Электромиография — метод диагностики конечностей при сосудистых и нервных заболеваниях. Чаще всего проводится совместно с электронейрографией в комплексном исследовании — электронейромиографии (ЭНМГ). Электромиографию используют для диагностики сдавливания нервов или травм, патологий нервных корешков и других заболеваний нервной системы и мышц при слабости в ногах, болях, ухудшении подвижности.
Пройти ЭМГ вы можете в нашем медцентре. Специалисты проводят электромиографию на высокоточных аппаратах, что позволяет получить максимально достоверные результаты.
Виды ЭМГ
Исследовать нижние конечности посредством электромиографии можно несколькими способами:
1. Поверхностный. Это неинвазивный метод, позволяющий изучить мышцы конечности в общем виде. Электроды в процессе процедуры накладывают на поверхность кожи. Применяется для диагностики детей и людей, имеющих низкий нижний предел чувствительности к боли.
2. Игольчатый. При проведении обследования используется электрод в форме иглы, которую вводят в мышцу. Инвазивный, но более информативный метод за счет непосредственной связи электромиографа с волокном мышц.
3. Стимуляционный. Проводится с использованием стимулирующего электрода, который вызывает мышечное сокращение. Благодаря этому специалист получает возможность измерить параметры проведения импульса через нервы ног.
Стоимость
Цена электромиографии нижних конечностей зависит от вида обследования. Цены на ЭМГ в нашем центре — средние по Москве. Примерную стоимость можно посмотреть в прайс-листе на сайте.
Запишитесь на ЭМГ нижних конечностей к опытным специалистам онлайн или по телефону. Вы можете получить и другую квалифицированную медицинскую помощь в центре детской и взрослой неврологии «Невро-Мед» в Москве.
Функциональное исследование, которое применяется для диагностики заболеваний и поражений спинного мозга, периферических нервов и скелетных мышц называется электронейромиография (ЭНМГ). Оно позволяет определить уровень и характер поражения мышечной или нервной ткани. На основании заключения, выданного врачом функциональной диагностики, неврологи выставляют окончательный диагноз и назначают лечение. В Юсуповской больнице ЭНМГ нижних конечностей по доступной цене выполняют нейрофизиологи, кандидаты медицинских наук.
Врачи не только дают заключение по ЭНМГ нижних конечностей, но и корригируют проводимую терапию. ЭНМГ нижних конечностей – больно ли это? Процедура ЭНМГ нижних конечностей совершенно безопасная и безболезненная. Пациенты могут ощущать дискомфорт во время введения в мышцы игольчатых электродов и симуляции нерва.
Виды электронейромиографии нижних конечностей
В Юсуповской больнице проводят обследование нижних конечностей с помощью следующих видов ЭНМГ:
- Стимуляционной – применяется для диагностики поражений периферических нервов или при нарушении передачи нервного импульса с нерва на мышцу;
- Игольчатой – информативна при поражениях спинного мозга или скелетных мышц;
- Комплексная – сочетает оба метода исследования, что позволяет неврологу различить заболевания со схожими клиническими проявлениями.
Стимуляционная ЭНМГ заключается в искусственной стимуляции электрическим током определённых периферических нервов. На поверхность кожи в местах, где проходят исследуемые нервы нижних конечностей, накладывают электроды, которые генерируют электрические импульсы. С помощью и компьютерной аппаратуры нейрофизиологи вычисляют скорость проведения нервного импульса по исследуемому нерву. Каждый неповреждённый нерв проводит импульсы с определённой скоростью. Её изменение может свидетельствовать о поражении нерва. Также при стимуляционной ЭНМГ регистрируют выраженность мышечного ответа, который возникает при подаче электрического импульса.
Суть метода игольчатой электронейромиографии заключается в ведении в мышцу специального игольчатого электрода в мышцу. После этого регистрируется электрическая активность мышцы, которая возникает в результате передачи на неё нервных импульсов. Отзывы о ЭНМГ нижних конечностей, выполненной в Юсуповской больнице, положительные.
