Study of the original and treatment of strabismus by EMG.

我们曾报道斜视的发病机制与本体感受性传入密切相关。本研究假设斜视的发展受视觉输入的影响，论证了本体感受性传入和视觉输入在斜视发育机制中的协同作用。研究对象为1岁零2个月至7岁的内斜视患者和15~62岁的外斜视患者。检测视觉诱发闪光刺激皮层电位(VECP)和肌电图仪(EMG)。用位于O2和O2的两个电极记录VECP，分别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。在全麻下记录儿童内斜视患者和清醒外斜视患者直肠肌的四条水平肌电活动，内斜视患者双眼VECP的0_1波幅和O_2波幅无明显差异。但在单眼VECP中，我们发现波幅降低。对侧VECP与同侧VECP比较。所有内斜视患者的EMG均有异常放电，但单眼VECP波幅不同的患者的EMG无差异。外斜视患者的单眼VECP和EMG异常放电无明显差异。我们认为，外斜视的本体感觉机制影响交叉视觉系统，而内斜视的本体感觉机制影响非交叉视觉系统。由于斜视在小于0.6勒克斯的光线下改变为正视，本体感觉传入可能在没有视觉输入的情况下起作用。由于一些内斜视患者表现出单眼刺激的对侧VECP波幅降低，内斜视患者可能存在切断的视神经纤维的紊乱。

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.