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1.
There are very few studies with more than 20 years' follow-up of lumbar spine fusions for disc degeneration. Currently, there is a lot of interest in the subject of degenerative changes above the level of fusion; this study is concerned with such changes in the very long term (30 years). Twenty-eight patients showing sound fusion on radiographs following posterior midline spinal fusion performed by a single surgeon between 1968 and 1970 were compared with an age- and gender-matched group of 28 patients who had undergone surgery for degenerative disc disease without fusion during the same period, by the same surgeon and using similar criteria for evaluation (Short Form 36 and Oswestry Disability Index; functional testing using self-paced walk and timed up-and-go; flexion and extension lateral radiographs of the lumbar spine). In this study, the incidence of radiographic changes at levels above the level of previous involvement was twice as high in the fusion group as in the non-fusion group. However, there was no statistically significant difference between the two groups in the outcomes measured using validated scales and functional testing. The study emphasises the importance of complete evaluation of these patients using validated outcome measurement instruments against the background of radiographic changes and subjective assessment of back pain. It also shows that radiographic changes do not necessarily mean functional impairment in all patients following lumbar spine fusion for degenerative disc disease.  相似文献
2.
Large and stiff thoracic scoliotic curves in the adolescent represent a classic indication of anterior release followed by posterior instrumentation. However, third-generation segmental spinal instrumentations have shown increased correction of thoracic curves. Indication for an anterior release may therefore not be required even in large and stiff thoracic curves. The objective of the study was, therefore, to analyze retrospectively the results of third-generation segmental posterior instrumentation in large and stiff thoracic curves and to compare our results with the current literature of anterior release followed by posterior instrumentation. An independent observer, who had not participated in any of the case, reviewed our electronic database of adolescent scoliosis surgery (Scolisoft) with the following query: thoracic curves, Cobb angle between 70° and 90° and posterior surgery only. He was able to identify 19 patients whose thoracic curves were measured between 70° and 90°. Out of these, four had convex-side bending Cobb angle values of less than 45° and were not included in the study, as they were judged too flexible. Fifteen patients (aged 11–18 years, mean 13.6 years) with thoracic scoliosis were left for the study (average Cobb angles 78.5° with a flexibility index of 32.5% (range, 19–42%). The mean follow-up period was 32 months (range 18–64 months). Classic parameters of deformity correction were analysed. The average operative time was 314 min and the mean total blood loss was 1,875 ml. Average level of instrumented vertebrae was 12 (Range, 10–14). Postoperatively, the thoracic Cobb angle was measured at 34.8° (range, 25–45°), which represents a correction rate of 54% (range, 40.0–67.1%) and remained unchanged at the last follow-up (35°). Patients with thoracic hypokyphosis improved from an average 11° to 18°. There were three complications (one excessive bleeding, one early infection and one late infection). One case showed an add-on phenomenon at the last follow-up. Coronal balance was improved from 1.8 cm (Range 0–4cm) down to 0.75 cm (range 0–2.5 cm). Shoulder balance was improved from 1.3 cm (range 0–4cm) down to 0.75 (0–2.5 cm). All patients reported satisfactory results except the patient with an adding-on phenomena. In the literature, most of the results of anterior thoracoscopic release and posterior surgery give a percentage of Cobb angle correction similar or inferior to our series for an average initial Cobb angle of less magnitude. Therefore, with adequate posterior release, and the use of third-generation segmental instrumentation there is no need for anterior release even for curves in the 70 –90° range.  相似文献
3.
The pathophysiology of disc degeneration: a critical review   总被引:1,自引:0,他引:1  
The pathophysiology of intervertebral disc degeneration has been extensively studied. Various factors have been suggested as influencing its aetiology, including mechanical factors, such as compressive loading, shear stress and vibration, as well as ageing, genetic, systemic and toxic factors, which can lead to degeneration of the disc through biochemical reactions. How are these factors linked? What is their individual importance? There is no clear evidence indicating whether ageing in the presence of repetitive injury or repetitive injury in the absence of ageing plays a greater role in the degenerative process. Mechanical factors can trigger biochemical reactions which, in turn, may promote the normal biological changes of ageing, which can also be accelerated by genetic factors. Degradation of the molecular structure of the disc during ageing renders it more susceptible to superimposed mechanical injuries. This review supports the theory that degeneration of the disc has a complex multifactorial aetiology. Which factors initiate the events in the degenerative cascade is a question that remains unanswered, but most evidence points to an age-related process influenced primarily by mechanical and genetic factors.  相似文献
