U.S. patent application number 15/017110 was filed with the patent office on 2016-07-28 for patient positioning support structure.
The applicant listed for this patent is Roger P. Jackson. Invention is credited to Roger P. Jackson.
Application Number | 20160213542 15/017110 |
Document ID | / |
Family ID | 56433668 |
Filed Date | 2016-07-28 |
United States Patent
Application |
20160213542 |
Kind Code |
A1 |
Jackson; Roger P. |
July 28, 2016 |
PATIENT POSITIONING SUPPORT STRUCTURE
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.
Inventors: |
Jackson; Roger P.; (Prairie
Village, KS) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Jackson; Roger P. |
Prairie Village |
KS |
US |
|
|
Family ID: |
56433668 |
Appl. No.: |
15/017110 |
Filed: |
February 5, 2016 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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13374034 |
Dec 8, 2011 |
9308145 |
|
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15017110 |
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61459264 |
Dec 9, 2010 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 6/0407 20130101;
A61G 13/0054 20161101; A61G 7/001 20130101; A61G 13/08 20130101;
A61G 7/008 20130101; A61B 6/0442 20130101; A61G 13/0036 20130101;
A61G 13/04 20130101 |
International
Class: |
A61G 13/08 20060101
A61G013/08; A61B 6/04 20060101 A61B006/04 |
Claims
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.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] 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.
BACKGROUND OF THE INVENTION
[0002] 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
[0003] 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.
[0004] 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.
[0005] 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.
[0006] 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.degree. 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.
[0007] 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.
[0008] 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.
[0009] 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.
[0010] 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.
[0011] 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.
SUMMARY OF THE INVENTION
[0012] 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.
[0013] 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.
[0014] 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.
[0015] 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.degree. repositioning of a patient, from a prone to
a supine position.
[0016] 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.
Objects and Advantages of the Invention
[0017] 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.
[0018] 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.
[0019] The drawings constitute a part of this specification and
include exemplary embodiments of the present invention and
illustrate various objects and features thereof.
BRIEF DESCRIPTION OF THE DRAWINGS
[0020] FIG. 1 is a perspective view of a patient support structure
according to the invention.
[0021] FIG. 2 is an enlarged and partial side elevational view of a
portion of the support structure of FIG. 1.
[0022] FIG. 3 is an enlarged and partial top plan view of the
support structure of FIG. 1.
[0023] FIG. 4 is an enlarged and partial perspective view of a
portion of the structure of FIG. 1.
[0024] FIG. 5 is an enlarged and partial side elevational view of a
portion of the structure of FIG. 1.
[0025] FIG. 6 is an enlarged and partial perspective view of a
portion of the structure of FIG. 1.
[0026] FIG. 7 is an enlarged and partial perspective view of a
first hinge of the structure of FIG. 1.
[0027] FIG. 8 is an enlarged and partial perspective view of a
cooperating second hinge of the structure of FIG. 1.
[0028] FIG. 9 is an enlarged and partial elevational view of the
hinge of FIG. 7.
[0029] FIG. 10 is an enlarged and partial perspective view of an
outer portion of the hinge of FIG. 7 with portions broken away to
show the detail thereof.
[0030] FIG. 11 is an enlarged and partial perspective view of an
inner portion of the hinge of FIG. 7 with portions broken away to
show the detail thereof.
[0031] FIG. 12 is an enlarged and partial perspective view of a
portion of the structure of FIG. 1 showing a cable drive motor and
winch cylinders.
[0032] FIG. 13 is a partial perspective view of a patient support
frame of the structure of FIG. 1.
[0033] FIG. 14 is a partial perspective view of a patient imaging
top for replacement with the patent support frame of FIG. 13.
[0034] FIG. 15 is a reduced perspective view of the structure of
FIG. 1 shown with an imaging top of FIG. 14 replacing the support
frame of FIG. 13 and shown in a planar inclined position.
[0035] FIG. 16 is a perspective view of the structure of FIG. 15
shown in a planar tilted position.
[0036] FIG. 17 is a perspective view of the structure of FIG. 15
shown in a planar inclined and tilted position.
[0037] FIG. 18 is a side elevational view of the structure of FIG.
15 shown in a symmetrical upward breaking position.
[0038] FIG. 19 is a side elevational view of the structure of FIG.
15 shown in a first inclined and upward breaking position.
[0039] FIG. 20 is a side elevational view of the structure of FIG.
15 shown in a second inclined and upward breaking position.
[0040] FIG. 21 is a side elevational view of the structure of FIG.
15 shown in a symmetrical downward breaking position.
[0041] FIG. 22 is a side elevational view of the structure of FIG.
15 shown in a first inclined and downward breaking position.
[0042] FIG. 23 is a side elevational view of the structure of FIG.
15 shown in a second inclined and downward breaking position.
[0043] FIG. 24 is an enlarged side elevational view of the
structure of FIG. 1 shown in an upward breaking, inclined and
tilted position.
[0044] 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.
[0045] FIG. 26 is a perspective view of the patient support
structure of FIG. 25 shown tilted in an intermediate position
during a rotation as would be used for a patient rollover.
[0046] FIG. 27 is a perspective view of the structure of FIG. 25
shown further tilted in a second intermediate position during
rotation.
[0047] FIG. 28 is a perspective view of the structure of FIG. 25
shown after rotation to a final flipped position.
[0048] FIG. 29 is a perspective view similar to FIG. 25 showing the
patient support frame and the imaging table in a second spaced
orientation.
[0049] FIG. 30 is a front elevational view of a third embodiment of
a patient support structure according to the invention.
[0050] FIG. 31 is a front elevational view of a fourth embodiment
of a patient support structure according to the invention.
[0051] 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.
[0052] FIG. 33 is a perspective view of the structure of FIG. 32
shown in an inclined and upward breaking position.
[0053] FIG. 34 is a perspective view of the structure of FIG. 32
shown in a substantially symmetrical downward breaking
position.
[0054] 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.
[0055] FIG. 36 is a reduced side elevational view of the structure
of FIG. 35 shown in a symmetrical downward breaking position.
[0056] FIG. 37 is a reduced side elevational view of the structure
of FIG. 35 shown in a symmetrical downward breaking position.
[0057] FIG. 38 is an enlarged and partial top plan view of a
portion of the structure of FIG. 35 and shown in the same position
as shown in FIG. 35.
[0058] FIG. 39 is an enlarged and partial side elevational view of
the structure of FIG. 35 and shown in the same position as shown in
FIG. 35.
[0059] FIG. 40 is an enlarged and partial side elevational view of
the structure of FIG. 35 and shown in the same position as shown in
FIG. 35.
[0060] FIG. 41 is an enlarged and partial perspective view of the
structure shown in FIG. 40.
[0061] FIG. 42 is an enlarged and partial top plan view of a
portion of the structure of FIG. 35 and shown in the same position
as shown in FIG. 36.
[0062] FIG. 43 is an enlarged and partial side elevational view of
the structure of FIG. 35 and shown in the same position as shown in
FIG. 36.
[0063] FIG. 44 is an enlarged and partial side elevational view of
the structure of FIG. 35 and shown in the same position as shown in
FIG. 36.
[0064] FIG. 45 is an enlarged and partial top plan view of a
portion of the structure of FIG. 35 and shown in the same position
as shown in FIG. 37.
[0065] FIG. 46 is an enlarged and partial side elevational view of
the structure of FIG. 35 and shown in the same position as shown in
FIG. 37.
[0066] FIG. 47 is an enlarged and partial side elevational view of
the structure of FIG. 35 and shown in the same position as shown in
FIG. 37.
[0067] 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.
[0068] FIG. 49 is a side elevation view of the patient support
structure of FIG. 48, shown in a downward breaking position and in
a fully elevated position.
[0069] FIG. 50 is a side elevation view of the patient support
structure of FIG. 48, shown in an upward breaking position and in a
fully lowered position.
[0070] FIG. 51 is an enlarged bottom perspective view of a portion
of the patient support structure of FIG. 48, and shown in the same
position as shown in FIG. 48.
[0071] FIG. 52 is an enlarged bottom perspective view of a portion
of the patient support structure of FIG. 48, shown in the same
position as shown in FIG. 49.
[0072] FIG. 53 is an enlarged bottom perspective view of a portion
of the patient support structure of FIG. 48, shown in the same
position as shown in FIG. 50.
[0073] FIG. 54 is an enlarged partial perspective view of the
patient support structure of FIG. 48, shown in a fully elevated
position.
[0074] FIG. 55 is an enlarged partial perspective view of the
patient support structure of FIG. 54, shown in a fully lowered
position.
[0075] FIG. 56 is a side perspective view of the patient support
structure of FIG. 52, shown in a downward breaking position and a
fully lowered position.
[0076] FIG. 57 is an enlarged top elevational view of the patient
support structure of FIG. 48, shown in the same position as shown
in FIG. 49.
[0077] FIG. 58 is an enlarged cross-sectional view of a portion of
the patient support structure of FIG. 57, taken along line 58-58 of
FIG. 57, and shown in the same position as shown in FIG. 48.
[0078] FIG. 59 is an enlarged cross-sectional view of a portion of
the patient support structure of FIG. 48, taken along line 58-58 of
FIG. 57, and shown in the same position as shown in FIG. 49.
