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《Injury》2023,54(6):1702-1710
IntroductionPatients with cirrhosis are at higher risk for morbidity after injury. Acetabular fractures represent a highly morbid injury pattern. Few studies have specifically examined an effect of cirrhosis on risk of complications after acetabular fracture. We hypothesized that cirrhosis is independently associated with increased risk of inpatient complications following operative treatment of acetabular fractures.MethodsAdults patients with acetabular fracture who underwent operative treatment were identified from Trauma Quality Improvement Program data from 2015 to 2019. Patients with and without cirrhosis were matched on a propensity score predicting cirrhotic status and inpatient complications based on patient, injury, and treatment characteristics. The primary outcome was overall complication rate. Secondary outcomes included serious adverse event rate, overall infection rate, and mortality.ResultsAfter propensity score matching, 137 cirrhosis+ and 274 cirrhosis- remained. No significant differences existed in observed characteristics after matching. Compared to cirrhosis- patients, cirrhosis+ patients experienced 43.4% (83.9 vs 40.5%, p < 0.001) greater absolute risk difference of any inpatient complication, 29.9% (51.8 vs 21.9%, p < 0.001) greater absolute risk difference of serious adverse events, 28.5% (41.6 vs 13.1%, p < 0.001) greater absolute risk difference of any infection, and 2.9% (2.9% vs 0.0%, p = 0.02) greater absolute risk difference of inpatient mortality.ConclusionCirrhosis is associated with higher rates of inpatient complications, serious adverse events, infection, and mortality among patients undergoing operative repair of acetabular fracture.Level of EvidencePrognostic Level III. 相似文献
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目的:探讨SPECT/CT融合显像在评价下肢骨折远期愈合能力方面的价值。方法:回顾性分析59例下肢骨折患者术后6个月后的SPECT/CT融合图像,分析骨折愈合情况,并与随访或手术比较,计算SPECT/CT融合显像对下肢骨折远期愈合的诊断准确率。结果:59例常规影像学检查均不能判断是否具有远期愈合可能。SPECT/CT示51例放射性核素通过骨折线,提示具有远期愈合的可能;其中,44例随访X线显示愈合,7例手术治疗后X线片显示未愈合。8例SPECT/CT融合显像未见放射性核素通过骨折线,提示骨折不愈合,愈合可能性较小;经再次手术证实为骨折不愈合。SPECT/CT诊断骨折愈合的准确率为88.1%(52/59)。结论:SPECT/CT可较准确地评价骨折远期愈合情况,对临床具有很大的指导意义。 相似文献
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《Fu? & Sprunggelenk》2022,20(3):165-176
Starting with Lorenz Heister, ankle fractures are dealt within German textbooks since the early 18th century. The Austrian surgeon Hönigschmied, in 1877, published a landmark series of biomechanical studies on the mechanism of fractures and avulsions around the ankle that are still valid today. German-speaking authors contributed particularly to the recognition and treatment of posterior malleolar fractures and fractures of the anterolateral distal tibia. The term “Volkmann Triangle”, however, is historically incorrect, as Volkmann most likely was the first to treat an anterolateral distal tibial fracture by resection but never described a posterior malleolar fracture. The founding of the AO (Arbeitsgemeinschaft für Osteosynthesefragen) by Swiss surgeons and engineers profoundly influenced evaluation and treatment of fractures worldwide. Proponents like Weber and Heim coined the modern principles of the treatment of malleolar and pilon fractures that are still in use and continue to evolve. 相似文献
