US20150059094A1 - Patient positioning support structure - Google Patents

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.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a continuation-in-part of U.S. Ser. No. 14/096,875, filed Dec. 4, 2013, and which is a continuation of U.S. Ser. No. 13/317,012, filed Oct. 6, 2011, now U.S. Pat. No. 8,719,979, all of which are incorporated by reference herein. U.S. Ser. No. 13/317,012 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 claimed the benefit of U.S. Provisional Application No. 60/798,288 filed May 5, 2006 and was also a continuation-in-part of pending U.S. patent application Ser. No. 11/159,494 filed Jun. 23, 2005, now U.S. Pat. No. 7,343,635, that 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, all of which are incorporated by reference herein. This application is a continuation-in-part of U.S. Ser. No. 14/050,998, filed Oct. 10, 2013, and which is a continuation-in-part of U.S. Ser. No. 13/317,012, filed Oct. 6, 2011, now U.S. Pat. No. 8,719,979, all of which are incorporated by reference herein. This application is also a continuation-in-part of U.S. Ser. No. 14/051,155, filed Oct. 10, 2013, and which is a continuation of U.S. Ser. No. 13/317,012, filed Oct. 6, 2011, now U.S. Pat. No. 8,719,979, all of which 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 and/or a joint 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 or navigated by continuous or repeated intra-operative imaging requiring patient positioning for image registration and navigation. 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 structure having an open frame or a flat top surface is not radiolucent or compatible with these imaging technologies, it may be necessary to interrupt the surgery periodically in order to remove the patient to a separate patient support structure 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 patient support 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 and without pulling out tubes and lines.
• 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 structures 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 structure 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, total disc prostheses and soft and dynamic stabilization system, 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 spacers and other types of elastic or 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 or corrective surgery.
• There is also a need for a patient support structure that can be rotated, angulated, articulated and translated 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 structure 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 structure 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 structure 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 with synchronization by software programs.
• While conventional operating tables generally include mechanisms that permits tilting or rotation of a patient support structure about a longitudinal axis, previous surgical support devices have attempted to address the need for unrestricted access by providing a cantilevered patient support structure on one end of a base. 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 can be problematic with respect to the movement of C-arm, CT scanners and O-arm mobile fluoroscopic imaging devices as well as other equipment. In addition, their patient support structures have not provided for much articulation or flexion and extension of the patient being supported. 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. In this regard, providing support on both outer ends of the patient support structure suspended therebetween can provide some advantages as further outlined herein.
SUMMARY OF THE INVENTION
• Prior developments for surgical tables have provided a patient support structure having one or more inward articulations that allow for the support structure to break or angulate. The articulation typically occurs between a head end section and a foot end section of the support structure. The articulation can have a virtual pivot axis, an actual pivot axis or a point along one of these axes. The articulation having a virtual pivot axis keeps the gap between the inner ends of the head and foot end sections or portions a fixed distance apart while they are being articulated into a flexed or extended position or orientation. Such an arrangement has several advantages in that the virtual pivot axis can be entirely radiolucent and it does not directly need to carry or support any load. Binding at the articulation is also not a concern when the outer ends of the head and foot sections, connected to a base, are at different elevations above the floor and the patient support structure itself is rolled or tilted. Load-sharing for this type of articulated patient support structure is concentrated or its outer ends connected to the base by a connection assembly providing rotation structures, angulation or pivot structure and translation compensation structure within the connection assembly between the base and the outer ends of the patient support structure.
• The patient support structure having an inward articulation with an actual pivot axis can have a pin about which angulation occurs. Again, the inner ends of the head and foot end section remain a fixed distance apart during the angulation at this inward articulation. This articulation is typically a hinge or joint structure. The hinge or joins structure can extend across the patient support structure or preferably be a pair of spaced apart hinges or joints. This articulation can also be radiolucent. It can participate in load-sharing equally with the outer ends of the patient support structure connected to the base by a connection assembly, or it can remain relatively unloaded while the load-sharing is done at said outer ends. This inward articulation can have an actuator that directly or indirectly moves it. The actuator can be located at or near the articulation or at to near the connection assembly between the base and the outer end or ends of the patient support structure. In either case, direct vertical structural support at both outer ends of the patient support structure is fundamental for the surgical table embodiments disclosed in this application. This occurs through multi-functional connection assemblies at both outer ends of the patient support structure.
• While manipulation of the patient when on the support structure suspended between outer end supports of the base is desirable, too much vertical and horizontal travel for the patient is not, as this can lead to unwanted consequences concerning anaesthesia, tubing, IV lines in the patient, and son on. Having translation occur at or near both outer ends of the patient support structure can help minimize at least the horizontal travel that might otherwise need to occur at or around the inward articulations, especially with breaking or angulation for patient positioning and during patient manipulations. This translation at both outer ends of the patient support structure can occur in different ways. For example, both outer ends of the patient support structure and the base end supports can translated inwardly simultaneously so as to keep the articulation from moving very much horizontally with angulation thereabout. This is generally favorable for the surgeon, but may not be for other members of the surgical team.
• Another way this necessary translation can occur is by dual translation connector mechanisms at both outer ends of the patient support structure, wherein the base end supports do not need to travel along the floor. The translation connectors can have activators or not, and the actuators can also provide for angulation and rotation at the connection assemblies between the base and the outer end of the patient support structure. When the actuators provide for the angulation between the base and the patient support structure at its outer ends, the inward articulations for the patient support structure need not carry much load. This allows for the hinge or joint mechanism to be fairly simple, wherein it can have a radiolucent pin about which the angulation can occur. Again, the connection assemblies between the outer ends of the patient support structure and the base can include horizontal translation connector subassemblies, in addition to powered mechanisms for angulation and rotation and in some cases even vertical translation for height adjustment above the floor.
• The translation connectors in the different table embodiments disclosed herein can also have a plurality of rotational or pivot axes, wherein the axes can translated horizontally with respect to each other. For example, a transverse axis of rotation can be located at or between the attachment of the translation connector mechanism to the end support of the base and a perpendicular axis of rotation can be located at or between the attachment of the translation connector mechanism to the outer end of the patient support structure. In this way, the translation connector mechanism can provide for at least two degrees of freedom for rotational movement between the outer ends of the patient support structure and the base, which is necessary when the patient support structure inward articulation is angulated and rolled, fore example. The roll can occur at the translation connector mechanism, at its outer end attachments or somewhere else in the connecting assembly, such as at the top of the base end supports. In this regard, the various structural components of the connection assemblies can be completely or partially powered.
• Therefore, the present invention is directed to patient support systems that permit 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 inclination, roll or tilting, rotation or angulation, breaking or bending and other manipulations as well as full and free access to the patient by medical personnel and equipment. The system of the present invention may be cantilevered, wherein load-sharing is primarily at the outer end of the patient support structure, or non-cantilevered and include a pair of spaced apart support ends, piers or columns that are each 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 in one embodiment. One support column according to the invention may be coupled with a wall mount or other stationary support. In each case, a patient support structure is connected to and bridges substantially between the pair of end supports. For example, in a preferred embodiment according to the invention, the patient support structure is hingedly suspended between the end supports.
• The patient support structure may be a frame or other patient support that is semi-constrained, having at least first and second hingeable or otherwise joined or connected portions or sections, the first and second portions being selectively lockable in a first substantially planar orientation along a longitudinal or horizontal 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 articulating, hinging or otherwise bending to form an angulation, break or joint, either upwardly or downwardly from a vertical starting position above the floor 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 rolled or rotated about a longitudinal axis thereof.