[0079] FIG. 60 is an enlarged cross-sectional view of a portion of
the patient support structure of FIG. 48, taken along line 58-58 of
FIG. 57, and shown in the same position as shown in FIG. 50.
[0080] FIG. 61 is an enlarged foot-end elevational view of the
patient support structure of FIG. 48 and shown in the same position
as shown in FIG. 49.
[0081] FIG. 62 is an enlarged head-end elevational view of the
patient support structure of FIG. 48 and shown in the same position
as shown in FIG. 49.
[0082] FIG. 63 is a side elevation view of the patient support
structure of FIG. 48, shown in an upwardly breaking position and in
a fully elevated position.
[0083] FIG. 64 is an enlarged top perspective view of a portion of
the hinge and roller of FIG. 48 and in a downward breaking
position.
[0084] FIG. 65 is an enlarged bottom perspective view of the hinge
and roller of FIG. 64.
[0085] FIG. 66 is an enlarge perspective view of the patient
support subassembly of the patient support structure of FIG. 48
with portions broken away and portions shown in phantom to show
detail thereof.
[0086] FIG. 67 is an enlarged perspective view of the gearbox of
the patient support structure of FIG. 48 with portions removed to
show detail thereof.
[0087] FIG. 68 is an enlarged partial perspective view of portions
of the tensioned angulation subassembly of the patient support
structure of FIG. 48, including the upper and lower rollers and
failsafe structure.
[0088] FIG. 69 is an enlarged partial side view of portions of the
tensioned angulation subassembly of the patient support structure
of FIG. 48, including the upper and lower rollers and failsafe
structure.
DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS
[0089] 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.
[0090] 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 in FIGS. 1-12. The structure 1
includes first and second upright support piers or columns 3 and 4
which are illustrated as independent, stationary floor base support
structures as shown in FIG. 1 or may be connected to one another by
a non-telescoping base support as illustrated in the embodiment
shown in FIGS. 25-28. In some embodiments according to the
invention as shown, for example, in FIGS. 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, the upright
support column 3 is connected to a first support assembly,
generally 5, and the upright support column 4 is connected to a
second support assembly, generally 6. Between them, the support
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 illustrated support structure 10 includes a first frame section
12, a second frame section 14 with a transverse support 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 a dual winch 18 and cooperating cables 20.
[0091] The columns 3 and 4 are supported by outwardly extending
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
the feet 12 into a floor-engaging position as shown in FIG. 1. The
columns 3 and 4 each include two or more telescoping lift arm
segments 3a, 3b and 4a, 4b, respectively that permit the height of
each of the columns 3 and 4 to be selectively increased and
decreased in order to raise and lower all or a selected portion of
the connected patient support structure 10. It is foreseen that the
vertical supports 3 and 4 may be constructed so that the column 3
has a greater mass than the support 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 the system 1 may be
employed in some embodiments to facilitate the approach of
personnel and equipment.
[0092] Each of the support assemblies 5 and 6 generally includes a
rotation subassembly 26 and 26' and an angulation subassembly 27
and 27', respectively, that are interconnected as will be described
in greater detail below and include associated power source and
circuitry linked to a controller 29 (FIG. 1) for cooperative and
integrated actuation and operation. The rotational subassemblies 26
and 26' enable coordinated rotation of the patient support
structure 10 about a longitudinal axis of the structure 1. The
angulation subassemblies 27 and 27' shown in FIGS. 2 and 3 enable
the selective hinging, articulation or breaking of the support 10
at the hinge assembly 16 at desired levels and increments as well
as selective tilting of the frame portions 12,14 with respect to a
longitudinal axis of such frame portion.
[0093] The rotation subassembly or mechanism 26, shown in FIGS. 1
and 5, includes at least one motor housing 30 surmounting the
support 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 the support column 4. A main
rotational shaft 32 extends from the motor housing 30 that turns a
rotation structure 33. The rotation structure 33 in turn rotates
the connected patient support 10 about a longitudinal axis as will
be described in greater detail below. The motor housing 30 contains
a rotary electric motor or other actuator drivingly engaged with
the shaft 32. The rotation mechanism 26 is operated by actuating
the motor using a switch or other similar means. The rotation
structure 33 is fixed to the shaft 32 at a location spaced from the
motor housing 30 and the support column 3 to provide clearance for
rotation of the connected patient support structure 10.
[0094] As shown in FIGS. 4 and 5, the rotation structure 33 is
attached to a pair of translation posts or H-bar posts 40 disposed
at either end of the rotation structure 33. The posts 40 are each
attached to the structure 33 by a pin 42, bolt, or other fixing
structure. A plurality of cooperating apertures 44 formed in the
posts 40 provide passageway for a pivot pin 46 to extend
therethrough. The pivot pin 46 is receivable in each cooperating
pair of apertures 44 allowing for selective placement of a
translation connector 48 that is sized and shaped to be received
between the pair of posts 40 and also receive the pivot pin 46
therethrough. The pin 46 and connector 48 are thus positionable in
an orientation transverse to the longitudinal extension of the
support 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 the frame 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 in FIGS.
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 in FIG. 5, the connector 48 has a slot 50 for receiving
the pivot pin 46.
[0095] Also with reference to FIGS. 4 and 5, the translation
connector 48 is in turn attached to a pivot connector 52. The pivot
connector 52 includes first and second outwardly opening shaped for
receiving the translation connector 48 and the second slot is sized
and shaped for receiving an end connection 58 of the frame section
12. The pivot connector 52 further includes a through aperture or
bore 60 running substantially perpendicular to the slot 54 and
communicating therewith. The aperture 60 is sized and shaped to
receive a pivot pin 62 therethrough. The connector 48 also includes
a through bore 60' that receives the pivot pin 62. The swivelable
connection provided by the pin 62 allows for some forward and
rearward lateral movement of the attached frame end connection 58
and thus the frame section 12, providing a degree of freedom and
clearance needed for rotation the patient support about a
longitudinal axis of a patient. The slot 56 is sized and shaped to
frictionally engage the frame end connection 58, thus securely
fixing the end connection 58 to the pivot connector 52. The frame
end connection 58 is in turn fixed to each of elongate frame
members 66 and 68 of the frame section 12. The frame members 66 and
68 are each hingedly connected to the hinge assembly 16 to be
described in greater detail below. Pivoting of the translation
connector 48 with respect to the pin 46 provides for selected
articulation of the frame section 12 (that includes the end
connection 58 and the frame members 66 and 68) and/or the entire
support 10 with respect to the support pier or column 3.
[0096] With reference to FIG. 6, at the support pier or column 4,
the support assembly 6 is substantially similar to the support
assembly 5 with the exception that the rotation subassembly 26' can
be passive and, therefore, not include a motor. However, the
support pier or column 4 preferably includes a powered mechanism to
provide selective height adjustment of the subassembly 26'. A
rotation structure 33' is spaced from and freely rotatable with
respect to the column 4. The structure 33' includes a shaft (not
shown) extending outwardly therefrom similar to the rotation shaft
32, the shaft being rotatingly received in an aperture in the
support column 4.
[0097] The rotation subassembly 26' and the angulation subassembly
27' otherwise include elements identical to or substantially
similar to the elements of the subassemblies 26 and 27.
Specifically, H-bar posts 40', pin 42', apertures 44', pivot pin
46', translation connector 48', slot 50', pivot connector 52', end
connector 58' and pivot 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 and pivot pin 62.
[0098] The frame 14 further includes frame members 66' and 68' that
are each fixed to the end connector 58'. The frame members 66' and
68' are pivotally or hingedly connected to respective frame members
66 and 68 by the hinge assembly 16. Specifically, the frame member
66 is attached to the frame member 66' by the hinge mechanism 70
and the frame member 68 is attached to the frame member 68' by the
hinge mechanism 72.
[0099] With particular reference to FIGS. 3, 7 and 9-11, the hinge
mechanism 70 includes an outer member 76 and an inner member 78.
The outer member 76 is fixed or may be integral with the elongate
frame member 66, while the inner member 78 is integral or otherwise
fixed to the frame member 66'. The outer member 76 further includes
an extension 80 with a groove 82 for receiving and guiding the
cable 20. The extension 80 tapers in a direction from the outer
member interior 84 to the groove 82. The extension 80 is configured
to cause a slight upward break or bend of the support 10 when the
extension 80 comes into contact with the cable 20 at the groove 82.
In that way, when the cables 20 are reeled in to shorten the
hypotenuse of the triangle formed by the cable, the section 12 and
the section 14, the sections 12 and 14 move toward one another,
resulting in the upward break as illustrated, for example, in FIG.
18. The downward break or joint illustrated, for example, in FIG.
21 is a result of lengthening the cable 20 distance and allowing
gravity to drop the hinge 70. The extension 80 is shaped to extend
slightly inwardly toward a longitudinal axis A of the support 10,
thereby guiding the cable 20 along a path within a periphery of the
frame sections 12 and 14 when the extension 80 is in contact with
the cable 20 when in a downward breaking configuration directed
toward the cable with the cable 20 being received at the groove
82.