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目的:探讨锁边悬吊联合三道钢丝垂直固定技术在髌骨下极粉碎性骨折中的临床应用。方法:自2016年8月至2019年5月,采用锁边悬吊联合三道钢丝垂直固定治疗23例髌骨下极粉碎性骨折患者,其中男14例,女9例;年龄34~68(55.0±1.2)岁。术后1年,采用疼痛视觉模拟评分(visual analogue scale,VAS),膝关节屈伸活动范围评估疼痛与功能,采用Lysholm膝关节评分标准评价临床疗效。结果:23例患者均获得随访,时间12~14(13.0±0.5)个月。1例出现钢丝尾部刺激皮肤外,其余均未出现切口感染、内固定松动、骨折移位等术后并发症。23例患者骨折均获得愈合,愈合时间10~14(12.0±1.1)周。VAS评分由术前的(7.96±0.93)分降到术后1年的(0.83±0.65)分,膝关节屈伸活动范围由术前的(20.30±8.69)°提高到术后1年的(127.39±6.55)°,Lysholm膝关节评分由术前的(18.48±4.00)分提高到术后1年的(96.09±4.91)分,差异均有统计学意义(P<0.05)。结论:锁边悬吊联合三道钢丝垂直固定治疗髌骨下极粉碎性骨折,固定可靠,骨折愈合率高,可满足快速康复功能锻炼要求,早期临床疗效满意。 相似文献
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目的 探讨液体伤口敷料脉冲式脓腔冲洗对化脓性皮脂腺囊肿切开引流的应用效果。方法 选择我院江北院区2020-06至2021-12收治的化脓性皮脂腺囊肿行切开引流的患者128例,按照随机数表法分为观察组与对照组,各64例。对照组以常规方法进行冲洗换药,观察组实施普朗特脉冲式冲洗换药。比较两组临床指标[换药次数、换药时间、伤口愈合时间、分泌物消失时间、换药视觉模拟疼痛评分(VAS)]、创面评分(创面面积、创面深度、肉芽情况和渗出情况)、皮肤舒适性(压红、压痛、灼热感、潮湿感)。结果 两组创面面积、创面深度、肉芽情况、渗出情况评分干预前及干预10 d后比较,差异无统计学意义;两组上述指标评分干预3 d后及干预7 d后比较,观察组显著低于对照组,差异有统计学意义(P<0.05)。观察组换药次数、换药时间、伤口愈合时间、分泌物消失时间、换药VAS评分显著低于对照组,差异有统计学意义(P<0.05)。结论 液体伤口敷料脉冲式脓腔冲洗用于化脓性皮脂腺囊肿切开引流患者,可获得明显的感染防治效果,对提高皮肤舒适度及降低炎症水平,促进创面愈合有积极作用。 相似文献
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间充质干细胞(MSCs)外泌体能够通过旁分泌作用,发挥类似干细胞的促进组织器官修复再生的功能,避免了直接移植MSCs的风险,如致瘤、伦理、免疫排斥反应等。MSCs外泌体参与细胞通讯,维持微环境的稳态,促进细胞的增殖、迁移及细胞外基质的修复再生,且能够在不同物种之间传递,却不会引起明显的免疫反应,在组织器官的修复与再生方面表现出巨大潜力。笔者就MSCs外泌体的特征、提取、鉴定及其在脊髓、皮肤、骨、肌腱和神经等组织器官创伤修复再生方面应用的研究进展作一综述,为临床应用MSCs外泌体修复组织器官提供参考。 相似文献
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《Journal of cranio-maxillo-facial surgery》2022,50(9):686-691
The aim of the study was to compare automated and manually conducted (slice-by-slice) virtual orbital wall reconstruction in terms of PSI design, manufacture, and clinical application for orbital fracture management.Patients with orbital wall fractures were evaluated for the potential for treatment with PSI, based on automated virtual wall reconstruction; these formed the main group. The surgical outcomes of these main-group patients' treatments were compared with those of the control group, which comprised patients randomly selected for this study, each of whom had the same orbital trauma patterns and were also managed with PSI. However, the control group patients were treated using ‘slice-by-slice’ virtual orbital reconstruction.Mean volume differences between the intact and reconstructed orbit were 0.65 ± 0.26 cm3 in the main group (n = 23) and 0.57 ± 0.23 cm3 in the control (n = 27; p = 0.837). In both groups, no cases of implant malposition or enophthalmos were detected after surgery. Orbital shape difference was similar for the main group and the control, at ?3.3 ± 3.5% and 3.25 ± 2.5%, respectively (p = 0.929). Diplopia was diagnosed at the 3-month follow-up in 13.0% of the main group and in 11.1% of the control (p = 0.651). The average times spent on computer-aided design (CAD) procedures, including segmentation, virtual orbital reconstruction, and PSI design, were 36.7 ± 6.9 min in the main group and 72.9 ± 7.7 min in the control group (p < 0.001).Within the limitations of the study it seems that PSI based on automated virtual reconstruction is a relevant alternative treatment option for orbital fractures because of its clinical efficacy that is similar to PSI based on a ‘slice-by-slice’ CAD protocol. 相似文献
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目的:探讨胫骨后Pilon骨折分型指导个体化治疗的临床疗效。
方法:回顾性研究分析我院自2017年3月至2020年4月收治入院手术的诊断为胫骨后Pilon骨折的19例患者的临床资料,其中男性9人,女性10人;年龄24-67岁,平均年龄49.89岁;受伤机制:行走跌倒14例,交通伤4例,重物砸伤 1例;所有患者行CT检查,根据CT检查分型后采用不同的手术入路和内固定方法。术后采用Burwell-Charnley放射学标准评价踝关节面的复位情况,同时采用AOFAS踝关节评分和疼痛视觉模拟评分(VAS)评价患者踝关节功能恢复情况。
结果:19例患者术后获12-24个月(平均15.79月)随访,根据Bruwell-Charnley评价标准评估术后踝关节面复位质量:13例优,6例可。术后一年AOFAS评分平均为85.95分,VAS评分平均为1.11分。
结论:胫骨后Pilon骨折根据受伤机制骨折类型多样,结合CT及AGH分型指导胫骨后Pilon骨折分型及个体化治疗后临床疗效满意。 相似文献