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1.
胡东  宁旭 《脊柱外科杂志》2020,18(1):64-67,72
腰椎椎间盘突出症(LDH)是指腰椎椎间盘发生退行性病理改变,纤维环破裂,髓核组织从破裂处突出/脱出,刺激或压迫神经引起的以腰腿痛为主要症状的病变,给患者的工作生活带来一定影响。近年有研究发现,脊柱-骨盆矢状面参数与LDH密切相关,正常脊柱-骨盆形态可使身体处于最佳平衡状态,若发生改变则平衡状态被破坏,导致脊柱矢状面生物力学发生改变,从而加速脊柱退行性变[1-3]。本文查阅分析脊柱-骨盆矢状面参数与LDH的相关性研究,发现脊柱-骨盆矢状面失衡不仅与LDH的发生机制相关,且与其临床症状和预后也有关联,现综述如下。  相似文献   
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PurposeThe objective of this study was to assess the reliability and reproducibility of existing and new computed tomography (CT)-pelvimetry measurements.Material and methodsA retrospective cohort study of 63 women with a mean age of 33.9 ± 5.2 (SD) years (range: 19–49 years) was conducted. Classical pelvimetry measurements were collected including the obstetric conjugate (OC), median transverse diameter (MTD), and interspinous diameter (ISD). Additionally, we used multiplanar reconstruction (MPR) mode to define two oblique planes: inlet pelvic plane (IPP) and mid-pelvic plane (MPP) and measure new pelvic parameters, including anteroposterior (APD), transverse diameters and circumference of both IPP and MPP (inletAPD, inletMTD, inletCIRC and midAPD, ISD, midCIRC, respectively). The reproducibility (intra- and inter-observer) of our results were assessed. Multivariate analyses using principal component analysis and clustering methods were conducted to analyze the association between pelvimetry measurements and identify patient sub-groups.ResultsAll linear measurements (OC, inletAPD, MTD, inletMTD, midAPD, and ISD) showed statistically “almost perfect” intra- and inter-observer correlation coefficients (range: 0.924–0.980). Circumferences (inletCIRC and midCIRC) showed statistically “almost perfect” intra- (range: 0.847–0.857) and inter-observer correlation coefficients (range: 0.923–0.957). The measurement of 6 pelvimetric parameters allowed determining three groups of pelvis size.ConclusionNew pelvic measurements have excellent reproducibility and are similar to the classical measurements, based on the MPR analysis of CT planes adjusted to the inner bony pelvis.  相似文献   
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目的分析比较≥65岁老年退变性腰椎滑脱症(degenerative lumbar spondylolisthesis,DLS)患者与同年龄段无滑脱人群的脊柱骨盆矢状面参数。方法选择2004年1月~2014年1月间于本院就诊,影像学资料完整,无峡部裂、椎体肿瘤,椎体结核、椎体压缩性骨折等疾病,且无腰椎手术史的≥65岁的DLS患者50例为滑脱组。以相同纳入标准选择50例年龄性别匹配的无腰椎滑脱的老年人为对照组。测量滑脱组患者腰椎滑脱椎间盘角和滑脱率均值,再测量并比较2组患者的腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)和骶骨倾斜角(sacral slope,SS)。滑脱组内再按性别分组比较各参数,并分别计算2组患者各参数间的相关性。结果滑脱组患者滑脱椎间盘角为7.4°±5.2°,滑脱率为(22.5±9.5)%。滑脱组患者的LL、PI、PT、SS均明显高于对照组。滑脱组内分性别比较时,滑脱参数和腰椎矢状面参数差异均无统计学意义。结论老年DLS患者较同龄无腰椎滑脱人群有着更大的LL、PI、PT、SS。性别因素可能对老年DLS患者的滑脱参数和主要脊柱骨盆矢状面参数无显著影响。  相似文献   
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目的 探讨不同类型腰椎退行性侧凸患者脊柱矢状位参数与骨盆参数的相关性.方法 70名脊柱形态正常的志愿者与110例腰椎退行性侧凸患者,摄站立位脊柱全长正侧位X线片,测量胸椎后凸角、胸腰段后凸角、腰椎前凸角、矢状位垂直轴、骨盆投射角、骶骨倾斜角和骨盆倾斜角.根据SRS测量标准,将腰椎退行性侧凸患者按脊柱矢状位形态分为三型:Ⅰ型45例、Ⅱ型48例、Ⅲ型17例.比较志愿者与各型退变侧凸组间的脊柱矢状位参数及骨盆参数,分析脊柱矢状位参数与骨盆参数的相关性.结果 骨盆投射角,Ⅲ型退行性侧凸组低于其他三组,差异有统计学意义;骨盆倾斜角,Ⅱ型、Ⅲ型退行性侧凸组高于志愿者组及Ⅰ型退行性侧凸组,差异有统计学意义,其中Ⅱ型与Ⅲ型的差异也有统计学意义;骶骨倾斜角,Ⅱ型、Ⅲ型退行性侧凸组小于志愿者组及Ⅰ型退行性侧凸组,差异有统计学意义.在志愿者组、Ⅰ型退行性侧凸组中未发现脊柱矢状位失平衡;Ⅱ型与Ⅲ型退行性侧凸组脊柱矢状位失平衡的发生率分别为17.8%、29.4%.志愿者组与Ⅰ型退行性侧凸组的脊柱矢状位参数间、骨盆参数间及矢状位脊柱-骨盆参数间存在相关性;Ⅱ、Ⅲ型退行性侧凸组的脊柱矢状位参数间的相关性逐渐减小,矢状位脊柱-骨盆参数间的相关性也减小甚至消失,而骨盆参数间的相关性存在;各型退行性侧凸组的腰椎前凸角、骨盆倾斜角均与矢状位垂直轴相关,其中后两者的相关性更大.结论 脊柱矢状位形态呈阶梯样改变,Ⅱ、Ⅲ型退行性侧凸患者的骨盆参数、脊柱矢状位参数与骨盆参数的相关性发生变化,更容易出现脊柱矢状位失平衡.  相似文献   
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The objective of this study was to assess the clinical value of pelvimetry to predict dystocia due to cephalopelvic disproportion.63 patients who had received an abdominal CT scan postpartum were included. Pelvimetry was performed retrospectively with these datasets on a 3D workstation; there were no CT examinations performed solely for pelvimetry, and there was no radiation exposure for study purposes. Patients were divided into three groups by the course of birth, i.e. normal vaginal delivery (A), dystocia due to cephalopelvic disproportion (B) and other patients (C). Previously