[0100] It is foreseen that if an exclusively upward breaking or
jointing embodiment is desired according to the invention, the
sections 12 and 14 may be positioned with respect to two end
columns to always include a slight upward break, joint or bend at
the hinge or pivot between the sections 12 and 14. When the
telescoping base is actuated to move the columns toward one
another, the sections 12 and 14 would automatically further break
or articulate upwardly and toward one another. Downward breaking or
jointing would not be possible in such an embodiment as the maximum
distance between the two end columns would still ensure a slight
upward break or hinge between the sections 12 and 14. Such an
embodiment would be acceptable for use because patient holding pads
could be positioned on the frames 12 and 14 such that the patient
would be in a substantially horizontal position even when there is
a slight upward bend or break at the hinge between the sections 12
and 14.
[0101] Returning to the hinge 70 of illustrated embodiment, the
inner member 78 is slidingly and rotatably receivable in an
interior 84 of the outer member 76. The outer member has a pair of
pivot apertures 86 and the inner member has a pivot aperture 87,
the apertures cooperating to create a through bore for receiving a
pivot pin 88 through both the inner and outer hinge members. The
interior 84 includes a curved partially cylindrical surface 89 for
slidingly receiving a cooperating outer rounded and partially
cylindrical surface 90 of the inner member 78. The inner member 78
further includes a downward breaking stop or projection 92 that
limits a downward pivot (in a direction toward the cables 20) of
the hinge 70 in the event the cables 20 should fail. The stop 92
abuts against a surface 93 of the interior 84. In the illustrated
embodiment, the stop 92 limits the extent of rotation or hinging of
the section 66 with respect to the section 66' to about twenty-five
degrees. Upward pivot (in a direction away from the cables 20) is
limited by abutment of an inner planar surface 95 with a planar
surface 96 of the hinge inner member 78.
[0102] With particular reference to FIG. 8, the hinge mechanism 72
is substantially a mirror image of the hinge mechanism 70 and
therefore includes the following elements: a hinge outer member
76', an inner member 78', an extension 80' with a groove 82', an
interior 84', pivot apertures 86', a pivot pin 88', a curved
surface 89'(not shown), an outer surface 90' (not shown), a stop
92' (not shown), an abutment surface 93', an inner planar surface
95' and a planar surface 96' that are identical or substantially
similar in shape and function to the respective hinge outer 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, inner planar surface 95 and planar
surface 96 described herein with respect to the hinge 70.
[0103] 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 the
sections 12 and 14. The disclosures of U.S. Pat. No. 7,152,261 and
U.S. patent application Ser. No. 11/159,494 are incorporated by
reference herein. It is foreseen that a rotating universal joint
operated type of hinge mechanism could be used with the invention,
etc.
[0104] With particular reference to FIGS. 6 and 12, the cable drive
system 18 includes a rotary motor 98 cooperating with and driving
by rotation a pair of winch cylinders 99 disposed on either side of
the motor 98. The motor 98 and cylinders 99 are mounted to the end
connector 58' located near the support column 4. Each cable 20 is
attached to one of the winch cylinders 99 at one end thereof and to
the end connector 58 at the other end thereof. In a first
longitudinal position wherein the section 12 is substantially
planar with the section 14, the cables 20 are wound about the winch
cylinders 99 an amount to provide enough tension in the cables 20
to maintain such a substantially planar orientation and
configuration, with the hinge extensions 82 and 82' being in
contact with each of the cables 20. The motor 98 is preferably low
speed and high torque for safely winding both of the cables 20
simultaneously about the cylinders 99 to draw the section 12 toward
the section 14 to result in an upward breaking or jointing
configuration with the hinges 70 and 72 disposed in spaced relation
with the cables 20 and the hinges 70 and 72. The motor 98 may be
reversed, reversing the direction of rotation of the winch
cylinders 99 for slowly unwinding the cables 20 to a downward
breaking or jointing configuration. As the cables 20 unwind,
gravity draws the support sections 12 and 14 downward with the
cables 20 being received in the grooves 82 and 82' of the hinge
extensions 80 and 80'. As the cables 20 slacken, the hinges 70 and
72 continue to lower pressing down upon the cables 20.
[0105] It is noted that the frame sections 12 and 14 are typically
equipped with pads (not shown) or other patient holding structure,
as illustrated, for example, in Applicant's U.S. Pat. No.
5,131,106, the disclosure of which is incorporated by reference
herein. It is foreseen that such patient holding structure could
translate or glide along the frame sections 12 and 14. Furthermore,
with respect to FIGS. 13 and 14, the frame member sections 66 and
68 of section 12 and the frame member sections 66' and 68' of the
section 14 may be replaced with substantially rectangular imaging
tops or sections 100 and 101' respectively. Each of the sections
100 and 101' having elongate slots 101 formed therein to allow for
attachment of the hinge mechanisms 70 and 72 in a manner identical
or substantially similar to what has been described herein with
respect to the frame sections 12 and 14.
[0106] With reference to FIGS. 15-17, the imaging sections 100 and
100' are illustrated, replacing the frame sections 12 and 14 of the
embodiment disclosed in FIGS. 1-12. Each of FIGS. 15-17 represent
configurations in which the cable drive 18 is tensioned such that
the sections 100 and 100' are kept in a substantially coplanar
configuration. FIG. 15 illustrates a configuration in which the
column 3 is telescoped upwardly with the frame sections hinging at
the support assemblies 5 and 6, resulting in an inclined position
or configuration of the entire patient support. In the illustrated
embodiment, the section 100 would preferably receive a patient's
head. Therefore, FIG. 15 illustrates a reverse Trendelenburg
position or orientation. FIG. 16 illustrates the sections 100 and
100' again in a substantially common plane with both sections being
rotated to a tilted position produced by a powered rotation of the
subassemblies 26 and passive rotation of the assembly 26' with both
columns 3 and 4 otherwise holding the sections 100 and 100' at the
same height. FIG. 17 illustrates both tilting due to rotation of
the assemblies 26 and 26' and also a sloping or inclined position
with the column 4 being extended vertically. Thus, FIG. 17
illustrates a Trendelenburg position or orientation with both the
sections 100 and 100' remaining in substantially the same plane. It
is foreseen that a bearing block assembly at one or both ends of
the table provides for some lateral translation to prevent binding
of the hinge mechanisms.
[0107] With reference to FIGS. 18-20, there is illustrated three
upward breaking or hinging configurations of the structure 1. FIG.
18 illustrates a symmetrical upward breaking configuration wherein
the columns 3 and 4 are holding the respective support assemblies 5
and 6 at substantially the same height with the cables 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 the
column 3 being extended to a maximum height and the cables reeled
to shorten a distance between the sections 100 and 100'. An example
of such an upward break or joint with reverse Trendelenburg would
be a head or column 3 height of 43 inches, a foot or column 4
height of 24 inches and a 35 degree upward break with zero degree
roll. FIG. 20 illustrates an upward breaking Trendelenburg with the
column 4 being extended to a maximum height.
[0108] With reference to FIGS. 21-23, there is illustrated three
downward breaking configurations of the structure 1. FIG. 21
illustrates a symmetrical downward breaking configuration wherein
the columns 3 and 4 are holding the support assemblies 5 and 6
respectively, at the same height with the cables 20 being unwound
or slackened to result in a downward break or joint in the hinge
assembly 16, the hinges 70 and 72 contacting the cables 20. FIG. 22
illustrates a downward breaking reverse Trendelenburg with the
column 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 the column 4 being extended to
a maximum height.
[0109] It is noted that in each of the configurations illustrated
in FIGS. 18-23, the sub-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 the structure 1 with support frame sections 12 and 14
positioned in a configuration similar to that illustrated in FIG.
19, but also including rotation, resulting in a tilting and
upwardly breaking or jointed configuration of the structure 1. An
example of the position illustrated in FIG. 24 would be: a head or
column 3 height of 41 inches, a foot or column 4 height of 34
inches and a 35 degree upward break or joint with 10 degree
roll.
[0110] With reference to FIGS. 25-29, another structure, generally
102 according to the invention is illustrated. The structure 102
utilizes all of the elements described herein with respect to the
structure 1 and therefore the same references numerals are used for
the same elements or features. The structure 102 differs from the
structure 1 in that the H-bar posts 40 and 40' are replaced or
modified to be extended H-bar posts 40A and 40A', allowing for the
mounting of two elongate structure 10 and cooperating cable drives
18. In the embodiment shown in FIG. 25, one of the structures 10
includes the frame member 12 and 14 while the other structure is an
imaging top having sections 100 and 100'. As previously described
herein, the cooperating H-bar posts 40A and 40A' equipped with a
plurality of apertures allows for the placement of the 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 in FIG. 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 in FIG. 25.
[0111] As illustrated in FIGS. 25-28, the structure 102 provides
for the complete rotation and thus a roll-over of a patient by
actuation of the motor of the rotation subassembly 26 using the
controller 29. The structure 102 shown in FIGS. 25-29 is further
illustrated with a non-telescoping base support 110 fixed to each
of the columns 3 and 4 and rollers or castors 112 at the base of
the structure 102.