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目的:探讨椎板开门角度对颈椎单开门椎管扩大成形术(expansion of open-door laminoplasty)治疗脊髓型颈椎病疗效的影响。方法:选取我院2006年7月至2009年1月采用颈椎后路单开门椎管扩大成形术治疗并获得24个月以上随访的脊髓型颈椎病患者198例,男115例,女83例;年龄29~72岁,平均49±5岁。双节段39例(C3~C5 11例,C4~C6 28例);三个节段(C4~C7)97例,四个节段(C3~C7)62例。患者均有术前颈椎正侧位、双斜位和过度屈伸位X线平片和颈椎CT及MRI检查图片;术前JOA评分4~9分,平均6.3±2.9分。按照术后1周CT片上测量的椎板开门角度以30°为界限分为两组,统计两组手术时间、出血量、术后出现并发症病例、C2-C7 Cobb角度、颈椎前凸指数、颈椎活动度和脊髓后移数值,末次随访时评价患者神经功能情况,计算神经功能改善率。结果:开门角度>30°的患者共76例(A组);开门角度15°~30°的患者共122例(B组)。两组术前JOA评分、C2-C7 Cobb角度、颈椎前凸指数及颈椎活动度无显著性差异(P>0.05)。A组手术时间110±13min,出血量250±80ml;B组手术时间120±30min,出血量230±100ml,两组比较均无显著性差异(P>0.05)。术后A组51例(67.1%)出现轴性症状,8例(10.4%)发生C5神经根麻痹,1例(1.32%)颈椎轻度后凸畸形;B组37例(10.5%)出现轴性症状,3例(2.4%)发生C5神经根麻痹,4例(3.28%)发生关门,A组轴性症状和C5神经根麻痹的发生率高于B组,差异有显著性(P<0.05)。术后1个月脊髓后移值为0~7.95mm,平均2.41±0.46mm。末次随访时两组C2-C7 Cobb角度、颈椎前凸指数及颈椎活动度无显著性差异(P>0.05);JOA评分改善率A、B组分别为(72.1±11.7)%和(69.0±12.3)%,两组间比较无显著性差异(P>0.05)。结论:不同椎板开门角度术后神经功能改善率无显著性差异;将椎板开门角度控制在15°~30°轴性症状及C5神经根麻痹发生率较低,但应防止发生关门。  相似文献
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7.
Numerous techniques for the internal fixation of the cervical spine have been developed in recent years. The indications for surgery must be strictly defined before the optimal type of implant can be selected on the basis of the advantages and potential risks. Wiring techniques are still commonly used for posterior stabilization. Anterior fusion can be accomplished without internal fixation in most cases. The halo vest is still widely used for the conservative management of cervical fractures and for postoperative external immobilization. Posteriorly, traditional wiring methods are still used, as well as newer techniques, such as C1-C2 screw fixation, occipitocervical plate fixation, and lateral-mass lower cervical plating. Anteriorly, meticulous Smith-Robinson surgical approach and grafting techniques are essential. Further studies are needed to define the exact indications for various new techniques, such as anterior odontoid screw fixation and anterior plating. The surgeon must choose an appropriate device on the basis of the mechanism of injury, the pathoanatomy of the lesion, and familiarity with the device, keeping in mind the goals of internal fixation-stabilization, reduction and maintenance of alignment, early rehabilitation, and perhaps enhancement of fusion and avoidance of the need to use an external halo vest.  相似文献
8.
We report on the conservative and surgical management of a patient with blastomycosis of the lumbar spine, causing severe and crippling deformity. The diagnosis was made through biopsy. Curative removal, reconstruction and realignment of the spine were achieved. Imaging modalities were highlighted, with a detailed discussion of the histology and conservative and surgical management. We emphasize the importance of early, aggressive treatment of blastomycosis to prevent deformity and disability, and to enable identification of the best management of a destructive lesion with deformity. This case demonstrates that empirical treatment should not be used in cases of unusual sinus and abscess locations. Specific diagnosis and early treatment are indicated to prevent dreadful complications and spinal deformity resulting from blastomycosis. Aggressive antifungal therapy can cure the disease but does not control complications related to deformity. The latter can only be addressed by surgical reconstruction. We review the literature of surgical treatment, focusing on abscess drainage, bone fusion and posterior instrumentation in the absence of addressing the deformity component. Received: 19 November 1997 Revised: 6 February 1998 Accepted: 16 April 1998  相似文献
9.
Posterior cervical plate-screw fixation is a safe, effective, and versatile fixation technique. It offers clear advantagesover other posterior cervical fixation techniques in the treatment of traumatic, neoplastic, or degenerative disorders in which the spinous processes, laminae, or facets are fractured, deficient, or absent. Because the occiput, C2 pedicles, C3-C7 lateral masses, C6-T4 pedicles, and T1-T4 transverse processes represent potential sites for screw fixation, it is particularly useful when fixation across multiple levels or across the occipitocervical or cervicothoracic junction is required. Familiarity with the bony anatomy of the potential sites for screw fixation and the relationship of this anatomy to the anatomy of adjacent neural and vascular structures is essential for safe, biomechanically effective fixation. With careful preoperative planning and meticulous performance of the surgical procedure, arthrodesis rates of approximately 90% to 100% without substantial loss of alignment may be expected. The small but finite incidence of clinically significant screw malposition (approximately 0.8%/screw) even in the hands of surgeons familiar with the technique suggests that its use should not supplant the use of posterior cervical wire techniques unless a specific indication for its use exists.  相似文献
10.

