5 минут Автор: Любовь Добрецова 2297
Электронейромиография нижних конечностей (ЭНМГ) – инновационная диагностическая методика, предназначенная для оценки активности мышечных волокон и скорости передачи импульсов по нервным окончаниям.
ЭНМГ имеет множество показаний к проведению и позволяет выявить общую клиническую картину. Особенно часто обследование назначается при подозрении на заболевания периферических отделов нервной системы и патологии мышечных тканей. Сегодня электромиография делается как в частных, так и в государственных клиниках.
Суть и разновидности обследования
ЭНМГ нижних конечностей имеет 2 разновидности. Исследование может быть поверхностным игольчатым (его также называют стимуляционным). Выписывать направление на тип обследования должен врач, отталкиваясь от предполагаемого диагноза и сопутствующих признаков. Обе методики включают в себя такие этапы:
- определение степени возбудимости мышц;
- изучение деятельности нервно-мышечной системы;
- оценка общего состояния нейронов;
- определение восприимчивости нервных волокон.
Расшифровка полученных результатов проводится квалифицированным специалистом. В редчайших случаях, когда невролог сомневается в постановке диагноза, для расшифровки анализа может быть назначен экспертный совет.
Поверхностная ЭНМГ
Обследование этого типа проводится путем накладывания на изучаемую область специальных электродов, подающих электрический разряд. Проходящий импульс провоцирует ответную реакцию мышц, которая регистрируется прибором и выводится в виде графика на монитор. Такой тип диагностики позволяет определить, в какой именно зоне локализуется очаг поражения периферического нерва и оценить, насколько сильно нарушена передача импульсов.
Главным достоинством методики является абсолютная безболезненность и простота. Провести поверхностную нейромиографию сможет любой врач. Обследование этого типа имеет минимальное количество противопоказаний, его разрешают проходить даже беременным женщинам и пациентам, у которых установлены кардиостимуляторы.
Игольчатая ЭНМГ
Данная методика является более сложной, что обусловлено ее инвазивностью. В отличие от поверхностного метода, при игольчатой ЭНМГ в мышцы нижних конечностей вводятся одноразовые тончайшие электроды, имеющие форму игл. При помощи их можно оценить выраженность поражения нервных стволов, сплетений и самих мышечных волокон.
Несмотря на необходимость установки игл, процедура является относительно безболезненной и не требует предварительно анестезии. Прибор строит график активности мышечных и нервных волокон, после чего врач расшифровывает полученные сведения. Такой тип диагностики является более точным и позволяет получить максимальные сведения.
При подозрении на тяжелые и запущенные формы заболевания всегда назначается игольчатая ЭНМГ, поскольку она позволяет подобрать наиболее оптимальную схему лечения для конкретного пациента. Еще одним преимуществом такого обследования является то, что при помощи его можно отличить патологию воспалительной природы от повреждения или банального пережатия нерва.
Показания к проведению
Чаще всего электронейромиография нижних конечностей назначается при подозрении на неврологические заболевания и генетические патологии. Также осмотр часто приводится для оценки состояния нервных и мышечных волокон после травм.
Основные показания к проведению процедуры:
- Остеохондроз поясничного отдела позвоночника, сопровождающийся формированием грыж.
- Невриты и нейропатии различного происхождения.
- Деформирование ног, снижение мышечной массы без видимых на то причин.
- Поражение головного мозга (парезы и параличи).
- Вибрационная болезнь.
- Перенесенные травмы позвоночного столба, сопровождающиеся нарушением двигательной функции и ухудшением чувствительности.
- Рассеянный склероз.
- Болезнь Паркинсона.
- Патологии мышечных тканей у детей и взрослых пациентов.
- Варикозное расширение вен, тромбоз и прочие патологии сосудистой системы.
Кроме предполагаемых болезней, обследование делается и для оценки эффективности назначенной схемы лечения. Оно помогает отследить динамику изменений. Если положительный результат отсутствует, проводится корректировка выбранной методики лечения.
Подготовка
Специальной подготовки в ЭМГ не требуется. Тем не менее при записи на процедуру специалист обязательно должен рассказать пациенту о факторах, которые могут повлиять на достоверность полученных сведений. Чтобы избежать постановки неправильного диагноза, рекомендуется запомнить и придерживаться таких рекомендаций.
