US20140201914A1 - Patient positioning support structure - Google Patents

Abstract

A patient support system includes independently adjustable columns supporting a hinged bending or breaking patient support structure. At least one column includes at least two sections. A coordinated drive system provides for upwardly breaking and downwardly breaking orientations of the two sections in various inclined and tilted positions.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a continuation of U.S. application Ser. No. 13/902,466 filed May 24, 2013, which application is a continuation of U.S. application Ser. No. 13/317,012 filed Oct. 6, 2011 entitled Patient Positioning Support Structure, which application is a continuation of U.S. Ser. No. 12/460,702, filed Jul. 23, 2009, now U.S. Pat. No. 8,060,960, which is a continuation of U.S. Ser. No. 11/788,513, filed Apr. 20, 2007, now U.S. Pat. No. 7,565,708, which claims the benefit of U.S. Provisional Application No. 60/798,288 filed May 5, 2006 and is also a continuation-in-part of U.S. patent application Ser. No. 11/159,494 filed Jun. 23, 2005, now U.S. Pat. No. 7,343,635, which is a continuation-in-part of U.S. patent application Ser. No. 11/062,775 filed Feb. 22, 2005, now U.S. Pat. No. 7,152,261. The disclosures of all the preceding applications and patents are incorporated by reference herein.
BACKGROUND OF THE INVENTION
• 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 bending of a trunk of a patient in a supine, prone or lateral position.
• Current surgical practice incorporates imaging techniques and technologies throughout the course of patient examination, diagnosis and treatment. For example, minimally invasive surgical techniques, such as percutaneous insertion of spinal implants, involve small incisions that are guided by continuous or repeated intra-operative imaging. These images can be processed using computer software programs that produce three dimensional images for reference by the surgeon during the course of the procedure. If the patient support surface is not radiolucent or compatible with the imaging technologies, it may be necessary to interrupt the surgery periodically in order to remove the patient to a separate surface for imaging followed by transfer back to the operating support surface for resumption of the surgical procedure. Such patient transfers for imaging purposes may be avoided by employing radiolucent and other imaging compatible systems. The patient support system should also be constructed to permit unobstructed movement of the imaging equipment and other surgical equipment around, over and under the patient throughout the course of the surgical procedure without contamination of the sterile field.
• It is also necessary that the patient support system be constructed to provide optimum access to the surgical field by the surgery team. Some procedures require positioning of portions of the patient's body in different ways at different times during the procedure. Some procedures, for example, spinal surgery, involve access through more than one surgical site or field. Since all of these fields may not be in the same plane or anatomical location, the patient support surfaces should be adjustable and capable of providing support in different planes for different parts of the patient's body as well as different positions or alignments for a given part of the body. Preferably, the support surface should be adjustable to provide support in separate planes and in different alignments for the head and upper trunk portion of the patient's body, the lower trunk and pelvic portion of the body as well as each of the limbs independently.
• Certain types of surgery, such as orthopedic surgery, may require that the patient or a part of the patient be repositioned during the procedure while in some cases maintaining the sterile field. Where surgery is directed toward motion preservation procedures, such as by installation of artificial joints, spinal ligaments and total disc prostheses, for example, the surgeon must be able to manipulate certain joints while supporting selected portions of the patient's body during surgery in order to facilitate the procedure. It is also desirable to be able to test the range of motion of the surgically repaired or stabilized joint and to observe the gliding movement of the reconstructed articulating prosthetic surfaces or the tension and flexibility of artificial ligaments 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 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 or corrective surgery.
• There is also a need for a patient support surface that can be rotated, articulated and angulated so that the patient can be moved from a prone to a supine position or from a prone to a 90° position and whereby intra-operative extension and flexion of at least a portion of the spinal column can be achieved. The patient support surface must also be capable of easy, selective adjustment without necessitating removal of the patient or causing substantial interruption of the procedure.
• For certain types of surgical procedures, for example spinal surgeries, it may be desirable to position the patient for sequential anterior and posterior procedures. The patient support surface should also be capable of rotation about an axis in order to provide correct positioning of the patient and optimum accessibility for the surgeon as well as imaging equipment during such sequential procedures.
