EP2890351B1

EP2890351B1 - Patient positioning support apparatus with virtual pivot-shift pelvic pads, upper body stabilization and fail-safe table attachment mechanism

Info

Publication number: EP2890351B1
Application number: EP13833588.0A
Authority: EP
Inventors: Lawrence E. Guerra; Trevor A. WAGGONER; Steven R. Walton; Michael A. HERRON; Roger P. Jackson
Original assignee: Warsaw Orthopedic Inc
Current assignee: Warsaw Orthopedic Inc
Priority date: 2012-08-29
Filing date: 2013-08-28
Publication date: 2019-01-16
Anticipated expiration: 2033-08-28
Also published as: WO2014035460A1; EP2890351A4; EP2890351A1

Description

BACKGROUND OF THE INVENTION

The present invention is direct to a patient support apparatus according to the preamble of claim 1. That is, the present invention is direct to structures for supporting 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 for manipulation of the patient during surgery including the tilting, pivoting, angulating or bending of a trunk and additionally or alternatively joint of a patient in a supine, prone or lateral-decubitus position, while simultaneously maintaining the patient's head in a convenient location for anesthesia and substantially preventing undesired stretching or compression of the patient's spine and the patient's skin.
Current surgical procedures and approaches incorporate imaging techniques and technologies that facilitate the surgical plan and improve outcomes and that provide for more rapid patient recovery. For example, minimally invasive surgical techniques, such as percutaneous insertion of spinal implants, involve small incisions that are guided by continuous or repeated intra-operative imaging and that are frequently associated with navigation technologies. These imaging and navigation techniques can be processed using computer software programs that produce two or three dimensional images for reference by the surgeon during the course of the procedure. If the patient support structure, apparatus, system or device is not radiolucent or configured to be compatible with the imaging technologies, it may be necessary to interrupt the surgery periodically in order to remove the patient to a separate structure for imaging followed by transfer back to the operating support structure for resumption of the surgical procedure. Such patient transfers for imaging purposes may be avoided by employing radiolucent and other imaging and navigation compatible systems. The patient support system should also be constructed to permit unobstructed movement of the imaging equipment and other surgical equipment around, over and under the patient throughout the course of the surgical procedure without contamination of the sterile field.
It is also necessary that the patient support structure be constructed to provide optimum access to the surgical field by the surgery team. Some procedures require positioning of portions of the patient's body in different ways at different times during the procedure. Some procedures, for example
spinal surgery, involve access through more than one surgical site or field. Since all of these fields may not be in the same plane or anatomical location, the patient support surfaces should be adjustable and capable of providing support in different planes for different parts of the patient's body as well as different positions or alignments for a given part of the body. Preferably, the patient support 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, soft or dynamic stabilization implants, spinal ligaments and total disc prostheses, for example, the surgeon must be able to manipulate certain joints while supporting selected portions of the patient's body during surgery in order to facilitate the procedure. It is also desirable to be able to test the range of motion of the surgically repaired or stabilized joint and to observe the gliding movement of the reconstructed articulating prosthetic surfaces or the tension and flexibility of artificial ligaments, cords, spacers and other types of dynamic stabilizers before the wound is closed. Such manipulation can be used, for example, to verify the correct positioning and function of an implanted prosthetic disc, spinal dynamic longitudinal connecting member, interspinous spacer or joint replacement during a surgical procedure. Where manipulation discloses binding, sub-optimal position or even crushing of the adjacent vertebrae, for example, as may occur with osteoporosis, the prosthesis can be removed and the adjacent vertebrae fused or otherwise treated 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, articulated and angulated so that the patient can be moved or rolled from a supine position to a prone position, or from a lateral-decubitus to a supine position, or from a prone position to a position with the hips and knees flexed or extended, and whereby intra-operative extension and flexion of at least a portion of the spinal column can be achieved to change lumbar lordosis. The patient support structure must also be capable of cooperating with the biomechanics of the patient for 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, posterior and additionally or alternatively lateral 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, and also without translating the patient's head, which could disrupt connection of the patient with anesthesia equipment, and also without undesirably distracting or compressing the patient's spine during angulation or rotation of the patient's pelvis around the hips.
Orthopedic procedures involving fractures and other trauma may require the use of traction equipment such as cables, tongs, pulleys and weights. The patient support system must include structure and accessories for anchoring such equipment and it must provide adequate support to withstand unequal forces generated by traction against such equipment.
Orthopedic procedures, especially spine surgery, may also require the use of an open frame, instead of a closed table top, that allows a prone patient's belly to hang downwardly therebetween so as to prevent compression of internal organs against the anterior side of the patient's spine and prevent compression of the patient's vessels to decrease blood loss.
Articulated robotic arms are increasingly employed to perform surgical techniques. These units are generally designed to move short distances and to perform very precise work. Reliance on the patient support structure to perform any necessary gross movement of the patient can be beneficial, especially if the movements are synchronized or coordinated. Such units require a surgical support surface capable of smoothly performing the multi-directional movements which would otherwise be performed by trained medical personnel. There is thus a need in this application as well for integration between the robotics technology and the patient positioning technology.
While conventional operating tables generally include structure that permits tilting or rotation of a patient support surface about a longitudinal axis, previous surgical support devices have attempted to address the need for access by providing a cantilevered patient support surface on one end. Such designs typically employ either a massive base to counterbalance the extended support member or a large overhead frame structure to provide support from above. The enlarged base members associated with such cantilever designs are problematic in that they can and do obstruct the movement of C-arm and O-arm mobile fluoroscopic imaging devices and other equipment. Surgical tables with overhead frame structures are bulky and may require the use of dedicated operating rooms, since in some cases they cannot be moved easily out of the way. Neither of these designs is easily portable or storable. More recent orthopedic surgical tables require complicated mechanisms to provide translation of the patient's trunk while manipulating the patient's lower body during surgery.
More recent and advanced articulating surgical tables are available, and include an open frame patient support for positioning with upper and lower body support portions joined by centrally located and spaced apart hinges. However, while these surgical tables enable bending the patient at the waist or hips, maintaining the vertical height of the surgical site can be difficult. These tables can also cause significant translation of the patient's trunk toward and away from anesthesia, which is undesirable. These tables also require complex translation compensation structural mechanisms to prevent potential patient injury.
Thus, there remains a need for a patient support structure 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, that can maintain the patient's head at a convenient location for anesthesia during positioning of the patient, that does not cause undesired stretching or compression of the patient's spine and skin and that does not require use of a dedicated operating room.
From e.g. US 2011/107516 A1 a patient support apparatus of the initially mentioned type is known.

