收费全文 | 970篇 |
免费 | 70篇 |
国内免费 | 3篇 |
耳鼻咽喉 | 3篇 |
儿科学 | 37篇 |
妇产科学 | 6篇 |
基础医学 | 143篇 |
口腔科学 | 11篇 |
临床医学 | 99篇 |
内科学 | 270篇 |
皮肤病学 | 17篇 |
神经病学 | 46篇 |
特种医学 | 22篇 |
外科学 | 120篇 |
综合类 | 17篇 |
预防医学 | 85篇 |
眼科学 | 11篇 |
药学 | 107篇 |
中国医学 | 7篇 |
肿瘤学 | 42篇 |
2023年 | 19篇 |
2022年 | 31篇 |
2021年 | 62篇 |
2020年 | 29篇 |
2019年 | 48篇 |
2018年 | 37篇 |
2017年 | 23篇 |
2016年 | 25篇 |
2015年 | 34篇 |
2014年 | 39篇 |
2013年 | 48篇 |
2012年 | 80篇 |
2011年 | 74篇 |
2010年 | 33篇 |
2009年 | 34篇 |
2008年 | 51篇 |
2007年 | 50篇 |
2006年 | 46篇 |
2005年 | 46篇 |
2004年 | 44篇 |
2003年 | 46篇 |
2002年 | 28篇 |
2001年 | 13篇 |
2000年 | 18篇 |
1999年 | 12篇 |
1998年 | 3篇 |
1997年 | 9篇 |
1996年 | 4篇 |
1995年 | 3篇 |
1994年 | 6篇 |
1993年 | 4篇 |
1992年 | 2篇 |
1991年 | 3篇 |
1990年 | 5篇 |
1989年 | 5篇 |
1988年 | 2篇 |
1987年 | 2篇 |
1986年 | 2篇 |
1985年 | 3篇 |
1984年 | 7篇 |
1983年 | 4篇 |
1980年 | 1篇 |
1979年 | 1篇 |
1978年 | 3篇 |
1977年 | 1篇 |
1976年 | 1篇 |
1975年 | 1篇 |
1972年 | 1篇 |
Tuberculous spondylitis (TBS) is the most common form of extra-pulmonary tuberculosis. The mainstay of TBS management is anti-tuberculous chemotherapy. Most of the patients with TBS are treated conservatively; however in some patients surgery is indicated. Most common indications for surgery include neurological deficit, deformity, instability, large abscesses and necrotic tissue mass or inadequate response to anti-tuberculous chemotherapy. The most common form of TBS involves a single motion segment of spine (two adjoining vertebrae and their intervening disc). Sometimes TBS involves more than two adjoining vertebrae, when it is called multilevel TBS. Indications for correct surgical management of multilevel TBS is not clear from literature.
Materials and methodsWe have retrospectively reviewed 87 patients operated in 10 years for multilevel TBS involving the thoracolumbar spine at our spine unit. Two types of surgeries were performed on these patients. In 57 patients, modified Hong Kong operation was performed with radical debridement, strut grafting and anterior instrumentation. In 30 patients this operation was combined with pedicle screw fixation with or without correction of kyphosis by osteotomy. Patients were followed up for correction of kyphosis, improvement in neurological deficit, pain and function. Complications were noted. On long-term follow-up (average 64 months), there was 9.34 % improvement in kyphosis angle in the modified Hong Kong group and 47.58 % improvement in the group with pedicle screw fixation and osteotomy in addition to anterior surgery (p < 0.001). Seven patients had implant failures and revision surgeries in the modified Hong Kong group. Neurological improvement, pain relief and functional outcome were the same in both groups.
ConclusionWe conclude that pedicle screw fixation with or without a correcting osteotomy should be added in all patients with multilevel thoracolumbar tuberculous spondylitis undergoing radical debridement and anterior column reconstruction.
相似文献OBJECTIVE
- ? To investigate whether the implementation of the August 2007 National Institute for Health and Clinical Excellence (NICE) guidelines would miss significant urinary tract pathology in children with urinary tract infection (UTI).
PATIENTS AND METHODS
- ? All ultrasound (US) performed in children aged >6 months, during the year 1 August 2006 to 31 July 2007 for UTI, were retrospectively studied.
- ? Each US scan in the study population of 346 was categorised dependent on whether it was appropriate or inappropriate to have been performed under the new guidelines and whether the US scan was normal or abnormal.
- ? The records of each patient with an inappropriate abnormal US scan were re‐analysed to see if patient management was affected by the US scan.
- ? In 2011 patients with an original inappropriate abnormal US scan were re‐evaluated to identify if any had presented with further urinary pathology.
RESULTS
- ? In accordance with the NICE guidelines patients were divided by age.
- ? Children aged 0.5–3 years: 78/95 (82%) US scans were inappropriate of which 12 (15%) were abnormal and four of these had a further documented UTI. After careful assessment of the US abnormalities it was judged that only one would have benefited from the initial US scan.
- ? Children aged >3 years: 146/251 (58%) US scans were inappropriate of which 21(14%) were abnormal and six of these (29%) had a further documented UTI. After careful assessment of the US abnormalities it was judged that only three of 21 (14%) would have benefited from the initial US scan.
CONCLUSIONS
- ? The vast majority of anomalies detected on the inappropriate US scans were of little clinical significance.
- ? It is difficult to identify any patient who would have been truly disadvantaged if the US scan had not been performed after the initial UTI.
- ? The NICE guidelines are safe to follow.
![点击此处可从《Gut》网站下载免费的PDF全文](/ch/ext_images/free.gif)