• Orthopedic procedures may also require the use of traction equipment such as cables, tongs, pulleys and weights. The patient support system must include structure for anchoring such equipment and it must provide adequate support to withstand unequal forces generated by traction against such equipment.
• Articulated robotic arms are increasingly employed to perform surgical techniques. These units are generally designed to move short distances and to perform very precise work. Reliance on the patient support structure to perform any necessary gross movement of the patient can be beneficial, especially if the movements are synchronized or coordinated. Such units require a surgical support surface capable of smoothly performing the multi-directional movements which would otherwise be performed by trained medical personnel. There is thus a need in this application as well for integration between the robotics technology and the patient positioning technology.
• While conventional operating tables generally include structure that permits tilting or rotation of a patient support surface about a longitudinal axis, previous surgical support devices have attempted to address the need for access by providing a cantilevered patient support surface on one end. Such designs typically employ either a massive base to counterbalance the extended support member or a large overhead frame structure to provide support from above. The enlarged base members associated with such cantilever designs are problematic in that they may obstruct the movement of C-arm mobile fluoroscopic imaging devices. Surgical tables with overhead frame structures are bulky and may require the use of dedicated operating rooms, since in some cases they cannot be moved easily out of the way. Neither of these designs is easily portable or storable.
• Thus, there remains a need for a patient support system that provides easy access for personnel and equipment, that can be easily and quickly positioned and repositioned in multiple planes without the use of massive counterbalancing support structure, and that does not require use of a dedicated operating room.
SUMMARY OF THE INVENTION
• 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 includes at least one support end or column that is height adjustable. The illustrated embodiment includes a pair of 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. The support structure may be a frame or other patient support having at least first and second hingeable or pivotally connected portions, the first and second portions being selectively lockable in a first substantially planar orientation along a longitudinal axis of the support structure. The first and second portions 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 or break, either upwardly or downwardly when the support structure is in a substantially horizontal position and also when the support structure is in an inclined position due to one of the support columns raising one end of the structure higher than another end. Of course, such a break may be from side-to-side when the support structure is rotated about a longitudinal axis thereof.
• In a particular illustrated embodiment, angulation or breaking of the support structure is supported by a cable drive system (tension band suspension) that supports angulation using stationary end supports. Other embodiments include cantilevered systems with connected or unconnected movable or telescoping base supports. The first and second 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.
• The patient support structure and the support column or columns are coupled with respective rotation, articulation or angulation adjustment structure for positioning the first support portion with respect to a first column or end support and with respect to the second support portion and the second support portion with respect to the second column or end support. Rotation adjustment structure in cooperation with pivoting and height adjustment structure provide for the lockable positioning of the first and second patient support portions at a variety of selected positions and articulations with respect to the support columns including angulation coupled with Trendelenburg and reverse Trendelenburg configurations as well as providing for patient roll over in horizontal or tilted orientation. Lateral movement (toward and away from a surgeon) may also be provided by a bearing block feature. A pair of patient support structures (such as a support frame and an imaging table) may be mounted between end supports of the invention and then rotated in unison about a longitudinal axis to achieve 180° repositioning of a patient, from a prone to a supine position.
• Various objects and advantages of this invention will become apparent from the following description taken in relation to the accompanying drawings wherein are set forth, by way of illustration and example, certain embodiments of this invention.
• The drawings constitute a part of this specification, include exemplary embodiments of the present invention, and illustrate various objects and features thereof.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a perspective view of a patient support structure according to the invention.