SUMMARY OF THE INVENTION

The present invention provides a patient support apparatus according to claim 1. Further embodiments of the apparatus are described in the dependent claims. That is, the present invention is directed to patient support structures 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 tilting, rotation, flexion, extension, angulation, articulation and bending, and other manipulations as well as full and free access to the patient by medical personnel and equipment. An embodiment of the present invention may be cantilevered or non-cantilevered apparatus, such as in the case of a dual-column base, and includes at least a prone patient support structure that is suspended above a floor, that is adapted to cooperate with the patient's biomechanics so as to allow positioning of the patient's hips and knees in a neutral position, a flexed position and an extended position. The apparatus allows positioning of the patient parallel with the floor or in Trendelenburg or reverse Trendelenburg surgical positions, and optionally while also tilting or rolling the patient with respect to the floor, along a horizontal axis, and while simultaneously maintaining the patient's head in a suitable location for anesthesia, without substantial horizontal translation, and also while preventing undesired spinal distraction or compression. The patient support structure of the present invention may include an open frame that allows the patient's belly to fall, extend, depend or hang downwardly therethrough between a pair of spaced opposed, or spaced apart and opposed, and somewhat centrally located radially sliding or gliding joints that enable flexion and extension of the prone patient's hips and knees with respect to a virtual pivot point located on or above patient pelvic support pads. The pelvic pads may be sized, shaped and configured to follow an arc of motion associated with the joint and defined by a radius. The joint may join the pelvic pads with a lower body or lower extremity support structure or frame. The prone patient support structure may include one or more hip-thigh or pelvic pads attached to one or both of the joints and an adjustable torso support with a chest pad slidingly attached to a fixed rigid outer frame. The torso support, chest pad and hip-thigh pads may be substantially radiolucent, so as to not interfere with the imaging when the patient is on the patient positioning support system.
The apparatus of the present invention may also include a supine patient support structure comprised of two sections and suspended above the floor. The sections are connected at a pair of spaced opposed hinges that angulate and translate. The supine patient support structure is size, shaped and configured for positioning the patient in an angulated or articulated and non-articulated prone, supine or lateral position and for performing a sandwich-and-roll procedure, wherein the patient is rolled over 180-degrees between supine and prone positions.
The surgical table of the present invention may also include a base that is sized, shaped and configured to hold the prone and supine patient supports above the floor and also to provide for vertical translation or height adjustment of one or both of the patient support structures as well as three degrees of freedom with respect to movement of the patient support structure relative to a roll axis, a pitch axis and a yaw axis.
The surgical table of the present invention may also include a fail-safe connection mechanism for connecting a patient support structure to the base while simultaneously preventing incorrect disconnection of a patient support structure from the base, which could cause the support structure to collapse and result in patient injury. The patient support structure can also provide for a length adjustment with respect to the base when the structure is angulated or the ends are pivoted so as to put the structure into a Trendelenburg or reverse Trendelenburg position.
In an embodiment of the present invention, a patient support apparatus for supporting a patient in a prone position during a surgical procedure is provided, wherein the apparatus includes an open fixed frame that is suspended above a floor, and a pair of spaced opposed radially sliding joints that cooperate with the frame, wherein each joint includes a virtual pivot point and an arc of motion spaced from the virtual pivot point, and the joints are movable along the arc so as to provide a pivot shift mechanism for a pair of pelvic pads attached to the joints.
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 patient positioning support system 5 of the present invention in one embodiment, including a base 10 and a prone patient support structure 15.
FIG. 2 is a perspective view of a base 10 of the patient positioning support system of FIG. 1, including a pair of laterally spaced opposed vertical translator subassemblies 16, 16'.
FIG. 3 is a perspective view of a prone patient support structure 15 of the patient positioning support system of FIG. 1.
FIG. 4 is right side view of the patient positioning support system of FIG. 1. It is noted that the head-end of the patient positioning support system is located on the right-hand side of the page, and the right and left sides of the patient positioning support system are associated with the right and left sides of a patient positioned in a prone position on the patient support structure.
FIG. 5 is a top view of the patient positioning support system of FIG. 4. In this view, the right side of the patient positioning support system is located on the right-hand side of the page.
FIG. 6 is a bottom view of the patient positioning support system of FIG. 4.
FIG. 7 is an enlarged head-end or front view of the patient positioning support system of FIG. 4.
FIG. 8 is an enlarged foot-end or rear view of the patient positioning support system of FIG. 4.
FIG. 9 is a left side view of the patient positioning support system of FIG. 1.
FIG. 10 is an enlarged perspective view of a ladder 100 of the patient positioning support system of FIG. 1.
FIG. 11 is an enlarged perspective view of a T-pin 101 of the patient positioning support system of FIG. 1.
FIG. 11a is an enlarged cross-sectional view of a portion of the T-pin to show greater detail of positioning of the locking portion thereof, taken on line 11a-11a of Fig. 11.
FIG. 12 is an enlarged perspective view of a torso support subassembly 362, or upper body support structure, of the patient positioning support system of FIG. 1.
FIG. 13 is an enlarged perspective view of a connection subassembly 75 and rotation subassembly 50 of the patient positioning support system of FIG. 1, with portions of the base broken away.
FIG. 14 is an enlarged cross-sectional perspective of the patient positioning support system connection and rotation subassemblies of FIG. 13, the cross-section being taken along the line 14-14 of FIG. 5, with portions of the ladder broken away.
FIG. 15 is an enlarged perspective view of the rotation block 57, including the ladder connection subassemblies of the patient positioning support system of FIG. 1.
FIG. 16 is a front view of the rotation block of FIG. 15.
FIG. 17 is a first side view of the rotation block of FIG. 15.
FIG. 18 is a second side view of the rotation block of FIG. 15.
FIG. 19 is a top view of the rotation block of FIG. 15.
FIG. 20 is a bottom view of the rotation block of FIG. 15.
FIG. 21 is a reduced back view of the rotation block of FIG. 15.
FIG. 22 is a back view of the ladder connection subassembly of FIG. 13.
FIG. 23 is a perspective view of the patient positioning support system of FIG. 1, with the patient support structure in a reverse Trendelenburg position.
FIG. 24 is an enlarged right side view of the patient positioning support system of FIG. 23.
FIG. 25 is an enlarged head-end view of the patient positioning support system of FIG. 23.
FIG. 26 is an enlarged foot-end view of the patient positioning support system of FIG. 23.
FIG. 27 is a top view of the patient positioning support system of FIG. 23.
FIG. 28 is a perspective view of the patient positioning support system of FIG. 23, wherein the patient support structure has been rolled or tilted 25° about the longitudinal or roll axis R and toward the left side of the surgical table or patient support structure.
FIG. 29 is an enlarged right-side view of the head-end of the patient positioning support system of FIG. 24, with portions broken away.
FIG. 30 is an enlarged right-side view of the foot- end of the patient positioning support system of FIG. 24, with portions broken away.
FIG. 31 is a perspective view of the patient positioning support system of FIG. 1, with the patient support structure in a Trendelenburg position.
FIG. 32 is an enlarged right side view of the patient positioning support system of FIG. 31.
FIG. 33 is a top view of the patient positioning support system of FIG. 31.
FIG. 34 is a head-end view of the patient positioning support system of FIG. 31.
FIG. 35 is a foot-end of the patient positioning support system of FIG. 31.
FIG. 36 is a perspective view of the patient positioning support system of FIG. 31, wherein the patient support structure has been rolled or tilted 25° toward the left side of the table.
FIG. 37 is an enlarged right side view of the head- end of the patient positioning support system of FIG. 32, with portions broken away.
FIG. 38 is an enlarged right side view of the foot-end of the patient positioning support system of FIG. 32, with portions broken away.
FIG. 39 is a perspective view of the patient positioning support system of FIG. 1, with the patient support structure positioned so as to maximally flex the hips and legs of a patient thereon.
FIG. 40 is an enlarged right side view of the patient positioning support system of FIG. 39.
FIG. 41 is a top view of the patient positioning support system of FIG. 39.
FIG. 42 is a head-end view of the patient positioning support system of FIG. 39.
FIG. 43 is a foot-end view of the patient positioning support system of FIG. 39.
