Study of the original and treatment of strabismus by EMG.

我们已经报道了斜视的发病机制与本体感觉事件密切相关。我们认为斜视的发展受到视觉输入的影响。本研究证明了本体感觉传入和视觉输入在斜视的发展机制中是协同作用的。本研究的病例包括年龄从1岁零2个月到7岁的内向型患者和年龄从15岁到62岁的外向型患者。观察脑皮层视诱发电位（VECP）和肌电图（EMG）。在O_2和O_2两个电极上记录VECP。采用单眼刺激和双眼刺激，并将闪光刺激投射到视网膜的所有视野。在全麻状态下，内斜视患儿和意识清醒的外斜视患儿分别记录4条水平直肠肌的肌电图。在内斜视的情况下，双眼VECP的振幅与0_1和O_2无差异。但在单眼VECP中，我们发现振幅减小。对侧VECP与同侧VECP比较。所有内斜视患者肌电图均有异常放电，单眼VECP波幅差异患者肌电图无差异。在外向型患者中，我们发现单眼VECP和肌电图异常放电无差异。我们认为，外斜视的本体感觉作用于对焦视系统，内斜视的本体感觉作用于非对焦视系统。由于斜视在小于0.6勒克斯的光线下发生矫正，因此本体感觉传入可能在没有视觉输入的情况下有效。由于部分内斜视患者单眼对侧VECP刺激振幅降低，内斜视可能存在糜散的视神经纤维紊乱。

We have reported that the pathogenesis of strabismus is closely related to proprioceptive afferents. And it is supposed that the development of strabismus is under the influence of the visual input In this study, we demonstrated the proprioceptive afferent and visual input were cooperative for the developmental mechanism of strabismus. Cases studied here were esotropic patients aged from one year and two months to seven years and exotropic ones aged from fifteen to sixty two years. Visually evoked cortical potentials to flash stimulation (VECP) and electromyograph (EMG) were examined. Recordings of VECP were made from two electrodes located at O_2 and O_2. Monocular stimulation of each eye and binocular stimulation were used and the flash stimuli were projected to all visual fields of retina. EMGs of four horizontal rectal muscles were recorded either under general anesthesia for esotropic patients of children or in conscious patients with exotropia.In cases with esotropia, there was no difference in amplitude from both 0_1, and O_2 in binocular VECP. But in monocular VECP, we found the reduced amplitude. of contralateral VECP as compared with that of ipsilateral VECP. While all esotropic patients showed abnormal discharges in EMG, there was no difference in EMG in the patients with the disparities of amplitudes in monocular VECP. In exotropic patients we found no difference in monocular VECP and abnormal discharges in EMG. We suppose the mechanism of proprioception in exotropia affects the decussating optic system and that in esotropia acts on the non-decussating optic system. Because strabismus changes to be orthophorized under the light of less than 0.6 lux, the proprioceptive afferents might be In effect without visual input.Since some patients with esotropia showed the reduced amplitude of contralateral VECP monocularly stimulated, there may be a disorganization of devussated optic nerve fibers in esotropia.