• In a particular illustrated embodiment, articulation, jointing or breaking of the patient support structure at an inward or central location between the pair of stationary end supports is supported by a cable drive system (tension band suspension). The tension band structure can be metal or radiolucent polymer. In another embodiment, a pull-rod assembly supports articulation to control the break or articulation angle and render the patient support structure rigid. Again, the pull-rod can be radiolucent. 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 translating 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 radiolucent surface.
• The patient support structure and the base support columns are coupled or connected with respective roll or rotation, articulation, pivot or angulation adjustment and horizontal translation structures in the form of connection and assemblies 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 provided by the connection assemblies allow 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 or pivot coupled with Trendelenburg and reverse Trendelenburg configurations as well as providing for patient roll over in horizontal or tilted orientation. Lateral movement or translation (toward and away from a surgeon) and longitudinal translation may also be provided by powered actuators in the base end support columns. A pair of patient support structures (such as a support frame and an imaging table) may be mounted between end supports of the invention and then rotated in unison about a longitudinal axis to achieve 180° repositioning of a patient, from a prone to a supine position in some embodiments.
• In another embodiment, an apparatus for supporting a patient during a medical procedure is provided, the apparatus including a base structure with first and second spaced opposed end supports; each end support being attached to the base structure; an elongate patient support structure including first and second portions joined inwardly at an articulation, the patient support structure outwardly connected to the end supports by connection assemblies and being alignable in a first plane and movable to a plurality of angular orientations with respect to one another on either side of the first plane; the inward articulation joining the first and second portions and movable to a plurality of angular orientations associated with the angular orientations of the outwardly connected ends of the patient support structure relative to the end supports and a translation connector subassembly connecting each outer end of the patient support structure to the base and cooperating with the inward articulation and outwardly connected ends of the patient support structure, as a component of the connection assemblies, so as to allow the patient support structure to move through the various angular orientations thereof without the spaced opposed end supports moving relative to each other with respect to a spaced opposed distance; and a structure to move the articulation into the various angular orientations.
• In a further embodiment, at least one of the end supports includes a first vertical height adjustor and a second vertical height adjustor is positioned between the spaced opposed end supports.
• In a further embodiment, a single translation connector subassembly can be used in the form of a slider bar, rigidly attached to one outer end of the first and second portions, the slider bar pivotally attached with transverse and perpendicular axes to one of the end supports and providing a large amount of translation at one end of the table so as to make up for not having translation at the opposed or opposite end.
• In a further embodiment, at least one of the end supports further includes a rotation mechanism.
• In a further embodiment, the patient support structure is detachable and positionable at either end in a plurality of locations vertically spaced from a floor.
• In a further embodiment, the articulation has a hinge or joint mechanism, load-sharing and not, that cooperates with the various angular orientations.
• Yet another embodiment provides an apparatus for supporting a patient during a medical procedure, including a support subassembly including first and second spaced opposed upright end supports; each end support being attached to a respective base structure; at least one of the first and second end supports being vertically height adjustable; an elongate patient support with first and second ends and extending between the first and second end supports; the patient support being held by the end supports in spaced relation with respect to a floor, the patient support connected to and supported between the end supports; the patient support having a single breaking location spaced from the end supports and adapted to interact with the patient when the patient is located on the patient support; and a vertical elevator connecting a patient support first end with a respective end support; the vertical elevator being controllable to allow continuous non-segmented adjustment of the support first end relative to the respective end support so as to align and orient the patient support subassembly; and wherein the patient support is controllable to be upwardly and downwardly articulatable at both the first and second ends of the patient support relative to respective end supports and at the breaking location so as to be adapted to manipulate a patient into a plurality of selectively prone and non-prone positions in cooperation with a pivoting end support translation compensation mechanism at both outer ends of the patient support structure, while also cooperating with the end supports to move the patient between vertical positions.
• Still another embodiment provides an apparatus for supporting a patient during a medical procedure, the apparatus including a support subassembly including first and second spaced opposed end supports; each end support being attached to a respective base structure; at least one of the first and second end supports being vertically height adjustable; an elongate patient support with first and second ends and extending between the first and second end supports; the patient support being held by the end supports in spaced relation with respect to a floor, the patient support connected to and supported between the end supports; the patient support having a single breaking location spaced from the end supports and adapted to interact with the patient when the patient is located on the patient support; and a vertical elevator connecting a patient support first end with a respective end support; the vertical elevator being controllable to allow continuous adjustment of the support first end relative to the respective end support so as to align and orient the patient support subassembly; and wherein the patient support is controllable to be upwardly and downwardly articulatable at both the first and second ends of the patient support relative to respective end supports and at the breaking location so as to be adapted to manipulate a patient into a plurality of selectively prone and non-prone positions in cooperation with a patient support translation compensation mechanism at both outer ends thereof, while also cooperating with the end supports to move the patient between vertical positions, and wherein at least one translation compensation mechanism is moved by an actuator in a longitudinal direction.
Objects and Advantages of the Invention
• 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 both outer ends 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; and providing apparatus and methods that are easy to use and especially adapted for the intended use thereof and wherein the apparatus are comparatively inexpensive to make and suitable for use.
• Other objects and advantages of this invention will become apparent from the following description taken in conjunction with the accompanying drawings wherein are set forth, by way of illustration and example, certain embodiments of this invention.
• The drawings constitute a part of this specification and include exemplary embodiments of the present invention and illustrate various objects and features thereof.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a perspective view of a breaking patient support structure according to the invention and having load-sharing hinges and translation compensation mechanisms on both outer ends of the patient support structure.
• FIG. 2 is an enlarged and partial side elevational view of a portion of the support structure ofFIG. 1.
• FIG. 3 is an enlarged and partial top plan view of the support structure ofFIG. 1.
• FIG. 4 is an enlarged and partial perspective view of a portion of the structure ofFIG. 1.
• FIG. 5 is an enlarged and partial side elevational view of a portion of the structure ofFIG. 1 showing a translation connector subassembly with longitudinally translating transverse and perpendicular axes with respect to each other.
• 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 radiolucent first hinge of the structure ofFIG. 1.
• FIG. 8 is an enlarged and partial perspective view of a cooperating radiolucent 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 an actuator in the form of a cable drive motor and winch cylinders.
• FIG. 13 is a partial perspective view of a patient support frame of the structure ofFIG. 1.
• FIG. 14 is a partial perspective view of a patient imaging top for replacement with the patent support frame ofFIG. 13.
• FIG. 15 is a reduced perspective view of the structure ofFIG. 1 shown with an imaging top ofFIG. 14 replacing the support frame ofFIG. 13 and shown in a planar inclined position.
• FIG. 16 is a perspective view of the structure ofFIG. 15 shown in a planar tilted position.
• FIG. 17 is a perspective view of the structure ofFIG. 15 shown in a planar inclined and tilted position.
• FIG. 18 is a side elevational view of the structure ofFIG. 15 shown in a symmetrical upward breaking position.
• FIG. 19 is a side elevational view of the structure ofFIG. 15 shown in a first inclined and upward breaking position.
• FIG. 20 is a side elevational view of the structure ofFIG. 15 shown in a second inclined and upward breaking position.
• FIG. 21 is a side elevational view of the structure ofFIG. 15 shown in a symmetrical downward breaking position.
• FIG. 22 is a side elevational view of the structure ofFIG. 15 shown in a first inclined and downward breaking position.
• FIG. 23 is a side elevational view of the structure ofFIG. 15 shown in a second inclined and downward breaking position.
• FIG. 24 is an enlarged side elevational view of the structure ofFIG. 1 shown in an upward breaking, inclined and tilted position.
• FIG. 25 is a is a perspective view of a second embodiment of a patient support structure according to the invention including a patient support frame and an imaging table shown in a first spaced orientation.
• FIG. 26 is a perspective view of the patient support structure ofFIG. 25 shown tilted in an intermediate position during a rotation as would be used for a patient rollover.
• FIG. 27 is a perspective view of the structure ofFIG. 25 shown further rolled or tilted in a second intermediate position during rotation.
• FIG. 28 is a perspective view of the structure ofFIG. 25 shown after rotation to a final flipped position.
• FIG. 29 is a perspective view similar toFIG. 25 showing the articulating patient support frame and the articulating imaging table in a second spaced orientation.
• FIG. 30 is a front elevational view of a third embodiment of a patient support structure according to the invention showing a pair of opposed translating (inwardly and vertically) end supports and a patient support structure articulation that does not share much loading due to angulation actuators at both outer ends thereof.