• FIG. 2 is an enlarged and partial side elevational view of a portion of the support structure ofFIG. 2.
• FIG. 3 is an enlarged and partial top plan view of the support structure ofFIG. 1.
• FIG. 4 is an enlarged and partial perspective view of a portion of the structure ofFIG. 1.
• FIG. 5 is an enlarged and partial side elevational view of a portion of the structure ofFIG. 1.
• FIG. 6 is an enlarged and partial perspective view of a portion of the structure ofFIG. 1.
• FIG. 7 is an enlarged and partial perspective view of a first hinge of the structure ofFIG. 1.
• FIG. 8 is an enlarged and partial perspective view of a cooperating second hinge of the structure ofFIG. 1.
• FIG. 9 is an enlarged and partial elevational view of the hinge ofFIG. 7.
• FIG. 10 is an enlarged and partial perspective view of an outer portion of the hinge ofFIG. 7 with portions broken away to show the detail thereof.
• FIG. 11 is an enlarged and partial perspective view of an inner portion of the hinge ofFIG. 7 with portions broken away to show the detail thereof.
• FIG. 12 is an enlarged and partial perspective view of a portion of the structure ofFIG. 1 showing a cable drive motor and winch cylinders.
• FIG. 13 is a partial perspective view of a patient support frame of the structure ofFIG. 1.
• FIG. 14 is a partial perspective view of a patient imaging top for replacement with the patent support frame ofFIG. 13.
• FIG. 15 is a reduced perspective view of the structure ofFIG. 1 shown with an imaging top ofFIG. 14 replacing the support frame ofFIG. 13 and shown in a planar inclined position.
• FIG. 16 is a perspective view of the structure ofFIG. 15 shown in a planar tilted position.
• FIG. 17 is a perspective view of the structure ofFIG. 15 shown in a planar inclined and tilted position.
• FIG. 18 is a side elevational view of the structure ofFIG. 15 shown in a symmetrical upward breaking position.
• FIG. 19 is a side elevational view of the structure ofFIG. 15 shown in a first inclined and upward breaking position.
• FIG. 20 is a side elevational view of the structure ofFIG. 15 shown in a second inclined and upward breaking position.
• FIG. 21 is a side elevational view of the structure ofFIG. 15 shown in a symmetrical downward breaking position.
• FIG. 22 is a side elevational view of the structure ofFIG. 15 shown in a first inclined and downward breaking position.
• FIG. 23 is a side elevational view of the structure ofFIG. 15 shown in a second inclined and downward breaking position.
• FIG. 24 is an enlarged side elevational view of the structure ofFIG. 1 shown in an upward breaking, inclined and tilted position.
• FIG. 25 is a is a perspective view of a second embodiment of a patient support structure according to the invention.
• FIG. 26 is a perspective view of the patient support structure ofFIG. 25 shown tilted in an intermediate position during a rotation as would be used for a patient rollover.
• FIG. 27 is a perspective view of the structure ofFIG. 25 shown further tilted in a second intermediate position during rotation.
• FIG. 28 is a perspective view of the structure ofFIG. 25 shown after rotation to a final flipped position.
• FIG. 29 is a front elevational view of a third embodiment of a patient support structure according to the invention.
• FIG. 30 is a front elevational view of a fourth embodiment of a patient support structure according to the invention.
• FIG. 31 is a perspective view of a fifth embodiment of a patient support structure according to the invention shown in a planar inclined position.
• FIG. 32 is a perspective view of the structure ofFIG. 31 shown in an inclined and upward breaking position.
• FIG. 33 is a perspective view of the structure ofFIG. 31 shown in a substantially symmetrical downward breaking position.
DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS
• As required, detailed embodiments of the present invention are disclosed herein; however, it is to be understood that the disclosed embodiments are merely exemplary of the invention, which may be embodied in various forms. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the present invention in virtually any appropriately detailed structure.
• Referring now to the drawings, a patient positioning support structure according to the invention is generally designated by the reference numeral1 and is depicted inFIGS. 1-12. The structure1 includes first and second upright support piers orcolumns3 and4 which are illustrated as independent, stationary floor base support structures as shown inFIG. 1 or may be connected to one another by a non-telescoping base support as illustrated in the embodiment shown inFIGS. 25-28. In some embodiments according to the invention as shown, for example, inFIGS. 31-33, 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 table support, or may even be a wall mount. In the illustrated embodiment, the upright support column3 is connected to a first support assembly, generally5, and theupright support column4 is connected to a second support assembly, generally6. Between them, the support assemblies5 and6 uphold an elongate and angulatable or breaking patient holding or support structure, generally10 and optionally, a removable patient support structure that will be described with respect to another embodiment of the invention. The illustrated support structure10 includes afirst frame section12, asecond frame section14 with a transversesupport cross bar15, and a pivot or hinge assembly, generally16. In the illustrated embodiment, the pivot assembly further includes a cable drive system including adual winch18 and cooperatingcables20.