Если пациенту назначена игольчатая ЭНМГ, необходимо убедиться в отсутствии проблем со свертываемостью крови. Это обусловлено тем, что при замедленном свертывании после постановки игл у пациента может возникнуть умеренное кровотечение. Чтобы избежать этого, перед проведением процедуры рекомендуется сделать лабораторные анализы (протромбированный индекс, фибриноген).
За 3 дня до сеанса запрещен прием психостимуляторов, поскольку подобные препараты искажают результаты исследования. В отличие от большинства других схожих исследований, перед проведением ЭНМГ не запрещается есть. Единственное, от чего придется отказаться пациенту (за 8–10 часов до сеанса) – от потребления продуктов, стимулирующих центральную нервную системы. К этой категории относится кофе, чай, шоколадные батончики, энергетики.
Как проводится электронейромиография
Прежде чем сделать нейромиографию, врач рассказывает пациенту о возможном дискомфорте и неприятных ощущениях (которые могут проявиться только при игольчатом типе обследования). Далее пациента укладывают на кушетку и обрабатывают нижние конечности антисептическим раствором или гелем. После этого врач накладывает специальные электроды или устанавливает одноразовые иглы на нижних конечностях.
Обычно один электрод устанавливается над сухожилием мышцы, а второй – над ее брюшком. Третий электрод фиксируется между ними и работает как заземлитель. При подаче импульсов прибор фиксирует все сведения, которые выводятся на мониторе либо отражаются на бумаге. В зависимости от того какое количество мышц нужно осмотреть, процедура занимает от 40 до 70 минут.
Противопоказания
Несмотря на то что данная методика является инновационной и максимально безопасной, она все же имеет определенные ограничения к проведению. Прежде чем записываться на сеанс, пациент обязательно должен оповестить врача о наличии любых проблем со здоровьем. В первую очередь это касается:
- наличия патологий кровеносной системы (в том числе, нарушения свертываемости крови);
- вынашивания ребенка (при беременности проводится только поверхностная ЭНМГ);
- приема медикаментов, которые оказывают влияние на кровеносную и нервную систему;
- наличия кардиостимулятора;
- сердечных заболеваний.
В некоторых случаях препятствием для процедуры может стать сильная отечность нижних конечностей и наличие избыточной массы тела. Также проводить такое обследование не рекомендуется пациентам с психическими расстройствами.
Заключение
Электронейромиография нижних конечностей – уникальная процедура, позволяющая получить максимальные сведения и выявить степень поражения мышечных и нервных волокон. При постановке точного диагноза назначенное лечение будет более эффективным, а пораженная конечность восстановится в кратчайший срок.
Преимущества проведения электронейромиографии в «СМ-Клиника»
- Для проведения процедуры мы используем современное высокоточное оборудование. Это позволяет нам получить максимально достоверные результаты и при необходимости назначить оптимальный курс лечения.
- Врачи-неврологи, выполняющие исследование, прошли специальное обучение, а их высокий профессионализм гарантирует корректность проведения процедуры и верную интерпретацию результатов.
- Мы предлагаем доступные цены на электронейромиографию, чтобы обследование мог пройти каждый пациент.
Зачем нужно проходить электронейромиографию
Электронейромиография – один из наиболее информативных методов исследования позволяющий на ранней стадии выявить различные неврологические заболевания, затрагивающие нервы и мышцы.
Первичная электромиография проводится для получения информации необходимой для постановки и подтверждения диагноза. Проведение ЭНМГ дает возможность выяснить, на каком уровне рефлекторной цепи имеется патология и насколько она серьезна.
Во время проведения лечения выявленного заболевания ЭМГ может проводится несколько раз с определенным интервалом для оценки эффективности терапии.
Показания к проведению электронейромиографии
Решение о проведении ЭНМГ принимает врач-невролог, основываясь на существующем диагнозе, осмотре пациента, имеющихся жалобах. Сделать электронейромиографию необходимо в следующих случаях:
- при наличии жалоб на мышечные боли, спазмы, судороги или же слабость в ногах или руках, при тунельном синдроме (когда нерв зажат в костном канале сухожилиями мышц);
- при грыжах межпозвонковых дисков и корешковом синдроме;
- при поражениях мышц и нарушениях мышечного тонуса: мышечной дистрофии, миотонии, миопатии, миастении;
- при поражениях нервов: нейропатии лицевого нерва, полинейропатии, полимиозите, рассеянном склерозе, полиомиелите, болезни Паркинсона и других заболеваниях;
- после переломов верхних и нижних конечностей.