FIG. 44 is an enlarged cross-section of the patient positioning support system of FIG. 39, with the cross-section being taken along the line 44-44 of FIG. 41, and with portions broken away.
FIG. 45 is another perspective view of the patient positioning support system of FIG. 39.
FIG. 46 is yet another perspective view of the patient positioning support system of FIG. 39.
FIG. 47 is an enlarged perspective view of the patient positioning support system of FIG. 39, with portions broken away.
FIG. 48 is a perspective view of the patient positioning support system of FIG. 39, wherein the prone patient support structure is rolled 25° toward the left side of the patient positioning support structure.
FIG. 49 is a reduced left side view of the patient positioning support system of FIG. 48.
FIG. 50 is an enlarged right side view of the patient positioning support system of FIG. 48.
FIG. 51 is an enlarged top view of the patient positioning support system of FIG. 48.
FIG. 52 is an enlarged head-end view of the patient positioning support system of FIG. 48.
FIG. 53 is an enlarged bottom view of the patient positioning support system of FIG. 48.
FIG. 54 is an enlarged foot-end view of the patient positioning support system of FIG. 48.
FIG. 55 is a perspective view of the patient positioning support system of FIG. 1, with the patient support structure positioned so as to maximally extend the hips and legs of a patient thereon.
FIG. 56 is an enlarged right side view of the patient positioning support system of FIG. 55.
FIG. 57 is an enlarged top view of the patient positioning support system of FIG. 55.
FIG. 58 is an enlarged bottom view of the patient positioning support system of FIG. 55.
FIG. 59 is an enlarged head-end view of the patient positioning support system of FIG. 55.
FIG. 60 is an enlarged view of the foot-end of the patient positioning support system of FIG. 56.
FIG. 61 is an enlarged view of the foot-end of the patient positioning support system of FIG. 56, with portions broken away.
FIG. 62 is an enlarged right-side view of the head- end of the patient positioning support system of Fig. 56, with portions broken away.
FIG. 63 is an enlarged side view of the patient positioning support system of FIG. 1, with the prone patient support structure positioned in the lowest possible position with respect to the floor F, and such that the legs and hips of a patient positioned thereon would be substantially non-flexed, non-extended and parallel with the floor.
FIG. 64 is an enlarged perspective view of the foot- end of the patient support structure FIG. 3 with the lower extremity support structure 344 positioned so as to extend the legs and hips of a patient supported thereon, and with portions broken away.
FIG. 65 is view of the patient positioning support structure of Fig. 64 with portions shown in phantom so as to show additional detail thereof.
FIG. 66 is an enlarged side view of the patient positioning support structure of FIG. 3 positioned so as to extend the hips and legs of a patient supported thereon.
FIG. 67 is a view of the patient positioning support structure of FIG. 66 positioned in a neutral position so as to support the legs of a patient substantially parallel with the floor, such that the hips and legs are non-flexed and non-extended.
FIG. 68 is a view of the patient positioning support structure of Fig. 66 positioned so as to flex the legs and hips of a patient supported thereon.
Fig. 69 is an enlarged overlaid cross-sectional schematic of the patient positioning support structures of FIGS. 66, 67 and 68 taken along the line 69-69 of FIG. 5.
FIG. 70 is an enlarged side view of the patient positioning support structure of FIG. 4 overlaid with an enlarged phantom side view of the patient positioning support structure of FIG. 56, so as to compare changes in the positions of various parts of the patient positioning support structure when moved between the positions shown in FIGS. 4 and 56.
FIG. 71 is an enlarged side view of a joint of the prone patient support structure of FIG. 3.
FIG. 72 is another enlarged side view of a joint of the prone patient support structure of FIG. 3.
FIG. 73 is yet another enlarged side view of a joint of the prone patient support structure of FIG. 3.
FIG. 74 is an enlarged side view of the prone patient support structure of FIG. 3, with portions broken away.
FIG. 75 is another enlarged side view of the prone patient support structure of FIG. 3, with portions broken away.
FIG. 76 is an enlarged perspective view-of a portion of the joint of the prone patient support structure of FIG. 3, with portions not shown.
FIG. 77 is a perspective view of a portion of the joint of FIG. 75.
FIG. 78 is an enlarged perspective view of a component of the joint of FIG. 75.
FIG. 79 is an enlarged head-end view of the left side joint and attached hip-thigh pad of the prone patient support structure of FIG. 3, with portions not shown.
FIG. 80 is an enlarge perspective view of the left- side joint with attached hip-thigh pad, and portions not shown so as to show greater detail thereof.
FIG. 81 is an inner side view of the joint of FIG. 79.
FIG. 82 is a top view of the joint of FIG. 79.
FIG. 83 is a rear view of the joint of FIG. 79.
FIG. 84 is an outer side view of the joint of FIG. 79.
FIG. 85 is a forward view of the joint of FIG. 79.
FIG. 86 is a perspective view of the patient positioning support system of FIG. 1, including an attached supine patient support structure 15', and in a raised position so as to perform a sandwich-and-roll procedure, wherein the supine patient support structure is attached to the base by a standard length ladder.
FIG. 87 is a right-side view of the patient positioning support system of FIG. 85.
FIG. 88 is a top view of the patient positioning support system of FIG. 85.
FIG. 98 is a bottom view of the patient positioning support system of FIG. 85.
FIG. 90 is an enlarged head-end view of the patient positioning support system of FIG. 85.
FIG. 91 is a foot-end view of the patient positioning support system of FIG. 85.
FIG. 92a is a reduced foot-end view of the patient positioning support system of FIG. 85, the patient support structures being positioned to begin the sandwich-and-roll procedure to roll a patient over from a supine position to a prone position.
FIG. 92b is foot-end view of the patient positioning support system of FIG. 91, wherein the supine patient support structure is attached to the base by an extended length, or long, ladder instead of a standard length ladder.
FIG. 93a is a foot-end view of the patient positioning support system of FIG. 92a, wherein the patient support structures has been rolled about 25°.
FIG. 93b is a perspective view of the patient positioning support system of FIG. 92a.
FIG. 93c is a right-side view of the patient positioning support system of FIG. 92a.
FIG. 94a is a foot-end view of the patient positioning support system of FIG. 92a, wherein the patient support structures has been rolled about 130°.
FIG. 94b is a perspective view of the patient positioning support system of FIG. 94a.
FIG. 94c is a right-side view of the patient positioning support system of FIG. 94a.
FIG. 95a is a foot-end view of the patient positioning support system of FIG. 92a, wherein the patient support structures has been rolled about 180°.
FIG. 95b is a perspective view of the patient positioning support system of FIG. 95a.
FIG. 95c is a right-side view of the patient positioning support system of FIG. 95a.
FIG. 96 is a top view of the patient positioning support system of FIG. 95b.
FIG. 97 is a bottom view of the patient positioning support system of FIG. 95b.
FIG. 98 is an enlarged head-end view of the patient positioning support system of FIG. 95b.
FIG. 99 is a foot-end view of the patient positioning support system of FIG. 95b.
FIG. 100 is a perspective view of the patient positioning support system of FIG. 91.
FIG. 101 is an enlarged right-side view of the patient positioning support system of FIG. 100.
FIG. 102 is a perspective view of a patient positioning support system of the present invention, in another embodiment, including a supine patient support structure attached to a base using standard length ladders.
FIG. 103 is perspective view of a supine patient support structure 15' of the present invention, in one embodiment.
FIG. 104 is a right-side view of the supine patient support structure of FIG. 103.
FIG. 105 is a top view of the supine patient support structure of FIG. 103.
FIG. 106 is a bottom view of the supine patient support structure of FIG. 103.
FIG. 107 is an enlarged head-end view of the supine patient support structure of FIG. 103.
FIG. 108 is an enlarged foot-end view of the supine patient support structure of FIG. 103.
FIG. 109 is a top view of the open breaking frame of the supine patient support structure of FIG. 103, including a pair of spaced opposed hinges.
FIG. 110 is perspective view of the supine patient support structure of FIG. 103 attached to a base using extended length ladders 100'.
FIG. 111 is an enlarged head-end view of the patient positioning support structure of FIG. 110.
FIG. 112 is a perspective view of the patient positioning support structure of FIG. 110, wherein the supine patient support structure is in a lateral-decubitus position.
FIG. 113 is a head-end view of the patient positioning support structure of FIG. 112.
FIG. 114 is a perspective view of the patient positioning support structure of FIG. 110, wherein the supine patient support structure is in a hinge down position.
FIG. 115 is an enlarged head-end view of the patient positioning support structure of FIG. 114.
FIG. 116 is an enlarged bottom perspective view of a portion of the supine patient support structure of FIG. 102 showing the spaced opposed, or spaced apart, hinges 376.
FIG. 117 is a side view of one the hinges of FIG. 116.
FIG. 118 is a side view of the hinge of FIG. 117 with shrouding not removed, so as to show detail of the worm gear drive of the hinge.
FIG. 119 is a bottom view of the hinge of FIG. 118.
FIG. 120 is a perspective view of the hinge of FIG. 118.