Purpose

Pyogenic spondylodiscitis (PS) is a potentially life-threatening infection burdened by high morbidity rates. Despite the rising incidence, the proper management of PS is still controversial. Aim of this study was to describe the clinical features of PS and to evaluate the prognostic factors and the long-term outcomes of a large population of patients.

Methods

207 cases of PS treated from 2008 to 2016 with a 2-year follow-up were enrolled. Clinical data from each patient were recorded. The primary outcome was the rate of healing without residual disability. Secondary outcomes included length of stay, healing from infection, death, relapse, and residual disability. Binomial logistic regression and multivariate analysis were used to evaluate prognostic factors.

Results

Median diagnostic delay was 30 days and the rate of onset neurological impairment was 23.6%. Microbiological diagnosis was established in 155 patients (74.3%) and the median duration of total antibiotic therapy was 148 days. Orthopedic treatment was conservative for 124 patients and surgical in 47 cases. Complete healing without disability was achieved in 142 patients (77.6%). Statistically confirmed negative prognostic factors were: negative microbiological culture, neurologic impairment at diagnosis and underlying endocarditis (p?≤?0.05). Healing from infection rate was 90.9%, while residual disabilities occurred in 23.5%. Observed mortality rate was 7.8%.

Conclusion

The microbiological diagnosis is the main predictive factor for successful treatment. Early diagnosis and multidisciplinary management are also needed to identify underlying aggressive conditions and to avoid neurological complications associated with poorer long-term outcomes. Despite high healing rates, PS may lead to major disabilities still representing a difficult challenge.

Graphical abstract

These slides can be retrieved under Electronic Supplementary material.
  相似文献
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