US20160213542A1 - Patient positioning support structure - Google Patents
Patient positioning support structure Download PDFInfo
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- US20160213542A1 US20160213542A1 US15/017,110 US201615017110A US2016213542A1 US 20160213542 A1 US20160213542 A1 US 20160213542A1 US 201615017110 A US201615017110 A US 201615017110A US 2016213542 A1 US2016213542 A1 US 2016213542A1
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- patient
- patient support
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- trolley
- support
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
- A61G13/00—Operating tables; Auxiliary appliances therefor
- A61G13/02—Adjustable operating tables; Controls therefor
- A61G13/08—Adjustable operating tables; Controls therefor the table being divided into different adjustable sections
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/04—Positioning of patients; Tiltable beds or the like
- A61B6/0407—Supports, e.g. tables or beds, for the body or parts of the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
- A61G13/00—Operating tables; Auxiliary appliances therefor
- A61G13/0036—Orthopaedic operating tables
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
- A61G13/00—Operating tables; Auxiliary appliances therefor
- A61G13/0036—Orthopaedic operating tables
- A61G13/0054—Orthopaedic operating tables specially adapted for back or spinal surgeries
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
- A61G13/00—Operating tables; Auxiliary appliances therefor
- A61G13/02—Adjustable operating tables; Controls therefor
- A61G13/04—Adjustable operating tables; Controls therefor tiltable around transverse or longitudinal axis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
- A61G7/00—Beds specially adapted for nursing; Devices for lifting patients or disabled persons
- A61G7/001—Beds specially adapted for nursing; Devices for lifting patients or disabled persons with means for turning-over the patient
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
- A61G7/00—Beds specially adapted for nursing; Devices for lifting patients or disabled persons
- A61G7/002—Beds specially adapted for nursing; Devices for lifting patients or disabled persons having adjustable mattress frame
- A61G7/008—Beds specially adapted for nursing; Devices for lifting patients or disabled persons having adjustable mattress frame tiltable around longitudinal axis, e.g. for rolling
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/04—Positioning of patients; Tiltable beds or the like
- A61B6/0407—Supports, e.g. tables or beds, for the body or parts of the body
- A61B6/0442—Supports, e.g. tables or beds, for the body or parts of the body made of non-metallic materials
Abstract
A patient support system includes independently adjustable end columns supporting a centrally hinged, jointed or breaking patient support structure. At least one column includes a powered rotation assembly. The patient support includes at least two sections. A coordinated drive system provides for both upwardly and downwardly breaking or jointed orientations of the two sections in various inclined and tilted positions. Cable, cantilevered and pull-rod systems are included. Primary and secondary elevators and a failsafe locking system are provided.
Description
- This application is a continuation of U.S. patent application Ser. No. 13/374,034, entitled “Patient Positioning Support Structure”, filed on filed Dec. 8, 2011, which claims priority to U.S. Provisional Application No. 61/459,264, filed Dec. 9, 2010, each of which is incorporated by reference in its entirety as if fully disclosed herein.
- The present invention is directed to structure for use in maintaining a patient in a desired position during examination and treatment, including medical procedures such as imaging and surgery and in particular to such a structure that allows a surgeon to selectively position the patient for convenient access to the surgery site and providing for manipulation of the patient during surgery including the tilting, pivoting, angulating or
- Current surgical practice incorporates imaging techniques and technologies throughout the course of patient examination, diagnosis and treatment. For example, minimally invasive surgical techniques, such as percutaneous insertion of spinal implants, involve small incisions that are guided by continuous or repeated intra-operative imaging. These images can be processed using computer software programs that produce three dimensional images for reference by the surgeon during the course of the procedure. If the patient support surface is not radiolucent or compatible with the imaging technologies, it may be necessary to interrupt the surgery periodically in order to remove the patient to a separate surface for imaging followed by transfer back to the operating support surface for resumption of the surgical procedure. Such patient transfers for imaging purposes may be avoided by employing radiolucent and other imaging compatible systems. The patient support system should also be constructed to permit unobstructed movement of the imaging equipment and other surgical equipment around, over and under the patient throughout the course of the surgical procedure without contamination of the sterile field.
- It is also necessary that the patient support system be constructed to provide optimum access to the surgical field by the surgery team. Some procedures require positioning of portions of the patient's body in different ways at different times during the procedure. Some procedures, for example, spinal surgery, involve access through more than one surgical site or field. Since all of these fields may not be in the same plane or anatomical location, the patient support surfaces should be adjustable and capable of providing support in different planes for different parts of the patient's body as well as different positions or alignments for a given part of the body. Preferably, the support surface should be adjustable to provide support in separate planes and in different alignments for the head and upper trunk portion of the patient's body, the lower trunk and pelvic portion of the body as well as each of the limbs independently.
- Certain types of surgery, such as orthopedic surgery, may require that the patient or a part of the patient be repositioned during the procedure while in some cases maintaining the sterile field. Where surgery is directed toward motion preservation procedures, such as by installation of artificial joints, spinal ligaments and total disc prostheses, for example, the surgeon must be able to manipulate certain joints while supporting selected portions of the patient's body during surgery in order to facilitate the procedure. It is also desirable to be able to test the range of motion of the surgically repaired or stabilized joint and to observe the gliding movement of the reconstructed articulating prosthetic surfaces or the tension and flexibility of artificial ligaments, spacers and other types of dynamic stabilizers before the wound is closed. Such manipulation can be used, for example, to verify the correct positioning and function of an implanted prosthetic disc, spinal dynamic longitudinal connecting member, interspinous spacer or joint replacement during a surgical procedure. Where manipulation discloses binding, sub-optimal position or even crushing of the adjacent vertebrae, for example, as may occur with osteoporosis, the prosthesis can be removed and the adjacent vertebrae fused while the patient remains anesthetized. Injury which might otherwise have resulted from a “trial” use of the implant post-operatively will be avoided, along with the need for a second round of anesthesia and surgery to remove the implant or prosthesis and perform the revision, fusion surgery.
- There is also a need for a patient support surface that can be rotated, articulated and angulated so that the patient can be moved from a prone to a supine position or from a prone to a 90° position and whereby intra-operative extension and flexion of at least a portion of the spinal column can be achieved. The patient support surface must also be capable of easy, selective adjustment without necessitating removal of the patient or causing substantial interruption of the procedure.
- For certain types of surgical procedures, for example spinal surgeries, it may be desirable to position the patient for sequential anterior and posterior procedures. The patient support surface should also be capable of rotation about an axis in order to provide correct positioning of the patient and optimum accessibility for the surgeon as well as imaging equipment during such sequential procedures.
- Orthopedic procedures may also require the use of traction equipment such as cables, tongs, pulleys and weights. The patient support system must include structure for anchoring such equipment and it must provide adequate support to withstand unequal forces generated by traction against such equipment.
- Articulated robotic arms are increasingly employed to perform surgical techniques. These units are generally designed to move short distances and to perform very precise work. Reliance on the patient support structure to perform any necessary gross movement of the patient can be beneficial, especially if the movements are synchronized or coordinated. Such units require a surgical support surface capable of smoothly performing the multi-directional movements which would otherwise be performed by trained medical personnel. There is thus a need in this application as well for integration between the robotics technology and the patient positioning technology.
- While conventional operating tables generally include structure that permits tilting or rotation of a patient support surface about a longitudinal axis, previous surgical support devices have attempted to address the need for access by providing a cantilevered patient support surface on one end. Such designs typically employ either a massive base to counterbalance the extended support member or a large overhead frame structure to provide support from above. The enlarged base members associated with such cantilever designs are problematic in that they can and do obstruct the movement of C-arm and 0-arm mobile fluoroscopic imaging devices and other equipment. Surgical tables with overhead frame structures are bulky and may require the use of dedicated operating rooms, since in some cases they cannot be moved easily out of the way. Neither of these designs is easily portable or storable.
- Thus, there remains a need for a patient support system that provides easy access for personnel and equipment, that can be easily and quickly positioned and repositioned in multiple planes without the use of massive counterbalancing support structure, and that does not require use of a dedicated operating room.
- The present invention is directed to a patient support system that permits adjustable positioning, repositioning and selectively lockable support of a patient's head and upper body, lower body and limbs in up to a plurality of individual planes while permitting tilting, rotation, angulation or bending and other manipulations as well as full and free access to the patient by medical personnel and equipment. The system of the invention may be cantilevered or non-cantilevered and includes at least one support end or column that is height adjustable. The illustrated embodiments include a pair of opposed independently height-adjustable end support columns. The columns may be independent or connected to a horizontally length-adjustable base. One support column according to the invention may be coupled with a wall mount or other stationary support. A patient support structure is connected to and bridges substantially between the pair of end supports. For example, in an embodiment according to the invention, the patient support structure is hingedly suspended between the end supports.
- The patient support structure may be a frame or other patient support that is semi-constrained, having at least first and second hingeable or otherwise joined or connected portions, the first and second portions being selectively lockable in a first substantially planar orientation along a longitudinal axis of the support structure that resembles conventional constrained or fixed patient support structures. However, the hinged or semi-constrained support structure of the invention provides for the first and second portions that are also positionable and lockable in a plurality of angles with respect to one another, with each portion being movable to a position on either side of the first planar orientation. In other words, the patient support structure is capable of hinging or otherwise bending to form an angulation, break or joint, either upwardly or downwardly from a horizontal starting position and also when the support structure is in an inclined or declined position due to one of the support columns raising one end of the structure higher than another end. Furthermore, in addition to an “up” or “down” break, such a break or joint created by the two portions may be oriented from side-to-side, as when the support structure is rotated about a longitudinal axis thereof.
- In a particular illustrated embodiment, articulation, jointing or breaking of the patient support structure at a central location between the pair of stationary end supports is supported by a cable drive system (tension band suspension). In another embodiment, a pull-rod assembly supports articulation to control the break or articulation angle and render the patient support structure rigid. Such an embodiment further includes a substantially fixed slider bar disposed at an end of the patient support, the patient support structure being supported by and slidingly movable along such slider bar with the bar following the angle of inclination of the patient support at such end. Other embodiments include cantilevered systems with connected or unconnected movable or telescoping base supports. The first and second patient support structure portions may be in the form of frames, such as rectangular frames or other support structure that may be equipped with support pads for holding the patient, or other structure, such as imaging tops which provide a flat surface.
- The patient support structure and the support column or columns are coupled with respective rotation, articulation or angulation adjustment structure for positioning the first support portion with respect to a first column or end support and with respect to the second support portion and the second support portion with respect to the second column or end support. Rotation adjustment structure in cooperation with pivoting and height adjustment structure provide for the lockable positioning of the first and second patient support portions at a variety of selected positions and articulations with respect to the support columns including angulation coupled with Trendelenburg and reverse Trendelenburg configurations as well as providing for patient roll over in horizontal or tilted orientation. Lateral movement (toward and away from a surgeon) may also be provided by a bearing block feature. A pair of patient support structures (such as a support frame and an imaging table) may be mounted between end supports of the invention and then rotated in unison about a longitudinal axis to achieve 180° repositioning of a patient, from a prone to a supine position.
- In some embodiments of the invention, primary and secondary elevators are provided, for increasing the amount of angulation of the patient support while simultaneously maintaining the patient's torso in a substantially horizontal position. A failsafe lock may be mounted in the angulation subassembly to lock the position of the patient support in the event of catastrophic failure of the patient support structure. Movement of the patient's torso in concert with changes in angulation are provided by linkage of the angulation subassembly with a cephalad and caudal slidable torso support structure.