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 various employ the present invention in virtually any appropriately detailed structure.

Patient Positioning Support System Components and Operation

Referring now to FIGS. 1-120, a patient positioning support system, structure, apparatus or table according to the invention is generally designated by the reference numeral 5, in one embodiment. FIG. 1 is a top perspective view of the patient positioning support system 5 of the present invention, which includes a base, generally 10, and a patient support structure or table top, generally 15‡, such as but not limited to at least one of a prone patient support structure 15, a supine patient support structure 15' (FIGS. 86, 110) and an alternatively sized, shaped and configured patient support structure. The patient positioning support system 5 includes a head-end 18, a foot-end 19, left-hand and right- hand sides 298, 300, and top and bottom sides, which for discussion purposes are denoted relative to the sides of a patient's body when the patient is positioned in a prone position on the prone patient support structure 15. For example, when the patient is face down on the surgical table 5, the right side of the patient is on the right-hand side of the table 5. The left-hand and right- hand sides 298 and 300 may simply be referred to as the left side 298 and the right side 300. In some circumstances, the top and bottom sides may be referred to as the upper and lower sides.
The patient support system 5 also includes a plurality of axes, including but not limited to roll, pitch, yaw and vertical translation axes, which are respectively denoted by R, Pn, Yn and Vn, wherein n denotes or identifies a specific axis, and all of which are most easily seen in FIGS. 1-3. The roll axis R extends longitudinally along a length of the patient support system 5, and intersects the head- and foot-ends 16 and 16', respectively, of the base 10. The base head-end 16 includes a first vertical translation axis V1 (FIG. 2) and a first yaw axis Y1. Similarly, the base foot-end 16' includes a second vertical translation axis V2 and a second yaw axis Y2. Finally, the patient support structure 15‡ includes three pitch axes, wherein the first pitch axis P1 is associated with a patient's hips, the second pitch axis P2 is associated with the head-end 18 of the patient support structure 15‡, and therefore with the patient's head, and the third pitch axis P3 is associated with the foot-end 19 of the patient support structure 15‡, and therefore with the patient's feet.
Generally, the roll, pitch and yaw axes, R, Pn and Yn (FIGS. 1-3), of the patient positioning support system 5 are axes about which rotational movement of at least a portion of the patient positioning support system 5 can occur, and therefore are functionally analogous to the roll, pitch and yaw axes of an airplane.
The term "rotational movement," as used herein, is a broad term and is used in its ordinary sense, including, without limitation tilting, rolling, angulating or articulating the patient support 15‡ about one or more of the roll axis R, the pitch axes Pn, and the yaw axes Yn. It is noted that rotational movement may occur at one or more of these axes, and that such movements may occur sequentially, simultaneously, or a combination thereof.
The terms "roll" and "tilt" as used herein, are broad terms and are used in their ordinary sense, including, without limitation movement of the patient support structure about the roll axis R. The amount of roll or tilt of the patient support structure 15‡ is measurable in degrees, similar to the manner in which the roll of an aircraft about its roll axis is measured. Tilting is a type of rolling, and the term "tilt" is generally used to refer to rolling an amount of about ±30° or less. At these low amounts of roll, the patient support 15‡ is generally locked in that position to improve access to the surgical site. Consequently, the term "roll" tends to be used for greater amounts of rotational movement about the R axis, such as about ±180°, such as is described elsewhere herein.
In some circumstances, the term "rotational movement" refers to upward and downward breaking, angulation or pivoting of the hinges located at or associated with P1. This type of rotational movement may also be referred to as angulation or articulation, and is also measurable in degrees.
In still other circumstances, the term "rotational movement" refers to movement of the patient support 15‡ about one of P2 and P3. This type of rotational movement modifies an angle that is formed by, or defined by, the patient support structure 15‡ and the adjacent vertical translation subassembly 20. This particular type of rotational movement occurs when the patient support structure 15‡ breaks upwardly or downwardly at P1, and additionally or alternatively when the patient support structure 15‡ is placed in a Trendelenburg or reverse Trendelenburg position. It is noted that rotational movement at P2 is often accompanied by rotational movement at P3.
The term "vertical translation", as used herein, is a broad term and is used in its ordinary sense, including, without limitation upward and downward movement with respect to the vertical translation axes Vn, which are associated with up and down lifting and lowering the head- and foot-ends 18, 19 of the patient support structure 15‡, such as with the primary or secondary elevators, which are described in greater detail below.
In various embodiments, the movements of the patient positioning support system 5, with respect to the head and foot-ends, left and right-hand sides, and top and bottom sides, as well as with respect to the roll, pitch, yaw and vertical translation axes, R, Pn, Yn and Vn, respectively, can be one or more of synchronous or sequential, active or passive, powered or non-powered, mechanically linked or synchronized by software, and continuous (e.g., within a range) or incremental, and such as is described in greater detail below.