• Thecolumns3 and4 are supported by outwardly extendingfeet22 that may or may not include spaced apart casters or wheels (not shown) each equipped with a floor-lock foot lever for lowering thefeet12 into a floor-engaging position as shown inFIG. 1. Thecolumns3 and4 each include two or more telescopinglift arm segments3a,3band4a,4b, respectively that permit the height of each of thecolumns3 and4 to be selectively increased and decreased in order to raise and lower all or a selected portion of the connected patient support structure10. It is foreseen that thevertical supports3 and4 may be constructed so that the column3 has a greater mass than thesupport column4 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 system1 may be employed in some embodiments to facilitate the approach of personnel and equipment.
• Each of the support assemblies5 and6 generally includes arotation subassembly26 and26′ and anangulation subassembly27 and27′, respectively, that are interconnected as will be described in greater detail below and include associated power source and circuitry linked to a controller29 (FIG. 1) for cooperative and integrated actuation and operation. Therotational subassemblies26 and26′ enable coordinated rotation of the patient support structure10 about a longitudinal axis. The angulation subassemblies27 and27′ enable the selective hinging or breaking of the support10 by thehinge assembly16 at desired levels and increments as well as selective tilting of the longitudinal axis of theframe portion12 or14.
• The rotation subassembly ormechanism26 is shown inFIG. 5 and includes at least onemotor housing30 surmounting the support column3. In the illustrated embodiment, only one rotational motor is provided, but it is foreseen that a cooperating motor may also be mounted on thesupport column4. A mainrotational shaft32 extends from themotor housing30 that turns arotation structure33. Therotation structure33 in turn rotates the connected patient support10 about a longitudinal axis as will be described in greater detail below. Themotor housing30 contains a rotary electric motor or other actuator drivingly engaged with theshaft32. Therotation mechanism26 is operated by actuating the motor using a switch or other similar means. Therotation structure33 is fixed to theshaft32 at a location spaced from themotor housing30 and the support column3 to provide clearance for rotation of the connected patient support structure10.
• As shown inFIG. 5, therotation structure33 is attached to a pair of translation posts or H-bar posts40 disposed at either end of therotation structure33. Theposts40 are each attached to thestructure33 by apin42, bolt, or other fixing structure. A plurality of cooperatingapertures44 formed in theposts40 provide passageway for a pivot pin46 to extend therethrough. The pivot pin46 is receivable in each cooperating pair ofapertures44 allowing for selective placement of a translation connector48 that is sized and shaped to be received between the pair ofposts40 and also receive the pivot pin46 therethrough. The pin46 and connector48 are thus positionable in an orientation transverse to the longitudinal extension of the support10 at a variety of heights to be selected by the surgeon and readily changeable, even during surgery if necessary, to vary the height of theframe section12. The multiple location or height feature is also advantageous when more than one frame or patent structure is mounted in tandem as shown, for example inFIGS. 25-28. The position of the frame or other structure may be desirably changed to provide close proximity to an imaging top with a distance between a patient support and an imaging top being expandable or reduceable depending upon the size or other attributes of a patient and surgical or other requirements. As illustrated inFIG. 5, the connector48 has a slot50 for receiving the pivot pin46.
• The translation connector48 is in turn attached to a pivot connector52. The pivot connector52 includes first and second outwardly opening and opposed slots54 and56. The first slot54 is sized and shaped for receiving the translation connector48 and the second slot is sized and shaped for receiving anend connection58 of theframe section12. The pivot connector52 further includes a through aperture or bore60 running substantially perpendicular to the slot54 and communicating therewith. Theaperture60 is sized and shaped to receive a pivot pin62 therethrough, allowing for some forward and rearward lateral movement of the attachedframe end connection58 and thus theframe section12, providing a degree of freedom and clearance needed for rotation the patient support about a longitudinal axis of a patient. The slot56 is sized and shaped to frictionally engage theframe end connection58, thus securely fixing theend connection58 to the pivot connector52. Theframe end connection58 is in turn fixed to each ofelongate frame members66 and68 of theframe section12. Theframe members66 and68 are each hingedly connected to thehinge assembly16 to be described in greater detail below. Pivoting of the translation connector48 with respect to the pin46 provides for selected articulation of the frame section12 (that includes theend connection58 and theframe members66 and68) and/or the entire support10 with respect to the support pier or column3.