• FIG. 31 is a front elevational view of a fourth embodiment of a patient support structure according to the invention.
• FIG. 32 is a perspective view of a fifth embodiment of a patient support structure according to the invention, shown in a planar inclined position, wherein the patient support structure can, again, have translation compensation at both of its outer ends.
• FIG. 33 is a perspective view of the structure ofFIG. 32 shown in an inclined and upward breaking position at an inward articulation that is only partially load-sharing due to an angulation actuator in one end of the base which carries most of the weight when loaded.
• FIG. 34 is a perspective view of the structure ofFIG. 32 shown in a substantially symmetrical downward breaking position.
• FIG. 35 is a reduced side elevational view of a sixth embodiment of a patient support structure having a load-sharing inward articulation according to the invention shown in a substantially horizontal and planar position and a large amount of translation compensation available on only one outer end of the support structure.
• FIG. 36 is a reduced side elevational view of the structure ofFIG. 35 shown in a symmetrical downward breaking position.
• FIG. 37 is a reduced side elevational view of the structure ofFIG. 35 shown in a symmetrical downward breaking position.
• FIG. 38 is an enlarged and partial top plan view of a portion of the structure ofFIG. 35 and shown in the same position as shown inFIG. 35.
• FIG. 39 is an enlarged and partial side elevational view of the structure ofFIG. 35 and shown in the same position as shown inFIG. 35.
• FIG. 40 is an enlarged and partial side elevational view of the structure ofFIG. 35 and shown in the same position as shown inFIG. 35.
• FIG. 41 is an enlarged and partial perspective view of the structure shown inFIG. 40.
• FIG. 42 is an enlarged and partial top plan view of a portion of the structure ofFIG. 35 and shown in the same position as shown inFIG. 36.
• FIG. 43 is an enlarged and partial side elevational view of the structure ofFIG. 35 and shown in the same position as shown inFIG. 36.
• FIG. 44 is an enlarged and partial side elevational view of the structure ofFIG. 35 and shown in the same position as shown inFIG. 36.
• FIG. 45 is an enlarged and partial top plan view of a portion of the structure ofFIG. 35 and shown in the same position as shown inFIG. 37.
• FIG. 46 is an enlarged and partial side elevational view of the structure ofFIG. 35 and shown in the same position as shown inFIG. 37 and showing all of the translation compensation occurring on the foot end of the patient support structure.
• FIG. 47 is an enlarged and partial side elevational view of the structure ofFIG. 35 and shown in the same position as shown inFIG. 37.
• FIG. 48 is a side view of an eighth embodiment, similar to that ofFIGS. 32-34, of a patient support structure, again, with translation compensation on both outer ends thereof, according to the invention, shown in a planar horizontal position, and including reversibly attached stationary upper body support assembly and hip-thigh pad structures.
• FIG. 49 is a side view of the structure ofFIG. 48 shown in an inclined and upward breaking position, and including reversibly attached upper body support and hip-thigh pad structures ofFIG. 48.
• FIG. 50 is a side view of the structure ofFIG. 48 shown in a Trendelenburg position, and including reversibly attached chest support and hip-thigh pad structures ofFIG. 48.
• FIG. 51 is a side view of the structure ofFIG. 48 shown in a downwardly breaking position, and including reversibly attached chest support and hip-thigh pad structures ofFIG. 48.
• FIG. 52 is a side view of the structure ofFIG. 48 showing the patient support structure and inward articulation in a horizontal and tilted position, and with the reversibly attached chest support assembly and hip-thigh pad structures ofFIG. 48 removed.
• FIG. 53 is a side view of the structure ofFIG. 48 shown in a horizontal and planar position, and including reversibly attached torso support translator with an actuator and the hip-thigh pad structures ofFIG. 48 positioned on the foot end portion of the frame adjacent the articulation, wherein D3 stays constant with frame articulation.
• FIG. 54 is an enlarged side elevational view of the translation connector component ofFIG. 5 toFIG. 33 andFIG. 48, with portions broken away or shown in cross-section, so as to show greater detail thereof.
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 thereference numeral1 and is depicted inFIGS. 1-12. Thestructure1 includes first and second support piers orcolumn assemblies3 and4 which are illustrated as independent, stationary floor base support structures as shown inFIG. 1 or may be connected to one another by a base support as illustrated in the embodiment shown inFIG. 30. In some embodiments according to the invention as shown, for example, inFIGS. 32-34, the base connection provides the columns with a motorized length adjustment compensation at both outer ends thereof. Additionally or alternatively, the base connection may be non-motorized and selectively retractable, such that the length of the base connection can be shortened, such as but not limited to for storing the base with a smaller footprint that the base has when in use. 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 as known in the art, having transverse and longitudinal translation (seeFIGS. 32-34 and48-54), or may even be a wall mount.
• In the first illustrated embodiment, each of thesupport columns3 and4 includes a translation angulation connection subassembly TAC (seeFIGS. 5 and 6), which includes a pivotal support assembly, a rotation subassembly and an angulation subassembly, which are described in greater detail below. Thesupport column3 includes an attached first pivotal support connection assembly, generally5, and thesupport column4 includes an attached second pivotal support assembly, generally6. Between them, thesupport connection assemblies5 and6 uphold an optionally removable elongate, articulate jointed or breaking patient holding or support structure, generally10 and optionally, a second removable patient support structure that will be described with respect to another embodiment of the invention. Thepatient support structure10 includes a rigid outer frame with an inwardly locatedarticulation16, such as but not limited to a real hinge or a virtual articulation (not shown, and which may be referred to as a virtual “hinge”) and is connected to the base end supports byconnection assemblies5 and6, which are described in greater detail below. The articulation is defined by being limited to vertical translation as opposed to longitudinal translation, or a combination of vertical and longitudinal translation. “Vertical translation” means movement of a structure such that the height of the structure is increased or decreased relative to the floor. Longitudinal translation is generally movement that runs parallel to the floor or to the longitudinal axis of the surgical table1. It is noted that in this embodiment, theconnection assemblies5 and6 equally share the load inwardly and outwardly, as opposed to load-bearing that is solely or primarily outwardly at theconnection assemblies5 and6.
• Thesupport connection assemblies5 and6 include structures to provide for putting the outer ends of thesupport structure10 into simultaneous roll, Trendelenburg, reverse Trendelenburg, pivot or angulation and at least horizontal translation with respect to each of thecolumns3 and4. The illustratedsupport structure10 includes afirst frame section12, asecond frame section14 with an optional transversesupport cross bar15, and a pivot or hinge assembly, generally16. In the illustrated embodiment, the pivot assembly further an actuator in the form of includes a cable drive system, including adual winch18 and cooperatingcables20; however, other drive systems are foreseen.
• 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 motorizedlift 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 connectedpatient support structure10 and position it into an inclined orientation. It is foreseen that thevertical supports3 and4 may be constructed so that thecolumn3 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 thesystem1 may be employed in some embodiments to facilitate the approach of personnel and equipment. It is foreseen that other types of end column vertical height adjustment mechanisms can also be used for the columns.
• Each of the support piers or columns include asupport connection assembly5 and6. Eachconnection assembly5 and6 includes two or more subassemblies for moving thepatient support10 in a particular manner. Eachconnection assembly5 and6 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 so as to maintain the hinges at a selected height and horizontal relationship with respect to the floor. Therotational subassemblies26 and26′ enable coordinated rotation of thepatient support structure10 about a longitudinal axis of thestructure1 and one generally located near an outer end of the patient support structure. The angulation subassemblies27 and27′ shown inFIGS. 2 and 3 include translation structure and enable the selective hinging, articulation or breaking of thesupport10 at thehinge assembly16 at desired levels and increments as well as selective tilting of theframe portions12,14 with respect to a longitudinal axis of such frame portion with longitudinal translation compensation occurring at both outer ends of the frame portions.
• The rotation subassembly ormechanism26, shown inFIGS. 1 and 5, includes at least onemotor housing30 surmounting thesupport column3; however, the rotation mechanism could be located closer to the patient support structure. 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. It is also foreseen that the rotational mechanism could be located somewhere other than insupport columns3 and4. A mainrotational shaft32 is shown extending from themotor housing30 that turns arotation structure33 in this particular embodiment. Therotation structure33 in turn rotates the connectedpatient 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. It is foreseen that the shaft could be located above or below the outer end of the patient support structure. Therotation mechanism26 is operated by actuating the motor using a switch or other similar means and can be controlled by a computer. Therotation structure33 is fixed to theshaft32 at a location spaced from themotor housing30 and thesupport column3 to provide clearance for rotation of the connectedpatient support structure10 in this embodiment.