[0112] 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 or columns 203 and 204 which are connected to
respective first and second support assemblies, generally 205 and
206. Between them, the support assemblies 205 and 206 uphold an
elongated breaking, hingeable or pivotable patient support
structure, generally 210. The hinge structure is described in
detail in Applicants' U.S. Pat. No. 7,152,261 and also U.S. patent
application Ser. No. 11/159,494, both disclosures of which are
incorporated by reference herein. The embodiment 200A illustrated
in FIG. 31 differs from the structure 200 only in that the
length-adjustable base 202 is replaced by a first base 220 attached
to the pier 203 and a second base 222 attached to the pier 204. All
of the bases 202, 220 and 222 include castors or rollers 230 or
some other movable structure to allow the piers 203 and 204 to move
toward and away from one another during upward or downward breaking
of the structure 210.
[0113] 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.
[0114] Another patient support structure according to the
invention, generally 301, is illustrated in FIGS. 32-34. The
structure 301 generally includes a horizontally telescoping floor
mounted base 302, a conventional or standard telescoping and
inclinable operating table support structure 304, a telescoping end
support or pier 306 and a hinged or pivotally upwardly and
downwardly breaking or jointing support structure 310 connected to
both the structure 304 and the pier 306. The patient support
structure 310 further includes a first cantilevered section 312 and
a second section 314. The first section 312 is fixed to and extends
from the operating table support 304. The second section is
attached to the pier 306 by a hinge or pivoting assembly 320, such
as the support assembly 5 described herein with respect to the
structure 1. The hinge mechanism 316 disposed between the support
sections 312 and 314 may be a conventional hinge, pivot, or pivot
or hinge systems previously described herein.
[0115] In use, the operating table support 304 utilizes electric or
other power means to move the support section 312 up and down and
at an incline, as is known in the art. The operating table support
304 can also tilt or rotate from side to side. In response to the
movement of the section 312, the section 314 also moves, resulting
in upward and downward breaking illustrated in FIGS. 32 and 33. In
response to the movement of the section 312, the electric powered
telescoping base 302 moves the pier 306 toward or away from the
support 304. The pier 306 includes a motor for raising and lowering
the pier at the connection 320.
[0116] 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.
[0117] With reference to FIGS. 35-47, another patient support
structure according to the invention, generally 401 includes first
and second upright support piers or columns 403 and 404 that are
connected to one another by a non-telescoping base support 402. In
some embodiments according to the invention, each column may be
surmounted on an independent movable or stationary base. The column
403 is connected to a first support assembly, generally 405 and the
column 404 is connected to a second support assembly, generally
406. Between them, the support assemblies 405 and 406 uphold at
least one removable elongate and articulate, substantially
centrally jointed or breaking patent holding or support structure,
generally 410. The assembly includes a first frame section 412, a
second frame section 414 and a pair of identical hinge assemblies,
generally 416, disposed between and connecting the first and second
frame sections 412 and 414. In the illustrated embodiment, the
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 the second frame section 414. Therefore, the spaced hinge
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.
[0118] The columns 403 and 404 are substantially similar in form
and function to the columns 3 and 4 previously described herein
with respect to the structure 1. The columns 403 and 404 are
supported by outwardly extending feet 422 that include casters that
may be equipped with a floor-lock foot lever for lowering the feet
422 into a floor-engaging position. The columns 403 and 404 each
include two or more telescoping lift arm segments respectively that
permit the height of each of the columns 403 and 404 to be
selectively increased and decreased in order to raise and lower all
or a selected portion of the connected patient support structure
410.
[0119] Each of the support assemblies 405 and 406 generally
includes a rotation subassembly 426 and 426' and an angulation
subassembly 427 and 427', respectively, that are the same or
substantially similar to the subassemblies 26, 26', 27 and 27'
previously described herein with respect to the structure 1. In the
illustrated embodiment, the angulation subassembly 427 connected to
the frame 412 for holding the head and upper body of a patient is
shown as substantially identical to the subassembly 27 and
therefore shall not be described further herein. The subassembly
427' is substantially similar to the subassembly 27', but with some
modifications, including a frame 436 disposed transverse to the
overall longitudinal axis X of the structure 401, the frame 436
providing for slidable support of the pair of identical slider bars
420 that are disposed at either side of the frame 414 and near the
subassembly 427'.
[0120] Similar to the rotation subassembly 26 previously described
herein, the rotation subassembly or mechanism 426, includes at
least one motor housing 430 surmounting the support column 403. It
is foreseen that a cooperating motor may also be mounted on the
support column 404. A main rotational shaft 432 extends from the
motor 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, the motor housing 430 contains a
rotary electric motor or other actuator drivingly engaged with the
shaft 432. The rotation mechanism 426 is operated by actuating the
motor using a switch or other similar means. The shaft 432
rotationally cooperates with a pair of substantially vertically
disposed translation posts or H-bar posts 440, the posts 440 being
attached to and disposed at either end of the transverse rotation
structure or bar 433. Each H-bar post 440 includes a plurality of
apertures 444, allowing for selective, hinged vertical placement of
the frame section 412 identical or substantially similar to what
has been described previously herein with respect to the H-bar
posts 40, the angulation sub-assembly 27 and the frame end section
58 of the frame section 12 previously described herein with respect
to the structure 1.
[0121] 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 passive rotational 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 cooperating
apertures 444' formed in the posts 440' provide passageway for a
pivot pin 446 to extend therethrough. The pivot pin 446 is
receivable in each cooperating pair of apertures 444', allowing for
selective placement of a translation connector 448 that is sized
and shaped to be received between the pair of posts 440' and also
receive the pivot pin 446 therethrough. The pin 446 and connector
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 the frame
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
in FIGS. 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. The
connector 448 has a slot for receiving the pivot pin 446. It is
noted that the H-bar support 440', apertures 444', elongate
transverse pin 446 and translation connector 448 are the same or
substantially similar in form and function with the respective
support 40, apertures 44, transverse pin 46 and translation
connector 48 previously described herein with respect to the
structure 1.
[0122] The translation connector 448 is in turn attached to a pivot
connector 452 that is substantially similar to the pivot connector
52 previously described herein with the exception that rather than
being attached directly to an end piece or section of the patient
support frame 414, the pivot connector 452 is fixed to the frame
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 the frame section 414 and disposed
substantially parallel to a longitudinal axis of the section 414 as
will be described in greater detail below. Such slidable attachment
facilitates upward and downward breaking or hinging of the section
414 with respect to the section 412 at the hinge mechanism 416.
Also as more fully described below, the pull rod assembly 418, that
is connected to both the frame section 414 and the hinge 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 the hinge
mechanism 416.
[0123] With particular reference to FIGS. 38 and 39, the support
frame section 414 includes opposed elongate and parallel frame
sections 466 and 468 attached to one another by a transverse end
frame section 469. A support plate 470 is attached to and is
disposed below each of the sections 466, 468 and 469 to provide
additional support and stability to the frame section 414 at and
near the end section 469. Further support is provided by a pair of
frame support plates 471, both of which are fixed to the end
support frame section 469 near one end thereof; one plate 471 being
fixed to the section 466 and the other plate 471 being fixed to the
section 468. At least one pair of slider bar holding structures 472
are fixed to the support plate 470 and extend downwardly therefrom
at each of the frame sections 466 and 468. Each structure 472
includes a through bore that extends parallel to the frame sections
466 and 468, the structure 472 for slidably receiving one of the
slider bars 420 directly below one of the frame sections 466 and
468 and also orienting the pair of slider bars 420 in a direction
substantially parallel to the frame sections 466 and 468. The
illustrated slider bar holding structures 472 are spaced from the
end frame section 469 and located near a forward edge 473 of the
plate 470. In the illustrated embodiment, the holding structures
472 are also bolted to the frame sections 466 or 468. A pair of
pull-rod supports 475 are also fixed to the support plate 470 and
the frame 414 and extend downwardly therefrom at each of the frame
sections 466 section 469. Each structure 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 the
support 475 at the pivot pin 476 and is thus in hinged relationship
with the support 475, pivotally attached thereto at end portions
478.
[0124] The pull-rod assembly 418 further includes a pair of
housings 480, each housing attached to an end portion 478 and
having a powered actuator 482 cooperating with one of a pair of
rotatable extendible and retractable rods 484 and a pair of hinge
connectors 486, each pivotally attached to a respective cam plate
488 of the respective hinge mechanism 416 at a respective pivot pin
490. The cam plate 488 has a substantially centrally located
curvilinear wall 489 forming a curvate aperture or slot, a lower
circular aperture for receiving the pin 490 and an upper circular
aperture for receiving a pin 502, described in greater detail
below. Each pull rod 484 is rotatably mounted within one of the
housings 480, such rotation being controlled by operation of the
actuator 482 located in the housing 480 and engaged with the rod
484 to screw and thus selectively move or draw the rod 484 into or
away from the hinge mechanism 416 in a direction along a
longitudinal axis of the rod 484, that in turn results in breaking
or jointing of the patient support 410 at the hinge 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 the mechanism 416, for example including,
but not limited to, polyaxial joints, roller with spokes,
sprockets, toothed gears, universal axis gears, or the like.
