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161.
Children with cerebral palsy frequently walk with excessive internal rotation of the hip. Spastic medial hamstrings or adductors are presumed to contribute to the excessive internal rotation in some patients; however, the capacity of these muscles to produce internal rotation during walking in individuals with cerebral palsy has not been adequately investigated. The purpose of this study was to determine the hip rotation moment arms of the medial hamstrings and adductors in persons who walk with a crouched, internally-rotated gait. Highly accurate computer models of three subjects with cerebral palsy were created from magnetic resonance images. These subject-specific models were used in conjunction with joint kinematics obtained from gait analysis to calculate the rotational moment arms of the muscles at body positions corresponding to each subject’s internally-rotated gait. Analysis of the models revealed that the medial hamstrings, adductor brevis, and gracilis had negligible or external rotation moment arms throughout the gait cycle in all three subjects. The adductor longus had an internal rotation moment arm in two of the subjects, but the moment arm was small (<4 mm) in each case. These findings indicate that neither the medial hamstrings nor the adductor brevis, adductor longus, or gracilis are likely to be important contributors to excessive internal rotation of the hip. This suggests that these muscles should not be lengthened to treat excessive internal rotation of the hip and that other factors are more likely to cause internally-rotated gait in these patients. 相似文献
162.
163.
目的评估四种手术方法治疗肩锁关节脱位的疗效,探讨如何改进手术技巧以提高手术疗效。方法采用双克氏针钢丝张力带固定、Dewar手术、锁骨钩钢板内固定、阔筋膜肌腱和碳纤维捆绑带修复重建喙锁韧带四种方法治疗AllmanⅢ型肩锁关节脱位患者共120例;其中有5例出现术中并发症。结果115例获得随访,平均随访时间4年1个月,根据Karlsson的疗效标准:双克氏针钢丝张力带固定组优良率75.6%,Dewar手术组优良率93.9%,锁骨钩钢板内固定组优良率96.7%,自体肌腱和碳纤维捆绑带固定组优良率85.7%,术后有14例出现并发症。结论锁骨钩钢板内固定和。Dewar术式是治疗肩锁关节脱位的较好选择,手术要根据病例选择合适的术式,还要注意术中的操作技巧和良好的术后管理。 相似文献
164.
Ossicles located in the acetabular fossa may confuse diagnostic and therapeutic work-up. An accessory ossification centre
may persist unfused as an os acetabuli centrale which is surrounded by intact hyaline cartilage representing an anatomic variant.
Bone islands located in the pillars of the acetabulum can project into the acetabular fossa simulating acetabular ossicles.
Osteochondrosis dissecans, posttraumatic articular bodies, degenerative disease and other rare lesions may be responsible
for clinical symptoms and are of similar appearance than anatomic variants. Plain film radiography, X-ray tomography, CT and
MRI are used to categorize these lesions. MRI is very valuable to assess cartilage integrity in a noninvasive way, but arthro-CT
or arthro-MRI have to be used in unclear cases. Therefore the purpose of this presentation is to discuss the appearance, the
possible etiology and the differential diagnosis of acetabular ossicles and how they can be evaluated to avoid an unnecessary
arthrotomy.
Received: 22 December 1998; Revised: 28 May 1999; Accepted: 8 July 1999 相似文献
165.
This pictorial review illustrates the anatomical features of normal intra-articular components of the hip and their common
disorders on MR arthrography. On T1-weighted MR arthrograms, the normal contrast-filled joint cavity shows a homogeneous high
signal intensity. Normal acetabular labrum appears as a well-delineated triangle showing a low signal intensity, surrounded
by contrast material in the perilabral recess. Intra-articular paramagnetic contrast outlines labral tears, loose bodies,
communicating labral cysts and cartilage lesions (traumatic tears, focal defects, degenerative fissures and thinning), and
improves their detection. Overall, MR arthrography enables accurate detection and staging of hip intra-articular structure
abnormalities.
