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1.
目的 通过对比颈椎前路椎间盘切除融合术(ACDF)、椎板切除融合术(LCF)和椎板成形术(LP)后颈椎矢状位形态改变情况,比较三者对多节段脊髓型颈椎病(MCSM)患者颈椎矢状位的矫形效果及对矫形效果的维持能力。方法 2016年1月—2019年12月,首都医科大学宣武医院收治MCSM患者188例,其中47例采用ACDF治疗(ACDF组)、72例采用LCF治疗(LCF组),69例采用LP治疗(LP组)。根据术前颈椎前凸角(CL,C2-7 Cobb角)将患者分为后凸型(CL < 0°)、平直型(0°≤CL < 10°)、前凸型(10°≤CL < 20°)和过度前凸型(CL≥20°)。根据术前和术后CL计算不同术式的前凸改变量(末次随访CL-术前CL)、前凸矫正量(术后1周CL-术前CL)和前凸丢失量(术后1周CL-末次随访CL)。采用日本骨科学会(JOA)评分和颈椎功能障碍指数(NDI)评估临床疗效。结果 3组临床疗效差异无统计学意义。ACDF组前凸改变量、前凸矫正量大于LCF组和LP组,差异均有统计学意义(P < 0.05)。ACDF可增加后凸型、平直型和前凸型患者的CL,随访中虽有部分丢失,但至末次随访时矫形效果维持良好;过度前凸型患者术后CL轻微增加,但随访时逐渐减小,过度前凸缓解。LCF可增加后凸型、平直型患者的CL,随访中前凸丢失量少于ACDF,但末次随访时矫形效果仍不如ACDF。LP术后各型患者CL均降低,但随访过程中前凸丢失量小于ACDF和LCF。结论 ACDF矫形能力较强,可用于治疗各种颈椎曲度类型MCSM患者,LCF适用于后凸型、平直型MCSM患者,LP可用于治疗CL > 10°的MCSM患者。MCSM手术方式的选择除常规考虑脊髓压迫位置、手术节段等,还应考虑患者颈椎矢状位形态特点。  相似文献   
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BACKGROUND CONTEXT

Cervical laminectomy and fusion (CLF) is a common surgical option for multilevel cord compression. Postoperative C5 palsy occurrence after CLF has been a vexing problem for spine physicians. The posterior shift of the cord following laminectomy has been implicated as a major factor for postoperative C5 palsy, but attempts by spine surgeons to mitigate excessive shift while providing sufficient decompression have not been well reported.

PURPOSE

To compare the incidence of postoperative C5 palsy after performing selective blocking laminoplasty concurrently with CLF to those of conventional CLF.

STUDY DESIGN

A retrospective comparative study of prospectively collected data.

PATIENT SAMPLE

Of 116 cervical myelopathy patients with degenerative cervical myelopathy, ossification of the posterior longitudinal ligament, and multilevel disc herniation, 93 patients (69 in group A [CLF group] and 24 in group B [selective blocking laminoplasty with CLF, CLF-S group]) were included in the study.

OUTCOME MEASURES

The primary outcome measure was the occurrence of postoperative C5 palsy. Secondary end points included (1) clinical outcomes based on pain intensity, neck disability index (NDI), Japanese Orthopaedic Association (JOA) score, (2) radiologic outcomes including cervical alignment and fusion rate at 1 year and hardware complications, and (3) perioperative data (hospital stay, blood loss, and operative times).

METHODS

We compared the occurrence of postoperative C5 palsy, as well as clinical, radiologic, and surgical outcomes, between the two groups at 1-year follow-up.

RESULTS

The patients in both groups were statistically similar between the groups with respect to demographic characteristics such as age, sex, smoking status, body mass index, preoperative pathology, surgical segments, and the degree of the cervical lordosis. Postoperative C5 palsy developed in 9 of 61 patients (14%) in group A and in 0 of 24 patients (0%) in group B (CLF-S group) (p=.03). Postoperative neck pain, NDI, and JOA improvement were not significantly different between the two groups (p=.93, 0.90, and 0.79, respectively). Perioperative data did not differ significantly between the two groups.