[0125] With particular reference to FIG. 41, the illustrated pair
of hinge mechanisms 416, each having a cam plate 488, further
include a pair of forked arms 492 extending from the frame section
412 and a pair of cooperating forked arms 494 attached to and
extending from the section 414. Hinge arms 496, 497, 498 and 499
having apertures near opposite ends thereof for receiving pivot
pins cooperate with the respective cam plate 488 and adjacent
forked arms 492 and 494 at pivot pins 501, 502, 503 and 504. All of
the pivot pins 490, 501, 502, 503 and 504 are disposed transverse
to the longitudinal axis X of the patient support structure 401. In
particular, the pivot pin 501 is received by circular apertures
located near first ends of the hinge arms 496 and 498 and a
circular aperture in the arm 492, thus pivotally attaching the arm
492 with both the hinge arms 496 and 498. The pivot pin 502 is
received by an upper circular aperture in the cam plate 488 and
circular apertures located near the ends of each of the forked arms
492 and 494, thus pivotally attaching the cam plate 488 with both
of the forked arms 492 and 494. The pivot pin 503 is received by
circular apertures located near first ends of the hinge arms 497
and 499 and a circular aperture in the arm 494, thus pivotally
attaching the arm 494 with both the hinge arms 497 and 499. The
pivot pin 504 is received by the slot 489 and also by circular
apertures located near second ends of the hinge arms 496, 497, 498
and 499, thus pivotally attaching all four hinge arms 496, 497, 498
and 499 with the cam plate 488 at the slot 489.
[0126] 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 the hinge mechanism 416 in such
neutral position, with the forked arms 492 and 494 in parallel. In
such position, the pin 504 is located at or near a rear-ward end of
the slot 489.
[0127] With reference to FIGS. 42-44, as the rod 484 is rotated to
selectively lengthen the rod 484, the pin 504 remains near the
rear-ward end of the slot 489 and the pushing of the rod toward the
hinge mechanism 416 pivots the cam plate 488 at the pivot pin 490,
causing the arms 492 and 494 to move toward the rod hinge connector
486 and thus pivot the patient support at the pin 502, causing a
downward break or joint in the patient support 410. With reference
to FIGS. 45-47, as the rod 484 is rotated to selectively shorten
the length thereof, the support portion 414 slides along the slider
bars 420 away from the end support 404. At the same time, the pin
504 slides along the slot 489 to an opposite or forward end thereof
as the cam plate pivots in a forward direction about the pin 490.
The movement of the rod 484 thus causes an upward break at the
pivot pin 502. In the illustrated embodiment, the patient frame is
pinned at the head end, but is free to move along the fixed slider
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.
[0128] 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.
[0129] As with the structure 1 configurations illustrated in FIGS.
18-23, the upward and downward breaking of the patient support 410
may be modified by placing the portions 412 and 414 at different
vertical locations along the H-bar supports 440 and 440', thus
resulting in symmetrical or asymmetrical breaking configurations.
Furthermore, the portions 412 and 414 may be rotated or tilted as
described above with respect to the structure 1.
[0130] FIG. 48 through FIG. 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 of articulation 601 relative to a floor F supporting
the apparatus 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. The apparatus 600 includes a longitudinal
axis of rotation B (see FIGS. 48 and 57), a perpendicular axis of
rotation C associated with the point of articulation 601 (see FIG.
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 602 and 604 are joined by a
non-telescoping base support structure 608, which may include a
cross-bar 610 running parallel with the axis B and a plurality of
casters 612. The base support structure 608 holds the lift
subassemblies 602 and 604 in opposed spaced relation to one
another, as well as preventing the lift subassemblies 602 and 604
from toppling over during operation of the apparatus 600 due to the
large forces exerted on the apparatus 600 by a patient during
surgery.
[0131] 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 the patient 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 the apparatus 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 the
articulation subassembly 607, such that an angle of articulation D
(see FIGS. 59 and 60) of the articulation point 601 may be modified
without a substantial change in height H of the articulation 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 the
patient support subassembly 606 in an infinitely adjustable range
from 0.degree. to 90.degree., and for example, about +5.degree.,
.+-.10.degree., .+-.15.degree., .+-.20.degree., .+-.25.degree. or
more relative to the axis of rotation B, also in cooperation with
the other components of the apparatus 600, as described herein. The
head-end lift subassembly 602 includes an individually operable and
continuously adjustable primary elevator 614, or primary lift
subassembly, a rotational subassembly, generally 616, and a footing
618, which are described in greater detail below.
[0132] The primary elevator 614, of the head-end lift subassembly
602, includes at least two risers, such as a lower riser 620 and an
upper riser 622, and an internal motorized structure for
telescopingly raising and lowering the upper riser 622 relative to
the lower riser 620 in a continuously or infinitely adjustable,
non-segmented manner. The primary elevator 614 includes one
intermediate risers 624 and it is foreseen that additional
intermediate rises may be utilized. When the primary elevator 614
includes an intermediate riser 624, the internal motorized
structure telescopingly raises and lowers the lower, upper and
intermediate risers 620, 622 and 624 relative to one another in a
continuously adjustable, non-segmented manner. It is foreseen that
the internal motorized structure for telescopingly raising and
lowering the risers 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
drives. The head-end lift sub assembly 602 includes a powered
actuator, electronics and the like, to actuate the primary elevator
614 and the rotation subassembly 616.
[0133] The primary elevator 614 moves under control to continuously
and adjustably between a maximum lift or fully extended position,
shown on the left side of FIG. 49, and minimum lift or fully
lowered position, shown on the left side of FIG. 50. Accordingly,
extension of the primary 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, the
risers 620, 622 and 624 are maximumly outwardly telescoped, or
opened, relative to one another, such that a top of the head-end
lift subassembly 602 is maximally elevated above the floor F. In
contrast, in the fully lowered position, the risers 620, 622 and
624 are maximumly inwardly telescoped, or closed, relative to one
another, such that the top of the head-end lift subassembly 602 is
as close to the floor F as mechanically possible.
[0134] FIG. 48 illustrates an intermediate position of the primary
elevator 614, wherein the risers 620, 622 and 624 are
intermediately outwardly telescoped relative to one another, such
that the top of the head-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 the risers 620, 622 and 624, in
conjunction with coordinated continuously adjustable, non-segmented
cooperative movement of other portions of the patient support and
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 of articulation 601 and optionally or
preferably maintaining the patient's torso in a generally
horizontal, non-head down position.
[0135] The lower riser 620 rests on the footing 618, which includes
a housing and at least some of the internal motorized structure of
the head-end lift subassembly 602. As shown in FIGS. 57 and 62, the
footing 618 extends perpendicularly outward relative to a
longitudinal axis B, so as to provide a sturdy support that
sufficiently resists sideways tipping of the apparatus 600. The
footing 618 includes top and bottom sides 626 and 628, and opposed
outer ends 630. A caster 612 extends downwardly from the bottom
side 628, adjacent to each of the outer ends 630. The cross-bar 610
is centrally attached to the footing bottom side 628, so as to
extend substantially parallel with the longitudinal axis B and the
floor F. The cross-bar 610 joins the footing 618 with a footing
618' of the foot-end lift subassembly 604, described below, so as
to hold the footings 618 and 618' in fixed relation and to provide
support to the apparatus 600.
[0136] The head-end lift subassembly 602 supports the rotational
subassembly 616, which includes an hydraulic piston assembly 632
that rotates or tilts the patient support subassembly 606 and a
rotational shaft 634, such as is described elsewhere herein. It is
foreseen that other structures such as motors or drives may be used
to rotate the subassembly 606. The rotational shaft 634 is
substantially parallel with axis of rotation B, and extends
longitudinally inward from the motor housing 632. The rotational
shaft 634 is rotatably joined with both the patient support
subassembly 606 and internal mechanical components of the
rotational subassembly 616, including a gear-driven device however,
it is foreseen that, screw-driven, cable-driven or piston-driven
drives the like. Rotating the rotational shaft 634 rotates or tilts
the patient support subassembly 606 clockwise or counter-clockwise
in a continuous range from 0.degree. to 90.degree. either way, for
example about .+-.5.degree., +10.degree., .+-.15.degree.,
.+-.20.degree., or more relative to axis B. It is foreseen that the
drive-device of the rotational 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 the rotational subassembly 616 and into the footing
618. In the illustrated embodiment, a piston 635 is located at the
side of the primary elevator 614, that operably rotates the patient
support subassembly 60 clockwise or counter-clockwise through a
range of plus or minus 20.degree. relative to axis B. Numerous
configurations are foreseen. Additionally or alternatively, it is
foreseen that a rotational subassembly 616' may be located at the
foot-end lift subassembly 604. The rotational shaft 634 may be
passive, and rotate in response to rotation of the patient support
subassembly 606 by other apparatus components, such as but not
limited to the rotational subassembly 616'. Alternatively, both the
rotational subassembly 616 and the rotational subassembly 616' may
actively drive rotation of the patient support subassembly 606,
such as by a gear-driven, screw-driven, cable-driven or
piston-driven drive known in the art.