- Therefore, it is an object of the present invention to overcome one or more of the problems with patient support systems described above. Further objects of the present invention include providing breaking or hinged patient support structures; providing such structures wherein such break or joint may be in any desired direction; providing such structures that include at least one base support structure that allows for vertical height adjustment; providing such a structure wherein such base support is located at an end of the patient support, allowing for patient positioning and clearance for access to the patient in a wide variety of orientations; providing such a structure that may be rotated about an axis as well as moved upwardly or downwardly at either end thereof; providing such structure for cooperatively continuously and non-segmentedly changing the height and angulation of the patient support while moving the patient's torso so as to prevent excessive extension and compression of the patient's spinal column; providing such structure for maintaining the height of the point of angulation of the patient while simultaneously changing the amount of angulation thereof; and providing apparatus and methods that are easy to use and especially adapted for the intended use thereof and wherein the apparatus are comparatively inexpensive to make and suitable for use.
- Other objects and advantages of this invention will become apparent from the following description taken in conjunction with the accompanying drawings wherein are set forth, by way of illustration and example, certain embodiments of this invention.
- The drawings constitute a part of this specification and include exemplary embodiments of the present invention and illustrate various objects and features thereof.
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FIG. 1 is a perspective view of a patient support structure according to the invention. -
FIG. 2 is an enlarged and partial side elevational view of a portion of the support structure ofFIG. 1 . -
FIG. 3 is an enlarged and partial top plan view of the support structure ofFIG. 1 . -
FIG. 4 is an enlarged and partial perspective view of a portion of the structure ofFIG. 1 . -
FIG. 5 is an enlarged and partial side elevational view of a portion of the structure ofFIG. 1 . -
FIG. 6 is an enlarged and partial perspective view of a portion of the structure ofFIG. 1 . -
FIG. 7 is an enlarged and partial perspective view of a first hinge of the structure ofFIG. 1 . -
FIG. 8 is an enlarged and partial perspective view of a cooperating second hinge of the structure ofFIG. 1 . -
FIG. 9 is an enlarged and partial elevational view of the hinge ofFIG. 7 . -
FIG. 10 is an enlarged and partial perspective view of an outer portion of the hinge ofFIG. 7 with portions broken away to show the detail thereof. -
FIG. 11 is an enlarged and partial perspective view of an inner portion of the hinge ofFIG. 7 with portions broken away to show the detail thereof. -
FIG. 12 is an enlarged and partial perspective view of a portion of the structure ofFIG. 1 showing a cable drive motor and winch cylinders. -
FIG. 13 is a partial perspective view of a patient support frame of the structure ofFIG. 1 . -
FIG. 14 is a partial perspective view of a patient imaging top for replacement with the patent support frame ofFIG. 13 . -
FIG. 15 is a reduced perspective view of the structure ofFIG. 1 shown with an imaging top ofFIG. 14 replacing the support frame ofFIG. 13 and shown in a planar inclined position. -
FIG. 16 is a perspective view of the structure ofFIG. 15 shown in a planar tilted position. -
FIG. 17 is a perspective view of the structure ofFIG. 15 shown in a planar inclined and tilted position. -
FIG. 18 is a side elevational view of the structure ofFIG. 15 shown in a symmetrical upward breaking position. -
FIG. 19 is a side elevational view of the structure ofFIG. 15 shown in a first inclined and upward breaking position. -
FIG. 20 is a side elevational view of the structure ofFIG. 15 shown in a second inclined and upward breaking position. -
FIG. 21 is a side elevational view of the structure ofFIG. 15 shown in a symmetrical downward breaking position. -
FIG. 22 is a side elevational view of the structure ofFIG. 15 shown in a first inclined and downward breaking position. -
FIG. 23 is a side elevational view of the structure ofFIG. 15 shown in a second inclined and downward breaking position. -
FIG. 24 is an enlarged side elevational view of the structure ofFIG. 1 shown in an upward breaking, inclined and tilted position. -
FIG. 25 is a is a perspective view of a second embodiment of a patient support structure according to the invention including a patient support frame and an imaging table shown in a first spaced orientation. -
FIG. 26 is a perspective view of the patient support structure ofFIG. 25 shown tilted in an intermediate position during a rotation as would be used for a patient rollover. -
FIG. 27 is a perspective view of the structure ofFIG. 25 shown further tilted in a second intermediate position during rotation. -
FIG. 28 is a perspective view of the structure ofFIG. 25 shown after rotation to a final flipped position. -
FIG. 29 is a perspective view similar toFIG. 25 showing the patient support frame and the imaging table in a second spaced orientation. -
FIG. 30 is a front elevational view of a third embodiment of a patient support structure according to the invention. -
FIG. 31 is a front elevational view of a fourth embodiment of a patient support structure according to the invention. -
FIG. 32 is a perspective view of a fifth embodiment of a patient support structure according to the invention shown in a planar inclined position. -
FIG. 33 is a perspective view of the structure ofFIG. 32 shown in an inclined and upward breaking position. -
FIG. 34 is a perspective view of the structure ofFIG. 32 shown in a substantially symmetrical downward breaking position. -
FIG. 35 is a reduced side elevational view of a sixth embodiment of a patient support structure according to the invention shown in a substantially horizontal and planar position. -
FIG. 36 is a reduced side elevational view of the structure ofFIG. 35 shown in a symmetrical downward breaking position. -
FIG. 37 is a reduced side elevational view of the structure ofFIG. 35 shown in a symmetrical downward breaking position. -
FIG. 38 is an enlarged and partial top plan view of a portion of the structure ofFIG. 35 and shown in the same position as shown inFIG. 35 . -
FIG. 39 is an enlarged and partial side elevational view of the structure ofFIG. 35 and shown in the same position as shown inFIG. 35 . -
FIG. 40 is an enlarged and partial side elevational view of the structure ofFIG. 35 and shown in the same position as shown inFIG. 35 . -
FIG. 41 is an enlarged and partial perspective view of the structure shown inFIG. 40 . -
FIG. 42 is an enlarged and partial top plan view of a portion of the structure ofFIG. 35 and shown in the same position as shown inFIG. 36 . -
FIG. 43 is an enlarged and partial side elevational view of the structure ofFIG. 35 and shown in the same position as shown inFIG. 36 . -
FIG. 44 is an enlarged and partial side elevational view of the structure ofFIG. 35 and shown in the same position as shown inFIG. 36 . -
FIG. 45 is an enlarged and partial top plan view of a portion of the structure ofFIG. 35 and shown in the same position as shown inFIG. 37 . -
FIG. 46 is an enlarged and partial side elevational view of the structure ofFIG. 35 and shown in the same position as shown inFIG. 37 . -
FIG. 47 is an enlarged and partial side elevational view of the structure ofFIG. 35 and shown in the same position as shown inFIG. 37 . -
FIG. 48 is a side elevational view of another embodiment of the patient support structure according to the invention, shown in a substantially horizontal and planar position. -
FIG. 49 is a side elevation view of the patient support structure ofFIG. 48 , shown in a downward breaking position and in a fully elevated position. -
FIG. 50 is a side elevation view of the patient support structure ofFIG. 48 , shown in an upward breaking position and in a fully lowered position. -
FIG. 51 is an enlarged bottom perspective view of a portion of the patient support structure ofFIG. 48 , and shown in the same position as shown inFIG. 48 . -
FIG. 52 is an enlarged bottom perspective view of a portion of the patient support structure ofFIG. 48 , shown in the same position as shown inFIG. 49 . -
FIG. 53 is an enlarged bottom perspective view of a portion of the patient support structure ofFIG. 48 , shown in the same position as shown inFIG. 50 . -
FIG. 54 is an enlarged partial perspective view of the patient support structure ofFIG. 48 , shown in a fully elevated position. -
FIG. 55 is an enlarged partial perspective view of the patient support structure ofFIG. 54 , shown in a fully lowered position. -
FIG. 56 is a side perspective view of the patient support structure ofFIG. 52 , shown in a downward breaking position and a fully lowered position. -
FIG. 57 is an enlarged top elevational view of the patient support structure ofFIG. 48 , shown in the same position as shown inFIG. 49 . -
FIG. 58 is an enlarged cross-sectional view of a portion of the patient support structure ofFIG. 57 , taken along line 58-58 ofFIG. 57 , and shown in the same position as shown inFIG. 48 . -
FIG. 59 is an enlarged cross-sectional view of a portion of the patient support structure ofFIG. 48 , taken along line 58-58 ofFIG. 57 , and shown in the same position as shown inFIG. 49 . -
FIG. 60 is an enlarged cross-sectional view of a portion of the patient support structure ofFIG. 48 , taken along line 58-58 ofFIG. 57 , and shown in the same position as shown inFIG. 50 . -
FIG. 61 is an enlarged foot-end elevational view of the patient support structure ofFIG. 48 and shown in the same position as shown inFIG. 49 . -
FIG. 62 is an enlarged head-end elevational view of the patient support structure ofFIG. 48 and shown in the same position as shown inFIG. 49 . -
FIG. 63 is a side elevation view of the patient support structure ofFIG. 48 , shown in an upwardly breaking position and in a fully elevated position. -
FIG. 64 is an enlarged top perspective view of a portion of the hinge and roller ofFIG. 48 and in a downward breaking position. -
FIG. 65 is an enlarged bottom perspective view of the hinge and roller ofFIG. 64 . -
FIG. 66 is an enlarge perspective view of the patient support subassembly of the patient support structure ofFIG. 48 with portions broken away and portions shown in phantom to show detail thereof. -
FIG. 67 is an enlarged perspective view of the gearbox of the patient support structure ofFIG. 48 with portions removed to show detail thereof. -
FIG. 68 is an enlarged partial perspective view of portions of the tensioned angulation subassembly of the patient support structure ofFIG. 48 , including the upper and lower rollers and failsafe structure. -
FIG. 69 is an enlarged partial side view of portions of the tensioned angulation subassembly of the patient support structure ofFIG. 48 , including the upper and lower rollers and failsafe structure. - As required, detailed embodiments of the present invention are disclosed herein; however, it is to be understood that the disclosed embodiments are merely exemplary of the invention, which may be embodied in various forms. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the present invention in virtually any appropriately detailed structure.
