0.05);延迟愈合组与正常愈合组在吸烟、糖尿病、开放性骨折、Gustlio分型Ⅲ型方面比较差异有统计学意义(P<0.05);经Logistic回归分析,吸烟、糖尿病、开放性骨折、Gustlio Ⅲ型骨折及术后4、8周时血清caveolin-1蛋白含量降低是骨折延迟愈合的危险因素(P<0.05);经ROC曲线分析,术后4、8周时血清caveolin-1蛋白含量对骨折延迟愈合具有预测价值,预测的最佳截断值分别为12.45、12.52 ng/ml,对应的灵敏度为45.34%、43.90%,特异性为80.65%、87.10%(P<0.05)。结论:胫骨骨折患者切开复位内固定术后4、8周时血清caveolin-1蛋白含量降低与延迟愈合有关,术后4、8周时检测血清caveolin-1蛋白含量对延迟愈合具有预测价值。  相似文献   
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目的 探讨术中撬拨复位经皮交叉克氏针固定治疗儿童不稳定性屈曲型肱骨髁上骨折的疗效。方法 回顾性分析我院2015年1月至2019年6月收治的27例不稳定性屈曲型肱骨髁上骨折手法复位失败的儿童的临床资料,男13例,女14例;年龄为2~14岁,平均7.31岁。按照骨折移位程度分型,完全移位断端接触17例,完全移位断端无接触10例。合并尺神经损伤5例,均为闭合性损伤。所有病人在手法复位失败后均采用术中撬拨复位经皮交叉克氏针固定治疗。术后4~6周拔出克氏针,记录并发症发生情况,术后6个月参照Flynn肘关节功能评分标准评定疗效。结果 病人手术时间为15~50 min,平均30 min。病人术中均覆盖防辐射铅衣保护,术中透视5~8次,平均7.5次。术后随访12~36个月,平均24个月。病人骨折愈合时间为4~6周,平均4.5周,术后3个月尺神经损伤均恢复。术后6个月参照Flynn肘关节功能评分标准评定疗效:优20例,良6例,可1例,优良率为98.8%(26/27)。所有病人均未发生肘内翻、骨化性肌炎、医源性神经损伤。结论 撬拨复位经皮交叉克氏针固定是治疗儿童不稳定性屈曲型肱骨髁上骨折手法复位失败后的较为理想的复位方法。  相似文献   
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《Seminars in Arthroplasty》2022,32(4):681-687
BackgroundThe objective of this study was to compare complication rates between patients undergoing reverse shoulder arthroplasty (RSA) after a prior open reduction and internal fixation (ORIF) for proximal humerus fracture (PHF) to those undergoing RSA as a primary treatment for PHFs, glenohumeral osteoarthritis, or rotator cuff tear arthropathy (CTA).MethodsPatients who underwent RSA between 2015 and 2020 were identified in the Mariner database. Patients were separated into 3 mutually exclusive groups: (1) RSA for osteoarthritis, rotator cuff tear, or CTA (Control-RSA); (2) RSA as a primary treatment for PHF (PHF-RSA); and (3) RSA for patients with prior ORIF of PHFs (ORIF-RSA). Ninety-day medical and 2-year postoperative surgical complications were identified. In addition, patients in the PHF-RSA group were subdivided into those undergoing RSA for PHF within 3 months of the fracture (acute) vs. those treated greater than 3 months from diagnosis (delayed). Multivariate regression was performed to control for differences in comorbidities and demographics.ResultsA total of 30,824 patients underwent primary RSA for arthritis or CTA, 5389 patients underwent RSA as a primary treatment for a PHF, and 361 patients underwent RSA after ORIF of a PHF. ORIF before RSA was associated with an increased risk of overall revision (odds ratio [OR] 2.45, P = .002), infection (OR 2.40, P < .001), instability (OR 2.43, P < .001), fracture (OR 3.24, P = .001), minor medical complications (OR 1.59, P = .008), and readmission (OR 2.55, P = .001) compared with the Control-RSA cohort. RSA as a primary treatment for PHF was associated with an increased risk of 2-year revision (OR 1.60, P < .001), infection (OR 1.51, P < .001), instability (OR 2.84, P < .001), and fracture (OR 2.54, P < .001) in addition to major medical complications (OR 2.02, P < .001), minor medical complications (OR 1.92, P < .001), 90-day emergency department visits (OR 1.26, P < .001) and 90-day readmission (OR 2.03, P < .001) compared with the Control-RSA cohort. The ORIF-RSA group had an increased risk of periprosthetic infection (OR 1.94, P = .002) when compared with the PHF-RSA cohort. There were no differences in medical or surgical complications in the RSA-PHF cohort between patients treated in an acute or delayed fashion.ConclusionRSA following ORIF of a PHF is associated with increased complications compared with patients undergoing RSA for nonfracture indications. Prior ORIF of a PHF is also an independent risk factor for postoperative infection after RSA compared with patients who undergo RSA as a primary operation for fracture. The timing of RSA as a primary operation for PHF does not appear to impact the rates of postoperative medical and surgical complications.  相似文献   
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