• As shown inFIGS. 4 and 5, therotation structure33 can be attached to a pair of translation posts or H-bar posts40 disposed at either end of therotation structure33; however, other connections are foreseen. Theposts40 are each attached to thestructure33 by apin42, bolt, or other fixing structure. One or more cooperatingapertures44 formed in theposts40 can provide passageway for apivot pin46 to extend therethrough. Thepivot pin46 is receivable in each cooperating pair ofapertures44 allowing for selective placement of a pivotingtranslation connector component48 and52 that, in this embodiment, is sized and shaped to be received between the pair ofposts40 and also receive thepivot pin46 therethrough. This enables the translation connector mechanism to have a transverse axis of rotation. Thepin46 andconnector48,52 are thus positionable in different angular orientations with respect to the longitudinal extension of thesupport10, wherein this connection mechanism can also translate horizontally at a variety of vertical heights to be selected by the surgeon and readily changeable, even during surgery if necessary, to vary the height of theframe section12. In one specific embodiment, the multiple location or height feature is also advantageous when more than one frame or patent structure is mounted in tandem as shown, for example inFIGS. 25-29. In this embodiment, 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, in one embodiment, the connector component orassembly48,52 has aslot50 for receiving apivot pin46, to provide for a passive transverse axis of rotation within the translation compensation mechanism. Further, theslot50 andpivot pin46 provide for manual, or passive, height adjustment, or vertical translation, of theconnector48, by manually lifting theconnector48 so that theslot50 is aligned with theapertures44 of the H-bar posts40, and then passing or installing thepivot pin46 through all three of the alignedapertures44 andslot50.
• Also with reference toFIGS. 4 and 5, thetranslation connector subassembly48,52 includes rigid attachment to an outer end of the patient support structure. In this embodiment, the attachment includes an additionalpivot axis structure52 with an open endedslot56, although other attachments to the patient support structure are foreseen. Theslot56 is sized and shaped for receiving anend connection58 of theframe section12. The pivotingtranslation connector subassembly48,52 further includes a through aperture or bore60 running substantially perpendicular to the slot. The alignedapertures60,60′ are sized and shaped to receive apivot pin62 therethrough oriented at a 90° angle with respect to thetransverse pivot pin46. The swivelable connection for the translation connector subassembly provided by thepin62 provides for some passive forward and rearward lateral movement and rotational movement of the attachedframe end connection58 and thus theframe section12, providing a degree of freedom and clearance needed for rotating the patient support about a longitudinal axis of a patient, with certain patient manipulations. The inner portion of the multifunctional translation connector subassembly is sized and shaped to frictionally engage theframe end connection58, thus securely fixing theend connection58 to the pivoting translation connector component of the connection assembly. Theframe end connection58 is in turn fixed to each ofelongate frame members66 and68 of theframe section12. Theframe members66 and68 are each hingedly connected to theinward hinge assembly16 to be described in greater detail below. Pivoting of thetranslation connector subassembly48,52 with respect to thepin46, or the transverse translation axis A2, and the perpendicular axis A1 provides for selected articulation (seeFIGS. 5-6), or passive modifications in pitch, of the frame section12 (that includes theend connection58 and theframe members66 and68) and/or theentire support10 with respect to the support pier orcolumn3, wherein the entire patient support structure is inwardly articulated and rolled with respect to the longitudinal or roll axis R (seeFIGS. 1 and 6). It if foreseen that, depending upon the table, all of the subassemblies can be powered (i.e., actively driven) or passive (i.e., movement with respect to the axis is driven by movement occurring in another part of the structure1).
• With reference toFIG. 6, at the support pier orcolumn4, the support assembly6 is substantially similar to thesupport assembly5; however, therotation subassembly26′ can include a motor or not include a motor. The support pier orcolumn4, again, includes a powered mechanism to provide selective height adjustment of thesubassembly26′. Arotation structure33′ is inwardly spaced from thecolumn4. Thestructure33′ includes a shaft (not shown) extending outwardly therefrom similar to therotation shaft32, the shaft being, again, rotatingly related to both the patient support structure and thesupport column4.
• In this particular arrangement shown, 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 connector subassembly48′,52′,end connector58′ andpivot 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 connector subassembly48,52,end connector58 andpivot pin62.
• Theframe14 further includesframe members66′ and68′ that are each fixed to theend connector58′. Theframe members66′ and68′ are pivotally 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, which, again, are preferably radiolucent.
• With particular reference toFIGS. 3,7 and9-11, thehinge mechanism70 includes anouter member76 and aninner member78. Theouter member76 is fixed or may be integral with theelongate frame member66, while theinner member78 is integral or otherwise fixed to theframe member66′. Theouter member76 further includes anextension80 with agroove82 for receiving and guiding thecable20. Theextension80 tapers in a direction from theouter member interior84 to thegroove82. Theextension80 is configured to cause a slight upward break or bend of thesupport10 when theextension80 comes into contact with thecable20 at thegroove82. 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 or joint illustrated, for example, inFIG. 21 is a result of lengthening thecable20 distance and allowing gravity to drop thehinge70. Theextension80 is shaped to extend slightly inwardly toward a longitudinal axis A of thesupport10, thereby guiding thecable20 along a path within a periphery of theframe sections12 and14 when theextension80 is in contact with thecable20 when in a downward breaking configuration directed toward the cable with thecable20 being received at thegroove82.
• It is foreseen that if an exclusively upward breaking or jointing 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, joint or bend at the hinge or pivot between thesections12 and14. When the base is actuated to move the columns toward one another, thesections12 and14 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 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, theinner 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, preferably radiolucent, through both the inner and outer hinge members. The interior84 includes a curved partiallycylindrical surface89 for slidingly receiving a cooperating outer rounded and partiallycylindrical surface90 of theinner member78. Theinner 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 asurface93 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 innerplanar surface95 with aplanar surface96 of the hingeinner 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′, aninner member78′, anextension80′ with agroove82′, an interior84′,pivot apertures86′, apivot pin88′, acurved surface89′(not shown), anouter surface90′ (not shown), astop92′ (not shown), anabutment surface93′, an innerplanar surface95′ and aplanar surface96′ that are identical or substantially similar in shape and function to the respective hingeouter member76,inner member78,extension80,groove82, interior84,pivot apertures86,pivot pin88,curved surface89,outer surface90, stop92,abutment surface93, innerplanar 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 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 thepatient support structure10 at the break or joint between thesections12 and14. 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, and the like. While a lead screw drive could also be utilized, a more radiolucent joint or hinge is preferred.
• With particular reference toFIGS. 6 and 12, 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 thehinge 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 or jointing 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 or jointing configuration. As thecables20 unwind, gravity draws thesupport sections12 and14 downward with thecables20 being received in thegrooves82 and82′ of thehinge extensions80 and80′. As thecables20 slacken, thehinges70 and72 continue to lower pressing down upon thecables20. Again, different ways to move the hinges are foreseen both directly and indirection with actuators that are more or less load-bearing.
• It is noted that theframe sections12 and14 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 theframe sections12 and14 and be radiolucent. 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 radiolucent imaging tops orsections100 and101′ respectively. Each of thesections100 and101′ havingelongate 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, theimaging 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 thesections100 and100′ are kept in a substantially coplanar configuration.FIG. 15 illustrates a configuration in which thecolumn3 is elevated upwardly with the frame sections hinging at thesupport assemblies5 and6, resulting in an inclined position or configuration of the entire patient support. In the illustrated embodiment, thesection100 would preferably receive a patient's head. Therefore,FIG. 15 illustrates a reverse Trendelenburg position or orientation.FIG. 16 illustrates thesections100 and100′ again in a substantially common plane with both sections being rotated to a tilted position produced by a powered rotation of thesub assemblies26 and passive rotation of theassembly26′ with bothcolumns3 and4 otherwise holding thesections100 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 thesections100 and100′ remaining in substantially the same plane. It is foreseen that a bearing block assembly at one or both ends of the table could provide for some lateral or transverse translation along with horizontal translation to prevent binding of the hinge mechanisms.
• With reference toFIGS. 18-20, there is illustrated three upward breaking or hinging configurations of thestructure1.FIG. 18 illustrates a symmetrical upward breaking configuration wherein thecolumns3 and4 and their respectivesupport connection assemblies5 and6 are holding the patient support structure at substantially the same height with thecables20 being shortened by rotation of the winch motor to result in an upward break or joint in thehinge assembly16.FIG. 19 illustrates thecolumn3 being extended to a maximum height and the cables reeled to shorten a distance between thesections100 and100′. An example of such an upward break or joint with reverse Trendelenburg would be a head orcolumn3 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 thestructure1.FIG. 21 illustrates a symmetrical downward breaking configuration wherein thecolumns3 and4 are holding the outer ends of the patient support structure, at the same height with thecables20 being unwound or slackened to result in a downward break or joint in thehinge assembly16, thehinges70 and72 contacting thecables20.FIG. 22 illustrates a downward breaking reverse Trendelenburg with thecolumn3 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 thestructure1 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 or jointed configuration of thestructure1. An example of the position illustrated inFIG. 24 would be: a head orcolumn3 height of 41 inches, a foot orcolumn4 height of 34 inches and a 35 degree upward break or joint with 10 degree roll. Such positioning capabilities is associated with translation compensation occurring at both outer ends of the breaking patient support structure.