Что показывает ЭНМГ нижних конечностей? Если нерв нижней конечности поражён в результате травмы или другого заболевания, скорость проведения импульса по нему замедлится. При сдавлении или полном разрыве нерва импульс по нему не проводится вообще, что будет выявлено в процессе ЭНМГ исследования. При нарушениях нервно-мышечной передачи. Если поражён синапс (структура, ответственная за передачу нервного импульса), имеют место характерные клинические проявления (мышечная слабость, нарушения произвольных движений). Нерв при этом функционирует нормально. По нему импульсы проводятся с нормальной скоростью, что определяют во время выполнения стимуляционной ЭНМГ.
Для проверки чувствительных нервов производят слабую электрическую стимуляцию исследуемой мышцы. В норме это приводит к рефлекторной ее активации, что регистрируется в процессе исследования. При поражении чувствительных нервных волокон не будет рефлекторного ответа.
С помощью игольчатой ЭНМГ нижних конечностей врачи получают необходимую информацию в случае поражения спинного мозга и непосредственно мышцы. В спинном мозге располагаются мотонейроны. Если они поражаются, определённые мышечные волокна перестают получать импульсы и начинают хаотично сокращаться. Такие сокращения нельзя увидеть невооружённым глазом, но можно выявить помощью игольчатой ЭНМГ. При поражении нескольких мотонейронов спинного мозга регистрируются выраженные хаотичные сокращения мышечных волокон, которые доставляют пациенту значительные неудобства.
ЭНМГ при диабете позволяет выявить изменения, характерные для диабетической полинейропатии. С помощью электромиографии нижних конечностей определяются изменения и в тех случаях, когда мотонейрон функционален и импульс от него проводится нормально, но функциональная активность мышечного волокна нарушена. Во время исследования регистрируются амплитуда и длительность мышечного сокращения, которое возникает в ответ на стимуляцию нервным импульсом. Снижение данных показателей свидетельствует о том, что мышца работает не нормально. При этом не будут регистрироваться хаотичные мышечные сокращения, характерные для поражения спинного мозга.
Подготовка к ЭНМГ и противопоказания к ЭНМГ нижних конечностей
На качество и достоверность результатов процедуры могут повлиять ряд факторов, на которые нейрофизиологи обращают внимание перед тем, как выполнить электронейромиографию ног:
- Приём пациентом препаратов, которые влияют на нервно-мышечную передачу импульсов. К ним относятся миорелаксанты – лекарственные средства, которые анестезиологи используют во время операций. Исследование ЭНМГ проводят не ранее, чем через 2 дня после оперативных вмешательств, проведенных под общим обезболиванием, или других процедур, при которых используются миорелаксанты;
- Свёртываемость крови. При некоторых заболеваниях крови и при использовании антикоагулянтов нару пациента может отмечаться склонность к кровотечениям. При выполнении стимуляционной ЭНМГ ног это имеет никакого значения, в то время как при игольчатой ЭНМГ после введения в мышцы ног электродов могут возникнуть мелкие или умеренные кровоизлияния. Во избежание этих осложнений врачи Юсуповской больницы перед тем, как выполнить ЭНМГ нижних конечностей, иногда назначают пациенту лабораторные анализы, с помощью которых можно оценивают состояние свёртывающей системы крови, и за 3-5 дней до процедуры отменяют антикоагулянты.
Накануне ЭНМГ ног за сутки до выполнения процедуры нейрофизиологи рекомендуют пациентам по согласованию с лечащим врачом прекратить принимать психостимуляторы. Также чтобы не исказить результаты исследования пациентам следует отказаться от кофе и чая, шоколада, энергетических напитков, шоколада.
Электронейромиография – это совершенно безопасная процедура. Она не имеет абсолютных противопоказаний. ЭНМГ выполняют с осторожностью беременным женщинам и пациентам с имплантированным кардиостимулятором. Избегают делать электронейромиографию пациентам, страдающим эпилепсией и психическими расстройствами, поскольку введение электродов в мышцы или стимуляция могут вызвать неадекватную реакцию или эпилептический приступ. При наличии воспалительных заболеваний или нарушения целостности кожи в местах установки электродов. Высокой температуры тела, катаральных явлений или обострения хронических заболеваний внутренних органов процедуру выполняют после нормализации состояния пациента.
Не стоит бояться инфицирования во время введения игольчатых электродов. В Юсуповской больнице используют одноразовые стерильные иглы для ЭНМГ, которые исключают возможность заразиться инфекционными болезнями, которые передаются с кровью. Врачи Юсуповской больницы индивидуально подходят к оценке показаний и противопоказаний к ЭНМГ нижних конечностей, принимают взвешенное решение, которое не навредит пациенту.