- Referring now to the drawings, a patient positioning support structure according to the invention is generally designated by the
reference numeral 1 and is depicted inFIGS. 1-12 . Thestructure 1 includes first and second upright support piers orcolumns FIG. 1 or may be connected to one another by a non-telescoping base support as illustrated in the embodiment shown inFIGS. 25-28 . In some embodiments according to the invention as shown, for example, inFIGS. 32-34 , the base connection places the columns in a selectively telescoping relationship. It is also foreseen that in certain embodiments according to the invention, one of the support columns may be replaced by a conventional operating room table, or may even be a wall mount. In the first illustrated embodiment, theupright support column 3 is connected to a first support assembly, generally 5, and theupright support column 4 is connected to a second support assembly, generally 6. Between them, thesupport assemblies 5 and 6 uphold a removable elongate, articulate jointed or breaking patient holding or support structure, generally 10 and optionally, a second removable patient support structure that will be described with respect to another embodiment of the invention. The illustratedsupport structure 10 includes afirst frame section 12, asecond frame section 14 with a transversesupport cross bar 15, and a pivot or hinge assembly, generally 16. In the illustrated embodiment, the pivot assembly further includes a cable drive system including adual winch 18 and cooperatingcables 20. - The
columns feet 22 that may or may not include spaced apart casters or wheels (not shown) each equipped with a floor-lock foot lever for lowering thefeet 12 into a floor-engaging position as shown inFIG. 1 . Thecolumns lift arm segments columns patient support structure 10. It is foreseen that thevertical supports column 3 has a greater mass than thesupport column 4 or vice versa in order to accommodate an uneven weight distribution of the human body. Such reduction in size at the foot end of thesystem 1 may be employed in some embodiments to facilitate the approach of personnel and equipment. - Each of the
support assemblies 5 and 6 generally includes arotation subassembly angulation subassembly FIG. 1 ) for cooperative and integrated actuation and operation. Therotational subassemblies patient support structure 10 about a longitudinal axis of thestructure 1. The angulation subassemblies 27 and 27′ shown inFIGS. 2 and 3 enable the selective hinging, articulation or breaking of thesupport 10 at the hinge assembly 16 at desired levels and increments as well as selective tilting of theframe portions - The rotation subassembly or
mechanism 26, shown inFIGS. 1 and 5 , includes at least onemotor housing 30 surmounting thesupport column 3. In the illustrated embodiment, only one rotational motor is provided, but it is foreseen that a cooperating motor may also be mounted on thesupport column 4. A mainrotational shaft 32 extends from themotor housing 30 that turns arotation structure 33. Therotation structure 33 in turn rotates the connectedpatient support 10 about a longitudinal axis as will be described in greater detail below. Themotor housing 30 contains a rotary electric motor or other actuator drivingly engaged with theshaft 32. Therotation mechanism 26 is operated by actuating the motor using a switch or other similar means. Therotation structure 33 is fixed to theshaft 32 at a location spaced from themotor housing 30 and thesupport column 3 to provide clearance for rotation of the connectedpatient support structure 10. - As shown in
FIGS. 4 and 5 , therotation structure 33 is attached to a pair of translation posts or H-bar posts 40 disposed at either end of therotation structure 33. Theposts 40 are each attached to thestructure 33 by apin 42, bolt, or other fixing structure. A plurality of cooperatingapertures 44 formed in theposts 40 provide passageway for apivot pin 46 to extend therethrough. Thepivot pin 46 is receivable in each cooperating pair ofapertures 44 allowing for selective placement of atranslation connector 48 that is sized and shaped to be received between the pair ofposts 40 and also receive thepivot pin 46 therethrough. Thepin 46 andconnector 48 are thus positionable in an orientation transverse to the longitudinal extension of thesupport 10 at a variety of heights to be selected by the surgeon and readily changeable, even during surgery if necessary, to vary the height of theframe section 12. The multiple location or height feature is also advantageous when more than one frame or patent structure is mounted in tandem as shown, for example inFIGS. 25-29 . The position of the frame or other structure may be desirably changed to provide close proximity to an imaging top with a distance between a patient support and an imaging top being expandable or reduceable depending upon the size or other attributes of a patient and surgical or other requirements. As illustrated inFIG. 5 , theconnector 48 has aslot 50 for receiving thepivot pin 46. - Also with reference to
FIGS. 4 and 5 , thetranslation connector 48 is in turn attached to apivot connector 52. Thepivot connector 52 includes first and second outwardly opening shaped for receiving thetranslation connector 48 and the second slot is sized and shaped for receiving anend connection 58 of theframe section 12. Thepivot connector 52 further includes a through aperture or bore 60 running substantially perpendicular to theslot 54 and communicating therewith. The aperture 60 is sized and shaped to receive apivot pin 62 therethrough. Theconnector 48 also includes a through bore 60′ that receives thepivot pin 62. The swivelable connection provided by thepin 62 allows for some forward and rearward lateral movement of the attachedframe end connection 58 and thus theframe section 12, providing a degree of freedom and clearance needed for rotation the patient support about a longitudinal axis of a patient. Theslot 56 is sized and shaped to frictionally engage theframe end connection 58, thus securely fixing theend connection 58 to thepivot connector 52. Theframe end connection 58 is in turn fixed to each ofelongate frame members frame section 12. Theframe members translation connector 48 with respect to thepin 46 provides for selected articulation of the frame section 12 (that includes theend connection 58 and theframe members 66 and 68) and/or theentire support 10 with respect to the support pier orcolumn 3. - With reference to
FIG. 6 , at the support pier orcolumn 4, the support assembly 6 is substantially similar to thesupport assembly 5 with the exception that therotation subassembly 26′ can be passive and, therefore, not include a motor. However, the support pier orcolumn 4 preferably includes a powered mechanism to provide selective height adjustment of thesubassembly 26′. Arotation structure 33′ is spaced from and freely rotatable with respect to thecolumn 4. Thestructure 33′ includes a shaft (not shown) extending outwardly therefrom similar to therotation shaft 32, the shaft being rotatingly received in an aperture in thesupport column 4. - The
rotation subassembly 26′ and theangulation subassembly 27′ otherwise include elements identical to or substantially similar to the elements of thesubassemblies bar posts 40′, pin 42′,apertures 44′,pivot pin 46′,translation connector 48′, slot 50′,pivot connector 52′,end connector 58′ andpivot pin 62′, are identical or substantially similar in form and cooperate with other elements identically or substantially similarly to what has been described previously herein with respective H-bar posts 40,pin 42,apertures 44,pivot pin 46,translation connector 48,slot 50,pivot connector 52,end connector 58 andpivot pin 62. - The
frame 14 further includesframe members 66′ and 68′ that are each fixed to theend connector 58′. Theframe members 66′ and 68′ are pivotally or hingedly connected torespective frame members frame member 66 is attached to theframe member 66′ by thehinge mechanism 70 and theframe member 68 is attached to theframe member 68′ by thehinge mechanism 72. - With particular reference to
FIGS. 3, 7 and 9-11 , thehinge mechanism 70 includes anouter member 76 and aninner member 78. Theouter member 76 is fixed or may be integral with theelongate frame member 66, while theinner member 78 is integral or otherwise fixed to theframe member 66′. Theouter member 76 further includes anextension 80 with agroove 82 for receiving and guiding thecable 20. Theextension 80 tapers in a direction from theouter member interior 84 to thegroove 82. Theextension 80 is configured to cause a slight upward break or bend of thesupport 10 when theextension 80 comes into contact with thecable 20 at thegroove 82. In that way, when thecables 20 are reeled in to shorten the hypotenuse of the triangle formed by the cable, thesection 12 and thesection 14, thesections FIG. 18 . The downward break or joint illustrated, for example, inFIG. 21 is a result of lengthening thecable 20 distance and allowing gravity to drop thehinge 70. Theextension 80 is shaped to extend slightly inwardly toward a longitudinal axis A of thesupport 10, thereby guiding thecable 20 along a path within a periphery of theframe sections extension 80 is in contact with thecable 20 when in a downward breaking configuration directed toward the cable with thecable 20 being received at thegroove 82. - It is foreseen that if an exclusively upward breaking or jointing embodiment is desired according to the invention, the
sections sections sections sections frames sections - Returning to the
hinge 70 of illustrated embodiment, theinner member 78 is slidingly and rotatably receivable in an interior 84 of theouter member 76. The outer member has a pair ofpivot apertures 86 and the inner member has apivot aperture 87, the apertures cooperating to create a through bore for receiving apivot pin 88 through both the inner and outer hinge members. The interior 84 includes a curved partiallycylindrical surface 89 for slidingly receiving a cooperating outer rounded and partially cylindrical surface 90 of theinner member 78. Theinner member 78 further includes a downward breaking stop orprojection 92 that limits a downward pivot (in a direction toward the cables 20) of thehinge 70 in the event thecables 20 should fail. Thestop 92 abuts against asurface 93 of the interior 84. In the illustrated embodiment, thestop 92 limits the extent of rotation or hinging of thesection 66 with respect to thesection 66′ to about twenty-five degrees. Upward pivot (in a direction away from the cables 20) is limited by abutment of an innerplanar surface 95 with aplanar surface 96 of the hingeinner member 78. - With particular reference to
FIG. 8 , thehinge mechanism 72 is substantially a mirror image of thehinge mechanism 70 and therefore includes the following elements: a hingeouter member 76′, aninner member 78′, anextension 80′ with agroove 82′, an interior 84′,pivot apertures 86′, apivot pin 88′, acurved surface 89′(not shown), an outer surface 90′ (not shown), astop 92′ (not shown), anabutment surface 93′, an innerplanar surface 95′ and aplanar surface 96′ that are identical or substantially similar in shape and function to the respective hingeouter member 76,inner member 78,extension 80,groove 82, interior 84,pivot apertures 86,pivot pin 88,curved surface 89, outer surface 90, stop 92,abutment surface 93, innerplanar surface 95 andplanar surface 96 described herein with respect to thehinge 70. - It is noted that other hinge or pivot mechanisms may be utilized in lieu of the hinge assembly 16. For example, the polyaxial joint 95 illustrated and described in Applicant's U.S. Pat. No. 7,152,261 and pending U.S. patent application Ser. No. 11/159,494 filed Jun. 23, 2005, may be incorporated into the
patient support structure 10 at the break or joint between thesections - With particular reference to
FIGS. 6 and 12 , thecable drive system 18 includes arotary motor 98 cooperating with and driving by rotation a pair ofwinch cylinders 99 disposed on either side of themotor 98. Themotor 98 andcylinders 99 are mounted to theend connector 58′ located near thesupport column 4. Eachcable 20 is attached to one of thewinch cylinders 99 at one end thereof and to theend connector 58 at the other end thereof. In a first longitudinal position wherein thesection 12 is substantially planar with thesection 14, thecables 20 are wound about thewinch cylinders 99 an amount to provide enough tension in thecables 20 to maintain such a substantially planar orientation and configuration, with thehinge extensions cables 20. Themotor 98 is preferably low speed and high torque for safely winding both of thecables 20 simultaneously about thecylinders 99 to draw thesection 12 toward thesection 14 to result in an upward breaking or jointing configuration with thehinges cables 20 and thehinges motor 98 may be reversed, reversing the direction of rotation of thewinch cylinders 99 for slowly unwinding thecables 20 to a downward breaking or jointing configuration. As thecables 20 unwind, gravity draws thesupport sections cables 20 being received in thegrooves hinge extensions cables 20 slacken, thehinges cables 20. - It is noted that the
frame sections frame sections FIGS. 13 and 14 , theframe member sections section 12 and theframe member sections 66′ and 68′ of thesection 14 may be replaced with substantially rectangular imaging tops orsections sections elongate slots 101 formed therein to allow for attachment of thehinge mechanisms frame sections - With reference to
FIGS. 15-17 , theimaging sections frame sections FIGS. 1-12 . Each ofFIGS. 15-17 represent configurations in which thecable drive 18 is tensioned such that thesections FIG. 15 illustrates a configuration in which thecolumn 3 is telescoped upwardly with the frame sections hinging at thesupport assemblies 5 and 6, resulting in an inclined position or configuration of the entire patient support. In the illustrated embodiment, thesection 100 would preferably receive a patient's head. Therefore,FIG. 15 illustrates a reverse Trendelenburg position or orientation.FIG. 16 illustrates thesections subassemblies 26 and passive rotation of theassembly 26′ with bothcolumns sections FIG. 17 illustrates both tilting due to rotation of theassemblies column 4 being extended vertically. Thus,FIG. 17 illustrates a Trendelenburg position or orientation with both thesections - With reference to
FIGS. 18-20 , there is illustrated three upward breaking or hinging configurations of thestructure 1.FIG. 18 illustrates a symmetrical upward breaking configuration wherein thecolumns respective support assemblies 5 and 6 at substantially the same height with thecables 20 being shortened by rotation of the winch motor to result in an upward break or joint in the hinge assembly 16.FIG. 19 illustrates thecolumn 3 being extended to a maximum height and the cables reeled to shorten a distance between thesections column 3 height of 43 inches, a foot orcolumn 4 height of 24 inches and a 35 degree upward break with zero degree roll.FIG. 20 illustrates an upward breaking Trendelenburg with thecolumn 4 being extended to a maximum height. - With reference to
FIGS. 21-23 , there is illustrated three downward breaking configurations of thestructure 1.FIG. 21 illustrates a symmetrical downward breaking configuration wherein thecolumns support assemblies 5 and 6 respectively, at the same height with thecables 20 being unwound or slackened to result in a downward break or joint in the hinge assembly 16, thehinges cables 20.FIG. 22 illustrates a downward breaking reverse Trendelenburg with thecolumn 3 being extended to a maximum height resulting in a patient's head end being at a maximum height.FIG. 23 illustrates a downward breaking Trendelenburg with thecolumn 4 being extended to a maximum height. - It is noted that in each of the configurations illustrated in
FIGS. 18-23 , thesub-assemblies 26 may be rotated in either direction, resulting in a tilted or rotated as well as upwardly or downwardly broken or hinged configuration. For example,FIG. 24 illustrates thestructure 1 withsupport frame sections FIG. 19 , but also including rotation, resulting in a tilting and upwardly breaking or jointed configuration of thestructure 1. An example of the position illustrated inFIG. 24 would be: a head orcolumn 3 height of 41 inches, a foot orcolumn 4 height of 34 inches and a 35 degree upward break or joint with 10 degree roll. - With reference to