CONCLUSIONS

This study showed that performing selective blocking laminoplasty might lead to reducing the incidence of postoperative C5 palsy in CLF surgery.  相似文献   
4.
IntroductionCervical degenerative myelopathy is a variable and progressive degenerative disease caused by chronic compression of the spinal cord. Surgical approaches for the cervical spine can be performed anteriorly and/or posteriorly. Regarding the posterior approach, there are 2 fundamental techniques: laminoplasty and laminectomy with posterior fixation (LPF). There is still controversy concerning the technique in terms of outcome and complications. The aim of the present work is to analyze from the clinical and radiological point of view these 2 techniques: laminoplasty and LPF.Materials and methodsA historical cohort of 39 patients was reviewed (12 LFP and 27 laminoplasty) including patients operated in a 10 years period at the Hospital Universitario La Paz with a follow-up of 12 months after surgery was carried out. The clinical results were analyzed and compared using the Nurick scale and the modified Japanese Orthopaedic Association Scale (mJOA) and the radiological results using the Cobb angle, Sagittal Vertical Axis, T1 Slope and alignment (measured by Cobb-T1 Sloppe).ResultsSignificant differences were observed in the postoperative improvement of the Nurick scale (P = .008) and mJOA (P = .018) in the laminoplasty group. In LFP there is a tendency to a greater improvement, but statistical significance is not reached due to the low sample size of this group. No statistically significant differences were observed in the radiological variables. Regarding the total number of complications, a higher number was observed in the laminoplasty group (7 cases) versus LFP (one case), but no statistically significant differences were observed.ConclusionsLaminoplasty and LFP are both safe and effective procedures in the treatment of cervical degenerative myelopathy. The findings of our study demonstrate statistically significant clinical improvement based on the Nurick and mJOA scales with laminoplasty. No significant differences in terms of complications or radiological variables were observed between the 2 techniques.  相似文献   
5.
目的 探讨三维可视化技术辅助设计手术治疗胸椎黄韧带骨化症的临床应用价值。方法 回顾性分析2013年11月—2016年12月郑州市骨科医院脊柱一科采用椎板切除治疗的44例胸椎黄韧带骨化症的临床资料。其中,男25例、女19例,年龄40~76岁。术前均采用Mimics软件对胸椎CT扫描的DICOM数据进行三维重建,在胸椎椎板和骨化黄韧带的三维可视化模型上观察骨化灶的立体结构以及与椎弓根、关节突、椎板的位置关系,计算数字模拟骨化灶体积;按照“分区椎板切除”的方式在三维可视化数字模型上进行骨化黄韧带的模拟切除;按照术前模拟切除步骤,实施手术操作。观察手术时间、术中出血量及并发症发生情况。术后12个月采用日本骨科协会(JOA)评分评估神经功能,根据术前和术后JOA评分计算JOA改良率,评估手术疗效。结果 三维重建模型44个,重建骨化灶103个,骨化灶体积为(1 831±443)mm3。44例患者均顺利完成手术,手术时间65~180(96.7±19.6)min;术中出血量230~1 350(432±83.5)mL。患者术后无脊髓神经损害症状加重者,术后神经症状均逐步好转。44例患者均获随访,随访时间13~46(25±10.3)个月。随访期间无迟发性感染、神经症状加重、内固定失败等并发症发生。术后12个月JOA评分(8.8±1.8)分,明显高于术前的(5.3±2.0)分,差异有统计学意义(t=11.566, P<0.01);JOA评分改善率为64.2%±21.7%,疗效评价优13例、良21例、可10例,优良率77.3%(34/44)。结论 应用三维可视化技术进行术前评估,能够立体、全面了解骨化黄韧带的形态,通过模拟手术,设计手术切除范围,可以提高手术精准度、安全性和有效性,为胸椎黄韧带骨化症的诊疗提供了一种新的术前影像学辅助方法。  相似文献   
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We describe a series of 15 patients scheduled for single level lumbar spine decompression with instrumentation receiving ultrasound (US) guided submultifidus block (SMFB). In this series, injections of local anesthetic deep to the multifidus muscle provided reliable block of dorsal rami of spinal nerves at multiple levels. With US, the multifidus muscle can be identified both in axial and parasagittal planes. Needle tip is easily visualized beneath the multifidus and medial to the transverse process. Good quality analgesia was documented by pain scores. There were no adverse events. Further studies are needed to compare this nerve block with routine multimodal analgesia or with the recently described thoracolumbar interfascial plane block to compare safety and analgesic efficacy.  相似文献   
8.
目的 评估对老年颈椎病患者(≥60岁)行双开门椎板成形椎管扩大术治疗的中远期疗效。方法 回顾性分析2002年1月~2010年6月行双开门椎板成形椎管扩大术并获>3年随访的63例老年患者资料,其中男43例,女20例;年龄为60~80岁,平均67.78岁。评估所有患者手术情况,记录术前、术后1周、术后3个月、术后6个月及之后每半年的日本骨科学会(Japanese Orthopaedic Association,JOA)颈椎评分和颈椎功能障碍指数(neck disability index, NDI),并根据患者年龄段(低龄,≥60且<70岁,n=49;高龄,≥70岁,n=14)和术前病程时间(>1年,n=21;≤1年,n=42)对部分指标进行对比。结果 术后所有患者JOA评分和NDI均有不同程度恢复,JOA评分由术前(9.45±3.87)分恢复到术后(13.85±3.73)分,NDI由术前(25.52±4.13)%恢复到术后(13.14±3.24)%。术后并发症泌尿系统感染、肺部感染、脑脊液漏和术后轴性症状各1例,并发症发生率为6.35%。低龄老年患者和高龄老年患者的术后末次随访JOA评分差异无统计学意义(P >0.05);NDI差异无统计学意义(P >0.05);高龄老年患者恢复时间(10.21±2.46)个月高于低龄老年患者(7.92±2.15)个月,差异有统计学意义(P< 0.05)。术前病程<1年的患者JOA评分改善率为(52.13±9.45)%,优于病程≥1年患者的(43.17±8.23)%,差异有统计学意义(P< 0.05);不同病程患者的NDI差异无统计学意义(P >0.05)。结论 在严格把握适应证的情况下,老年颈椎病患者行双开门椎板成形椎管扩大术治疗的中远期疗效可靠。  相似文献   
9.
目的探讨对胸椎后纵韧带骨化(ossification of posterior longitudinal ligament,OPLL)合并黄韧带骨化(ossification of ligamentum flavum,OLF)患者行后路全椎板切除减压并椎弓根内固定治疗的临床疗效。方法回顾性研究2008年7月~2013年4月,15例胸椎OPLL并OLF患者行后路全椎板切除减压并椎弓根内固定术治疗。分别统计患者一般情况、手术时间、出血量、卧床时间、术后并发症发生率、术前术后日本骨科学会(Japanese Orthopaedic Association,JOA)评分,并进行比较。结果平均随访38.7个月,患者术前、术后3个月及末次随访时JOA评分分别为3.9±1.2、8.1±2.2及10.3±2.5,差异具有统计学意义(P<0.05)。术中1例患者出现脑脊液漏,术后1例患者出现浅表伤口感染,1例患者出现血肿。结论胸椎OPLL并OLF患者行全椎板切除减压并椎弓根内固定术治疗,可获得满意的临床疗效。但该术式容易造成严重脊髓损伤,对术者技巧要求较高。  相似文献   
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