Base Structure and Function

FIG. 2 is a perspective view of a base 10 of the patient positioning support system 5, in an exemplary embodiment. The base 10 may also be referred to as a base structure or base subassembly. The base 10 is adapted to support the patient support structure 15‡ above the floor F (FIG. 4). The base 10 includes structure that is adapted to lift and lower, tilt, roll, rotate and, additionally or alternatively, angulate at least a portion of the patient support structure 15‡ relative to the floor F, so as to position a patient's body in a desired position for a medical procedure, such as is described in greater detail below.
The base 10 includes at least one vertical translation subassembly 20, which may also be referred to as a vertical elevator, a telescoping pier, a vertical translator, or the like. In an exemplary embodiment, such as that shown in FIGS. 2, 7, 8 and 24, the base includes a vertical translation subassembly 20 at each of its head- and foot-ends 16, 16'; wherein the pair of spaced opposed vertical translation subassemblies 20 are joined by a longitudinally extending supportive cross-bar 25 or beam. In the illustrated embodiment, the vertical translation subassemblies 20 are generally identical and face one another, or are mirror images of one another, though this is not required in all embodiments. It is foreseen that one or both vertical translation subassemblies 20 may have an alternative structure. For example, the telescoping riser of the vertical translation subassemblies (described below) may be off-set, or not centered over the foot or base portion, such as is described elsewhere herein. In another example, one or both of the vertical translation subassemblies 20 may be constructed such as described in U.S. Patent No. 7,152,261 , U.S. Patent No. 7,343,635 , U.S. Patent No. 7,565,708 , U.S. Patent No. 8,060,960 , or U.S. Patent Application No. 60/798,288 , U.S. Patent Application No. 12/803,173 , U.S. Patent Application No. 12/803,192 , or U.S. Patent Application No. 13/317,012 .
The cross-bar 25 is a substantially rigid support that joins and holds the vertical translation subassemblies 20 in spaced opposed relation to one another. In some embodiments, the cross-bar 25 is non-adjustable. However, in some other embodiments, the cross-bar 25 is removable or telescoping, so that the vertical translation subassemblies 20 can be moved closer together, such as for storage. In certain embodiments, the cross-bar 25 is longitudinally adjustable so that the vertical translation subassemblies 20 can be moved closer together or farther apart, such as, for example, to support or hold different patient support structures 15 of various lengths or configurations, such as but not limited to interchangeable or modular patient support structures 15. In certain other embodiments, there patient positioning support system 5 does not include a cross-bar 25. Numerous cross-bar 25 variations are foreseen. It is foreseen that the cross-bar 25 may be telescoping, and additionally or alternatively removable, such that the cross-bar 25 can be lengthened, shortened, or removed, such as for storage of the base 10. It is foreseen that the cross-bar 25 can include a mechanism (not shown) for locking the cross-bar 25 at a selected length. Additionally, the cross-bar 25 may include motorized means (not shown) for lengthening or shortening the cross-bar 25.
Regardless of the presence or absence of any such cross-bar 25 described herein or foreseen, the vertical translation subassemblies 20 are substantially laterally non-movable with respect to one another, either closer together or farther apart, once a patient support structure 15‡ has been attached to or joined with the base 10, and during use or operation of the patient positioning support system 5.
Referring again to FIG. 2, each vertical translation subassembly 20 includes a lower portion 30, an upper portion 35 and a vertical translation axis V1 or V2 that extends upwardly from the floor F so as to be substantially perpendicular thereto. The lower portion 30 includes a lower support structure 40, such as a base portion or a foot, and a riser assembly 45. The riser assembly 45 includes a mechanical drive system or mechanism (not shown), such as is known in the art that lifts and lowers the upper portion 35 along the respective vertical translation axis V1, V2 and relative to the floor F. As mentioned elsewhere herein, the riser assembly 45 may be off-set with respect to the lower support structure 40.
At least one of the vertical translation subassembly upper portions 35 includes a rotation subassembly, generally 50, that enables tilting and rolling of the patient support structure 15‡ about the roll axis R, such as is described below. The roll axis R extends longitudinally between the upper portions 35.
The rotation subassembly 50 includes a mechanical rotation motor, a rotation shaft 56 and a rotation or ladder connection block 57. The rotation motor may be any motor known in the art that is strong enough to rotate the patient support structure 15‡ about the roll axis R and optionally to lock the patient support structure 15‡ in a tilted orientation with respect to the floor F. Harmonic motors are particularly useful as the rotation motor due to their strength. Alternatively, the rotation subassembly 50 may be constructed such as described in U.S. Patent No. 7,152,261 , U.S. Patent No. 7,343,635 , U.S. Patent No. 7,565,708 , U.S. Patent No. 8,060,960 , or U.S. Patent Application No. 60/798,288 , U.S. Patent Application No. 12/803,173 , U.S. Patent Application No. 12/803,192 , or U.S. Patent Application No. 13/317,012 . Numerous variations are foreseen. Non-motorized rotation subassemblies 50 are also foreseen.
The motor is enclosed or shrouded by a housing 60, with front and back portions 61, 62, a top portion 63, opposed side portions 64 and an optional front plate or rotation plate 65, so as to be protected thereby.
Accordingly, the rotation shaft 56 extends through the housing front portion 61, as is described below.
The rotation shaft 56 is generally cylindrical in shape, with a circular cross-section, and is substantially parallel with the floor F. The rotation shafts 56, of the opposed vertical translation subassembly upper portions 35, are each movable with respect to an associated vertical translation axes V1 or V2, so as to be locatable or placeable at a selectable distance above the floor F. When the opposed rotation shafts 56, of two vertical translation subassemblies 20, are equally spaced above the floor F, such as is shown in FIGS. 4 and 40, the rotation shafts 56 are also substantially coaxial with the roll axis R. However, when one of the rotation shafts 56 is raised or lowered, such that the shafts 56 are no longer equally spaced from, or raised above, the floor F, such as is shown in FIGS. 24 and 32, the rotation shafts 56 intersect roll axis R but are not coaxial with the roll axis R.
Each rotation shaft 56 includes inner and outer portions, 70, 71, respectively. The rotation shaft inner portion 70 is engaged by and cooperates with the rotation motor, so as to be rotatable, turnable or rollable in either the clockwise or counter-clockwise directions, such as is illustrated in FIGS. 92a-95a.
The outer portion 71 of the rotation shaft 56 includes a substantially cylindrical side surface 76 with opposed side surface openings (not shown), an outer or inboard face 77 and a through-channel 78 that joins the side surface openings and extends through the outer portion 71 so as to form a bore-like structure. Thus, the interior of the through-channel 78 is joined with the side surface 76 by the surface openings. As noted below, the through-channel 78 of the rotation shaft outer portion 71 is sized to receive a yaw pin 79 therethrough, so as to join the shaft outer portion 71 with the associated rotation block 57.
The rotation shaft outer portion 71 extends out of the housing 60 and in an inboard direction toward the upper portion 35 of the opposed vertical translation subassembly 20. The outer portion 71 is joined with the rotation block 57, also referred to as a connection member or first portion, by the yaw pin 79, inner connector shaft, peg, post or connector, that extends through the shaft outer portion through-channel 78 and into the rotation block 57. Each yaw pin 79 is coaxial with a respective yaw axis Y1 or Y2, so as to enable the rotation block 57 to rotate at least a small amount about the yaw axis Y1 or Y2. One or more bushings 80 sleeve at least a portion of the yaw pin 79, such as is shown in FIGS. 13-22, so as to reduce friction and to secure the yaw pin 79 to the shaft outer portion 71. It is foreseen that the rotation block 57 may be connected to the rotation shaft 56 by an alternative structure that also permits movement about the yaw axis Yn, such as but not limited to a universal joint. It is also foreseen that the rotation block 57 may be connected to the rotation shaft 56 by a structure that prevents such yaw, and that yaw may be provided in another part of the patient positioning support structure 5.
In some embodiments, a rotation plate 65 joins the inner and outer portions 70 and 71 of the rotation shaft 56. The rotation plate 65 may also be referred to as an optional front plate 65 of the housing 60. The rotation plate 65 may be integral with or separate from the rotation shaft 56. In some embodiments, the housing front portion 61 includes, and is optionally integral with, the rotation plate 65, which functions as a face plate that covers and protects the inboard side 85 of the rotation motor 55. It is foreseen that the patient positioning support system 5 may include no front or rotation plate 65.
The base 10 includes a pair of connection subassemblies 75, for reversible attachment with a patient support structure 15‡. Each connection subassembly 75 includes a respective rotation block 57, a ladder 100 or 100' (FIGS. 10, 110-115) and a T-pin 101 (Fig. 11). The T-pin 101 includes a rod portion 102 and a handle portion 103. In the illustrated embodiment, the connection subassemblies 57 are each joined with one of the vertical translation subassemblies 20, such as but not limited to by a respective rotation subassembly 50. The rotation block 57, also referred to as a ladder connection block 57, is reversibly or removably attachable or connectable to at least one ladder structure 100, 100', which in turn is reversibly attachable to an end of the patient support structure 15‡, such as is described below. The connection subassemblies 57 provide structure for removably connecting, attaching or joining the base 10 with a patient support structure 15t. In the illustrated embodiment, the head-end and foot-end rotation blocks 57 are substantially identical, or mirror images of one another; however, it is foreseen that one or both of the blocks 57 may have an alternative size, shape and additionally or alternatively configuration.
The connection subassemblies 57 provide structure for at least some vertical translation, or height adjustment, of an attached patient support structure 15t, such as is described below. Further, the two connection subassemblies 57 cooperate with each other and optionally with the patient support structure 15t, to provide structure for a fail-safe structure or mechanism, such as is described below. The fail-safe substantially blocks incorrect detachment of an attached patient support structure 15‡, wherein such incorrect detachment can result in catastrophic collapse of at least a portion of the patient positioning support system 5 and patient injury.