FIGS. 25-29 , another structure, generally 102 according to the invention is illustrated. Thestructure 102 utilizes all of the elements described herein with respect to thestructure 1 and therefore the same references numerals are used for the same elements or features. Thestructure 102 differs from thestructure 1 in that the H-bar posts bar posts elongate structure 10 and cooperating cable drives 18. In the embodiment shown inFIG. 25 , one of thestructures 10 includes theframe member top having sections bar posts support structures 10 at a variety of locations. For example,FIGS. 25-28 illustrate a first spaced orientation of the elongate frame with respect to the elongate imaging top with the imaging top located at a “lower” position identified by the reference letter L. The identical components are shown inFIG. 29 with the imaging top located at a “mid-position” identified by the reference letter M, illustrating a more compact or closely spaced orientation of the elongate frame with respect to the elongate imaging top than what is shown inFIG. 25 . - As illustrated in
FIGS. 25-28 , thestructure 102 provides for the complete rotation and thus a roll-over of a patient by actuation of the motor of therotation subassembly 26 using thecontroller 29. Thestructure 102 shown inFIGS. 25-29 is further illustrated with anon-telescoping base support 110 fixed to each of thecolumns castors 112 at the base of thestructure 102. - With reference to
FIGS. 30 and 31 , another embodiment or system according to the invention, generally 200 is illustrated. The system 200 broadly includes an elongate length-adjustable base 202 surmounted at either end by respective first and second upright support piers orcolumns support assemblies FIG. 31 differs from the structure 200 only in that the length-adjustable base 202 is replaced by afirst base 220 attached to thepier 203 and asecond base 222 attached to thepier 204. All of thebases rollers 230 or some other movable structure to allow thepiers structure 210. - It is foreseen that cable drives as described herein, other types of motor drives including screw drives, universal joints, hydraulic systems, and the like, may be utilized to facilitate both upward and downward breaking of the
support structure 210. - Another patient support structure according to the invention, generally 301, is illustrated in
FIGS. 32-34 . Thestructure 301 generally includes a horizontally telescoping floor mountedbase 302, a conventional or standard telescoping and inclinable operatingtable support structure 304, a telescoping end support orpier 306 and a hinged or pivotally upwardly and downwardly breaking orjointing support structure 310 connected to both thestructure 304 and thepier 306. Thepatient support structure 310 further includes a firstcantilevered section 312 and asecond section 314. Thefirst section 312 is fixed to and extends from theoperating table support 304. The second section is attached to thepier 306 by a hinge or pivotingassembly 320, such as thesupport assembly 5 described herein with respect to thestructure 1. Thehinge mechanism 316 disposed between thesupport sections - In use, the
operating table support 304 utilizes electric or other power means to move thesupport section 312 up and down and at an incline, as is known in the art. Theoperating table support 304 can also tilt or rotate from side to side. In response to the movement of thesection 312, thesection 314 also moves, resulting in upward and downward breaking illustrated inFIGS. 32 and 33 . In response to the movement of thesection 312, the electric poweredtelescoping base 302 moves thepier 306 toward or away from thesupport 304. Thepier 306 includes a motor for raising and lowering the pier at theconnection 320. - As stated above with respect to other embodiments of the invention described herein, it is foreseen that cable drives as described herein, other types of drives including screw drives, hydraulic systems, and the like, may be utilized to facilitate both upward and downward breaking of the
support structure 310 at the joint 316. - With reference to
FIGS. 35-47 , another patient support structure according to the invention, generally 401 includes first and second upright support piers orcolumns non-telescoping base support 402. In some embodiments according to the invention, each column may be surmounted on an independent movable or stationary base. Thecolumn 403 is connected to a first support assembly, generally 405 and thecolumn 404 is connected to a second support assembly, generally 406. Between them, thesupport assemblies first frame section 412, asecond frame section 414 and a pair of identical hinge assemblies, generally 416, disposed between and connecting the first andsecond frame sections first frame section 412 for holding a head and upper body of a patient is of a slightly shorter longitudinal length (along an axis X) than thesecond frame section 414. Therefore, the spacedhinge assemblies 416 are approximately centrally located relative to a body of a patient being placed on the structure 410. In the illustrated embodiment, the hinge assembly further includes a drive system that includes a pull rod assembly, generally 418, and cooperating spaced slider bars 420. Again, other drive systems are foreseen. - The
columns columns structure 1. Thecolumns feet 422 that include casters that may be equipped with a floor-lock foot lever for lowering thefeet 422 into a floor-engaging position. Thecolumns columns - Each of the
support assemblies rotation subassembly angulation subassembly subassemblies structure 1. In the illustrated embodiment, theangulation subassembly 427 connected to theframe 412 for holding the head and upper body of a patient is shown as substantially identical to thesubassembly 27 and therefore shall not be described further herein. Thesubassembly 427′ is substantially similar to thesubassembly 27′, but with some modifications, including aframe 436 disposed transverse to the overall longitudinal axis X of the structure 401, theframe 436 providing for slidable support of the pair of identical slider bars 420 that are disposed at either side of theframe 414 and near thesubassembly 427′. - Similar to the
rotation subassembly 26 previously described herein, the rotation subassembly ormechanism 426, includes at least onemotor housing 430 surmounting thesupport column 403. It is foreseen that a cooperating motor may also be mounted on thesupport column 404. A mainrotational shaft 432 extends from themotor housing 430 that turns a rotation structure or bar that in turn is connected to and rotates the patient support 410 about a longitudinal axis. In particular, themotor housing 430 contains a rotary electric motor or other actuator drivingly engaged with theshaft 432. Therotation mechanism 426 is operated by actuating the motor using a switch or other similar means. Theshaft 432 rotationally cooperates with a pair of substantially vertically disposed translation posts or H-bar posts 440, theposts 440 being attached to and disposed at either end of the transverse rotation structure orbar 433. Each H-bar post 440 includes a plurality ofapertures 444, allowing for selective, hinged vertical placement of theframe section 412 identical or substantially similar to what has been described previously herein with respect to the H-bar posts 40, theangulation sub-assembly 27 and theframe end section 58 of theframe section 12 previously described herein with respect to thestructure 1. - With particular reference to
FIGS. 38-40 , as stated above, the sub-assembly 426′ is substantially similar to the sub-assembly 426 and therefore may include a motor and further includes either an active or passiverotational shaft 432′ that engages a rotation structure or bar 433′ that is attached to a pair of substantially vertically disposed H-bar posts 440′. A plurality of cooperatingapertures 444′ formed in theposts 440′ provide passageway for apivot pin 446 to extend therethrough. Thepivot pin 446 is receivable in each cooperating pair ofapertures 444′, allowing for selective placement of atranslation connector 448 that is sized and shaped to be received between the pair ofposts 440′ and also receive thepivot pin 446 therethrough. Thepin 446 andconnector 448 are thus positionable in an orientation transverse to the longitudinal axis X of the patient support frame 410 at a variety of heights to be selected by the surgeon and readily changeable, even during surgery if necessary, to vary the height of theframe section 414. The multiple location or height feature is also advantageous when more than one frame or patent structure is mounted in tandem, for example, when both a frame and imaging table are used together, such as is shown in the embodiment illustrated inFIGS. 25-29 . The position of the frame or other structure may be desirably changed to provide close proximity to an imaging top with a distance between a patient support and an imaging top being expandable or reduceable depending upon the size or other attributes of a patient and surgical or other requirements. Theconnector 448 has a slot for receiving thepivot pin 446. It is noted that the H-bar support 440′,apertures 444′, elongatetransverse pin 446 andtranslation connector 448 are the same or substantially similar in form and function with therespective support 40,apertures 44,transverse pin 46 andtranslation connector 48 previously described herein with respect to thestructure 1. - The
translation connector 448 is in turn attached to apivot connector 452 that is substantially similar to thepivot connector 52 previously described herein with the exception that rather than being attached directly to an end piece or section of thepatient support frame 414, thepivot connector 452 is fixed to theframe 436 that is fixed to and supports the slider bars 420 near end surfaces 464 thereof. Thus, the slider bars 420 are in a hinged relationship with the H-bar supports 440′. The slider bars 420 are also in slidable attachment with theframe section 414 and disposed substantially parallel to a longitudinal axis of thesection 414 as will be described in greater detail below. Such slidable attachment facilitates upward and downward breaking or hinging of thesection 414 with respect to thesection 412 at thehinge mechanism 416. Also as more fully described below, thepull rod assembly 418, that is connected to both theframe section 414 and thehinge mechanism 416, is extendable and retractable, controlling the hinge or break angle of the patient support 410 and rendering the support 410 rigid at a desired upward or downward break or joint of thehinge mechanism 416. - With particular reference to
FIGS. 38 and 39 , thesupport frame section 414 includes opposed elongate andparallel frame sections end frame section 469. Asupport plate 470 is attached to and is disposed below each of thesections frame section 414 at and near theend section 469. Further support is provided by a pair offrame support plates 471, both of which are fixed to the endsupport frame section 469 near one end thereof; oneplate 471 being fixed to thesection 466 and theother plate 471 being fixed to thesection 468. At least one pair of sliderbar holding structures 472 are fixed to thesupport plate 470 and extend downwardly therefrom at each of theframe sections structure 472 includes a through bore that extends parallel to theframe sections structure 472 for slidably receiving one of the slider bars 420 directly below one of theframe sections frame sections bar holding structures 472 are spaced from theend frame section 469 and located near aforward edge 473 of theplate 470. In the illustrated embodiment, the holdingstructures 472 are also bolted to theframe sections support plate 470 and theframe 414 and extend downwardly therefrom at each of theframe sections 466section 469. Eachstructure 475 includes a through bore for receiving a transverse pivot pin or bar 476 mounted below the slider bars 420. The pull-rod assembly 418 is attached to thesupport 475 at thepivot pin 476 and is thus in hinged relationship with thesupport 475, pivotally attached thereto atend portions 478. - The pull-
rod assembly 418 further includes a pair ofhousings 480, each housing attached to anend portion 478 and having apowered actuator 482 cooperating with one of a pair of rotatable extendible andretractable rods 484 and a pair ofhinge connectors 486, each pivotally attached to arespective cam plate 488 of therespective hinge mechanism 416 at arespective pivot pin 490. Thecam plate 488 has a substantially centrally locatedcurvilinear wall 489 forming a curvate aperture or slot, a lower circular aperture for receiving thepin 490 and an upper circular aperture for receiving apin 502, described in greater detail below. Eachpull rod 484 is rotatably mounted within one of thehousings 480, such rotation being controlled by operation of theactuator 482 located in thehousing 480 and engaged with therod 484 to screw and thus selectively move or draw therod 484 into or away from thehinge mechanism 416 in a direction along a longitudinal axis of therod 484, that in turn results in breaking or jointing of the patient support 410 at thehinge mechanism 416. It is foreseen that other embodiments according to the invention may utilize other types of push/pull rods or mechanisms, including, for example hydraulic systems. An additional centrally located pull-rod or piston may be included to provide additional support. Furthermore, other hinge mechanisms according to the invention may be utilized in lieu of themechanism 416, for example including, but not limited to, polyaxial joints, roller with spokes, sprockets, toothed gears, universal axis gears, or the like. - With particular reference to
FIG. 41 , the illustrated pair ofhinge mechanisms 416, each having acam plate 488, further include a pair of forkedarms 492 extending from theframe section 412 and a pair of cooperating forkedarms 494 attached to and extending from thesection 414.Hinge arms respective cam plate 488 and adjacent forkedarms pivot pin 501 is received by circular apertures located near first ends of thehinge arms arm 492, thus pivotally attaching thearm 492 with both thehinge arms pivot pin 502 is received by an upper circular aperture in thecam plate 488 and circular apertures located near the ends of each of the forkedarms cam plate 488 with both of the forkedarms pivot pin 503 is received by circular apertures located near first ends of thehinge arms arm 494, thus pivotally attaching thearm 494 with both thehinge arms pivot pin 504 is received by theslot 489 and also by circular apertures located near second ends of thehinge arms arms cam plate 488 at theslot 489. - Also, with particular reference to
FIGS. 35 and 38-41 , the structure 401 is shown in a neutral, planar orientation, with the pull-rod assembly 418 holding thehinge mechanism 416 in such neutral position, with the forkedarms pin 504 is located at or near a rear-ward end of theslot 489. - With reference to
FIGS. 42-44 , as therod 484 is rotated to selectively lengthen therod 484, thepin 504 remains near the rear-ward end of theslot 489 and the pushing of the rod toward thehinge mechanism 416 pivots thecam plate 488 at thepivot pin 490, causing thearms rod hinge connector 486 and thus pivot the patient support at thepin 502, causing a downward break or joint in the patient support 410. With reference toFIGS. 45-47 , as therod 484 is rotated to selectively shorten the length thereof, thesupport portion 414 slides along the slider bars 420 away from theend support 404. At the same time, thepin 504 slides along theslot 489 to an opposite or forward end thereof as the cam plate pivots in a forward direction about thepin 490. The movement of therod 484 thus causes an upward break at thepivot pin 502. In the illustrated embodiment, the patient frame is pinned at the head end, but is free to move along the fixedslider bar 420 at the foot end, providing dynamic support to the patient frame. The slider bar mechanism can be attached to a bearing block mechanism to provide lateral translation movement, as described previously. - It is noted that since the patient frame is free to move over the slider bar, a horizontal force component is generated by the combined components of the patient support. When the support is broken or jointed upward, the angle of the foot end frame imparts a horizontal force on the slider that urges the end supports 403 and 404 toward one another. When the table is broken downward, a horizontal force develops that tends to push the end supports apart. It has been found that the magnitude of the horizontal force is a function of support loading and break angle, and thus, for example, if a working limit of five hundred pounds is selected for the patient support, a worst case of horizontal loading is only about fifty-eight pounds at an upward break or joint of thirty-five degrees. It is noted that the illustrated structure 401 advantageously supports a breaking or jointing range from about thirty-five degrees up to about twenty degrees down. Throughout such range, the horizontal forces imposed by the structure are minimized by the illustrated locked support frame that moves on a slider bar at the foot end of the support.