• With reference toFIG. 6, at the support pier orcolumn4, the support assembly6 is substantially similar to the support assembly5 with the exception that therotation subassembly26′ is passive and therefore does not include a motor. However, the support pier orcolumn4 preferably includes a powered mechanism to provide selective height adjustment of thesubassembly26′. Arotation structure33′ is spaced from and freely rotatable with respect to thecolumn4. Thestructure33′ includes a shaft (not shown) extending outwardly therefrom similar to therotation shaft32, the shaft being rotatingly received in an aperture in thesupport column4.
• Therotation subassembly26′ and theangulation subassembly27 otherwise include elements identical to or substantially similar to the elements of thesubassemblies26 and27. Specifically, H-bar posts40′, pin42′,apertures44′, pivot pin46′, translation connector48′, slot50′, pivot connector52′,end connector58′ and pivot pin62′, 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 posts40,pin42,apertures44, pivot pin46, translation connector48, slot50, pivot connector52,end connector58 and pivot pin62.
• Theframe14 further includesframe members66′ and68′ that are each fixed to theend connector58′. Theframe members66′ and68′ are pivotably or hingedly connected torespective frame members66 and68 by thehinge assembly16. Specifically, theframe member66 is attached to theframe member66′ by thehinge mechanism70 and theframe member68 is attached to theframe member68′ by thehinge mechanism72. With particular reference to FIGS.7 and9-11, thehinge mechanism70 includes, anouter member76 and an inner member78. Theouter member76 is fixed or may be integral with theelongate frame member66, while the inner member78 is integral or otherwise fixed to theframe member66′. Theouter member76 further includes anextension80 with a groove82 for receiving and guiding thecable20. Theextension89 tapers in a direction from theouter member interior84 to the groove82. Theextension89 is configured to cause a slight upward break or bend of the support10 when theextension89 comes into contact with thecable20 at the groove82. In that way, when thecables20 are reeled in to shorten the hypotenuse of the triangle formed by the cable, thesection12 and thesection14, thesections12 and14 move toward one another, resulting in the upward break as illustrated, for example, inFIG. 18. The downward break illustrated, for example, inFIG. 21 is a result of lengthening thecable20 distance and allowing gravity to drop thehinge70. Theextension89 is shaped to extend slightly inwardly toward a longitudinal axis A of the support10, thereby guiding thecable20 along a path within a periphery of theframe sections12 and14 when theextension89 is in contact with thecable20 when in a downward breaking configuration directed toward the cable with thecable20 being received at the groove82.
• It is foreseen that where an upward breaking (only) embodiment is desired according to the invention, thesections12 and14 may be positioned with respect to two end columns to always include a slight upward break or bend at the hinge or pivot between thesections12 and14. When the telescoping base is actuated to move the columns toward one another, thesections12 and14 would automatically further break upwardly and toward one another. Downward breaking 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 thesections12 and14. Such an embodiment would be acceptable for use because patient holding pads could be positioned on theframes12 and14 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 thesections12 and14.
• Returning to thehinge70 of illustrated embodiment, the inner member78 is slidingly and rotatably receivable in an interior84 of theouter member76. The outer member has a pair ofpivot apertures86 and the inner member has apivot aperture87, the apertures cooperating to create a through bore for receiving apivot pin88 through both the inner and outer hinge members. The interior84 includes a curved partiallycylindrical surface89 for slidingly receiving a cooperating outer rounded and partially cylindrical surface90 of the inner member78. The inner member78 further includes a downward breaking stop orprojection92 that limits a downward pivot (in a direction toward the cables20) of thehinge70 in the event thecables20 should fail. Thestop92 abuts against a surface93 of the interior84. In the illustrated embodiment, thestop92 limits the extent of rotation or hinging of thesection66 with respect to thesection66′ to about twenty-five degrees. Upward pivot (in a direction away from the cables20) is limited by abutment of an inner planar surface95 with aplanar surface96 of the hinge inner member78.
• With particular reference toFIG. 8, thehinge mechanism72 is substantially a mirror image of thehinge mechanism70 and therefore includes the following elements: a hingeouter member76′, and inner member78′, andextension80′ with a groove82′, and interior84′pivot apertures86′ and88′, apivot pin88′, acurved surface89′, and outer surface90′, astop92′, an abutment surface93′, an inner planar surface95′ and aplanar surface96′. These elements are substantially similar in shape and function to the respective hingeouter member76, inner member78,extension80, groove82, interior84,pivot apertures86 and88,pivot pin88,curved surface89, outer surface90, stop92, abutment surface93, inner planar surface95 andplanar surface96 described herein with respect to thehinge70.