[0137] The second or foot-end lift subassembly 604 provides for
continuous adjustable raising and lowering of the foot-end of the
patient 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 the apparatus 600, as
described herein. The foot-end lift subassembly 604 also provides
for continuous adjustable, non-segmented rotation or tilting of the
patient support subassembly 606 over an infinitely adjustable
range, for example an amount up to about +5.degree.,
.+-.10.degree., .+-.15.degree., .+-.20.degree., or more relative to
the axis B, also in cooperation with other components of the
apparatus 600, as described herein. The foot-end lift subassembly
604 includes primary and secondary elevators 614' and 636, a
passive rotational subassembly 616' and a footing 618'. However, it
is foreseen that the rotational 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 the
primary elevator 614', which supports the rotational subassembly
616'. Unlike the head-end lift subassembly 602, the secondary
elevator 636 is operably joined with the rotational subassembly
616' of the foot-end lift subassembly 604. The primary and
secondary elevators 614' and 636 are individually yet cooperatively
operable and continuously adjustable in a non-segmented infinitely
adjustable manner.
[0138] The primary elevator 614' is substantially similar to the
primary elevator 614 and cooperates with other apparatus
components, such as the head-end lift subassembly 602, the
secondary elevator 636 and the articulation subassembly 607, such
that the angle of articulation D may be modified without a
substantial change in height H of the articulation point 601.
Accordingly, the primary elevator 614' includes at least two
risers, such as a lower riser 620' and an upper riser 622', and an
internal motorized structure such as described herein, and provides
for modification of a height of the primary 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. The primary elevator 614' may include
one or more intermediate risers 624'. In the illustrated
embodiment, the primary elevator 614' shown on the right side of
FIG. 49 includes one intermediate riser 624'. It is foreseen that
in some circumstances, the primary elevator 614' may include two or
more intermediate risers 624'. When the primary elevator 614'
includes an intermediate riser 624', the internal motorized
structure telescopingly raises and lowers the lower, upper and
intermediate 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 the risers 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.
[0139] Referring again to FIGS. 49 and 50, the primary elevator
614' is adapted to move between a maximum lift or fully extended
position, shown on the right side of FIG. 49, and a minimum lift or
fully lowered position, shown on the right side of FIG. 50. In the
fully extended position, the risers 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, the risers 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
the primary elevator 614' is in the least-outwardly telescoped
position or configuration thereof, only the lower riser 620' is
visible from the side of the apparatus 600. For example, the
intermediate riser 624' is operably so as to slide downwardly into
the lower riser 620', and the upper riser 622' is operable so as to
slide downwardly into the intermediate riser 624'. In some
circumstances, the housing of the rotational subassembly 616'
shrouds at least a portion of the risers 620', 622' and 624'. FIG.
48 illustrates an intermediate position of the primary elevator
614, wherein the risers 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 the risers 620', 622' and
624', in conjunction with cooperative movement of other portions of
the patient support and articulation 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.
[0140] The primary elevator 614' is joined with the footing 618',
which is substantially similar to the footing 618, and which may
house a portion of the internal motorized lift structure. The
footing 618' includes a top surface 626', a bottom surface 628' and
opposed outer ends or surfaces 630'. Casters 612 are attached to
the outer ends 630' of the footing 618', and the cross-bar 610 is
attached to the bottom 628' of the footing 618', such as described
herein with respect to footing 618.
[0141] The foot-end lift subassembly 604 includes at least a
passive rotational subassembly 616'. It is foreseen that the
subassembly 604 may include an active or powered rotational
subassembly 616' that is similar to the rotational subassembly 616
of the head-end lift subassembly 602.
[0142] Referring to FIGS. 54 and 55, the secondary elevator 636 is
joined with the top of the primary elevator 614' of the foot-end
lift subassembly 604, such as, for example, at the housing of the
rotational subassembly 616', such that the secondary elevator 636
in use is operationally raisable or lowerable by the primary
elevator 614'. The secondary elevator cooperates with other
apparatus components, such as the head-end lift subassembly 602,
the primary elevator 614' and the articulation subassembly 607,
such that the angle of articulation of the articulation point 601
may be modified without a substantial change in height H of the
articulation point 601.
[0143] 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 the secondary 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. The secondary 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 in FIG. 56, the bottom 642 of the
secondary elevator 636 is located near the top 626' of the footing
618'.
[0144] Referring to FIGS. 54-55, the front or inboard side 644, or
face, of the secondary elevator 636 includes an extended vertical
slot 646 with a height sufficient to adjustably continuously raise
or lower the foot-end of the patient 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
second rotational shaft 634' extends toward the patient support
subassembly 606 from the vertical slot 646 such that the shaft 634'
is substantially parallel to the axis B or the floor F. The
secondary elevator 636 includes a motorized drive, such as is known
in the art and described herein, that vertically raises and lowers
the shaft 634' within the slot 646. As shown in FIGS. 50 and 60,
when the primary elevator 614' is in the lowest telescoping
position or closed, the secondary elevator 636 is lower the
outboard end, generally 652, of the patient 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 the shaft 634' in a most elevated position with
respect to the secondary elevator 636, wherein the shaft 364' is at
the top 648 of the slot 646. In comparison, FIG. 55 shows shaft
634' is at the bottom 650 of the slot 646. In use, the secondary
elevator 636 is independently operated relative to the primary
elevator 614' or cooperatively with the primary elevator 614'.
[0145] The patient support and articulation apparatus 600 includes
a patient support subassembly 606 rotatably joined with the
head-end and foot-end lift subassemblies 602 and 604. The 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 respective rotational
subassembly 616, 616' by an intervening translation subassembly 655
and 655' that includes one or more of an attachment plate 656 and
656', a cross-bar 658 and 658', and one or more pivot joints 660
and 660', such as universal joints or pairs of perpendicularly
oriented joints or other suitable pivot structures known in the
art. In the illustrated embodiment, such as is shown in FIGS. 54
and 55, the attachment 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, the attachment plate 656' and the cross-bar
568' pivot with respect to each other at the joint 660'. Similar
angulation occurs between the attachment plat 656 and the cross-bar
658 at joint 660.
[0146] Each of the head-end and foot-end supports 654 and 654'
includes a pair of longitudinally extending frames 661A and 661B,
respectively, for support of the patient. The frames 661A, 661B may
be made of any sufficiently strong, rigid material, such as
aluminum, carbon fiber, hardened metal, and the like. Preferably,
the material of construction of the frames 661A and 661B is non
opaque to x-rays, so that imaging can occur during surgery. In
cross-section, the frames 661A, 661B of the illustrated embodiment
are trapezoidal, with the bottom side being wider than the top
side, such that the frames 661A, 661B substantially resists torque
and tensions applied thereto during movement of the apparatus 600.
However, it is foreseen that the frames 661A, 661B may include
other cross-sections, such as but not limited to circles, ovals,
triangles, rectangles, quadrilaterals and the like.
[0147] Each of the frames 661A, 661B includes a longitudinally
extending elongate slot or through-bore, generally 662. In the
illustrated embodiment, the 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 the
elongate slot 662 may have a fourth side, such that the area of the
slot 662 is a fully enclosed through-bore, such as is known in the
art. Alternatively, the frames 661A, 661B may be tubes with
longitudinally extending through-bores 662 therethrough. It is also
foreseen that the elongate slot 662 may include other
cross-sections, such as but not limited to circles, ovals,
triangles, rectangles, quadrilaterals and the like.
[0148] Referring to FIG. 57, pairs of frames 661A and 661B are
joined at their respective outboard ends, but not at their inboard
ends. Referring to FIG. 66, at the outboard ends, the frames 661A
are joined by a perpendicular cross-bar 678 that is joined with the
cross-bar 656 of the translation subassembly 655. In contrast, the
outboard ends of the frames 661B are joined by a gearbox 680, which
is also part of the angulation subassembly 607. As is discussed in
greater detail below, and is shown in FIGS. 50, 55, 56, 60, and 67,
the gearbox 680 includes an arch 676, or bowed portion, sized and
shaped such that portions 678 of the gearbox 680 may be lowered
near to the floor F and around the base support cross-bar 610. It
is noted that lowering the outboard end of the foot-end support
654' sufficiently that the gearbox 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.
[0149] Referring to FIG. 66, the frames 661A and 661B are joined at
the point of articulation 601, or the axis of rotation C, by a
hinge 663. Accordingly, the frames 661A, 661B provide an open
framework for supporting the patient in a prone, pendulous manner,
with his stomach hanging downwardly, such as is shown in FIGS. 57
and 66. Additionally or alternatively, rectangular surgical support
tops or imaging tops, similar to tops 100 and 100', may be placed
on the framework such that the patient can be supported in a supine
position or on one of the patient's sides.
[0150] Referring to FIGS. 51-53 and 64-65, each hinge 663 includes
a pair of knuckles 664 joined by an upper axle 665, upper and lower
rollers 667 and 668, a plurality of V-links 669, and a lower axle
665' pivotably joining the lower roller 668 and the V-links 669.