Received: 6 June 1998; Revision received: 2 January 1999; Accepted: 2 April 1999 相似文献
166.
Fitzpatrick R. Norquist J.M. Jenkinson C. Reeves B.C. Morris R.W. Murray D.W. Gregg P.J. 《Quality of life research》2004,13(2):331-338
The purpose of this study was to examine whether there are advantages in terms of outcome assessment of using Rasch methods of scoring the 12-item Oxford Hip Score (OHS) questionnaire over conventionally Likert scores. As part of a prospective cohort study of total hip replacements in five former regions of England the OHS was sent to patients pre-operatively, at 3 months and 1 year post-operatively. Post-operative data was collected on over 5000 cases. Based on the level of satisfaction with surgery, patients were divided into satisfied and dissatisfied. Analyses were performed to test the relative precision (RP) of Rasch scoring vs. conventionally Likert scores in discriminating the groups experiencing different level of satisfaction. Considerable gains in precision were achieved with Rasch scoring methods when groups were compared 3 and 12 months post-operatively. The results from the current study suggest that in some situations there may be substantial gains in measuring health related outcomes using Rasch-based scoring methods. 相似文献
167.
168.
Pavlik支具治疗婴儿髋关节脱位的随访观察 总被引:5,自引:0,他引:5
目的 观察 6个月以下髋脱位患儿初次治疗年龄与Pavlik支具应用时间之间的关系 ,探讨患儿各初次治疗年龄组和各Pavlik支具应用时间组髋臼指数和Y -协调指数的变化情况。方法 本研究共随访了 1994年 1月至 2 0 0 2年 12月间我院采用Pavlik支具治疗的先天性髋关节脱位患儿 30例 (4 2个髋关节 )。随访期限为 9.4~ 81个月 ,平均随访时间为 32 .9个月 ,初次就诊年龄介于生后 0 .5 3~ 8个月之间 (6个月以上者只有 1例 ) ,平均初次就诊年龄为生后 2 .9个月 ,Pavlik支具应用的时间为 3~ 9个月 ,平均应用时间为 4 .7个月。结果 本文所得的复位成功率为 91.2 % ,无一例患儿发生股骨头坏死。 6个月以下患儿各初治年龄组的支具应用时间之间差异不显著 ,各支具应用时间组的患儿初治年龄之间也没有差异。支具应用 6个月时 90 .5 %的患儿可以去除支具。具有完整资料的34个脱位髋关节初次治疗时的髋臼指数均值为 30 .6 2°,其标准差为 6 .5 6°。本次随访所得髋臼指数的均值为 18.75° ,其标准差为 5 .78°。髋臼指数的前后变化差异有非常显著性意义 (P <0 .0 0 1)。本次记录的反映髋关节脱位治疗前后股骨头与髋臼同心情况的Y 协调指数 ,在初次治疗时其均值为 0 .94 ,标准差为 0 .0 6 ;而在随访时所得的均值为 0 .8 相似文献
169.
生化检查对人工髋关节感染的诊断价值 总被引:7,自引:1,他引:7
目的评价翻修术前生化检查对人工髋关节感染的诊断价值。方法对145例人工髋关节翻修患者进行回顾性分析,分别以血沉(ESR)和C-反应蛋白(CRP)作为诊断标准对人工髋关节感染进行诊断,并与“金标准”的诊断结果进行比较分析。结果血沉和CRP诊断人工髋关节感染的灵敏度分别为57.89%、68.42%,特异度分别为85.71%、88.89%,阳性预测值分别为37.93%、48.15%,阴性预测值分别为93.10%、94.92%,准确度分别为20.00、18.62,Youden指数分别为0.44、0.57。结论血沉和CRP作为人工髋关节翻修术前的常规检查,对人工髋关节感染的诊断具有筛选价值;两者结合起互补作用,可以增加诊断的准确性。 相似文献
170.