• With reference toFIGS. 25-29, another structure, generally102 according to the invention is illustrated. Thestructure102 utilizes all of the elements described herein with respect to thestructure1 and therefore the same references numerals are used for the same elements or features. Thestructure102 differs from thestructure1 in that the H-bar posts40 and40′ are replaced or modified to be extended H-bar posts40A and40A′, allowing for the mounting of twoelongate structure10 and cooperating cable drives18 or other actuators to move the hinges. In the embodiment shown inFIG. 25, one of thestructures10 includes theframe member12 and14 while the other structure is an imagingtop having sections100 and100′. As previously described herein, the cooperating H-bar posts40A and40A′ equipped with a plurality of apertures allows for the placement of thesupport structures10 at a variety of locations. For example,FIGS. 25-28 illustrate a first spaced orientation of the elongate frame with respect to the elongate imaging top with the imaging top located at a “lower” position identified by the reference letter L. The identical components are shown inFIG. 29 with the imaging top located at a “mid-position” identified by the reference letter M, illustrating a more compact or closely spaced orientation of the elongate frame with respect to the elongate imaging top than what is shown inFIG. 25.
• As illustrated 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 thecontroller29. Thestructure102 shown inFIGS. 25-29 is further illustrated with abase support110 fixed to each of thecolumns3 and4 and rollers orcastors112 at the base of thestructure102.
• With reference toFIGS. 30 and 31, further embodiments according to the invention, generally200 is illustrated. The system200 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 connection assemblies, generally205 and206 that translate, rotate, and angulate or pivot. Between them, thesupport assemblies205 and206 uphold an elongated breaking, hingeable or pivotable patient support structure, generally210. The hinge structure is described in detail in Applicants's 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. In this embodiment, the inward articulations remain mostly unloaded and translation compensation can occur at both outer ends of the patient support structure. Theembodiment200A illustrated inFIG. 31 differs from the structure200 only in that the length-adjustable base202 is replaced by afirst base220 attached to thepier203 and asecond 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. In this embodiment, it is foreseen that actuators would provide rotation, angulation and horizontal translation at both outer ends of the patient support structure.
• It is foreseen that cable drives, as described herein, other types of motor drives, including screw drives with gears, universal joints, hydraulic systems, and other like actuators, 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. 32-34, again, providing translation compensation on both outer ends. The structure301 generally includes a translating actuator on one end known in the prior table art as an inclinable and transversely and horizontally translatable operatingtable support structure304, a vertically height adjustable end support orpier306 and a hinged or pivotally upwardly and downwardly breaking orjointing support structure310 connected to both thestructure304 and thepier306 by pivoting translation compensation mechanisms. Thepatient support structure310 further includes a first actively angulatedsection312 moved by an actuator and asecond section314. Thefirst section312 is fixed to and extends from theoperating table support304. The second section is attached to thepier306 by a pivotingtranslation connector assembly320, such as thesupport connection assembly5 described herein with respect to thestructure1. Thehinge mechanism316 disposed between thesupport sections312 and314 may be a conventional hinge, pivot, or pivot or hinge systems previously described herein. Preferably, it is a simple hinge and does not need to carry much load.
• In use, theoperating table support304 utilizes electric or other power means to move thesupport section312 up and down at an incline and to translate it transversely and longitudinally, as is known in the art. Theoperating table support304 can also tilt or rotate from side to side. In response to the movement of thesection312, thesection314 also moves, resulting in upward and downward breaking illustrated inFIGS. 33 and 34. In response to the movement of thesection312, theconnection320 provides translation compensation horizontally along with rotation and angulation degrees of freedom of movement. Thepier306 includes a motor for raising and lowering the pier at theconnection320. It is foreseen that theconnection320 could have actuators for rotation, angulation and translation.
• 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, gear mechanisms, hydraulic systems, and other actuator like mechanisms, may be utilized to facilitate both upward and downward breaking of thesupport structure310 at the joint316.
• With reference toFIGS. 35-47, another patient support structure according to the invention, generally401 includes first and second upright support piers orcolumns403 and404 that are connected to one another by abase support402. In some embodiments according to the invention, each column may be surmounted on an independent movable or stationary base. Thecolumn403 is connected to a first support assembly, generally405 and thecolumn404 is connected to a second support assembly, generally406. Between them, thesupport assemblies405 and406 uphold at least one removable elongate and articulate, substantially centrally jointed or breaking patent holding or support structure, generally410. The assembly includes afirst frame section412, asecond frame section414 and a pair of identical hinge assemblies, generally416, disposed between and connecting the first andsecond frame sections412 and414. In the illustrated embodiment, thefirst frame section412 for holding a head and upper body of a patient is of a slightly shorter longitudinal length (along an axis X) than thesecond frame section414. Therefore, the spacedhinge assemblies416 are approximately centrally located relative to a body of a patient being placed on thestructure410. In the illustrated embodiment, the hinge assembly further includes a drive system that includes a pull rod assembly, generally418, and cooperating spaced slider bars420. Again, other drive systems are foreseen, especially lead screws, chains and other linkages.
• Thecolumns403 and404 are substantially similar in form and function to thecolumns3 and4 previously described herein with respect to thestructure1. Thecolumns403 and404 are supported by outwardly extendingfeet422 that include casters that may be equipped with a floor-lock foot lever for lowering thefeet422 into a floor-engaging position. Thecolumns403 and404 each include two or more lift arm segments respectively that permit the height of each of thecolumns403 and404 to be selectively increased and decreased in order to raise and lower all or a selected portion of the connectedpatient support structure410.
• Each of thesupport connection assemblies405 and406 generally includes arotation subassembly426 and426′ and anangulation subassembly427 and427′, respectively, that are the same or substantially similar to thesubassemblies26,26′,27 and27′ previously described herein with respect to thestructure1. In the illustrated embodiment, theangulation subassembly427 connected to theframe412 for holding the head and upper body of a patient is shown as substantially identical to thesubassembly27 and, therefore, shall not be described further herein. Thesubassembly427′ is substantially similar to thesubassembly27′, but with some modifications, including aframe436 disposed transverse to the overall longitudinal axis X of the structure401, theframe436 providing for slidable support of the pair of identical slider bars420 that are disposed at either side of theframe414 and near thesubassembly427′.
• Similar to therotation subassembly26 previously described herein, the rotation subassembly ormechanism426, includes at least onemotor housing430 surmounting thesupport column403. It is foreseen that a cooperating motor may also be mounted on thesupport column404. A mainrotational shaft432 extends from themotor housing430 that turns a rotation structure or bar that in turn is connected to and rotates thepatient support410 about a longitudinal axis. In particular, themotor housing430 contains a rotary electric motor or other actuator drivingly engaged with theshaft432. Therotation mechanism426 is operated by actuating the motor using a switch or other similar means. Theshaft432 rotationally cooperates with a pair of substantially vertically disposed translation posts or H-bar posts440, theposts440 being attached to and disposed at either end of the transverse rotation structure orbar433. Each H-bar post440 includes a plurality ofapertures444, allowing for selective, hinged vertical placement of theframe section412 identical or substantially similar to what has been described previously herein with respect to the H-bar posts40, theangulation sub-assembly27 and theframe end section58 of theframe section12 previously described herein with respect to thestructure1.
• With particular reference toFIGS. 38-40, as stated above, the sub-assembly426′ is substantially similar to the sub-assembly426 and therefore may include a motor and further includes either an active or passiverotational shaft432′ that engages a rotation structure or bar433′ that is attached to a pair of substantially vertically disposed H-bar posts440′. A plurality of cooperatingapertures444′ formed in theposts440′ provide passageway for apivot pin446 to extend therethrough. Thepivot pin446 is receivable in each cooperating pair ofapertures444′, allowing for selective placement of atranslation connector448,452 component that is part of the connection assembly. In this embodiment, the translation connector is sized and shaped to be received between the pair ofposts440′ and also receive thepivot pin446 therethrough. Thepin446 andconnector448 are thus positionable in an orientation transverse to the longitudinal axis X of thepatient support frame410 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 section414. The multiple location or height feature is also advantageous when more than one frame or patent structure is mounted in tandem, for example, when both a frame and imaging table are used together, such as is shown in the embodiment illustrated inFIGS. 25-29. The position of the frame or other structure may be desirably changed to provide close proximity to an imaging top with a distance between a patient support and an imaging top being expandable or reduceable depending upon the size or other attributes of a patient and surgical or other requirements. Theconnector448 has a slot for translatably receiving thepivot pin446. It is noted that the H-bar support440′,apertures444′, elongatetransverse pin446 andtranslation connector448,452 component are the same or substantially similar in form and function with therespective support40,apertures44,transverse pin46 andtranslation connector48 previously described herein with respect to thestructure1.