- As with the
structure 1 configurations illustrated inFIGS. 18-23 , the upward and downward breaking of the patient support 410 may be modified by placing theportions portions structure 1. -
FIG. 48 throughFIG. 69 illustrate a non-incrementally, continuously or infinitely adjustable patient support and articulation apparatus, generally 600, for supporting a patient during a medical procedure, and to modify or change the angle of articulation of the patient, such as at a point of articulation, generally 601, preferably without substantially changing a height H of the point ofarticulation 601 relative to a floor F supporting theapparatus 600 according to the invention during a particular surgery. However, the height of the articulation is also variable, for example to adjust for the height of different surgeons or for particular procedures. Theapparatus 600 includes a longitudinal axis of rotation B (seeFIGS. 48 and 57 ), a perpendicular axis of rotation C associated with the point of articulation 601 (seeFIG. 57 ), spaced head-end and foot-end lift subassemblies, generally 602 and 604, also referred to as first and second piers or columns, a patient support subassembly, generally 606, an articulation subassembly, generally 607, and a powered actuator. The head-end and foot-end lift subassemblies base support structure 608, which may include a cross-bar 610 running parallel with the axis B and a plurality ofcasters 612. Thebase support structure 608 holds thelift subassemblies lift subassemblies apparatus 600 due to the large forces exerted on theapparatus 600 by a patient during surgery. - Referring to
FIGS. 48-50, 56-60, 62-63 , the first or head-end lift subassembly 602 provides for continuous adjustable raising and lowering of the head-end of thepatient support subassembly 606 over an infinitely adjustable range and, for example, a distance from about 0.5-inches or less to about 6-inches, 1-foot, 1.5-feet, 2.0-feet, 2.5-feet, 3.0 feet or more, in cooperation with other components of theapparatus 600, as described herein. It is noted that the head-end lift subassembly 602 operates in concert with or cooperates with other apparatus components, such as the foot-end lift subassembly 604 and thearticulation subassembly 607, such that an angle of articulation D (seeFIGS. 59 and 60 ) of thearticulation point 601 may be modified without a substantial change in height H of thearticulation point 601 during a particular surgery, so as to maintain the surgical site of the patient at a preferred height for the surgeon conducting the surgery. The head-end lift subassembly 602 also provides for continuously adjustable rotation or tilting of thepatient support subassembly 606 in an infinitely adjustable range from 0° to 90°, and for example, about +5°, ±10°, ±15°, ±20°, ±25° or more relative to the axis of rotation B, also in cooperation with the other components of theapparatus 600, as described herein. The head-end lift subassembly 602 includes an individually operable and continuously adjustableprimary elevator 614, or primary lift subassembly, a rotational subassembly, generally 616, and afooting 618, which are described in greater detail below. - The
primary elevator 614, of the head-end lift subassembly 602, includes at least two risers, such as alower riser 620 and anupper riser 622, and an internal motorized structure for telescopingly raising and lowering theupper riser 622 relative to thelower riser 620 in a continuously or infinitely adjustable, non-segmented manner. Theprimary elevator 614 includes oneintermediate risers 624 and it is foreseen that additional intermediate rises may be utilized. When theprimary elevator 614 includes anintermediate riser 624, the internal motorized structure telescopingly raises and lowers the lower, upper andintermediate risers risers lift sub assembly 602 includes a powered actuator, electronics and the like, to actuate theprimary elevator 614 and therotation subassembly 616. - The
primary elevator 614 moves under control to continuously and adjustably between a maximum lift or fully extended position, shown on the left side ofFIG. 49 , and minimum lift or fully lowered position, shown on the left side ofFIG. 50 . Accordingly, extension of theprimary elevator 614 may be adjusted over an infinitely adjustable wide range, for example a distance from about 0.5-inches or less to about 6-inches, 1-foot, 1.5-feet, 2.0-feet, 2.5-feet, 3.0 feet or more. In the fully extended position, therisers end lift subassembly 602 is maximally elevated above the floor F. In contrast, in the fully lowered position, therisers end lift subassembly 602 is as close to the floor F as mechanically possible. -
FIG. 48 illustrates an intermediate position of theprimary elevator 614, wherein therisers end lift subassembly 602 is in between the minimum and maximum possible heights. As will be described in greater detail, below, continuously adjustable, non-segmented inward and outward telescoping of therisers articulation apparatus 600 is associated with positioning the patient, so that the patient's spine will be in a suitable lordotic or kyphotic position for a given surgical procedure or on their side, such as changing the angle D while substantially maintaining the height H of the point ofarticulation 601 and optionally or preferably maintaining the patient's torso in a generally horizontal, non-head down position. - The
lower riser 620 rests on thefooting 618, which includes a housing and at least some of the internal motorized structure of the head-end lift subassembly 602. As shown inFIGS. 57 and 62 , thefooting 618 extends perpendicularly outward relative to a longitudinal axis B, so as to provide a sturdy support that sufficiently resists sideways tipping of theapparatus 600. Thefooting 618 includes top andbottom sides caster 612 extends downwardly from thebottom side 628, adjacent to each of the outer ends 630. The cross-bar 610 is centrally attached to the footingbottom side 628, so as to extend substantially parallel with the longitudinal axis B and the floor F. The cross-bar 610 joins thefooting 618 with afooting 618′ of the foot-end lift subassembly 604, described below, so as to hold thefootings apparatus 600. - The head-
end lift subassembly 602 supports therotational subassembly 616, which includes anhydraulic piston assembly 632 that rotates or tilts thepatient support subassembly 606 and arotational shaft 634, such as is described elsewhere herein. It is foreseen that other structures such as motors or drives may be used to rotate thesubassembly 606. Therotational shaft 634 is substantially parallel with axis of rotation B, and extends longitudinally inward from themotor housing 632. Therotational shaft 634 is rotatably joined with both thepatient support subassembly 606 and internal mechanical components of therotational subassembly 616, including a gear-driven device however, it is foreseen that, screw-driven, cable-driven or piston-driven drives the like. Rotating therotational shaft 634 rotates or tilts thepatient support subassembly 606 clockwise or counter-clockwise in a continuous range from 0° to 90° either way, for example about ±5°, +10°, ±15°, ±20°, or more relative to axis B. It is foreseen that the drive-device of therotational subassembly 616 may be located in the top or side of the head-end lift subassembly and in some circumstances, some portions of the drive-device may extend downwardly from therotational subassembly 616 and into thefooting 618. In the illustrated embodiment, apiston 635 is located at the side of theprimary elevator 614, that operably rotates the patient support subassembly 60 clockwise or counter-clockwise through a range of plus or minus 20° relative to axis B. Numerous configurations are foreseen. Additionally or alternatively, it is foreseen that arotational subassembly 616′ may be located at the foot-end lift subassembly 604. Therotational shaft 634 may be passive, and rotate in response to rotation of thepatient support subassembly 606 by other apparatus components, such as but not limited to therotational subassembly 616′. Alternatively, both therotational subassembly 616 and therotational subassembly 616′ may actively drive rotation of thepatient support subassembly 606, such as by a gear-driven, screw-driven, cable-driven or piston-driven drive known in the art. - The second or foot-
end lift subassembly 604 provides for continuous adjustable raising and lowering of the foot-end of thepatient support subassembly 606 over an infinitely adjustable range, for example a distance from about 0.5-inches or less to about 6-inches, 1-foot, 1.5-feet, 2.0-feet, 2.5-feet, 3.0 feet or more, in cooperation with other components of theapparatus 600, as described herein. The foot-end lift subassembly 604 also provides for continuous adjustable, non-segmented rotation or tilting of thepatient support subassembly 606 over an infinitely adjustable range, for example an amount up to about +5°, ±10°, ±15°, ±20°, or more relative to the axis B, also in cooperation with other components of theapparatus 600, as described herein. The foot-end lift subassembly 604 includes primary andsecondary elevators 614′ and 636, a passiverotational subassembly 616′ and afooting 618′. However, it is foreseen that therotational subassembly 616′ may also be active and include the same structure as the head-end. Similar to the head-end lift subassembly 602, the footing 618′ supports theprimary elevator 614′, which supports therotational subassembly 616′. Unlike the head-end lift subassembly 602, thesecondary elevator 636 is operably joined with therotational subassembly 616′ of the foot-end lift subassembly 604. The primary andsecondary elevators 614′ and 636 are individually yet cooperatively operable and continuously adjustable in a non-segmented infinitely adjustable manner. - The
primary elevator 614′ is substantially similar to theprimary elevator 614 and cooperates with other apparatus components, such as the head-end lift subassembly 602, thesecondary elevator 636 and thearticulation subassembly 607, such that the angle of articulation D may be modified without a substantial change in height H of thearticulation point 601. Accordingly, theprimary elevator 614′ includes at least two risers, such as alower riser 620′ and anupper riser 622′, and an internal motorized structure such as described herein, and provides for modification of a height of theprimary elevator 614′ over an infinitely adjustable range, and for example, a distance from about 0.5-inches or less to about 6-inches, 1-foot, 1.5-feet, 2.0-feet, 2.5-feet, 3.0 feet or more. Theprimary elevator 614′ may include one or moreintermediate risers 624′. In the illustrated embodiment, theprimary elevator 614′ shown on the right side ofFIG. 49 includes oneintermediate riser 624′. It is foreseen that in some circumstances, theprimary elevator 614′ may include two or moreintermediate risers 624′. When theprimary elevator 614′ includes anintermediate riser 624′, the internal motorized structure telescopingly raises and lowers the lower, upper andintermediate risers 620′, 622′ and 624′ and relative to one another in a continuously and infinitely adjustable, non-segmented manner. It is foreseen that the internal motorized structure for telescopingly raising and lowering therisers 620′, 622′ and 624′ may include any suitable continuously adjustable, non-segmented drive known in the art, such as but not limited to a cable drive, screw drives and hydraulic systems, such as described herein. - Referring again to
FIGS. 49 and 50 , theprimary elevator 614′ is adapted to move between a maximum lift or fully extended position, shown on the right side ofFIG. 49 , and a minimum lift or fully lowered position, shown on the right side ofFIG. 50 . In the fully extended position, therisers 620′, 622′ and 624′ are maximumly outwardly telescoped, or opened, relative to one another, such that a top of the foot-end lift subassembly 604 is maximally elevated above the floor F. In contrast, in the fully lowered position, therisers 620′, 622′ and 624′ are maximumly inwardly telescoped, or closed, relative to one another, such that the top of the foot-end lift subassembly 604 is maximally lowered toward the floor F. It is noted that, in the illustrated embodiment, when theprimary elevator 614′ is in the least-outwardly telescoped position or configuration thereof, only thelower riser 620′ is visible from the side of theapparatus 600. For example, theintermediate riser 624′ is operably so as to slide downwardly into thelower riser 620′, and theupper riser 622′ is operable so as to slide downwardly into theintermediate riser 624′. In some circumstances, the housing of therotational subassembly 616′ shrouds at least a portion of therisers 620′, 622′ and 624′.FIG. 48 illustrates an intermediate position of theprimary elevator 614, wherein therisers 620′, 622′ and 624′ are intermediately outwardly telescoped relative to one another, such that the top of the foot-end lift subassembly 604 is in between the minimum and maximum possible heights. As will be described in greater detail, below, inward and outward telescoping of therisers 620′, 622′ and 624′, in conjunction with cooperative movement of other portions of the patient support andarticulation apparatus 600 is associated with positioning the patient, so that the patient's spine will be in a suitable lordotic, kyphotic or sideways position for a given surgical procedure. - The