• It is noted that other hinge or pivot mechanisms may be utilized in lieu of thehinge assembly16. For example, the polyaxial joint95 illustrated and described in Applicant's pending U.S. patent application Ser. No. 11/062,775 filed Feb. 22, 2005, and pending U.S. patent application Ser. No. 11/159,494 filed Jun. 23, 2005, may be incorporated into the patient support structure10 at the break between thesections12 and14. Both of these U.S. applications (Ser. Nos. 11/062,775 and 11/159,494) are hereby incorporated by reference herein.
• Thecable drive system18 includes arotary motor98 cooperating with and driving by rotation a pair ofwinch cylinders99 disposed on either side of themotor98. Themotor98 andcylinders99 are mounted to theend connector58′ located near thesupport column4. Eachcable20 is attached to one of thewinch cylinders99 at one end thereof and to theend connector58 at the other end thereof. In a first longitudinal position wherein thesection12 is substantially planar with thesection14, thecables20 are wound about thewinch cylinders99 an amount to provide enough tension in thecables20 to maintain such a substantially planar orientation and configuration, with the hinge extensions82 and82′ being in contact with each of thecables20. Themotor98 is preferably low speed and high torque for safely winding both of thecables20 simultaneously about thecylinders99 to draw thesection12 toward thesection14 to result in an upward breaking configuration with thehinges70 and72 disposed in spaced relation with thecables20 and thehinges70 and72. Themotor98 may be reversed, reversing the direction of rotation of thewinch cylinders99 for slowly unwinding thecables20 to a downward breaking configuration. As thecables20 unwind, gravity draws thesupport sections12 and14 downward with thecables20 being received in the grooves82 and82′ of thehinge extensions80 and80′. As thecables20 slacken, thehinges70 and72 continue to lower pressing down upon thecables20.
• It is noted that theframe sections12 and14 are typically equipped with pads (not shown) or other patient holding structure. Furthermore, with respect toFIGS. 13 and 14, theframe member sections66 and68 ofsection12 and theframe member sections66′ and68′ of thesection14 may be replaced with substantially rectangular imaging tops or sections100 and101′ respectively. Each of the sections100 and101′ having elongate slots101 formed therein to allow for attachment of thehinge mechanisms70 and72 in a manner identical or substantially similar to what has been described herein with respect to theframe sections12 and14.
• With reference toFIGS. 15-17, the imaging sections100 and100′ are illustrated, replacing theframe sections12 and14 of the embodiment disclosed inFIGS. 1-12. Each ofFIGS. 15-17 represent configurations in which thecable drive18 is tensioned such that the sections100 and100′ are kept in a substantially coplanar configuration.FIG. 15 illustrates a configuration in which the column3 is telescoped upwardly with the frame sections hinging at the support assemblies5 and6, resulting in an inclined position or configuration of the entire patient support. In the illustrated embodiment, the section100 would preferably receive a patient's head. Therefore,FIG. 15 illustrates a reverse Trendelenburg position or orientation.FIG. 16 illustrates the sections100 and100′ again in a substantially common plane with both sections being rotated to a tilted position produced by a powered rotation of the rotation thesub assemblies26 and passive rotation of theassembly26′ with bothcolumns3 and4 otherwise holding the sections100 and100′ at the same height.FIG. 17 illustrates both tilting due to rotation of theassemblies26 and26′ and also a sloping or inclined position with thecolumn4 being extended vertically. Thus,FIG. 17 illustrates a Trendelenburg position or orientation with both the sections100 and100′ remaining in substantially the same plane.
• With reference toFIGS. 18-20, there is illustrated three upward breaking or hinging configurations of the structure1.FIG. 18 illustrates a symmetrical upward breaking configuration wherein thecolumns3 and4 are holding the respective support assemblies5 and6 at substantially the same height with thecables20 being shortened by rotation of the winch motor to result in an upward break in thehinge assembly16.FIG. 19 illustrates the column3 being extended to a maximum height and the cables reeled to shorten a distance between the sections100 and100′. An example of such an upward break with reverse Trendelenburg would be a head or column3 height of 43 inches, a foot orcolumn4 height of 24 inches and a 35 degree upward break with zero degree roll.FIG. 20 illustrates an upward breaking Trendelenburg with thecolumn4 being extended to a maximum height.