ЭНМГ не проводят пациентам, страдающим эпилепсией, психическими расстройствами, имеющим кардиостимулятор, а также в период обострения инфекционных или сердечно-сосудистых заболеваний.
Как подготовиться к проведению электронейромиографии
Как проводится электронейромиография
Перед началом процедуры наш врач обязательно расскажет вам обо всех этапах обследования и о ваших ощущениях. Электромиография проводится амбулаторно в положении лежа или полулежа, при этом важно максимально расслабиться. В зависимости от обследуемой зоны врач определяет места наложения электродов, обрабатывает их антисептическим раствором и смазывает гелем.
Электроды, подсоединенные к электромиографу, специалист фиксирует на коже в области обследуемой мышцы. Сигнал, поступающий к электроду, переходит на нерв и вызывает сокращение мышцы. В ходе процедуры врач может попросить напрячь ту или иную мышцу, сделать это несколько раз или с разным временным интервалом. Все показания и колебания потенциалов фиксируются аппаратом и записываются на бумагу или магнитный носитель. Графически результат электронейромиографии напоминает результаты ЭКГ – там присутствуют такие же скачущие зубцы и волны.
Во время процедуры вы можете ощущать легкое покалывание, которое пройдет после ее завершения.
В зависимости от объема исследования электронейромиография длится от 30 минут до 1 час.
Результаты обследования
Как записаться на электронейромиографию в «СМ-Клиника»
Цены на электронейромиография (ЭНМГ) в «СМ-Клиника»
| Наименование услуги | Цена (руб.)* |
| Электронейромиография лица: вызванный кожно-симпатический потенциал | 3 400 |
| Электронейромиография лица: круговой мышцы глаза, круговой мышцы рта (лицевой нерв) | 3 400 |
| Электронейромиография лица: блинк-рефлекс (тройничный нерв) | 3 950 |
| Электронейромиография игольчатая (1 мышца) | 3 400 |
| Электронейромиография: Н-рефлекс | 3 400 |
| Электронейромиография: тетанизация | 4 500 |
| Стимуляционная электронейромиография одной верхней конечности (1 чувствительный нерв) | 1 700 |
| Стимуляционная электронейромиография одной верхней конечности (1 нерв) | 3 400 |
| Стимуляционная электронейромиография одной верхней конечности (2 нерва) | 4 500 |
| Стимуляционная электронейромиография одной верхней конечности (все нервы) | 6 750 |
| Стимуляционная электронейромиография одной нижней конечности (1 двигательный нерв) | 2 850 |
| Стимуляционная электронейромиография одной нижней конечности (все нервы) | 6 750 |
| Дополнителое исследование к стимуляционной электронейромиографии одной верхней конечности при туннельном синдроме (самостоятельно не проводится) | 2 850 |
* Администрация клиники принимает все меры по своевременному обновлению размещенного на сайте прайс-листа, однако во избежание возможных недоразумений, советуем уточнять стоимость услуг в регистратуре или в контакт-центре по телефону +7 (495)
Размещенный прайс не является офертой. Медицинские услуги оказываются на основании договора.
Электромиография показана при любых проблемах мышечной ткани, после травм и для выявления динамики на протяжении лечения заболевания. Противопоказания минимизированы, что делает ЭМГ популярной и часто используемой. Данная диагностика — единственный метод, который точно устанавливает место, где имеется повреждение нервного волокна, дает точные данные о причине дисфункции. Для беспроблемного проведения исследования убедитесь, что у больного нет проблем с сердечно-сосудистой системой и психологического расстройства.
Что это такое?
Электромиография – это метод диагностического исследования, который исследует биоэлектрические потенциалы, образующиеся в мышечной ткани, когда идет возбуждение нервов. Открыл эту методику Пипереом Г. При проведении электромиографии используют аппарат электромиограф. Он усиливает и регистрирует биопотенциалы мышечной и нервной системы. Использующееся современное компьютерное оборудование способно зафиксировать даже незначительные электроимпульсы, которые считываются на автомате, а в дальнейшем производится спектральный анализ полученной информации.