primary elevator 614′ is joined with thefooting 618′, which is substantially similar to thefooting 618, and which may house a portion of the internal motorized lift structure. The footing 618′ includes atop surface 626′, abottom surface 628′ and opposed outer ends or surfaces 630′.Casters 612 are attached to the outer ends 630′ of thefooting 618′, and the cross-bar 610 is attached to the bottom 628′ of thefooting 618′, such as described herein with respect tofooting 618. - The foot-
end lift subassembly 604 includes at least a passiverotational subassembly 616′. It is foreseen that thesubassembly 604 may include an active or poweredrotational subassembly 616′ that is similar to therotational subassembly 616 of the head-end lift subassembly 602. - Referring to
FIGS. 54 and 55 , thesecondary elevator 636 is joined with the top of theprimary elevator 614′ of the foot-end lift subassembly 604, such as, for example, at the housing of therotational subassembly 616′, such that thesecondary elevator 636 in use is operationally raisable or lowerable by theprimary elevator 614′. The secondary elevator cooperates with other apparatus components, such as the head-end lift subassembly 602, theprimary elevator 614′ and thearticulation subassembly 607, such that the angle of articulation of thearticulation point 601 may be modified without a substantial change in height H of thearticulation point 601. - The
secondary elevator 636 extends along the inboard side or face of the foot-end lift subassembly 604, from about the top 638, or top surface, of the foot-end lift subassembly 614, downwards toward the floor F. A top 640 of thesecondary elevator 636 may be about coplanar with the top 638 of the foot-end lift subassembly 614, or the top 640 may be somewhat above or below the top 638 of the foot-end lift subassembly 614. Thesecondary elevator 636 preferably includes a height, or length, sufficient that when the foot-end lift subassembly 604 is in the lowest elevational position, such as is shown inFIG. 56 , thebottom 642 of thesecondary elevator 636 is located near the top 626′ of thefooting 618′. - Referring to
FIGS. 54-55 , the front orinboard side 644, or face, of thesecondary elevator 636 includes an extendedvertical slot 646 with a height sufficient to adjustably continuously raise or lower the foot-end of thepatient support subassembly 606 in an infinitely adjustable range, for example, a distance of between about less than 0.5-inches, about 0.5-inches, 6-inches or 1-foot and about 1.5-feet, 2.0-feet, 2.5-feet or 3.0 feet or more. A secondrotational shaft 634′ extends toward thepatient support subassembly 606 from thevertical slot 646 such that theshaft 634′ is substantially parallel to the axis B or the floor F. Thesecondary elevator 636 includes a motorized drive, such as is known in the art and described herein, that vertically raises and lowers theshaft 634′ within theslot 646. As shown inFIGS. 50 and 60 , when theprimary elevator 614′ is in the lowest telescoping position or closed, thesecondary elevator 636 is lower the outboard end, generally 652, of thepatient support subassembly 606 into close proximity with the floor, for example, within a few inches of the floor F, such as a distance of about 1-inch or less, about 2-inches, about 3-inches, about 4-inches, about 5-inches, or more.FIG. 54 shows theshaft 634′ in a most elevated position with respect to thesecondary elevator 636, wherein the shaft 364′ is at the top 648 of theslot 646. In comparison,FIG. 55 showsshaft 634′ is at the bottom 650 of theslot 646. In use, thesecondary elevator 636 is independently operated relative to theprimary elevator 614′ or cooperatively with theprimary elevator 614′. - The patient support and
articulation apparatus 600 includes apatient support subassembly 606 rotatably joined with the head-end and foot-end lift subassemblies patient support subassembly 606 includes a head-end support 654 and a foot-end support 654′, each of which has an inboard end and an outboard end. At the outboard ends, the head-end and foot-end supports 654 and 654′ are joined to a respectiverotational subassembly translation subassembly attachment plate more pivot joints FIGS. 54 and 55 , theattachment plate 656′ and the cross-bar 658′ are joined by the joint 660′. When the outboard end of the foot-end support 654′ continuously moves between raised and lowered positions, or when the angulation of the pivot point 601 (e.g., angle D) is modified or changed, theattachment plate 656′ and the cross-bar 568′ pivot with respect to each other at the joint 660′. Similar angulation occurs between theattachment plat 656 and the cross-bar 658 at joint 660. - Each of the head-end and foot-end supports 654 and 654′ includes a pair of longitudinally extending
frames frames frames frames frames apparatus 600. However, it is foreseen that theframes - Each of the
frames elongate slot 662 includes a rectangular cross-section and opens downwardly, such as on the bottom side of the cross-section. However, it is foreseen that theelongate slot 662 may have a fourth side, such that the area of theslot 662 is a fully enclosed through-bore, such as is known in the art. Alternatively, theframes bores 662 therethrough. It is also foreseen that theelongate slot 662 may include other cross-sections, such as but not limited to circles, ovals, triangles, rectangles, quadrilaterals and the like. - Referring to
FIG. 57 , pairs offrames FIG. 66 , at the outboard ends, theframes 661A are joined by a perpendicular cross-bar 678 that is joined with the cross-bar 656 of thetranslation subassembly 655. In contrast, the outboard ends of theframes 661B are joined by agearbox 680, which is also part of theangulation subassembly 607. As is discussed in greater detail below, and is shown inFIGS. 50, 55, 56, 60, and 67 , thegearbox 680 includes an arch 676, or bowed portion, sized and shaped such thatportions 678 of thegearbox 680 may be lowered near to the floor F and around thebase support cross-bar 610. It is noted that lowering the outboard end of the foot-end support 654′ sufficiently that thegearbox 680 is located at least partially around the cross-bar 610 enables the head-end support 654 to be maintained in a substantially horizontal orientation, or substantially parallel with the floor F, during angulation of the patient (e.g., angle D), such that the patient's torso may be supported or held in a substantially horizontal or near horizontal orientation, without the head hanging downward and thus reducing side effects of the surgery on the patient. - Referring to
FIG. 66 , theframes articulation 601, or the axis of rotation C, by ahinge 663. Accordingly, theframes FIGS. 57 and 66 . Additionally or alternatively, rectangular surgical support tops or imaging tops, similar totops - Referring to
FIGS. 51-53 and 64-65 , eachhinge 663 includes a pair ofknuckles 664 joined by anupper axle 665, upper andlower rollers links 669, and alower axle 665′ pivotably joining thelower roller 668 and the V-links 669. The hinge can be a wide range of structures that allows articulation between theframes knuckle 664 includes a pair of longitudinally extending, spacedfingers 670. Each of thefingers 670 includes a through-bore 672 that is coaxial with axis C. Theupper axle 665 rotatably engages the through-bores 672, such that theupper axle 665 is coaxial with axis C. Therespective frames knuckles 664 at their associated outboard ends 674. Accordingly, the knuckles can pivot on theupper axle 665 with respect to axis C to thereby modify angle D. Theupper roller 667 includes a through-bore 667A that pivotably receives theupper axle 665 therethrough, such that theupper roller 665 is located between thefingers 670 of the joinedknuckles 664. Theupper roller 665 is coaxial with axis C and adapted to pivot freely thereabout independently of theknuckles 664 or of angulation of angle D. In the illustrated embodiment, theupper roller 667 includes a circular cross-section. However, it is foreseen that theupper roller 667 may have an alternatively shaped cross-section, such as but not limited to a rectangle, a polygon, an oval, or the like. It is foreseen that theupper roller 667 may be an alternative structure that provides the same function as theupper roller 667. Theupper roller 667 may be fabricated of any suitable material that is sufficiently strong so as to withstand the high forces applied thereto during surgery, while still being able to pivot or roll. For example, theroller 667 may be fabricated of hardened metals, carbon fibre, brass, aluminum, and the like, preferably a hardened steel. In some circumstances, the roller may be coated with a hard slick material to facilitate rolling, such as is known in the art. - In the illustrated embodiment, the
lower roller 668 is substantially similar to theupper roller 667 in size, shape and fabrication. However, thelower roller 668 may be include alternative sizes, shapes and materials known in the art. - The rod-like V-
links 669 pivotably engage theknuckles 664 and thelower axle 665′, such that an angle E is defined by a pair of intersecting V-links 669 (seeFIGS. 50, 52 and 53 ). Pins pivotably secure the V-links 669 with theknuckles 664 at rear through-bores 676. The V-links 669 are configured and arranged such that the angle E operably moves through a plurality of continuous angles associated with articulation of thepatient support subassembly 606. The V-links may be fabricated of any sufficiently resilient material that can withstand high stress and tension. Suitable materials include but are not limited to carbon fiber, hardened metals, aluminum, certain polymers, and the like, and preferably a hardened steel. In some circumstances, the V-links may be fabricated of strong elastic materials, such as certain polymers and composites. Further, in some embodiments, instead of being rod-shaped, the V-links may be braided or non-braided cords, bars, elastic bands and the like, such as is known in the art. - Pairs of V-links engage the
lower axle 665′ on either side of thelower roller 668. For example, as shown inFIG. 61 , two V-links 669 are joined at the left-hand and right-hand ends, or inner and outer ends, of each of the associatedlower axle 665′, for a total of four V-links engaging eachlower axle 665′. Thelower roller 668 is slidingly received on thelower axle 665′ so as to be located between the engagements of the pairs of V-links 669, such as is shown inFIG. 53 . It is foreseen that only two V-links 669 may be used, such as at only left-hand end or the right-hand end of the associatedlower axle 665′. - The
lower roller 668 is substantially similar or even identical to theupper roller 667. Accordingly, thelower roller 668 includes a through-bore 668A that pivotably receives thelower axle 665′ therethrough. Thelower roller 668 is sized and shaped to pivot freely about thelower axle 665′. In the illustrated embodiment, thelower roller 668 includes a circular cross-section. However, it is foreseen that thelower roller 668 may instead be a slide having a cross-section of another shape, such as but not limited to a rectangle, a polygon, an oval, or the like. It is also foreseen that thelower roller 668 may be an alternative structure that provides the same function as thelower roller 668. - The patient support and
articulation apparatus 600 includes an orientation subassembly that includes an individually operable and continuouslyadjustable articulation subassembly 607 interconnected with therotation subassemblies patient support subassembly 606 so as to allow thepatient support subassembly 606 to move through a plurality of infinitely adjustable and non-segmented angular orientations in cooperation with one or more of the primary andsecondary elevators articulation subassembly 607 is adapted to articulate thepatient support subassembly 606 at the point ofarticulation 601 up to 90° up or down, for example in an amount of about ±5°, ±10°, ±15°, ±20°, ±25°, ±30°, ±35°, ±40°, ±45°, ±50° or more with respect to an axis of rotation C and to thesubassembly 606 in a horizontal configuration. In some embodiments, the maximum upward breaking position is about +35° and the maximum downward breaking position, or an angle of articulation D, is about −20°, relative to axis C, thereby providing a total range of motion of the point ofarticulation 601 of about 55°. However, it is foreseen that, in some embodiments, thearticulation subassembly 607 may move through an infinitely adjustable non-segmented plurality of angular orientations, so as to break upwardly an amount up to about 90° or more, and as to break downwardly an amount up to about 90°, or more. - Referring to