Как проводится электронейромиография нижних конечностей нижних конечностей
В Юсуповской больнице ЭНМГ нервов нижних конечностей выполняют в подготовленном кабинете, оснащённом необходимым оборудованием. Цена и техника выполнения зависит от вида процедуры и от нервов, которые обследуют. После предварительной обработки кожи на неё накладывают электроды, регистрирующие нервные импульсы. Седалищный нерв является самым крупным нервом человеческого тела, который иннервирует всю нижнюю конечность. Во время проведения ЭНМГ седалищного нерва важно точно определить область его поражения, так как это играет ключевую роль в назначении лечения. Для этого регистрирующие электроды можно накладывать на различные участки стопы или голени, после чего производить стимуляцию кожи в различных областях, на которые данный нерв проецируется.
В области бедра седалищный нерв делится на более тонкие нервы – большеберцовый (медиальный подколенный) и общий малоберцовый (латеральный подколенный) нерв. На ЭНМГ их исследуют в отдельности тогда, когда стимуляция до разветвления седалищного нерва не позволяет поставить диагноз. При выполнении игольчатой ЭНМГ малоберцового нерва электроды вводят в различные мышцы бедра, голени и стопы. При системных поражениях мышечной ткани и обширном поражении спинного мозга характерные изменения наблюдаются во всех исследуемых мышцах. Некоторые мышцы или ветви седалищного нерва могут быть поражены при травме, в то время как другие функционируют нормально. Все это нейрофизиологи Юсуповской больницы устанавливают только после комплексного исследования нижней конечности.
Расшифровка ЭНМГ нижних конечностей в Юсуповской больнице проводится кандидатами медицинских наук, нейрофизиологами. Результаты исследования выводят на экран монитора или распечатывают на специальной бумаге. Внешне они представляют собой ряд графиков и линий. При расшифровке результатов ЭНМГ нижних конечностей врачи функциональной диагностики учитывают следующие показатели:
- Проведение импульса по нерву – отсутствие проведения импульса по нерву свидетельствует о том, что он перерезан, передавлен или разрушен воспалительным процессом;
- Скорость проведения нервных импульсов по нервам – её снижение указывает на поражение миелиновой оболочки нервного волокна, что имеет место при рассеянном склерозе;
- Амплитуду (силу, высоту) мышечной активности – снижение амплитуды амплитуда мышечного ответа может указывать на поражение самого нерва или нарушение нервно-мышечной передачи импульса или на поражение нерва, увеличение – о поражении спинного мозга;
- Определение наличия или отсутствия фасцикуляций (спонтанных мышечных сокращений) – их наличие может свидетельствовать о поражении спинного мозга.
Электронейромиографию (ЭНМГ) нижних конечностей в Москве можно сделать по доступной цене в Юсуповской больнице. Звоните в контакт центр, и специалисты запишут вас на приём к врачу функциональной диагностики, нейрофизиологу в удобное вам время.
Показания к исследованию:
- болезни двигательного нейрона
- плексо- и радикулопатии
- моно- и полинейропатии
- миастения и миастеноподобные заболевания
- миопатии, миодистрофии, миотонии и др.
Противопоказания к исследованию:
— абсолютных противопоказаний нет.
В НЦН используются следующие методики:
- Стимуляционная электронейромиография (ЭНГ) с оценкой
— параметров исследования моторных ответов и величин скорости распространения возбуждения по моторным волокнам,
— параметров исследования сенсорных ответов и величин скорости распространения возбуждения по сенсорным волокнам,
— параметров исследования поздних нейрографических ответов: F- и H-волн,
— параметров мигательного рефлекса,
— декремент-тест с оценкой надёжности нервно-мышечной передачи. - Игольчатая электромиография (иЭМГ) с исследованием функционального состояния мышц в покое и при произвольном напряжении.
По результатам комплексного ЭНМГ-исследования уточняется уровень поражения периферического нейро-моторного аппарата, определяется характер, выраженность и распространённость патологического процесса, а при исследовании в динамике – эффективность проводимой терапии.
ВНИМАНИЕ:
— при себе необходимо иметь направление от лечащего врача на ЭНМГ-исследование с обязательным указанием предварительного диагноза.
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