Spastic squint is a localized movement disorder, the pathogenesis of which is related to the deformation of the paramedian tract of the thalamus. The main manifestation of this disease is involuntary movement of the head and neck to one side with cervical muscle spasm, and in severe cases, the head position can only be corrected with the help of hands. In the past 5 years, 78 cases of spastic squint were admitted to our hospital and treated with personalized triple therapy. 1, Data and methods 1.1 General data 42 cases in males and 36 cases in females, duration of disease 1~5 years, age 20~68 years old, average age 40 years old. The cases in this group were classified according to the mode of muscle spasm, and those with continuous muscle spasm were tonic type, accounting for 56 cases, including 41 cases of rotational ST, 7 cases of lateral flexion ST, 5 cases of supination ST, 2 cases of pronation ST, and 1 case of mixed ST; those with paroxysmal muscle seizure were clonic type, accounting for 22 cases, including 15 cases of rotational ST, 4 cases of lateral flexion ST, 2 cases of supination ST, and 1 case of pronation ST. There was one case of anterior flexion type ST. 1.2 Preoperative CT/MR scan of cervical muscle: Due to the long-term involuntary movement of the spastic muscle group, it is inevitable that it will thicken and hypertrophy itself. As the amount of movement of each spastic muscle varies during abnormal movement, the degree of thickening must be different, so the spastic muscles of the neck are divided into three classes. Prokinetic muscle: the spastic muscle is more than 50% hypertrophy than the contralateral homonymous muscle; Synergic muscle: the spastic muscle is more than 20% hypertrophy than the contralateral homonymous muscle and less than 50%; follower muscle: the spastic muscle is less than 20% hypertrophy than the contralateral homonymous muscle. 1.3 Preoperative electromyography (EMG) tracing: EMG can help to find out the muscle groups involved in spasm in the neck, and can reveal the functional status and level of spastic and antagonistic muscles. According to the EMG tracing of the electrical activity of the spastic muscles in the neck, the spastic muscles are also divided into three levels: prokinetic muscles: a large number of motor units overlapping each other in a completely disturbed phase, with a frequency of 20-50 weeks/second and an amplitude greater than 1200 microvolts; synergistic muscles: a reduced or incompletely disturbed phase, with a frequency of 10-20 weeks/second and an amplitude of 400-1200 microvolts; follower muscles: single motor units appearing in bunches, There is a resting zone, with a frequency of 5-10 weeks/second and an amplitude of less than 400 microvolts. 1.4 Surgical method: Selective cervical spastic muscle resection and selective cervical nerve dissection (duplex or triplex surgery) were used for ST posture fractionation, including operation 1: selective posterior cervical spastic muscle resection or partial resection. Procedure II: selective cervical nerve 1 to 6 (C1 to 6) posterior branch severance on one side. Procedure 3: contralateral paranectomy or sternocleidomastoidectomy. Rotational ST and lateral flexion ST are performed in the first, second and third procedures, i.e., triple surgery; retroflexion ST is performed in the first and second procedures bilaterally; anterior flexion ST is performed in the third procedure bilaterally; mixed ST is performed by staged cervical nerve selective dissection and muscle selective resection. The main points of the operation: dual treatment of denervation plus myotomy for the prime movers; denervation plus partial myotomy for the initiating muscles; single denervation for the follower muscles. 2, the results of the efficacy assessment criteria: 6 months after surgery follow-up, the efficacy will be divided into ineffective, improved, effective, cured four levels. Ineffective: no significant change compared with preoperative; improved: the angle of deviation improved or reduced by less than 50% compared with preoperative; effective: the angle of deviation reduced by more than 50%, and the posture of head and neck was more or less normal; cured: the head and neck resumed normal activities and posture, and could engage in daily life, study and work. In this group, there were 78 cases, among which 41 cases (73.2%) were cured, 12 cases (21.4%) were effective, 3 cases (5.4%) were improved and 0 cases were invalid in the tonic ST group. 7 cases (31.8%) were cured, 8 cases (36.4%) were effective, 6 cases (27.3%) were improved and 1 case (4.5%) was invalid in the clonic ST group. 1 case (4.5%), with an excellent rate of 68.2%. There were no deaths or serious complications in either group. The data of the two groups were statistically compared at P<0. 05, indicating that there was a significant difference in the surgical efficacy between the two groups, with tonic ST having a higher surgical efficacy than clonic ST. 3. Discussion To date, there is no clear conclusion on the etiology and pathology of spastic strabismus in the domestic and international literature. Freikman believes that the peripheral lesion may be the compression of the paraneoplastic nerve by microvessels. Based on the above arguments: intracranial directional surgery and vascular decompression surgery are clinically available for treatment, but the reports about the efficacy have uncertainties. In 1969, Chen Xinkang first proposed that ST was caused by a group of limited muscle groups in the neck, and advocated a peripheral nerve cut and myotomy (duplex surgery), with an excellent surgical rate of 80%. The excellent rate was 87.19%. The good results of selective resection of spastic muscles and selective severance of cervical nerves were attributed to the fact that the spastic muscles were strictly confined to the neck and did not cause abnormal cranial posture and movement disorders after surgery. The incidence ratio of tonic ST to spastic ST was about 2.7:1. Our cases were divided into two groups, including 56 cases of tonic ST and 22 cases of clonic ST, with an incidence ratio of 2.5:1, which was similar to that reported by other scholars in China. According to the electromyography (EMG) tracing results, both groups were treated with selective excision of cervical spastic muscles and selective excision of cervical nerves, followed by physiotherapy and rehabilitation of antagonistic muscles, and the results were compared with the efficacy of the two groups in six months. There were no deaths or serious complications in either group. Therefore, the treatment of tonic ST by selective excision of cervical spastic muscles and selective severance of cervical nerves is safe and effective. The reason for the relatively unsatisfactory surgical outcome of clonic ST may be that the clinical manifestations as well as the physiological and biochemical processes of brain~nerve~muscle of clonic S T are different from those of tonic S T, but a comprehensive elaboration and explanation cannot be made yet. Compared with tonic ST, the spastic muscles of the three classes of prokinetic, synergic, and follower muscles of clonic S T are more likely to change roles. Because of the constant shaking of the neck in patients with clonic ST, the spastic muscles are more hypertrophied than in tonic ST, while the antagonist muscles on the opposite side are more atrophied, resulting in postoperative neck strength instability and unsatisfactory outcome. The authors obtained several insights from this study: for the clonic type of ST, EMG tracings of the neck muscles should be repeatedly performed several times before surgery, and the results of image verification tracings should be integrated to enhance the accuracy of determining the prime movers, synergists, and follower muscles; the surgical methods should be improved, such as expanding the resection range of the synergists and partially removing the follower muscles; and whether the combination of central stereotactic surgery can be considered to complement each other, so as to achieve good antispasticity. These questions need to be further investigated in the future.