FIGS. 51-53, 58-60 and 66 , thearticulation subassembly 607 cooperates with the head-end and foot-end lift subassemblies patient support subassembly 606 at the point of articulation 601 (e.g., modify angle D) while simultaneously substantially maintaining the height H of the point ofarticulation 601 relative to the floor F. Additionally, during this articulation at the point ofarticulation 601, thearticulation subassembly 607 cooperates with the head-end and foot-end lift subassemblies end support 654 of thepatient support subassembly 606 in a position that is about parallel with the floor F, such that a patient supported thereon will not be in a substantially head-down position. Thefront tether 690 may be a rod, a band, a cord, a cable, and the like. Therear tether 692 may be fabricated of any suitable elastic or non-elastic material known in the art. - The
articulation subassembly 607 includes thegearbox 680 operably linked with a pair of tensioned angulation subassemblies, generally 686, that slidingly engage the hinge upper andlower rollers hinges 663 to break upwardly and downwardly. Eachtensioned angulation subassembly 686 includes a tetheredtranslation wedge 688, thefront tether 690, and the tensionedrear tether 692, atrolley slider 694, and atranslation member 696 that engages thegearbox 680. Thewedge 688 and therear tether 692 are constantly under tension so as to urge thewedge 688 at the right inFIG. 59 or toward the end. - As shown in
FIG. 66 , thetrolley sliders 694 slidably engage the associatedframe 661A from the bottom thereof, such that thetrolley sliders 694 at least partially surround the associatedframes 661A, including portions of the bottom and two sides of theframes 661A. Thetrolley sliders 694 are adapted to slide in the cephalad and caudad directions along theframes 661A. In some circumstances, the surfaces of thetrolley slider 694 engaging the frame 6612A are lubricated. Eachtrolley slider 694 is engaged by afront tether 690 that pushes or pulls thetrolley slider 694 in cephalad and caudad directions in response to actuation of the tensionedangulation subassembly 696. - A
torso trolley 701 rests on theframes 661A and includesslide channel members 700 adapted to slidingly engage the tops and sides of theframes 661A and to releasably engage thetrolley sliders 694. Movement of thetrolley sliders 694, such as in the cephalad and caudad directions, translates thetorso trolley 701 along theframes 661A, such as is described in greater detail below. - The
translation wedge 688 includes first and second ends 702 and 704, top andbottom portions translation wedge 688 is generally thin, flat and triangular in shape. However, thetranslation wedge 688 may have any other shape so long as it fulfills its function as described herein. For example, it is foreseen that thetranslation wedge 668 may be a cam, a roller, a polygon, a sphere, and the like. Thetranslation wedge 688 may be fabricated of any sufficiently strong and resilient material able to withstand high stress and tension resulting from theapparatus 600 supporting a patient weighing up to at least 500-pounds. Suitable materials include but are not limited to aluminum, hardened metals and carbon fiber. It is foreseen that the top andbottom portions - Referring to
FIGS. 58-60, 66 and 68-69 , afirst end 702 of thetranslation wedge 688 engages thefront tether 690, asecond end 704 of thetranslation wedge 688 engages therear tether 692. The translation wedge top andbottom portions lower rollers translation wedge 688 is pulled between the upper andlower rollers rear tether 692, which in turn is pushed and pulled by thetranslation member 696 in response to actuation of thegearbox 680, as is described herein. Thewedge 688, because of the weight of the structure acting thereon is always urged away from therear tether 692, so as to place tension thereon. - The
rear tether 692 includes first and second ends 712 and 714, and may be a rod, a band, a cord, a cable, and the like. Therear tether 692 may be fabricated of any suitable flexible, but generally non-stretchable or non-elastic material known in the art. Therear tether 692 is tensioned between thesecond end 704 of thetranslation wedge 688 and thetranslation member 696. As shown inFIG. 58 , thefirst end 712 of therear tether 692 engages thesecond end 704 of thetranslation wedge 688, and thesecond end 714 of therear tether 692 engages thetranslation member 696 by an interveningtranslation nut member 728. Therear tether 692 is pulled or released in the cephalad and caudad directions, respectively, through thetranslation member 696. - The
translation member 696 engages thetranslation nut member 728 and thegearbox 680. As shown inFIGS. 66 and 67 , thegearbox 680 includes a motorized gear assembly, generally 716, and amotor 718. In the illustrated embodiment, thegear assembly 716 includes a worm gear. However, it is foreseen that any type ofgear assembly 716 may be used, so long as is can move thetranslation member 696 in the cephalad and caudad directions. Thetranslation member 696 also includes anouter translation structure 720, such as a tube, that passes through a through-bore 722 in thegear assembly 716. Aninner translation structure 724, such as a translation rod or bar, slides in and out of theouter translation structure 720. Atranslation screw 726 is secured to an end of theinner translation structure 724 within theouter translation structure 720. Thetranslation screw 726 engages thetranslation nut member 728 that engages thesecond end 714 of therear tether 692. Thetranslation nut member 728 moves along atranslation track 730 located within theelongate slot 662 of theframe 661B, in the cephalad and caudad directions, in response to actuation of thetranslation screw 726. - To articulate the
patient support subassembly 606 in an upwardly or downwardly breaking configuration, or to align thesubassembly 606 in the first plane P, thegearbox 680 is actuated. Actuation of thegearbox 680 moves thetranslation wedge 688 between the upper andlower rollers tether 692 toward thegearbox 680 or allowing thetether 692 slack so that the tension at thewedge 688 pulls the rear tether away from thegearbox 680. Upward and downward breaking is associated with a distance between the rollers, the distance being generally perpendicular to the floor F. When therollers hinge 663 breaks downwardly. When therollers hinge 663 breaks downwardly. Gravity and the weight of the patient facilitate downward breaking. When thetranslation wedge 688 moves in a cephalad direction, therollers bottom portions first end 702, such that therollers translation wedge 688, thereby causing thepatient support subassembly 606 to break downwardly. When thetranslation wedge 688 moves in a caudad direction, therollers bottom portions second end 704, therollers patient support subassembly 606 to break upwardly. Accordingly, a distance between the upper andlower rollers translation wedge 688 moves in the cephalad and caudad directions, respectively. - It is noted that the degree of angulation D is associated with the shape of the
translation wedge 688 and the spacial relationship between thetranslation wedge 688 and therollers bottom portions bottom portions second end 704. For example, the longer the top andbottom portions rollers patient support subassembly 606 possible. In a certain embodiment, movement of one inch of thewedge 688 relative to therollers -
FIG. 58 shows thepatient support subassembly 606, or the head-end and foot-end supports 654 and 654′, aligned in the first plane P. When thepatient support subassembly 606 is aligned with the first plane P, the upper andlower rollers translation wedge 688. Concurrently, thetrolley slider 694 is located medially along the length of the head-end support 654. Theinner translation structure 724 is moved into theouter translation structure 720, thetranslation nut member 728 is medially along thetranslation track 730, and thegearbox 680 is located near the cross-bar 658′. -
FIG. 59 shows thepatient support subassembly 606 in a downwardly breaking configuration, wherein thehinge 663 is located below the first plane P. Theapparatus 600 is adapted to move in a smooth, continuously and infinitely adjustable, non-segmented manner between the configuration ofFIG. 58 and the configuration shown inFIG. 59 and back again. In the configuration shown inFIG. 59 , the upper andlower rollers second end 704 of thetranslation wedge 688. When moving from theFIG. 58 configuration to theFIG. 59 configuration, thetrolley slider 694 moves “up hill” in a cephalad direction, or towards the head-end lift subassembly 602. Movement of thetrolley slider 694 moves thetorso trolley 701 towards the head-end lift subassembly 602 a distance associated with the amount of downward breaking or angulation of angle D. Thetranslation wedge 688 is sized and shaped such that when thehinge 663 breaks downwards, thetorso trolley 701 slides towards the head-end lift subassembly 602, or “up hill.” It is noted that in the configuration ofFIG. 59 , thetranslation nut member 728 has moved along thetranslation track 730, towards thehinges 663. Accordingly, thetranslation wedge 688 has been drawn between therollers bottom portions rollers second end 704. Thetranslation nut member 728 has also moved along thetranslation screw 726 towards the head-end lift subassembly 602, which is actuated by rotation of thetranslation screw 726. Further, actuation of thegearbox 680 rotates thetranslation screw 726 and moves theinner translation structure 724 away from the foot-end lift subassembly 604, effectively lengthening the foot-end lift subassembly 604. -
FIG. 60 shows thepatient support subassembly 606 in an upwardly breaking configuration, wherein thehinge 663 is located above the first plane P. Theapparatus 600 is adapted to move in a smooth, continuously adjustable, non-segmented manner between the configuration ofFIG. 58 and the configuration shown inFIG. 60 and back again. In the configuration shown inFIG. 60 , the upper andlower rollers first end 702 of thetranslation wedge 688. It is noted that thetrolley slider 694 is again moved “up hill”, in a caudad direction, or towards the foot-end lift subassembly 604. Movement of thetrolley slider 694 moves thetorso trolley 701 away from the head-end lift subassembly 602 a distance associated with the amount of downward breaking or angulation of angle D. Thetranslation wedge 688 is sized and shaped such that when thehinge 663 breaks upward, thetorso trolley 701 slides towards the foot-end lift subassembly 604, also up hill. It is noted that in the configuration ofFIG. 60 , thetranslation nut member 728 has moved along thetranslation track 730, towards the foot-end lift subassembly 604. Accordingly, thetranslation wedge 688 has been pulled between therollers rollers first end 702 of thetranslation wedge 688. Thetranslation nut member 728 has also moved along thetranslation screw 726 towards the foot-end lift subassembly 604, which is actuated by rotation of thetranslation screw 726. Further, actuation of thegearbox 680 rotates thetranslation screw 726 and moves theinner translation structure 724 towards the foot-end lift subassembly 604, effectively lengthening the foot-end lift subassembly 604. It is again noted that when theapparatus 600 is in the configuration shown inFIG. 60 , wherein thehinge 663 is in an upwardly breaking configuration and the foot-end lift subassembly 604 is in its lowest possible configuration and the primary and secondary elevators are both maximally lowered, the intersection of theinner translation member 728 and the cross-bar 658′ are substantially near the floor F, such that the ends of the cross-bar 658′ pass around the cross-bar 610 of thebase support 608 andportions 684 of thegearbox 680 pass around the cross-bar 610 so as to be located near the floor F, instead of being located above the cross-bar 610. This enables maintaining the head-end support 654 in a substantially horizontal position, relative to the floor F, such as by raising the head-end lift subassembly 602, while providing the amount or degree of angulation at the point ofangulation 601 required to a given surgical procedure. - The distance the