Показания
Электромиография конечностей назначается, если у больного есть подозрения или он жалуется на:
- боли в мышцах;
- систематическую слабость;
- возникновение периодических судорог;
- миотонию (затрудненное расслабление мышц после их долгого, сильного сокращения);
- миастению (ослабленность мускулатуры);
- миопатию (атрофию мышечной ткани);
- полимиозит;
- безпричинную потерю мышечной массы;
- миоклонию (непроизвольные мышечные сокращения);
- синдром Паркинсона;
- тремор конечностей;
- микроинсульт;
- радикулопатию после травмы позвонков или при грыже;
- признаки бокового амиотрофического склероза;
- склероз рассеянного типа;
- какие-либо изменения в позвоночном столбе дистрофического характера;
- полинейропатию или нейропатию.
Также показания к проведению электромиографии это:
- травмирование у человека нервных сплетений;
- необходимость точного введения ботокса (детям с ДЦП или в косметологических целях);
- контроль во время лечения.
Пациент должен быть готов к тому, что процедура будет повторяться еще несколько раз (имеются в виду процедуры, которые будут проводиться в процессе лечения). Это нужно для отслеживания динамики во время терапии, если таковая будет присутствовать.
Противопоказания
Миография невредный и безболезненный метод, что говорит о его безопасности. Данное обследование допускается проводить детям.
Несмотря на вышеперечисленные преимущества, есть и противопоказания в виде:
- инфекционных и неинфекционных болезней острого характера;
- заболеваний ЦНС;
- наличия эпилепсии;
- серьезных неврологических отклонений;
- патологий сердечной мышцы и сосудов в острой стадии;
- присутствия повреждений на кожных покровах (сыпь, гнойники, раны);
- наличия кардиостимулятора.
Игольчатая электромиография не проводится, если человек:
- носитель ВИЧ-инфекции, гепатита и т. п.;
- страдает гемофилией и заболеваниями, связанными со свертываемостью крови;
- жалуется на систематические и длительные кровотечения;
- имеет высокий болевой порог.
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Электромиографию можно сделать нескольких типов. Разница их в том, какой электрод используется во время процедуры. Бывает ЭМГ стимуляционной или игольчатой. Имейте в виду, что каждый вид проводится при определенных заболеваниях. Выбор делает врач, поставив предварительный диагноз. Иногда назначаются два типа.
Стимуляционная (ЭНМГ электронейромиография)
Стимуляционная электромиография — это неинвазивное поверхностное исследование, которое дает возможность определить мышечную и нервную активность на большой площади. Данный вариант диагностики безболезнен.
Такая электромиография мышц способна указать, на какой степени заболевание, уровень, как проходит процесс, все о его распространенности, характер и даже механизм развития.
Игольчатая (дополнительная ЭМГ)
Игольчатая электромиография подразумевает под собой локальное введение специальной иглы (электрода) в мышцу. Именуют инвазивной методикой, которая целесообразна для исследования определенного элемента. Большую площадь обследовать не получится. Такой тип миографии разрешен с восьмилетнего возраста, если отсутствуют какие-либо патологии нервной системы.
Как подготовиться?
ЭМГ это один из видов обследования, который не подразумевает под собой какие-либо специальные подготовительные меры. Но, предварительно учтите, что нежелателен прием лекарственных средств, которые возбуждают нервную систему или тонизирует мускулатуру.
Также до процедуры нецелесообразно есть ту пищу и пить напитки, которые возбуждают, а именно:
- шоколад и любые продукты с его содержанием;
- кока-колу;
- кофе и какао;
- крепкий чай;
- энергетики;
- спиртные напитки.
Предварительно следует отказаться от табакокурения.
Если планируется игольчатая электромиография, то нельзя пить лекарства, которые понижают свертываемость крови.
Как проводится?
Электромиография мышц проводится амбулаторно или при стационаре. Есть некоторая разница в проведении игольчатой и поверхностной ЭМГ.
Рассмотрим технику проведения на нижних и верхних конечностях отдельно.
Нижних конечностей
Если выбор пал на игольчатый способ, то действия будут следующие:
- Больного просят занять полулежащее, лежачее положение. Обязательное условие — полное расслабление исследуемых мышц на начальном этапе, после нужно немного их напрячь.
- Специалист наносит на кожные покровы области ног специальный раствор, обрабатывает антисептиком.
- Вводятся электроды-иглы.
- Начинается диагностика. Первый этап — в расслабленном состоянии. Второй — в напряжении.