Referring to FIGS. 13-22, each rotation block 57 is generally block-shaped or rectangular and includes spaced and opposed (or spaced opposed) front and rear faces 105, 110 (FIG. 18), spaced opposed top and bottom faces 115 and spaced opposed end faces 120 (FIG. 16). The faces may also be referred to as sides, ends, surfaces or portions. In the illustrated embodiment, the faces of each pair of opposed faces, such as the front and rear faces 105, 110, the top and bottom faces 115, and the end faces 120, are substantially parallel with one another; but, it is foreseen that this may not be the case in other embodiments.
The rotation block front face 105 includes a front surface 123 (FIG. 15) with a centrally located front opening 125 and at least one rail-receiving groove 127 or channel (FIG. 14). In the illustrated embodiment, the front 105 includes a pair of parallel rail-receiving grooves 127, which are denoted as first and second rail-receiving grooves 128 and 129, respectively, with reference to the figures. In some circumstances, the first rail-receiving groove 128 may also be referred to as an upper rail-receiving groove, and the second rail-receiving groove 129 may be referred to as a lower rail-receiving groove 129. The terms "first" and "second", and "upper" and "lower" are names or identifiers used to distinguish between the two grooves 128 and 129, and do not necessarily refer to which groove is physically positioned above the other in space. It is noted that when the rotation block 57 is rotated 180° about the R axis, the physical position of the grooves 128 and 129 are reversed in space, as compared with their positions prior to the rotation.
Each rail-receiving groove 127 includes a contoured inner surface 130 and an outer lip 131. The inner surface 130 and lip 131 are sized, shaped and configured to receive an upper rail 133 of a ladder 100, 100' therein. In the illustrated embodiment, the upper rail 133 is substantially cylindrical with a circular cross-section. Accordingly, the groove inner surface 130 and lip 131 are sized, shaped and configured to reversibly receive therein and to engage the cylindrical upper rail 133. In some embodiments, the contoured inner surface 130 is adapted to frictionally engage the upper rail 133. It is foreseen that the ladder upper rail 133 may be alternatively shaped. For example, the upper rail 133 may be box-shaped with a square cross-section, and the rail-receiving groove 127 includes a complementary box shape with an inner surface 130 having planar surface portions and a lip 131 that are adapted to engage and retain the upper rail 133.
The rotation block rear face 110 includes a rear (or back) surface 134 (FIG. 22) and a centrally located rear (or back) opening 135. The surface 134 is generally flat and planar, but may include some non-planar portions, in some embodiments.
The block front and rear openings 125, 135 are joined by a block through-bore 140 or channel that is sized, shaped and adapted to receive at least a portion of the rotation shaft 56 therein, whereby by the block 57 is attached to the rotation shaft 56. In some embodiments, the rotation shaft 56 extends through the block through-bore 140.
The rotation block through-bore 140 includes an inner surface 145 (FIG. 16), with upper, lower and side surfaces 150, 155 and 160, respectively, and one or more engagement surfaces 165 that are shaped to engage one or more portions of the rotation subassembly 50, such as but not limited to the rotation shaft outer portion ,71. For example, as shown in FIGS. 15, 16 and 22, the engagement surfaces 165 include at least one partially cylindrical bushing engagement surface 170 and an optional substantially planar engagement surface 175 (see FIGS. 15 and 22). While in the illustrated embodiment the rotation block through-bore 140 is generally box-shaped, it is foreseen that the through-bore 140 may have other shapes, such as but not limited to cylindrical, conical and prismatic shapes.
The rotation block 57 is joined with the rotation shaft outer portion 71 (FIGS. 14 and 121). Namely, the shaft outer portion 71 extends into and optionally through the block through-bore 140. A yaw pin, peg or post 79 attaches, fixes, joins or connects the through-bore 140 with the shaft outer portion 71. The yaw pin 79 extends through the shaft through channel 78 and into the side surface 160 of the block through-bore 140. One or more of the engagement surfaces 165 contacts and engages the surface 183 of the yaw pin 79. One or more bushings 80 may be received over or around the yaw pin 79, so as to provide spacing. This attachment ensures that rotation of the rotation shaft 56 rotates the rotation block 57.
Returning to FIGS. 14 and 22, in some embodiments, one or more bushings 80 are received over the yaw pin 79. The bushings 80 provide for at least some engagement between the yaw pin 79 and the bushing engagement surfaces 170 and optionally additional engagement surfaces 165, 175 of the block through-bore 140. As shown in FIG. 14, the bushings 80 space or separate the rotation shaft 56 from the inner surface 145 of the block through-bore 140. Further, the bushings 80 can provide a snug and secure fit or connection between the rotation shaft 56 and the rotation block 57. While the illustrated yaw pin 79 is substantially cylindrical with a circular cross-section, it is foreseen that the yaw pin 79 may be any other useful three-dimensional shape, such as a cone or a prism, optionally with a cylindrical portion.
The illustrated yaw pin 79 is coaxial with a respective yaw axis Y1 or Y2, and is adapted to enable or allow rotational movement of the rotation block 57 about the respective yaw axis Y1 or Y2. Such rotational movement may be referred to as "yaw". In addition, as shown in FIGS. 29-30 and 122-125, each of the rotation blocks 57 is attached to a respective shaft 75 so as to provide a space 180 or distance between the block rear face 110 and the housing front 61. This space 180 is particularly important, as described below, because the rotation block 57 is adapted to yaw or rotate about the associated yaw axis Y1 or Y2, such as is indicated by the double-headed directional arrow 185. This yaw motion brings a portion of the block rear face 110 closer to the housing front 61, and the space 180 must be sufficient to prevent the structures from contacting or bumping into each other, wherein such contact between the block rear face 110 and the housing front 61 could inhibit free, or smooth, rotation of the block 57 with respect to the roll axis R. Accordingly, in preferred embodiments, the space 180 is sufficient to substantially block or prevent contact between the block rear face 110 and the housing front 61 when the respective rotation block 57 rotates about the respective yaw axis Y1 or Y2. It is foreseen that the rotation block 57 may be rigidly fixed to the rotation shaft 56, so as to prevent, disallow or block yaw at this location. In such circumstances, yaw may be additionally or alternatively provided in one or both of the patient support structure 15# and the base 10. It is foreseen that the patient positioning support system 5 can be adapted and configured such that yaw is no longer necessary and therefore not provided.
Referring to FIGS. 13-22 and 121, each rotation block 57 is attached to or joined with a respective rotation shaft outer portion 71 of the vertical translation subassembly 20. The rotation shafts 56 of the opposed vertical translation subassemblies 20 are rotated in synchronization, toward either the left-hand side or right-hand side of the patient positioning support system 5 and also at the same speed. Each of the rotation shafts 56 rotates an attached block 57 clockwise or counter-clockwise, which in turn rotates the attached ladders 100 or 100' about the roll axis R. As the ladders 100 or 100' are rotated in unison, they cooperatively rotate a patient support structure 15# that is attached or suspended therebetween.
The block through-bore 140 is located so as to enable the rotation shaft outer portion 71 to smoothly and evenly rotate the ladder connection block 57 with respect to the roll axis R. A shaft through-channel 78 pierces or extends through the shaft outer portion 71. The yaw pin 79 extends through both the rotation block through-bore 140 and the rotation shaft through-channel 78 so as to join, fix, connect or attach the rotation shaft outer portion 71 with the ladder connection block 57.
The yaw pin 79 is substantially coaxial with the associated yaw axis Yn, so as to enable the ladder connection block 57 to be rotated, articulated or pivoted either clockwise or counter-clockwise about the associated yaw axis Yn, such as is indicated by directional arrow 185 (FIG. 15). For example, in FIGS. 19 and 20, the yaw axis Yn extends out of the page, so as to be substantially perpendicular to the plane of the page. In the illustrated embodiment, the cylindrical yaw pin 79 includes a circular cross-section. It is foreseen that the yaw pin 79 may have any other shaped cross-section that enables the ladder connection block 57 to sufficiently pivot about the yaw axis Yn, and thereby to prevent buckling of the patient positioning support system 5 when the patient support structure 15‡ is placed in a Trendelenburg or reverse Trendelenburg position and is also rolled or tilted about the roll axis R, such as is shown in FIGS. 28 and 36. For example, in some embodiments, a universal joint-like structure replaces or is substituted for the yaw pin 79.
Each rotation block 57 includes at least one ladder connection structure 190, or ladder connection subassembly, which is complementary in size, shape and configuration with a block connection structure 191, or block connection subassembly, of a ladder 100, 100'. The block connection structures 191, of the ladders 100, 100', are described below. Cooperation between the block's ladder connection structure 190 and the ladder's block connection structure 191 enables removable attachment, engagement or mating of a ladder 100, 100' to the block 57.
Referring to FIGS. 13-22, the ladder connection structure 190, of the rotation block 57, includes the rail-receiving groove 127 (described above) and a pair of ladder engagement pegs 195. As shown in FIG. 16, each of the engagement pegs 195 extends outwardly from an associated rotation block end face 120. The pegs 195 are positioned on the end faces 120 so as to be coaxially aligned with one another. Further, the pair of pegs 195 are positioned so as to cooperate with the associated rail-receiving groove 127. In preferred embodiments, the rotation block 57 includes two ladder connection structures 190. Accordingly, the rotation block 57 includes two pairs of engagement pegs 195, such as upper and lower pairs 200, 205 of pegs 195, or a first pair 200 of pegs 195 and a second pair 205 of pegs 195. The upper pair 200 of pegs 195 is associated with the upper or first rail-receiving groove 128, and the lower pair 205 of pegs 195 is associated with the lower or second rail-receiving groove 129.
The engagement pegs 195 of each pair 200 or 205 of pegs 195 are aligned with one another and spaced from an adjacent ladder connection groove 201 so as to enable connection of a ladder 100 to the ladder connection block 57. For example, the upper pegs 200 are coaxial with one another and spaced from the first rail-receiving groove 128, and the lower pegs 205 are coaxial with one another and spaced from the second rail-receiving groove 129, such that a ladder 100 or 100' can be engaged either with the upper pair of pegs 200 and the upper groove 128 or with the lower pair of pegs 205 and the lower groove 129. Engagement or connection of a rotation block 57 and a ladder 100 or 100' is described in greater detail below.
The ladders 100, 100', which may also be referred to as "H-frames," are substantially rigid and facilitate or provide attachment of a patient support structure 15t, such as but not limited to a prone patient support structure 15 and a supine patient support structure 15', to the base 10 of the patient positioning support system 5.