torso trolley 701 moves is associated with the change in angulation of angle D, which in turn is associated with the location of the upper andlower rollers translation wedge 688. The distance between thetrolley slider 694 and thetranslation wedge 688 is fixed by the length of the front tether. Accordingly, the greater the change in angle D, the farther thetorso trolley 701 is moved. In an exemplary embodiment, a change in the angle D is associated with about movement of thetorso trolley 701 that is approximately equal to the shortening of the distance between the opposite ends of the patient support or the change in the hypotenuse associated with the patient support subassembly. Depending upon the shape and size of thetranslation wedge 688 and other factors, this can vary somewhat so as to provides the optimal positioning of the patient's torso. It is foreseen that, if the amount of change in angulation is represented by the letter W and the amount of distance moved by the torso trolley is represented by the letter V, that the ratio of W:V may vary. - The
apparatus 600 includes a failsafe structure, generally 732, adapted to operably engage thearticulation subassembly 607 in the event of catastrophic failure of theapparatus 600. Catastrophic failure includes but is not limited to physical or mechanical breaking, or wearing out, of ahinge 663, a V-link 669, thetranslation wedge 688, a front orrear tether apparatus 600, into various components such as the head-end and foot-end lift subassemblies patient support subassembly 606. - In the illustrated embodiment of the invention, the
failsafe structure 732 is associated with thehinges 663 and thetranslation wedge 688. Referring toFIGS. 65, 68 and 69 , thefailsafe structure 732 includes at least one, preferably twoguides 734, aratchet locking structure 736, pawl or ratchet break 735, and a toothed ratchetedstrip 738 attached to at least oneface 710 of thetranslation wedge 688 adjacent to thetop portion 706 thereof. Theratchet locking structure 736 is located between twoguides 734 and includes agripping surface 740 sized and shaped to grippingly engage thesurface 742 of theupper roller 667. Theratchet locking structure 736 also includes a plurality ofratchet teeth 744 sized and shaped to engage theratchet teeth 746 of the ratchetedstrip 738. Thefailsafe structure 732 may include a device for preventing engagement of theteeth solenoid 748. For example, asolenoid 748 such as shown inFIG. 65 may bias theratchet locking structure 736 upwardly, so as to block engagement of theteeth leaf spring 750 biases theratchet locking structure 736 downwardly, so as to facilitate engagement of theteeth - During normal operation of the
apparatus 600, when thetranslation wedge 688 is moved towards the foot-end lift subassembly 604, theratchet locking structure 736 slides along the ratchetedstrip 738, such that theteeth ratchet locking structure 736 may be biased upwardly, such as by thesolenoid 748, so that theteeth translation wedge 688 is moved towards the head-end lift subassembly 602, theratchet locking structure 736 is biased upwardly, such as by thesolenoid 748, so that theteeth - In the event of a catastrophic failure of the
apparatus 600, for example power failure, thesolenoid 748 no longer maintains separation and theteeth 744 of the downwardly biasedratchet locking structure 736 engage the ratchetedstrip teeth 746. Since thetranslation wedge 688 is biased towards the head-end lift subassembly 602 by downward forces from the weight of the patient on theassembly 600, thetranslation wedge 688 pulls or pushes the ratchetedlocking structure 736 between theupper roller 667 and the translationwedge top portion 706. Thegripping surface 740 non-slidingly engages thesurface 742 of theupper roller 667 and theratchet teeth 744 of theratchet locking structure 736 lockingly engages the ratchetedstrip 738, thereby locking or binding-uptranslation wedge 688 and theupper roller 667, and substantially blocking further movement or articulation of thearticulation subassembly 607. - The
apparatus 600 includes a powered actuator and electronics such as are known in the art and described herein. - As described above, the head-
end support 654 slidably supports thetorso trolley 701. A number of attachments may be removably attached to the head-end and foot-end supports and/or thetorso trolley 701 such as but not limited to arm supports, a chest pad, hip pads, flat operating boards, radiopaque boards, straps for securing the patient to theframes - It is to be understood that while certain forms of the present invention have been illustrated and described herein, it is not to be limited to the specific forms or arrangement of parts described and shown.
Claims (28)
1-60. (canceled)
61. A patient support apparatus for supporting a patient having a torso above a floor, the apparatus comprising:
a patient support structure having a head portion and a foot portion that are pivotly connected by a hinge structure, the head portion being articulatable with respect to the foot portion in a plurality of angular orientations;
a first end support connected to the head portion of the patient support structure, and a second end support connected to the foot portion of the patient support structure;
an articulation assembly operably coupling the second end support and the foot portion and articulating at least a portion of the patient support structure through a plurality of angular orientations, the articulation assembly comprising a motorized gear assembly to cause the patient support structure to break upwardly and downwardly; and
a trolley slider assembly comprising a torso trolley and at least one elongate member, the torso trolley movably positionable upon the head portion of the patient support structure and configured for supporting the torso of the patient, the trolley slider assembly cooperating with the articulation assembly to move the torso trolley in a first direction along the head portion in response to the articulation of the head portion with respect to the foot portion, the at least one elongate member operably coupled to the torso trolley and configured to move in the first direction while causing the torso trolley to also move in the first direction.
62. The apparatus of claim 61 , wherein the hinge structure comprises a pair of spaced opposed hinges.
63. The apparatus of claim 61 , wherein each of the head portion and foot portion comprises a pair of longitudinally extending frames for supporting the patient.
64. The apparatus of claim 63 , wherein the trolley slider slidably assembly engages the frames of the head portion, and the trolley slider is configured to slide longitudinally along the frames of the head portion.
65. The apparatus of claim 61 , wherein the first and second end supports are vertically adjustable so as to raise and lower the head and foot portions, respectively.
66. The apparatus of claim 61 , wherein the at least one elongate member comprises a translation member operably coupled with the motorized gear assembly.
67. The apparatus of claim 66 , wherein a translational wedge is coupled between the torso trolley and the translation member.
68. The apparatus of claim 67 , wherein the translational wedge is slidably engaged between an upper roller and a lower roller.
69. The apparatus of claim 68 , wherein the translation wedge is configured to move between the upper and lower rollers by actuating the motorized gear assembly.
70. The apparatus of claim 68 , wherein articulation of the head portion relative to the foot portion about the hinge structure is configured to cause the torso trolley to move in the same direction as the translation wedge moves when the patient support structure articulates about the hinge structure positioning the patient in flexion or in tension.
71. The apparatus of claim 68 , wherein the trolley slider assembly is coupled to the translation wedge such that the torso trolley slides longitudinally in response to actuation of the motorized gear assembly.
72. The apparatus of claim 65 , wherein the motorized gear assembly comprises an actuator to actively move the hinge structure.
73. The apparatus of claim 61 , further comprising a first translation subassembly coupled to the first end support, and a second translation subassembly coupled to a second end support opposing to the first end support and coupled to the foot portion, the first and the second translation subassemblies operably allowing articulation of the head and foot portions with respect to each other and to the first and second end supports, respectively, while the distance between the first and second end supports remains fixed.
74. The apparatus of claim 61 , wherein the first direction is towards the first end support.
75. The apparatus of claim 61 , wherein the first direction is towards the second end support.
76. The apparatus of claim 61 , wherein the trolley slider assembly cooperates with the articulation assembly to move the torso trolley in a second direction along the head portion in response to the articulation of the head portion with respect to the foot portion, the translation member operably coupled to the torso trolley and configured to move in the second direction while causing the torso trolley to also move in the second direction, the second direction being generally opposite of the first direction.
77. The apparatus of claim 76 , wherein the first direction is towards the first end support and the second direction is towards the second end support.
78. The apparatus of claim 61 , wherein the at least one elongate member comprises multiple members linked together and between the motorized gear assembly and the torso trolley such that a force applied by the motorized gear assembly in the first direction is transmitted through the multiple members to the torso trolley to also move the torso trolley in the first direction.
79. The apparatus of claim 78 , wherein the multiple members comprise a translational wedge and a translation member.
80. A patient support apparatus for supporting a patient having a torso above a floor, the apparatus comprising:
a patient support structure comprising a head-end section coupled with a foot-end section pivotly connected by a pair of spaced apart hinges;
a first lift assembly coupled to the head-end section and an opposing second lift assembly coupled to the foot-end section, the first and second lift assemblies configured for raising or lowering opposing ends of the patient support structure;
a torso trolley movably positionable on the head-end section of the patient support structure and configured to support the torso of the patient thereon; and
an angulation assembly operably coupled with the torso trolley and comprising a motorized gear assembly operably linked with the pair of spaced apart hinges to cause the patient support structure to break upwardly and downwardly, the motorized gear assembly joined to an outboard end of the foot-end section.
81. The patient support apparatus of claim 80 , wherein the angulation assembly comprises at least one rod coupled to the hinges, such that as the at least one rod moves toward or away from the hinges, the torso trolley moves in the same general direction.
82. The patient support apparatus of claim 81 , wherein the motorized gear assembly is coupled to the at least one rod comprising a translation wedge slidably engaging between upper and lower rollers positioned at or near the spaced apart hinges, the motorized gear assembly configured to actuate the translation wedge to change the angulation between the head-end section and the foot-end section.
83. The patient support apparatus of claim 82 , wherein the upper roller has an axis of rotation, the lower roller is spaced from the upper roller and has a second axis of rotation substantially parallel to the first axis of rotation.
84. The patient support apparatus of claim 83 , wherein the translation wedge slidably engages the upper and lower rollers and is movable in a direction perpendicular to the first and second axes of rotation, so as to vertically bias the first and second rollers away from one another.
85. The apparatus of claim 82 , wherein the translation wedge includes first and second opposed ends, the first end having a first height and the second end having a second height substantially greater than the first height, wherein when the upper and lower rollers engage the translation wedge adjacent to the first end, the pair of spaced apart hinges articulate in a downwardly breaking position, and when the upper and lower rollers engage the translation wedge adjacent to the second end, the pair of spaced apart hinges articulate in an upwardly breaking position.
86. The patient support apparatus of claim 80 , wherein the angulation assembly is cooperatively linked with the first and second lift assemblies so as to articulate the head-end section and foot-end section relative to each other about the hinges while simultaneously substantially maintaining the height of the hinges relative to the floor.
87. The patient support apparatus of claim 80 , wherein the head-end section comprises inboard and outboard ends, and the torso trolley cooperating with the hinge to slide between the inboard and outboard ends of the head-end section.
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