Все происходящее записывается на электромиограмме. Результаты изучаются специалистом. Дополнительная электромиография нижних конечностей может осуществляться на конкретно выбранном участке (на икроножной мышце, седалищном нерве).
После манипуляции иногда возникают неприятные ощущения, боли. Устранить такой дискомфорт помогут обезболивающие препараты. Еще один неприятный момент после электромиографии— появление небольшой гематомы в месте введения электрода. Через несколько дней синяк проходит сам собой.
Если проводится стимуляционная электромиография ног, то:
- Пациента кладут на кушетку.
- На площадь ног (при таком методе это большая площадь) наносят специальный раствор.
- Накожно накладываются тонкие пластины (электроды).
- Происходит изучение мышечной ткани в расслабленном и напряженном состоянии.
После такого вида никаких неприятных ощущений не наблюдается и человек может возвращаться к привычной жизни.
Верхних конечностей
Если планируется электромиография верхних конечностей, то технология та же, только больной может занять положение сидя. Если ему удобнее лечь, специалист против не будет. Врач-невролог напомнит, что данная поза должна дать возможность полностью расслабить мускулатуру рук.
При игольчатой электромиографии обрабатывается небольшая область и в эту зону вводят иглы-электроды. При поверхностной могут исследоваться большие площади.
Длительность манипуляций зависит от диагностируемой области и используемого типа электромиографии. Если область незначительна, может хватить и двадцати минут. При исследовании всей области рук или ног длительность процедуры растягивается на час.
Расшифровка электромиографии
Результат электромиографии может быть неточным, если у человека присутствуют проблемы со свертываемостью крови, а также при наличии толстого слоя жировой клетчатки.
- При наличии миозита или дистрофии мышц наблюдается сниженная осцилляция.
- Если у человека поражена периферическая нервная система, присутствует урежение осцилляций. Если ее вовсе нет — это знак того, что нервные волокна разрушены.
- При постепенном снижении осцилляции можно говорить о миотонических синдромах.
- Если активность резкая — признак заболевания спинного мозга (точнее его нейронов), такая патология относится к генетическим болезням.
- Периодическая активность связана с болезнью Паркинсона.
Опытный и квалифицированный специалист в данной отрасли без труда даст верную расшифрову электромиограммы.
Преимущества и недостатки
Исходя из вышеизложенной информации, выделим плюсы и минусы электромиограммы:
К преимуществам электромиографии отнесем:
- отсутствие болей во время и после процедуры (только единицы после игольчатой миографии чувствуют дискомфорт);
- возможность многоразового проведения;
- не нужно специально готовиться к процедуре;
- методика полностью изучена и проверена.
Недостатки электромиографии заключаются в:
- длительности проведения процедуры (от получаса до часа);
- информативна диагностика только в комплексе с иными обследованиями;
- при использовании игольчатых электродов возможны неприятные ощущения;
- противопоказания при нервных расстройствах и проблемах со свертываемостью крови (при игольчатой ЭМГ).
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Где сделать?
Приведем примеры медицинских центров, где вы сможете сделать электромиографию. Записаться на обследование можно путем звонка по указанному номеру телефона. Если есть возможность, можно прийти лично в клинику.
| Наименование мед. центра | Адрес | Телефон |
| Клиника Доктор Сан на Марата | г. Санкт-Петербург, м. Звенигородская, улица Марата, дом 78 | 81-22-43-19-60 |
улица Академика Байкова, дом 8
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Сколько стоит?
Стоимость электромиографии может отличаться, иногда довольно-таки значительно, начиная от 500 рублей и заканчивая 8000 рублей. Зависит цена от месторасположения клиники, квалификации врачей, типа диагностики, исследуемой области и пр.
Чтобы уточнить сумму на электромиографию, следует обратиться непосредственно в выбранную клинику. Для этого необязательно идти по указанному адресу, достаточно одного телефонного звонка.
Вывод
Чтобы сделать электромиографию рук или ног, не нужно готовиться заранее и отказывать себе в пище и пр. Данная диагностика имеет массу плюсов и проводится даже в детском возрасте. Тип ЭМГ определяет лечащий врач, при необходимости назначается сразу два исследования. Результаты будут известны в тот же день. Чтобы поставить четкий диагноз иногда недостаточно одной электромиографии. Могут дать направление и на другие диагностические мероприятия.
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