In the illustrated embodiment, the patient positioning support system 5 includes at least one pair of ladder structures or ladders. The ladders may be a provided in a variety of lengths, such as but not limited to standard and non-standard lengths. Ladders having a standard length are denoted by the number 100, and ladders having a non-standard length are generally denoted by the number 100', so as to distinguish between the sizes for discussion purposes. Non-standard length ladders 100' include a length that is relatively longer or shorter than a standard length ladder 100. FIG. 10 illustrates an exemplary standard length ladder 100. An exemplary pair of extended length ladders 100' is shown in FIGS. 110-115.
It is noted that in the illustrated embodiment, the ladders 100, 100' are provided in one of two lengths, a standard length ladder 100 and non-standard length ladder 100', wherein the non-standard length ladder 100' includes an extended length, or a length greater than that of the standard length ladder 100. It is foreseen that ladders 100' of other, non-standard lengths can be provided. In the illustrated embodiment, pairs of matched ladders 100 or 100', or two ladders 100 or 100' having substantially the same length, are attached to the opposed rotation blocks 57. It is foreseen that miss-matched pairs of ladders 100, 100' could be attached to the rotation blocks 57.
It is foreseen that the ladder 100 or 100' may be permanently attached to the patient support structure 15‡, and therefore non-removable. It is foreseen that a non-standard length ladder 100' may be used instead of a standard length ladder 100 in some circumstances. It is foreseen that other or alternative attachment structures may be substituted for the ladders 100, 100' to removably connect the patient support structure 15‡ to the base 10. In some circumstances these other attachment structures may be permanently attached to the respective patient support structure 15‡.
Each ladder 100, 100' includes a pair of rigid spaced opposed ladder side members, generally denoted by the number 231. The pair of ladder side members 231 are joined at or near their upper ends 232 also referred to as connection ends, by the upper rail 133 described above. At their lower ends 233, the ladder side members 231 are joined by a second or lower rail 234. In some embodiments, the ladder 100 or 100' may include additional stabilizing rails (not shown).
Each ladder side member 231 includes inner and outer faces or sides 235 and 236, respectively, and inboard and outboard faces or sides 237 and 238, respectively. As shown in FIGS. 1, 101 and 102, when a ladder 100, 100' is attached to the base 10, the ladder connection block or rotation block 57 and also, or alternatively, to a patient support structure 15t, the inboard faces 237 are positioned toward or closer to the patient support structure 15t. Similarly, the outboard faces 238 are positioned toward the associated, attached or connected vertical translation subassembly 20.
At the upper ends 232, the ladder side members 231 each include an engagement peg receiving groove 239 that is complementary in shape and cooperates with the peg 195. The engagement peg receiving groves 239 are cut into the inner faces 235 of the ladder side members 231, and extend from the outboard side 238 toward the inboard side 237 so as to provide a peg-receiving channel 240 with an opening 241 and a peg-engaging chamber 243. The peg-receiving channel 240 is sized and shaped to removably slidingly receive a ladder engagement peg 195 therein. The two channels 240 are generally or substantially parallel with one another, and are located to as to engage a pair of ladder engagement pegs 195 such as but not limited to pair 200 and pair 205, such as are shown in FIG. 16. The peg-engaging chamber 243 is sized and shaped to lockingly engage the peg 195 received in the channel 240. It is foreseen that the ladder engagement peg receiving grooves 239 and the associated ladder engagement pegs 195 may be attached to the alternate or opposite structure so long as the ladder 100, 100' can be removably attached to the base 10. For example, the ladder may include the pegs 195 and the rotation block 57 may include the grooves 239. It is foreseen that alternative attachment structures may be used to lockingly attach the ladders 100, 100' to the rotation block 57.
Prior to reversibly or releasably connecting, joining or attaching a patient support structure 15# to the base 10, a pair of ladders 100, 100' must be attached to the base 10.
In a first step, the ladder channel openings 241 are aligned with the block pegs 195, such as the upper pair 200 of pegs 195, such as is indicated by the directional arrow denoted by the numeral 245. The openings 241 are correctly aligned with the upper pair of pegs 200 by orienting, tilting or tipping the ladder 100 such that the lower rail 234 is located more inboard than the upper rail 133. Accordingly, when in this position, the lower rail 234 is spaced or located higher from the floor F than the upper rail 133.
In a second step, the peg- receiving channel openings 241 are placed, installed or engaged around the upper pegs 200, such that the upper pegs 200 are effectively inserted into the openings 241. The peg-receiving channels 240 are then slid, moved or placed around the pegs 200, such that the pegs 200 are slid or moved along or through the channels 240, such as by tilting or rotating the lower end of the ladder 100 in an outboard direction, such as is indicated by the directional arrow denoted by the numeral 246. The ladder 100 is moved or tilted until it comes into a vertical orientation or configuration. While the pegs 200 are becoming engaged, the ladder upper rail 133 fits into and engages the ladder connection groove 127 on the front face 105 of the rotation block 57, and the outer surface 205 of the upper rail 133 frictionally engages the groove surface 203. When the ladder 100 is in the vertical orientation, the pegs 200 are substantially engaged by, or located or received within, the respective channel chambers 243.
It is noted that a pair of opposed ladders 100 or 100' attached to the respective vertical translation subassemblies 20 provide a fail-safe mechanism that prevents improper disconnection of an attached or engaged patient support structure 15‡ from the base 10. This fail-safe mechanism includes two components. First, the ladders 100 and 100' cannot be disconnected from the base 10 unless no patient support structure 15‡ is attached thereto. Second, the ladders 100 and 100' must be disconnected or removed from the base 10 by performing the attachment steps in reverse order. Accordingly, the ladder lower ends 233 must be tilted in an inboard direction, before the respective ladder upper ends 232 can be disconnected or disengaged from the rotation block 57. Other fail-safe mechanisms, structures or subassemblies are foreseen.
In some embodiments, the rotation block 57 includes at least one locking mechanism, structure or device, generally 250, adapted to lock the ladder upper rail 133 in the engaged rail-receiving groove 127. In these embodiments, the locking mechanism 250 can be actuated or engaged as an optional step in attaching the ladder 100, 100' to the rotation block 57.
Referring to FIGS. 15-20, the rotation block 57 includes upper and lower pairs of lock mechanisms 250. Each lock mechanism 250 includes an inner locking portion 255 and a handle 260 that extends outwardly from the front face 105 of the rotation block 57. The inner locking portion 255 can be swiveled into and out of the opening 265 of the associated rail-receiving groove 127, or ladder connection groove, by manually turning or rotating the associated handle 260 on the front face 105 of the rotation block 57, such that the lock 250 is engaged or closed. It is foreseen that the lock mechanisms 250 could be motorized and controlled by software or otherwise mechanically actuateable.
Closing the locks 250, prevents or blocks removal, disengagement, detachment or disconnection of the upper rail 133 from the engaged, attached or connected first rail-receiving groove 128. To disconnect the ladder 100, 100' from the first rail-receiving groove 128, the lock mechanisms 250 must be opened, disengaged, deactivated or de-actuated. In embodiments of the patient positioning support system 5 including a lock mechanism 250, it is foreseen that the lock mechanism 250 must be substantially opened prior to attachment or installation of a ladder 100 or 100' with the rotation block 57.
With reference to FIGS. 13, 21 and 85-100, it is noted that the patient positioning support system 5 is adapted, configured and arranged for reversible attachment of up to two ladders 100, 100', such as upper and lower ladders, to each rotation block 57. Accordingly, two such ladders 100, 100' attached to a single rotation block 57 are substantially vertically opposed to one another and also co-planar with one another. In contrast, a pair of ladders 100 or 100' attached to the two opposed rotation blocks 57 at either end of the base 10, such as a pair of ladders 100 or 100' attached to either the first rail-receiving grooves 128 or the lower rail-receiving grooves 129, are substantially opposed to and parallel with one another. When the ladder 100, 100' is attached to the block 57, a plane that runs parallel with and through the ladder side members 231 is substantially perpendicular to the floor F. Alternative configurations are foreseen.
In some embodiments, the rotation block. 57 is sized, shaped and configured such that when two ladders 100, 100' attached thereto, their upper ends 232 kiss or contact one another. It is foreseen that, in some embodiments, the upper ends 232 may not contact one another, depending upon the location or placement of the upper and lower pairs 200, 205 of ladder engagement pegs 195.
Attaching two ladders 100, 100' to each of the rotation blocks 57 of the patient positioning support system 5 enables attachment of two patient support structures 15‡, such as for example a prone patient support structure 15 and a supine patient support structure 15', such as is described elsewhere herein. For example, a patient can be positioned on a first of two patient support structures 15t, such as for a first surgical procedure, and then transferred to the second of the two patient support structures 15t, such as for performing a second surgical procedure with the patient in a 'different body position. Such transferring of a patient between the two patient support structures 15‡ can be performed in numerous ways, including but not limited to a sandwich-and-roll procedure, such as is described below.
The ladders 100, 100' are sized, shaped, configured and arranged for attachment to a patient support structure 15‡ in addition to the base 10. Each ladder side member 231 includes a plurality of spaced through-bores 270 joining its respective inner and outer faces 235 and 236. The through-bores 270 of the opposed ladder side members 231 are sized, shaped and located or aligned such that pairs of opposed through-bores 270 can removably or reversibly slidingly receive the rod portion 102 of a T-pin 101 therethrough. For example, with reference to FIG. 10, through-bores 275 and 280 are coaxially aligned such that a single, or the same, T-pin 101 is receivable therethrough (e.g., a single T-pin 101 is receivable through both of the through-bores 275 and 280).
Additional aspects of attaching the ladders to the patient support structure 15‡ are described in greater detail below, with respect to the structure for the patient support structure 15‡. Further, additional information regarding ladders can be found in U.S. Patent Application No. 13/507,618, filed June 18, 2012 .