• Thetranslation connector448, again, has an attachedpivot connector452 that is substantially similar to thepivot connector52 previously described herein, with the exception that rather than being attached directly to an end piece or section of thepatient support frame414, thepivot connector452 is fixed to theframe436 that is fixed to and supports the slider bars420 near end surfaces464 thereof. Thus, the slider bars420 are in a hinged relationship with the H-bar supports440′. The slider bars420 are also in slidable relation with theframe section414 while being securely attached thereto and disposed substantially parallel to a longitudinal axis of thesection414, as will be described in greater detail below. Such slidable attachment facilitates upward and downward breaking or hinging of thesection414 with respect to thesection412 at thehinge mechanism416. Also as more fully described below, thepull rod assembly418, that is connected to both theframe section414 and thehinge mechanism416, is rotatable so as to control the hinge or break angle of thepatient support410 and render thesupport410 rigid at a desired upward or downward break or joint of thehinge mechanism416.
• With particular reference toFIGS. 38 and 39, thesupport frame section414 includes opposed elongate andparallel frame sections466 and468 attached to one another by a transverseend frame section469. Asupport plate470 is attached to and is disposed below each of thesections466,468 and469 to provide additional support and stability to theframe section414 at and near theend section469. Further support is provided by a pair offrame support plates471, both of which are fixed to the endsupport frame section469 near one end thereof; oneplate471 being fixed to thesection466 and theother plate471 being fixed to the section468. At least one pair of sliderbar holding structures472 are fixed to thesupport plate470 and extend downwardly therefrom at each of theframe sections466 and468. Eachstructure472 includes a through bore that extends parallel to theframe sections466 and468, thestructure472 for slidably receiving one of the slider bars420 directly below one of theframe sections466 and468 and also orienting the pair of slider bars420 in a direction substantially parallel to theframe sections466 and468. The illustrated sliderbar holding structures472 are spaced from theend frame section469 and located near aforward edge473 of theplate470. In the illustrated embodiment, the holdingstructures472 are also bolted to theframe sections466 or468. A pair of pull-rod supports475 are also fixed to thesupport plate470 and theframe414 and extend downwardly therefrom at each of theframe sections466 and468 and also downwardly from theend frame section469. Eachstructure475 includes a through bore for receiving a transverse pivot pin or bar476 mounted below the slider bars420. The pull-rod assembly418 is attached to thesupport475 at thepivot pin476 and is thus in hinged relationship with thesupport475, pivotally attached thereto at end portions478.
• Theactuator assembly418 further includes a pair ofhousings480, each housing attached to an end portion478 and having apowered actuator482 cooperating with one of a pair of rotatable extendible andretractable rods484 and a pair ofhinge connectors486, each pivotally attached to arespective cam plate488 of therespective hinge mechanism416 at arespective pivot pin490. Thecam plate488 has a substantially centrally locatedcurvilinear wall489 forming a curvate aperture or slot, a lower circular aperture for receiving thepin490 and an upper circular aperture for receiving apin502, described in greater detail below. Eachpull rod484 is rotatably mounted within one of thehousings480, such rotation being controlled by operation of theactuator482 located in thehousing480 and engaged with therod484 to screw and thus selectively move or draw therod484 into or away from thehinge mechanism416 in a direction along a longitudinal axis of therod484, that in turn results in breaking or jointing of thepatient support410 at thehinge mechanism416. It is foreseen that other embodiments according to the invention may utilize other types of push/pull rods or actuator mechanisms, including, for example hydraulic systems and actuators that can provide angulation. 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 themechanism416, for example including, but not limited to, polyaxial joints, roller with spokes, sprockets, toothed gears, universal axis gears, or the like.
• With particular reference toFIG. 41, the illustrated pair ofhinge mechanisms416, each having acam plate488, further include a pair of forkedarms492 extending from theframe section412 and a pair of cooperating forkedarms494 attached to and extending from thesection414.Hinge arms496,497,498 and499 having apertures near opposite ends thereof for receiving pivot pins cooperate with therespective cam plate488 and adjacent forkedarms492 and494 at pivot pins501,502,503 and504. All of the pivot pins490,501,502,503 and504 are disposed transverse to the longitudinal axis X of the patient support structure401. In particular, thepivot pin501 is received by circular apertures located near first ends of thehinge arms496 and498 and a circular aperture in thearm492, thus pivotally attaching thearm492 with both thehinge arms496 and498. Thepivot pin502 is received by an upper circular aperture in thecam plate488 and circular apertures located near the ends of each of the forkedarms492 and494, thus pivotally attaching thecam plate488 with both of the forkedarms492 and494. Thepivot pin503 is received by circular apertures located near first ends of thehinge arms497 and499 and a circular aperture in thearm494, thus pivotally attaching thearm494 with both thehinge arms497 and499. Thepivot pin504 is received by theslot489 and also by circular apertures located near second ends of thehinge arms496,497,498 and499, thus pivotally attaching all four hingearms496,497,498 and499 with thecam plate488 at theslot489.
• Also, with particular reference to FIGS.35 and38-41, the structure401 is shown in a neutral, planar orientation, with the pull-rod assembly418 holding thehinge mechanism416 in such neutral position, with the forkedarms492 and494 in parallel. In such position, thepin504 is located at or near a rear-ward end of theslot489.
• With reference toFIGS. 42-44, as therod484 is rotated to selectively move the hinge mechanism, thepin504 remains near the rear-ward end of theslot489 and the action of the rod causes thehinge mechanism416 to pivot thecam plate488 at thepivot pin490, causing thearms492 and494 to move toward therod hinge connector486 and thus pivot the patient support at thepin502, causing a downward break or joint in thepatient support410. With reference toFIGS. 45-47, as therod484 is rotated to selectively shorten the length thereof, thesupport portion414 slides along the slider bars420 away from theend support404. At the same time, thepin504 slides along theslot489 to an opposite or forward end thereof as the cam plate pivots in a forward direction about thepin490. The movement of therod484 thus causes an upward break at thepivot pin502. In the illustrated embodiment, the patient frame is pinned at the head end, but is free to move along the fixedslider bar420 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 or transverse translation movement, as described previously. The sidebar is configured to provide for a considerable amount of translation which is required for this type of breaking table.
• 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 supports403 and404 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 structure401 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. This provides a significant improvement to the prior art.
• As with thestructure1 configurations illustrated inFIGS. 18-23, the upward and downward breaking of thepatient support410 may be modified by placing theportions412 and414 at different vertical locations along the H-bar supports440 and440′, thus resulting in symmetrical or asymmetrical breaking configurations. Furthermore, theportions412 and414 may be rotated or tilted as described above with respect to thestructure1.
• With reference toFIGS. 48-54, another patient support structure according to the invention, generally601, includes a floor mountedbase602, a conventional or standard vertically adjustable, and inclinable operatingtable support structure604 known in the industry, a vertically height adjustable end support, pier orcolumn606 and a hinged or pivotally upwardly and downwardly breaking or jointingpatient support structure610 connected to both thetable support structure604 and thepier606 with pivoting translation compensation capabilities. Thepatient support structure610 further includes afirst frame section612 and asecond frame section614 joined together by a pair of upwardly and downwardly breaking hinges616. An intervening second base, longitudinal translation subassembly orlongitudinal translation connector617 surmounts theoperating table support604. Thefirst frame section612 is engaged by, fixed or attached to thesecond base617 such that thefirst frame section612 extends outwardly from theoperating table support604 and toward thepier606. Thetable support structure604 includes a powered mechanism, electronics and acontroller618 for selectively adjusting the height, inclination and tilt or roll of thepatient support structure610. Thesecond base617 includes a motor (not shown), electronics (not shown) and structure that slidingly moves or longitudinally translates thefirst frame section612 with respect to theoperating table support604.
• Thesecond base617 slidingly moves, or translates in a longitudinal direction, thefirst frame612 a distance D1 toward or away from thepier606, as is indicated by thearrow623. The distance D1 is measurable from the rear orouter end617aof thesecond base617 and the rear orouter end612aof thefirst frame section612. Longitudinal translation, or longitudinal movement or sliding, of thefirst frame section612, such as with respect to theoperating table support604, and resultant changes or variation in D1, is coordinated and synchronized by a controller with changes in the angulation of thehinges616, at thetable support604 and at thepier606, so as to position thepatient support610 in various positions determined by the surgeon, such as is described elsewhere herein. In this embodiment, thehinges616 themselves need not carry much load.
• The pier orsupport column606 includes a rotation subassembly, generally626, and an angulation subassembly, generally627, that are interconnected and include an associated power source and circuitry linked to a controller, such as but not limited tocontroller618, for cooperative and integrated actuation and operation. Therotation subassembly626, anangulation subassembly627 and pivoting translation subassembly are the same or substantially similar to therotation subassembly26′, theangulation subassembly27′, and thetranslation connector48,52 inFIGS. 4 and 5, respectively. Therotational subassembly626 enables coordinated rotation or tilting of thepatient support structure610 about the longitudinal axis of thestructure601. Theangulation subassembly627 enables the selective hinging, articulation or breaking of thepatient support610 at thehinge assemblies616 at desired levels and increments as well as selective tilting of theframe portions612,614 with respect to a longitudinal axis of such frame portion.
• The rotation subassembly ormechanism626, shown inFIGS. 48-54, includes at least onemotor housing630 surmounting thepier606. A main rotational shaft632 (most easily seen inFIG. 54) extends from themotor housing630 that turns arotation structure633. Therotation structure633 in turn rotates the connectedpatient support610 about a longitudinal axis. Themotor housing630 contains a rotary electric motor or other actuator drivingly or actively engaged with theshaft632. Therotation mechanism626 is operated by actuating the motor using a switch or other similar means, such as but not limited tocontroller618, such as is known in the art. Therotation structure633 is fixed to theshaft632 at a location spaced from themotor housing630 and thepier606 to provide clearance for rotation of the connectedpatient support structure610. In some embodiments, therotation subassembly626 can be passive and, therefore, not include a motor. However, thesupport pier606 preferably includes a powered mechanism to provide selective height adjustment of theassembly626. The rotation subassembly can be at different locations between the end support of the base and the outer end of the patient support structure.