• With reference toFIGS. 21-23, there is illustrated three downward breaking configurations of the structure1.FIG. 21 illustrates a symmetrical downward breaking configuration wherein thecolumns3 and4 are holding the support assemblies5 and6 respectively, at the same height with thecables20 being unwound or slackened to result in a downward break in thehinge assembly16, thehinges70 and72 contacting thecables20.FIG. 22 illustrates a downward breaking reverse Trendelenburg with the column3 being extended to a maximum height resulting in a patent's head end being at a maximum height.FIG. 23 illustrates a downward breaking Trendelenburg with thecolumn4 being extended to a maximum height.
• It is noted that in each of the configurations illustrated inFIGS. 18-23, thesub assemblies26 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 structure1 withsupport frame sections12 and14 positioned in a configuration similar to that illustrated inFIG. 19, but also including rotation, resulting in a tilting and upwardly breaking configuration of the structure1. An example of the position illustrated inFIG. 24 would be: a head or column3 height of 41 inches, a foot orcolumn4 height of 34 inches and a 35 degree upward break with 10 degree roll.
• With reference toFIGS. 25-28, another structure, generally102 according to the invention is illustrated. Thestructure102 utilizes all of the elements described herein with respect to the structure1 and therefore the same references numerals are used for the same elements or features. Thestructure102 differs from the structure1 in that the H-bar posts40 and40′ are replaced or modified to be extended H-bar posts40A and40A′, allowing for the mounting of two elongate structure10 and cooperating cable drives18. In the embodiment shown inFIG. 25, one of the structures10 includes theframe member12 and14 while the other structure is an imaging top having sections100 and100′. As previously described herein, the cooperating H-bar posts40A and40A′ equipped with a plurality of apertures allows for the placement of the support structures10 at a variety of locations. As illustrated inFIGS. 25-28, thestructure102 provides for the complete rotation and thus a roll-over of a patient by actuation of the motor of therotation subassembly26 using the controller29. Thestructure102 is further illustrated with a non-telescoping base support110 fixed to each of thecolumns3 and4 and rollers or castors112 at the base of thestructure102.
• With reference toFIGS. 29 and 30, another embodiment or system according to the invention, generally200 is illustrated. Thesystem200 broadly includes an elongate length-adjustable base202 surmounted at either end by respective first and second upright support piers orcolumns203 and204 which are connected to respective first and second support assemblies, generally205 and206. Between them, thesupport assemblies205 and206 uphold an elongated breaking, hingeable or pivotable patient support structure, generally210. The structure is described in detail in Applicants's pending U.S. patent application Ser. No. 11/062,775 filed Feb. 22, 2005, Ser. No. 11/159,494 filed Jun. 23, 2005, both of which are incorporated by reference herein. The embodiment200A illustrated inFIG. 30 differs from thestructure200 only in that the length-adjustable base202 is replaced by afirst base220 attached to thepier203 and a second base222 attached to thepier204. All of thebases202,220 and222 include castors orrollers230 or some other movable structure to allow thepiers203 and204 to move toward and away from one another during upward or downward breaking of thestructure210.
• It is foreseen that cable drives as described herein, other types of motor drives including screw drives, hydraulic systems, and the like, may be utilized to facilitate both upward and downward breaking of thesupport structure210.
• Another patient support structure according to the invention, generally301, is illustrated inFIGS. 31-33. The structure301 generally includes a horizontally telescoping floor mountedbase302, a conventional or standard telescoping and inclinable operatingtable support structure304, a telescoping end support orpier306 and a hinged or pivotally upwardly and downwardly breakingsupport structure310 connected to both thestructure304 and thepier306. Thepatient support structure310 further includes a firstcantilevered section312 and asecond section314. Thefirst section312 is fixed to and extends from theoperating table support304. The second section is attached to thepier306 by a hinge or pivotingassembly320, such as the support assembly5 described herein with respect to the structure1. Thehinge mechanism316 disposed between thesupport sections312 and314 may be a conventional hinge, pivot, or pivot or hinge systems previously described herein.
• In use, theoperating table support304 utilizes electric or other power means to move thesupport section312 up and down and at an incline, as is known in the art. In response to the movement of thesection312, thesection314 also moves, resulting in upward and downward breaking illustrated inFIGS. 32 and 33. In response to the movement of thesection312, the electric poweredtelescoping base302 moves thepier306 toward or away from thesupport304. Thepier306 includes a motor for raising and lowering the pier at theconnection320.
• 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 thesupport structure310.
• It is to be understood that while certain forms of the present invention have been illustrated and described herein, it is not to be limited to the specific forms or arrangement of parts described and shown.