described methods were evaluated for their accuracy in diagnosing cephalopelvic disproportion.The pelvimetric parameters did not show significant differences between groups A (n = 20) and B (n = 20) except for the sagittal mid-pelvic diameter (q) with 12.7 ± 0.6 cm vs. 11.9 ± 0.6 cm (p = 0.0001). The ROC analysis of the previously described methods showed areas under the curve between 0.50 and 0.67. The ROC curves for q had an area of 0.88, providing 85% sensitivity with 85% specificity.In conclusion, the sagittal mid-pelvic diameter shows potential to detect cephalopelvic disproportion with acceptable accuracy. With the information gained on the CT data, a prospective trial based on MR imaging can be set up to validate the diagnostic accuracy.  相似文献   
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目的:为掌握壮族骨盆的结构特点并向临床应用提供骨盆的形态学资料,作者对来源于壮族居民世代聚居地区,生前资料比较完整可靠的壮族成人骨盆标本100例,进行体质人类学调查。方法:采用国际标准进行了28项线性测量。结果:得到了壮族成年男女骨盆各50例较系统的形态学资料及12项指数。对壮族骨盆与其他不同种族、民族的骨盆作了比较,并对壮族骨盆的特点及有关临床问题进行了讨论。  相似文献   
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Pelvic tilt is often quantified using the angle between the horizontal and a line connecting the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS). Although this angle is determined by the balance of muscular and ligamentous forces acting between the pelvis and adjacent segments, it could also be influenced by variations in pelvic morphology. The primary objective of this anatomical study was to establish how such variation may affect the ASIS-PSIS measure of pelvic tilt. In addition, we also investigated how variability in pelvic landmarks may influence measures of innominate rotational asymmetry and measures of pelvic height. Thirty cadaver pelves were used for the study. Each specimen was positioned in a fixed anatomical reference position and the angle between the ASIS and PSIS measured bilaterally. In addition, side-to-side differences in the height of the innominate bone were recorded. The study found a range of values for the ASIS-PSIS of 0–23 degrees, with a mean of 13 and standard deviation of 5 degrees. Asymmetry of pelvic landmarks resulted in side-to-side differences of up to 11 degrees in ASIS-PSIS tilt and 16 millimeters in innominate height. These results suggest that variations in pelvic morphology may significantly influence measures of pelvic tilt and innominate rotational asymmetry.  相似文献   
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Our objective was to compare maternal pelvimetry and patient acceptability between open low-field (0.5-T) and closed 1.5-T MR systems. Thirty women referred for pelvimetry (pregnant: n=15) were scanned twice in the supine position, once in the vertical open system and once in the closed system. Each patient completed a comfort and acceptability questionnaire. Pelvimetric and questionnaire data were compared between systems. Total scan time was double in the open system (7:52±1:47 vs 3:12±1:20 min). Poor image quality in the open system prevented assessment of interspinous and intertuberous diameters in one woman and all measurements in another, both pregnant, with abdominal circumferences >120 cm. The open system was much more acceptable in terms of claustrophobia and confinement (both p<0.01). Claustrophobia interrupted one closed examination. Thirty-three percent of pregnant women in both systems reported fear of fetal harm. Sixty percent of all women preferred the open system, 7% the closed system, and 33% had no preference. Limits of agreement of 3–5% from the mean for all diameters confirmed good pelvimetric reproducibility. Women's preference for open-system MR pelvimetry is feasible with abdominal circumferences ≤120 cm. Electronic Publication  相似文献   
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本文采用自制“骨盆倾斜度测量器”对126例生育年龄未孕妇女同时进行骨盆倾斜度临床测量与X光片测量;计算两种方法获得值的相关系数。结果表明,相关系数r=0.85具高度显著性,推出用临床测量值推算骨盆真实倾斜度回归方程:=1.3567X—3.6132±0.1435,t_b=9.45,P<0.0005,具有高度显著性,证明骨盆倾斜度测量器及上述回归方程准确、可靠、方法简便、实用,值得推广,足以取代X线测量法。  相似文献   
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