• In the embodiment shown, therotation structure633 is attached to an H-frame bracket640. The translation connector subassembly is the bracket located by apin642, bolt, or other fixing structure. Thepivot pin646 andtranslation connector648 are thus positionable in an orientation transverse to the longitudinal extension of thepatient support610. As illustrated inFIG. 54, thetranslation connector648 includes aslot650 for receiving thepivot pin646 therethrough. Thetranslation connector648 is slidable with respect to thepivot pin646, as is described in greater detail below.
• Thetranslation connector subassembly648 again includes apivot connector652. Thepivot connector652 is the same or substantially similar to the pivot connector described above with respect toFIGS. 4 and 5. Thepivot connector652 includes a slot sized and shaped for receiving anend connection658 of theframe section614. Thepivot connector652 further includes a through aperture or bore60 running substantially perpendicular to theslot654 and communicating therewith. As shown inFIG. 54, theaperture660 is sized and shaped to receive apivot pin662 therethrough. Theconnector648 also includes a throughbore660′ that receives thepivot pin662. The swivelable connection provided by thepin662 allows for some forward and rearward lateral movement of the attachedframe end connection658 and thus theframe section614, providing a degree of freedom and clearance needed for rotation or tilting thepatient support610 about a longitudinal axis of a patient. Theslot656 is sized and shaped to frictionally engage theframe end connection658, thus securely fixing theend connection658 to thepivot connector652. Theframe end connection658 is in turn fixed to elongateframe members667 and668 (seeFIG. 52) of theframe section614. Theframe members667 and668 are each hingedly connected to thehinge assembly616 as described herein. Pivoting of thetranslation connector648 with respect to thepin646 provides for selected articulation, angulation or pivoting of the frame section614 (that includes theend connection658 and theframe members667 and668) and/or theentire support610 with respect to the support pier orcolumn606.
• With reference toFIG. 54, a bold dashed line that is parallel with the axis A1, intersects thetransverse pivot pin646. Thepivot pin646 is spaced a variable distance D1 from the A1 axis, wherein the distance D1 is measured between the A1 axis and the bold dashed line. As thepatient support610 is moved between various positions, thetranslation connector subassembly648 is moved or translated along thepivot pin646 atslot650 and toward or away from thepier606, as is indicated by the arrows D2. Accordingly, the distance D2 varies in cooperation with actuation of other components of theapparatus601 that position thepatient support610. Thetranslation connector subassembly648 moves with respect to thepivot pin646 in response to movement increasing and decreasing the inclination of thepatient support610 and positioning thepatient support610. When theframe610 is inclined or placed in a breaking position or configuration (seeFIGS. 49-51) thetranslation connector subassembly648 moves away from thepier606, thereby increasing the distance D1 between the axis A1 and the transverse axis. Upon returning to the planar position that is parallel with the floor (see FIGS.48-52-53) thetranslation connector subassembly648 moves toward thepier606, thereby decreasing the distance D2. For example, when thepatient support610 is in a planar position parallel with the floor (FIGS. 48,52 and52), thetranslation connector648 is in a starting position with respect to thepivot pin646, and such that the distance D2 is a starting distance. When the patient support is moved into an upwardly breaking position (FIG. 49) or a downwardly breaking position (FIG. 51), and possibly a Trendelenburg position (FIG. 50), or a reverse-Trendelenburg position (not shown), thetranslation connector648 is passively moved away from thepier606 such that D2 is reduced relative to the starting distance. When thepatient support610 is returned to the initial planar position that is parallel with the floor, thetranslation connector648 is passively moved back toward the starting position, and D2 is increased. Changes in the distance D2, or translation compensation, are in response to coordinated movements and positioning of thepatient support610. The amount of change in D2 is coordinated with the breaking of thehinges616 and movement of other portions of theapparatus601, such as by synchronizing electronics and a controller, such as but not limited tocontroller618.
• Thepatient support610 is sized and shaped to reversibly receive thereon and engage a body support structure. Generally, numerous body support structures are attached to or fixed to theframes portions612,614 along their lengths. Such body support structures are know in the art and include, but are not limited to hip-thigh pads, generally670, chest or torso support assemblies, generally672, and chest or torso translation assemblies, generally674. Detailed descriptions of several of these body support structures can be found in U.S. patent application Ser. No. 12/803,192, filed Jun. 21, 2010, U.S. patent application Ser. No. 13/956,728, filed Aug. 1, 2013, and U.S. patent application Ser. No. 14/012,434, filed Aug. 28, 2013, each of which is incorporated by reference herein in its entirety.
• The hip-thigh pads670 are generally attached adjacent to thehinges616. In some embodiments, the hip-thigh pads670 are incorporated into or include thehinges616. The placement of the upper body supports depends upon the location of the hip-thigh pads670 and the length of the patient's spine. Generally, it is desirable to maintain a substantially constant distance D3 (seeFIG. 48) between the patient's hips, or thehip pads670, and an upper body support, such as thechest support672 ortorso trolley674. Upward and downward breaking of thehinges616 is associated with flexion and extension, respectively, of the patient's hips. Therefore, keeping distance D3 substantially constant advantageously prevents excessive, or undesirable, pulling and compression of the patient's spine during upward and downward breaking of thehinges616.
• In some embodiments, such as is shown inFIGS. 48-51, both the hip-thigh pads670 and the upper body support are located on the same side of thehinges616. For example, the hip-thigh pads670 and the upper body support may be attached to theframe portion614. Accordingly, since the hip-thigh pads670 are stationary, it is acceptable to support the patient's upper body with a stationary upper body support, such as thechest support672, which is fixed to and locks onto theframe614.
• In other embodiments, the hip-thigh pads670 and the upper body support are located on the opposite side of thehinges616, or thehinges616 include the hip-thigh pads. For example, as shown inFIG. 53, the hip-thigh pads670 are attached to theframe612 such that they are located adjacent to thehinges616, and thetorso trolley674 is attached to theframe614. Thetorso trolley674 includes upperbody support portion676 and anactuator678. Theactuator678 moves the upperbody support portion676 longitudinally, as is indicated by thearrow680, so as to maintain the distance D3 substantially constant. Movement of upperbody support portion676 by theactuator678 is coordinated, or synchronized, with the movements of thehinges616 by software and a controller, such as but not limited tocontroller618.
• Thus, if the hip-thigh pads670 are located on the opposite side of thehinges616 from the upper body support, and the upper body support is stationary, the distance D3 will vary (i.e., increase and decrease) during actuation of thehinges616. However, if the upper body support is longitudinally movable, such as is thetorso trolley674, the upper body support can move longitudinally along theframe614 at a suitable rate and in a direction that is sufficient to keep the distance D3 substantially constant. For example, when theframe610 is in a planar configuration, thetorso trolley674 is attached to theframe614 at a location along the length of theframe614, such that the upperbody support portion676 is spaced an initial distance of D3 from the hip-thigh pads670. When the hinges616 are actuated and moved to an upwardly or downwardly breaking position or configuration, the hip-thigh pads670 swing away from their initial position. If the upper body support is stationary, like thechest support672, the distance D3 would be increased. Thetorso trolley674 avoids this problem, because as the hip-thigh pads670 swing away from their initial position, theactuator678 of thetorso trolley674 moves thebody support676 toward thehinges616. Thebody support676 is moved at a rate sufficient to keep the distance D3 substantially constant, and such movement is coordinated and synchronized with the movements of thehinges616. When the hinges616 are moved back to their starting position, wherein thepatient support610 is planar, the hip-thigh pads670 swing back toward their initial position. Simultaneously, theactuator678 moves theupper body support676 away from thehinges616 at a rate sufficient to keep the distance D3 substantially constant.
• It is noted that the components of theapparatus601 cooperate, or work in concert, perform several functions at the same time, so as to move or place a patient's body in a desirable position for performing the surgical procedure. These functions include, but are not limited to, simultaneously maintaining the surgical site at a substantially constant height H, maintaining the surgical site at a substantially constant location along longitudinal axis of theapparatus601, and enabling or allowing movement and positioning of the patient's body during the surgical procedure, such as (but not limited to) by upward and downward breaking, inclination and tilting of thepatient support610.
• It is noted that providing for translation of thepatient support610 at both outer ends thereof, such as is provided by thesecond base617, and thetranslation connector648 and angulation subassembly267 enables thehinges616 to be substantially stationary in a longitudinal direction, such that thehinges616 do not move substantially toward either the operatingtable support structure604 or thepier606. Preventing thehinges616 from moving longitudinally substantially prevents the surgical site, on the patient, from moving longitudinally toward either end of theapparatus601. Many surgeries are performed under magnification and/or in conjunction with continuous imaging of the surgical site. As is known in the art, even small movements of the surgical site parallel with the longitudinal axis of theapparatus601 is substantially disruptive of such surgical procedures. Accordingly, longitudinal translation at both ends of theapparatus1 provides significant advantages over surgical tables that include such longitudinal translation at only one end thereof.
• 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 (6)