Claims (21)

What is claimed and desired to be secured by Letters Patent is as follows:

1. A surgical table comprising:

first and second vertical supports spaced-apart from each other;

a patient support extending between the first and second supports and comprising first and second ends opposite from each other and a joint intermediate a length of the patient support; and

first and second mechanical arrangements respectively operably coupling the first and second ends to the first and second vertical supports,

wherein the first and second mechanical arrangements are configured so the patient support can pivot between the vertical end supports in a direction transverse to the length of the patient support and articulate at the joint, a change in a lengthwise distance between the first and second ends of the patient support on account of the patient support articulating at the joint being compensated for in a shared manner by the first and second mechanical arrangements.

2. The surgical table ofclaim 1, wherein, when the patient support articulates at the joint, a distance between the first and second vertical supports does not change.

3. The surgical table ofclaim 1, wherein the surgical table is configured such that the first and second ends are independently adjustable with respect to height.

4. The surgical table ofclaim 1, wherein each vertical support of the first and second vertical supports is independently adjustable with respect to height so as to cause the first and second ends to be independently adjustable with respect to height.

5. The surgical table ofclaim 4, wherein each vertical support of the first and second vertical supports comprises a telescopic configuration.

6. The surgical table ofclaim 1, wherein the patient support comprises a first segment extending between the first end and the joint and a second segment extending between the second end and the joint, the first and second segments both comprising an open-frame configuration defined by transversely spaced-apart longitudinally extending frame members.

7. The surgical table ofclaim 1, wherein each of the first and second mechanical arrangements comprises a rotation subassembly and an angulation subassembly coupled to the rotation subassembly.

8. The surgical table ofclaim 7, wherein the rotation subassembly enables the patient support to pivot between the vertical end supports in the direction transverse to the length of the patient support, and the angulation subassembly enables the patient support to articulate at the joint such that angulation subassembly compensates for a portion of the change in the lengthwise distance between the first and second ends.

9. The surgical table ofclaim 8, wherein the angulation subassembly is pivotally coupled to a respective vertical support of the first and second vertical supports by the rotation subassembly.

10. The surgical table ofclaim 8, wherein the rotation subassembly comprises a pivot shaft extending in a direction of the length of the patient support, each end of the first and second ends pivotally coupled via such a pivot shaft to a respective vertical support of the first and second vertical supports.

11. The surgical table ofclaim 10, wherein such a pivot shaft enables the patient support to pivot between the vertical end supports in the direction transverse to the length of the patient support.

12. The surgical table ofclaim 11, wherein such a pivot shaft projects from the respective vertical support.

13. The surgical table ofclaim 7, wherein the angulation subassembly is located below the rotation subassembly when a patient supporting surface of the patient support is facing upward.

14. The surgical table ofclaim 7, wherein the angulation subassembly comprises a pivot transverse to the length of the patient support, a respective end of the first and second ends pivoting about the pivot when the patient support articulates at the joint.

15. The surgical table ofclaim 14, wherein the angulation subassembly further comprise a mechanical configuration that acts with the pivot to allow the angulation subassembly to compensate for the portion of the change in the lengthwise distance between the first and second end when the patient support articulates at the joint.

16. The surgical table ofclaim 15, wherein the mechanical configuration comprises a member with a slot in which the pivot is received, the slot displacing along the pivot as the angulation subassembly compensates for the portion of the change in the lengthwise distance between the first and second end when the patient support articulates at the joint.

17. The surgical table ofclaim 14, wherein the pivot is located below the rotation subassembly when a patient supporting surface of the patient support is facing upward.

18. The surgical table ofclaim 17, wherein a linear member extends downward from the rotation subassembly to the pivot when a patient supporting surface of the patient support is facing upward, the linear member maintaining the pivot in a spaced-apart relation to the rotation subassembly.

19. The surgical table ofclaim 18, wherein the rotation subassembly comprises a pivot shaft extending in a direction of the length of the patient support, the pivot shaft enabling the patient support to pivot between the vertical end supports in the direction transverse to the length of the patient support, the linear member located between the pivot shaft and the pivot and maintaining the pivot in a spaced-apart relation to the pivot shaft, the pivot being located below the pivot shaft when the patient supporting surface of the patient support is facing upward.

20. The surgical table ofclaim 1, wherein the first and second mechanical arrangements are configured so the patient can make a full rotation when pivoting between the vertical end supports in a direction transverse to the length of the patient support.

21. The surgical table ofclaim 1, further comprising a drive system that actively drives the joint in articulating the patient support at the joint.

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