The hinge can be a wide range of structures that allows
articulation between the frames 661A and 661B and is located
whereat it is best for the patient to bend during surgery. In the
illustrated embodiment, each knuckle 664 includes a pair of
longitudinally extending, spaced fingers 670. Each of the fingers
670 includes a through-bore 672 that is coaxial with axis C. The
upper axle 665 rotatably engages the through-bores 672, such that
the upper axle 665 is coaxial with axis C. The respective frames
661A, 661B are joined or engaged by the knuckles 664 at their
associated outboard ends 674. Accordingly, the knuckles can pivot
on the upper axle 665 with respect to axis C to thereby modify
angle D. The upper roller 667 includes a through-bore 667A that
pivotably receives the upper axle 665 therethrough, such that the
upper roller 665 is located between the fingers 670 of the joined
knuckles 664. The upper roller 665 is coaxial with axis C and
adapted to pivot freely thereabout independently of the knuckles
664 or of angulation of angle D. In the illustrated embodiment, the
upper roller 667 includes a circular cross-section. However, it is
foreseen that the upper 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 the upper roller 667 may
be an alternative structure that provides the same function as the
upper roller 667. The upper 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, the roller 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.
[0151] In the illustrated embodiment, the lower roller 668 is
substantially similar to the upper roller 667 in size, shape and
fabrication. However, the lower roller 668 may be include
alternative sizes, shapes and materials known in the art.
[0152] The rod-like V-links 669 pivotably engage the knuckles 664
and the lower axle 665', such that an angle E is defined by a pair
of intersecting V-links 669 (see FIGS. 50, 52 and 53). Pins
pivotably secure the V-links 669 with the knuckles 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 the patient 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.
[0153] Pairs of V-links engage the lower axle 665' on either side
of the lower roller 668. For example, as shown in FIG. 61, two
V-links 669 are joined at the left-hand and right-hand ends, or
inner and outer ends, of each of the associated lower axle 665',
for a total of four V-links engaging each lower axle 665'. The
lower roller 668 is slidingly received on the lower axle 665' so as
to be located between the engagements of the pairs of V-links 669,
such as is shown in FIG. 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 associated lower axle 665'.
[0154] The lower roller 668 is substantially similar or even
identical to the upper roller 667. Accordingly, the lower roller
668 includes a through-bore 668A that pivotably receives the lower
axle 665' therethrough. The lower roller 668 is sized and shaped to
pivot freely about the lower axle 665'. In the illustrated
embodiment, the lower roller 668 includes a circular cross-section.
However, it is foreseen that the lower 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 the lower roller 668 may be an alternative structure
that provides the same function as the lower roller 668.
[0155] The patient support and articulation apparatus 600 includes
an orientation subassembly that includes an individually operable
and continuously adjustable articulation subassembly 607
interconnected with the rotation subassemblies 616 and 616'. The
orientation subassembly cooperatively rotates and articulates at
least a portion of the patient support subassembly 606 so as to
allow the patient 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 and
secondary elevators 616, 614' and 636. The articulation subassembly
607 is adapted to articulate the patient support subassembly 606 at
the point of articulation 601 up to 90.degree. up or down, for
example in an amount of about .+-.5.degree., .+-.10.degree.,
.+-.15.degree., .+-.20.degree., .+-.25.degree., .+-.30.degree.,
.+-.35.degree., .+-.40.degree., .+-.45.degree., .+-.50.degree. or
more with respect to an axis of rotation C and to the subassembly
606 in a horizontal configuration. In some embodiments, the maximum
upward breaking position is about +35.degree. and the maximum
downward breaking position, or an angle of articulation D, is about
-20.degree., relative to axis C, thereby providing a total range of
motion of the point of articulation 601 of about 55.degree..
However, it is foreseen that, in some embodiments, the articulation
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.degree. or more, and as to break
downwardly an amount up to about 90.degree., or more.
[0156] Referring to FIGS. 51-53, 58-60 and 66, the articulation
subassembly 607 cooperates with the head-end and foot-end lift
subassemblies 602 and 604, so as to continuously and
non-segmentedly articulate the 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
of articulation 601 relative to the floor F. Additionally, during
this articulation at the point of articulation 601, the
articulation subassembly 607 cooperates with the head-end and
foot-end lift subassemblies 602 and 604 so as to maintain the
head-end support 654 of the patient 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. The front tether 690 may be a rod, a band, a cord, a
cable, and the like. The rear tether 692 may be fabricated of any
suitable elastic or non-elastic material known in the art.
[0157] The articulation subassembly 607 includes the gearbox 680
operably linked with a pair of tensioned angulation subassemblies,
generally 686, that slidingly engage the hinge upper and lower
rollers 667 and 668 so as to cause the hinges 663 to break upwardly
and downwardly. Each tensioned angulation subassembly 686 includes
a tethered translation wedge 688, the front tether 690, and the
tensioned rear tether 692, a trolley slider 694, and a translation
member 696 that engages the gearbox 680. The wedge 688 and the rear
tether 692 are constantly under tension so as to urge the wedge 688
at the right in FIG. 59 or toward the end.
[0158] As shown in FIG. 66, the trolley sliders 694 slidably engage
the associated frame 661A from the bottom thereof, such that the
trolley sliders 694 at least partially surround the associated
frames 661A, including portions of the bottom and two sides of the
frames 661A. The trolley sliders 694 are adapted to slide in the
cephalad and caudad directions along the frames 661A. In some
circumstances, the surfaces of the trolley slider 694 engaging the
frame 6612A are lubricated. Each trolley slider 694 is engaged by a
front tether 690 that pushes or pulls the trolley slider 694 in
cephalad and caudad directions in response to actuation of the
tensioned angulation subassembly 696.
[0159] A torso trolley 701 rests on the frames 661A and includes
slide channel members 700 adapted to slidingly engage the tops and
sides of the frames 661A and to releasably engage the trolley
sliders 694. Movement of the trolley sliders 694, such as in the
cephalad and caudad directions, translates the torso trolley 701
along the frames 661A, such as is described in greater detail
below.
[0160] The translation wedge 688 includes first and second ends 702
and 704, top and bottom portions 706 and 708, and a pair of opposed
faces 710. In the illustrated embodiment, the translation wedge 688
is generally thin, flat and triangular in shape. However, the
translation wedge 688 may have any other shape so long as it
fulfills its function as described herein. For example, it is
foreseen that the translation wedge 668 may be a cam, a roller, a
polygon, a sphere, and the like. The translation wedge 688 may be
fabricated of any sufficiently strong and resilient material able
to withstand high stress and tension resulting from the apparatus
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 and
bottom portions 706 and 708 may be treated to increase or decrease
lubrication, as is known in the art.
[0161] Referring to FIGS. 58-60, 66 and 68-69, a first end 702 of
the translation wedge 688 engages the front tether 690, a second
end 704 of the translation wedge 688 engages the rear tether 692.
The translation wedge top and bottom portions 706 and 708 slidably
engages the upper and lower rollers 667 and 668, respectively. The
translation wedge 688 is pulled between the upper and lower rollers
667 and 668 by the rear tether 692, which in turn is pushed and
pulled by the translation member 696 in response to actuation of
the gearbox 680, as is described herein. The wedge 688, because of
the weight of the structure acting thereon is always urged away
from the rear tether 692, so as to place tension thereon.
[0162] 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. The
rear tether 692 may be fabricated of any suitable flexible, but
generally non-stretchable or non-elastic material known in the art.
The rear tether 692 is tensioned between the second end 704 of the
translation wedge 688 and the translation member 696. As shown in
FIG. 58, the first end 712 of the rear tether 692 engages the
second end 704 of the translation wedge 688, and the second end 714
of the rear tether 692 engages the translation member 696 by an
intervening translation nut member 728. The rear tether 692 is
pulled or released in the cephalad and caudad directions,
respectively, through the translation member 696.
[0163] The translation member 696 engages the translation nut
member 728 and the gearbox 680. As shown in FIGS. 66 and 67, the
gearbox 680 includes a motorized gear assembly, generally 716, and
a motor 718. In the illustrated embodiment, the gear assembly 716
includes a worm gear. However, it is foreseen that any type of gear
assembly 716 may be used, so long as is can move the translation
member 696 in the cephalad and caudad directions. The translation
member 696 also includes an outer translation structure 720, such
as a tube, that passes through a through-bore 722 in the gear
assembly 716. An inner translation structure 724, such as a
translation rod or bar, slides in and out of the outer translation
structure 720. A translation screw 726 is secured to an end of the
inner translation structure 724 within the outer translation
structure 720. The translation screw 726 engages the translation
nut member 728 that engages the second end 714 of the rear tether
692. The translation nut member 728 moves along a translation track
730 located within the elongate slot 662 of the frame 661B, in the
cephalad and caudad directions, in response to actuation of the
translation screw 726.
[0164] To articulate the patient support subassembly 606 in an
upwardly or downwardly breaking configuration, or to align the
subassembly 606 in the first plane P, the gearbox 680 is actuated.
Actuation of the gearbox 680 moves the translation wedge 688
between the upper and lower rollers 667 and 668, in either a
cephalad and caudad direction by drawing the tether 692 toward the
gearbox 680 or allowing the tether 692 slack so that the tension at
the wedge 688 pulls the rear tether away from the gearbox 680.
Upward and downward breaking is associated with a distance between
the rollers, the distance being generally perpendicular to the
floor F. When the rollers 667 and 668 are closer together, the
hinge 663 breaks downwardly. When the rollers 667 and 668 are
farther apart, the hinge 663 breaks downwardly. Gravity and the
weight of the patient facilitate downward breaking. When the
translation wedge 688 moves in a cephalad direction, the rollers
667 and 668 roll along the top and bottom portions 706 and 708
towards the translation wedge first end 702, such that the rollers
667 and 668 are pushed apart by the translation wedge 688, thereby
causing the patient support subassembly 606 to break downwardly.