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

1. An apparatus for supporting and positioning a patient during a surgical procedure, comprising:

a) a breaking patient support structure with first and second frame portions joined by an articulation; and

b) a surgical table base that includes first and second base structures, wherein:

i) the first base structure is attached to the first frame portion and actively longitudinally translated the patient support structure, whereby the first base structure operably raises, tilts and inclines the patient support structure; and

ii) the second base structure is attached to the second frame portion such that the patient support structure is passively longitudinally translated.

2. The apparatus according toclaim 1, including:

a) a translation connector, a connection pin and a pivot pin; wherein

b) the connection pin engages the translation connector and the patient support structure, whereby the translation connector and the patient support structure are pivotably joined together;

c) the pivot pin engages the translation connector and an angulation subassembly, whereby the translation connector and the angulation subassembly are pivotably joined together; and

d) a distance between the connection pin and the pivot pin, the distance varying in cooperation with positioning of the patient support structure.

3. The apparatus according toclaim 2, wherein:

a) the first base structure includes a vertically adjustable pier including the angulation subassembly and a rotation subassembly, the pier cooperating with the surgical table base to position the patient support structure in a plurality of selectable positions.

4. The apparatus according toclaim 1, wherein:

a) first and second frame portions each include an inner end, the inner ends being joined by the articulation; and

b) the articulation is substantially longitudinally stationary during the position the patient support in a plurality of selectable positions.

5. The apparatus according toclaim 4, wherein:

a) the articulation includes a pair of spaced apart hinges.

6. An apparatus for supporting and positioning a patient during a surgical procedure, comprising:

a) a pair of translation connectors, each of the translation connectors being located between a respective outer end of a patient support structure and a respective vertically adjustable pier of a base; wherein

b) a first of the translation connectors is non-slidably fixed directly to the patient support structure, such that the first translation connector and the patient support structure are in non-slidable relationship to one another.

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