When the translation wedge 688 moves in a caudad direction, the
rollers 667 and 668 roll along the top and bottom portions 706 and
708 towards the translation wedge second end 704, the rollers 667
and 668 move back together, thereby causing the patient support
subassembly 606 to break upwardly. Accordingly, a distance between
the upper and lower rollers 667 and 668 increases or decreases as
the translation wedge 688 moves in the cephalad and caudad
directions, respectively.
[0165] It is noted that the degree of angulation D is associated
with the shape of the translation wedge 688 and the spacial
relationship between the translation wedge 688 and the rollers 667
and 668, such as but not limited to the length of the top and
bottom portions 706 and 708 and the size of an angle defined by the
top and bottom portions 706 and 708 and the second end 704. For
example, the longer the top and bottom portions 706 and 708 and/or
a greater the angle facilitates moving the rollers 667 and 668
farther apart, and in turn the greater the amount of angulation of
the patient support subassembly 606 possible. In a certain
embodiment, movement of one inch of the wedge 688 relative to the
rollers 667 and 668 translates to ten degrees of angulation;
however, it is foreseen that this could be varied greatly, for
example one inch could translate to 2, 5, 20 or any selected
degrees.
[0166] FIG. 58 shows the patient support subassembly 606, or the
head-end and foot-end supports 654 and 654', aligned in the first
plane P. When the patient support subassembly 606 is aligned with
the first plane P, the upper and lower rollers 667 and 668 are
located medially between the first and second ends 702 and 704 of
the translation wedge 688. Concurrently, the trolley slider 694 is
located medially along the length of the head-end support 654. The
inner translation structure 724 is moved into the outer translation
structure 720, the translation nut member 728 is medially along the
translation track 730, and the gearbox 680 is located near the
cross-bar 658'.
[0167] FIG. 59 shows the patient support subassembly 606 in a
downwardly breaking configuration, wherein the hinge 663 is located
below the first plane P. The apparatus 600 is adapted to move in a
smooth, continuously and infinitely adjustable, non-segmented
manner between the configuration of FIG. 58 and the configuration
shown in FIG. 59 and back again. In the configuration shown in FIG.
59, the upper and lower rollers 667 and 668 are located near the
second end 704 of the translation wedge 688. When moving from the
FIG. 58 configuration to the FIG. 59 configuration, the trolley
slider 694 moves "up hill" in a cephalad direction, or towards the
head-end lift subassembly 602. Movement of the trolley slider 694
moves the torso trolley 701 towards the head-end lift subassembly
602 a distance associated with the amount of downward breaking or
angulation of angle D. The translation wedge 688 is sized and
shaped such that when the hinge 663 breaks downwards, the torso
trolley 701 slides towards the head-end lift subassembly 602, or
"up hill." It is noted that in the configuration of FIG. 59, the
translation nut member 728 has moved along the translation track
730, towards the hinges 663. Accordingly, the translation wedge 688
has been drawn between the rollers 667 and 668, which roll along
the top and bottom portions 706, 708 until the rollers 667 and 668
are located near the translation wedge second end 704. The
translation nut member 728 has also moved along the translation
screw 726 towards the head-end lift subassembly 602, which is
actuated by rotation of the translation screw 726. Further,
actuation of the gearbox 680 rotates the translation screw 726 and
moves the inner translation structure 724 away from the foot-end
lift subassembly 604, effectively lengthening the foot-end lift
subassembly 604.
[0168] FIG. 60 shows the patient support subassembly 606 in an
upwardly breaking configuration, wherein the hinge 663 is located
above the first plane P. The apparatus 600 is adapted to move in a
smooth, continuously adjustable, non-segmented manner between the
configuration of FIG. 58 and the configuration shown in FIG. 60 and
back again. In the configuration shown in FIG. 60, the upper and
lower rollers 667 and 668 are located near the first end 702 of the
translation wedge 688. It is noted that the trolley slider 694 is
again moved "up hill", in a caudad direction, or towards the
foot-end lift subassembly 604. Movement of the trolley slider 694
moves the torso trolley 701 away from the head-end lift subassembly
602 a distance associated with the amount of downward breaking or
angulation of angle D. The translation wedge 688 is sized and
shaped such that when the hinge 663 breaks upward, the torso
trolley 701 slides towards the foot-end lift subassembly 604, also
up hill. It is noted that in the configuration of FIG. 60, the
translation nut member 728 has moved along the translation track
730, towards the foot-end lift subassembly 604. Accordingly, the
translation wedge 688 has been pulled between the rollers 667 and
668, until the rollers 667 and 668 are located near the first end
702 of the translation wedge 688. The translation nut member 728
has also moved along the translation screw 726 towards the foot-end
lift subassembly 604, which is actuated by rotation of the
translation screw 726. Further, actuation of the gearbox 680
rotates the translation screw 726 and moves the inner translation
structure 724 towards the foot-end lift subassembly 604,
effectively lengthening the foot-end lift subassembly 604. It is
again noted that when the apparatus 600 is in the configuration
shown in FIG. 60, wherein the hinge 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 the inner
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 the base support 608 and portions 684
of the gearbox 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 of angulation 601
required to a given surgical procedure.
[0169] 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 and lower rollers 667 and 668
relative to the translation wedge 688. The distance between the
trolley slider 694 and the translation wedge 688 is fixed by the
length of the front tether. Accordingly, the greater the change in
angle D, the farther the torso trolley 701 is moved. In an
exemplary embodiment, a change in the angle D is associated with
about movement of the torso 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
the translation 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.
[0170] The apparatus 600 includes a failsafe structure, generally
732, adapted to operably engage the articulation subassembly 607 in
the event of catastrophic failure of the apparatus 600.
Catastrophic failure includes but is not limited to physical or
mechanical breaking, or wearing out, of a hinge 663, a V-link 669,
the translation wedge 688, a front or rear tether 690, 692,
loosening of a screw or bolt, wearing out of a gear or motor, and
electrical failure. It is foreseen that numerous failsafe devices
known in the art can be incorporated into the apparatus 600, into
various components such as the head-end and foot-end lift
subassemblies 602 and 604, and the patient support subassembly
606.
[0171] In the illustrated embodiment of the invention, the failsafe
structure 732 is associated with the hinges 663 and the translation
wedge 688. Referring to FIGS. 65, 68 and 69, the failsafe structure
732 includes at least one, preferably two guides 734, a ratchet
locking structure 736, pawl or ratchet break 735, and a toothed
ratcheted strip 738 attached to at least one face 710 of the
translation wedge 688 adjacent to the top portion 706 thereof. The
ratchet locking structure 736 is located between two guides 734 and
includes a gripping surface 740 sized and shaped to grippingly
engage the surface 742 of the upper roller 667. The ratchet locking
structure 736 also includes a plurality of ratchet teeth 744 sized
and shaped to engage the ratchet teeth 746 of the ratcheted strip
738. The failsafe structure 732 may include a device for preventing
engagement of the teeth 744 and 746, such as but not limited to a
solenoid 748. For example, a solenoid 748 such as shown in FIG. 65
may bias the ratchet locking structure 736 upwardly, so as to block
engagement of the teeth 744 and 746. A leaf spring 750 biases the
ratchet locking structure 736 downwardly, so as to facilitate
engagement of the teeth 744 and 746 and it is foreseen that this
function could be provided by a solenoid or other device.
[0172] During normal operation of the apparatus 600, when the
translation wedge 688 is moved towards the foot-end lift
subassembly 604, the ratchet locking structure 736 slides along the
ratcheted strip 738, such that the teeth 744 and 746 do not become
engaged. Alternatively, the ratchet locking structure 736 may be
biased upwardly, such as by the solenoid 748, so that the teeth 744
and 746 do not become engaged. When the translation wedge 688 is
moved towards the head-end lift subassembly 602, the ratchet
locking structure 736 is biased upwardly, such as by the solenoid
748, so that the teeth 744 and 746 do not become engaged.
[0173] In the event of a catastrophic failure of the apparatus 600,
for example power failure, the solenoid 748 no longer maintains
separation and the teeth 744 of the downwardly biased ratchet
locking structure 736 engage the ratcheted strip teeth 746. Since
the translation wedge 688 is biased towards the head-end lift
subassembly 602 by downward forces from the weight of the patient
on the assembly 600, the translation wedge 688 pulls or pushes the
ratcheted locking structure 736 between the upper roller 667 and
the translation wedge top portion 706. The gripping surface 740
non-slidingly engages the surface 742 of the upper roller 667 and
the ratchet teeth 744 of the ratchet locking structure 736
lockingly engages the ratcheted strip 738, thereby locking or
binding-up translation wedge 688 and the upper roller 667, and
substantially blocking further movement or articulation of the
articulation subassembly 607.
[0174] The apparatus 600 includes a powered actuator and
electronics such as are known in the art and described herein.
[0175] As described above, the head-end support 654 slidably
supports the torso trolley 701. A number of attachments may be
removably attached to the head-end and foot-end supports and/or the
torso 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 the frames 661A, 661B, such as are known in
the art and described herein.
[0176] 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.
* * * * *