Roll, Vertical Translation and Yaw Axes

As noted above, the base includes a plurality of axes, including a longitudinally extending roll axis R, at least one vertical axis denoted by the letter Vn, wherein n is an integer indicating, identifying or denoting a particular or specific vertical axis, and at least one yaw axis denoted by the letter Yn, wherein n is an integer indicating a particular or specific yaw axis. The base 10 is configured and arranged for movement with respect to these axes, such as is described below and elsewhere herein.

Roll Axis

The roll axis R extends longitudinally along a length of the patient positioning support system 5. In particular, the roll axis R extends between the outer portions 71 of the rotation shafts. In an exemplary embodiment, when the upper portions 35 of the opposed vertical translation subassemblies 20 are located substantially equidistant from the floor F, such as is shown in FIG. 4, the roll axis R is substantially coaxial with the rotation shafts 56. In another exemplary embodiment, when the upper portions 35 are not equidistant from the floor F, such as is shown in FIGS. 24 and 32, the roll axis R intersects the rotation shaft outer portions 71. The roll axis R is movable to numerous positions, such as parallel with the floor F and non-parallel with (at an angle to) the floor F, such as by vertical translation of the vertical translation subassemblies 20.
The base 10 is adapted to tilt, roll, turn over, or rotate the patient support structure 15‡ such as but not limited to the prone patient support structure 15 and the supine patient support structure 15' about or around the roll axis R. The patient support structure 15‡ can be reversibly rolled or tilted an amount or distance of between about 1° and about 360°, such as relative to a plane intersecting the roll axis R wherein the plane is parallel with the floor F, or such as relative to a starting position associated with a plane parallel with the floor F, wherein the plane intersects with the roll axis R. For example, in some embodiments, the patient support structure 15‡ may be tilted a distance of about 5°, about 10°, about 15°, about 20°, about 25°, about 30°, about 35°, or about 40° about the roll axis R, relative to a starting position associated with a plane parallel with the floor F, wherein the plane intersects with the roll axis R, so as to provide improved access to a surgical site. In a further embodiment, the patient support structure 15‡ may be tilted a distance of about. 45°, 50°, 55°, 60°, 65°, 70°, 75°, 80°, 85°, 90°, 95° or 100° about the roll axis R, relative to a starting position associated with a plane parallel with the floor F, wherein the plane intersects with the roll axis R. In some embodiments, the patient support structure 15‡ may be tilted a distance of about 110°, 115°, 120°, 125°, 130°, 135°, 140°, 145°, 150°, 155°, 160°, 165°, 170°, 175° or 180° about the roll axis R, relative to a starting position associated with a plane parallel with the floor F, wherein the plane intersects with the roll axis R. In some embodiments, the patient support structure 15‡ may be rolled a distance of more than 180° about the roll axis R, relative to a starting position associated with a plane parallel with the floor F, wherein the plane intersects with the roll axis R. In some embodiment, the patient support structure 15‡ can be rolled clockwise or counter-clockwise, or toward either the left-hand or the right-hand side with respect to the roll axis R. In some circumstances, both the prone and supine patient support structure 15 and 15' may be attached to the base 10 and rolled together with respect to the roll axis R.
FIGS. 92a, 93a, 94a and 95a illustrate rolling the prone and supine patient support structures 15, 15' about the roll axis R, in one embodiment, wherein the patient support structures 15, 15' are reversibly attached to a base 10, such as but not limited to during a sandwich-and-roll procedure. In FIG. 92a, the supine patient support structure 15' is below the roll axis R and the prone patient support structure 15 is above the roll axis R. In FIG. 93a, the prone and supine patient support structures 15 and 15' are tilted about the roll axis R, or toward the right of the page, a distance of about 25°. FIGS. 93b and 93c provide alternative views of tilting the prone and supine patient support structures 15 and 15' about 25° around the roll axis R. Then, either the prone and supine patient support structures 15, 15' can be locked in this position, such as for improved access to a surgical site, or they can be rolled farther, such as is described herein. FIGS. 94a-94c illustrate rolling the prone and supine patient support structures 15 and 15' even farther about the roll axis R, a distance of about 130°, such as if the patient is being rolled over in a sandwich-and-roll procedure. FIGS. 95a, 95b and 95c show the positions of the prone and supine patient support structures 15, 15' after completion of an 180° roll. In this position, the supine patient support structure 15' is located above the roll axis R and the prone patient support structure 15 is below the roll axis R, and a patient thereon would be facing downward toward the floor F.
In some embodiments, the patient positioning support system 5 is configured and arranged to roll the prone and supine patient support structures 15, 15' a full 360° about the roll axis R in at least one direction, so as to return to the orientation shown in FIG. 92a.
In other embodiments, the base 10 is adapted to roll the patient support structures 15, 15' backwards, or in a reverse direction, about the roll axis R, so as to be rolled a suitable distance, so as to position the patient in an orientation associated therewith, such as but not limited to the positions shown in FIGS. 92a through 95c.

Vertical Axes

Each vertical translation subassembly 20 includes a vertical translation axis, which is denoted by V1 or V2. Vertical translation or movement, of at least a portion of the patient positioning support apparatus 5 may occur along one or both of the vertical translation axes V1 and V2. For example, the vertical translation subassembly 20 on the right side of FIG. 2 raises and lowers the associated upper portion 35 along the first vertical translation axis V1. Similarly, the vertical translation subassembly 20 on the left side of FIG. 2 raises and lowers the associated upper portion 35 along the second vertical translation axis V2. Such vertical translation may be synchronous or asynchronous, such as is described in greater detail below.
Each vertical translation subassembly 20 includes maximum and minimum translation or lift distances. The maximum lift distance is the maximum amount, most or highest the riser assembly 45 can be telescoped outwardly or upwardly, or extended. For example, the maximum lift distance is the highest that the rotation shaft outer portion 71 (Fig. 14) can be spaced from or above the floor F. In an exemplary embodiment, FIG. 4 shows both of the upper portions 35 positioned at substantially equal distances above the floor F, wherein the distance is about equal to the maximum lift distance described above, and the roll axis R is substantially parallel with the floor F. In another example, FIG. 50 shows both of the vertical translation subassemblies 20 in a maximally outwardly telescoped, raised, opened or fully open configuration, orientation or position with respect to their respective vertical translation axis V1, V2 and also with respect to the floor F.
The minimum lift distance is the minimum amount, least, farthest downward, or the lowest the riser assembly 45 can be telescoped downwardly or inwardly, contracted or closed. For example, the minimum lift distance is the lowest height that the rotation shaft outer portion 71 can be spaced, located or extended above the floor F. In an alternative example, shown in FIGS. 1 and 45, both of the vertical translation subassemblies 20 are in a maximally inwardly telescoped, lowered, closed, contracted, or fully closed configuration, orientation or position, with respect to their respective vertical translation axis V1, V2 and also with respect to the floor F, such that the upper portions 35 are both located as close to the floor F as possible.
The vertical translation subassemblies 20 are sized, shaped, arranged, configured, or adapted to move, translate, or lift and lower the rotation shaft outer portion 71 vertically, between the maximum and minimum lift positions. In some embodiments, this vertical translation is incremental. For example, in one embodiment, the vertical translation subassembly 20 includes a ratchet mechanism (not shown) that controls the intervals of lift, and an operator must select a number of discrete intervals for the upper portion 35 to be moved. In other embodiments this vertical translation is non-incremental, or continuous, between the maximum and minimum lift positions or distances. For example, in an embodiment, the vertical translation subassembly 20 includes a screw-drive mechanism (not shown) that smoothly lifts and lowers the upper portion 35 an amount determined by an operator, wherein the amount of movement includes no discrete intervals or distances.
Depending upon the desired positioning of the patient, the vertical translation subassemblies 20 can be moved in the same direction or in opposite directions. Further, the vertical translation subassemblies 20 can translate their respective upper portions 35 the same distance or different distances.
In yet another embodiment, both of the vertical translation subassemblies 20 are positionable at substantially equally telescoped positions, relative to their respective vertical translation axis V1, V2 and the floor F, and wherein the telescoped positions are between the fully open and fully closed positions. When in this position, the roll axis R is substantially parallel with the floor F.
In another embodiment, the vertical translation subassemblies 20 are movable in opposite directions, and additionally or alternatively, positionable at different heights. For example, the vertical translation subassemblies 20 can be moved and placed such that one of the upper portions 35 is located farther from the floor F, or higher than, the opposed upper portion 35. For example, FIG. 23 shows the head-end upper portion 35 fully opened, and the foot-end upper portion 35 is closed, such that attached prone patient support structure 15 is positioned in a reverse Trendelenburg position. In this example, the upper portions 35 do not both intersect a single horizontal plane running parallel with the floor F; or the upper portions 35 are not at the same, relative to the floor F.
Fig. 32 shows another example, wherein the head-end vertical translation subassembly 20 is telescoped closed, and the foot-end vertical translation subassembly 20 is fully opened, such that the attached prone patient support structure 15 is in a Trendelenburg position. In yet another example, both of the vertical translation subassemblies 20 are positionable at substantially unequally telescoped positions, relative to their respective vertical translation axis V1, V2 and the floor F, and wherein the telescoped positions are between the fully open and fully closed positions. When in this position, the roll axis R is not substantially parallel with the floor F. Numerous positions of the patient support structure 15# are foreseen, wherein the upper portions 35 are raised to various different heights relative to the floor F.
The vertical translation subassemblies 20 can be operated singly or together, and synchronously or asynchronously. For example, one of the vertical translation subassemblies 20 may be telescoped, expanded, lifted or moved, while the opposed vertical translation subassembly 20 is not telescoped or moved, or is held or maintained immobile. In another example, both of the vertical translation subassemblies 20 are moved in the same or opposite directions at the same time, and at the same or different rates of vertical movement. Numerous variations are foreseen.
Operation of the vertical translation subassemblies 20 is generally coordinated and controlled electronically, or synchronized, such as by a computer system (not shown) that interacts with one or more motion sensors (not shown) associated with various parts of the patient positioning support system 5 and the motorized drives, such as is known in the art. However, it is foreseen that one or more portions or subsystems of the vertical translation subassemblies 20 may be operated manually. Further, in some circumstances, an automatic electronic control (not shown) of the patient positioning support system 5, or the drive system, can be turned off, or at least temporarily disconnected, so that one or more portions of the patient positioning support system 5 can be moved manually. For example, during a sandwich-and-roll procedure, such as is described elsewhere herein, at least the step of rolling the patient over is usually performed manually by two, three or preferably four or more operators or medical staff, after the drive system (not shown), or a clutch (not shown), has been temporarily disconnected or released, so as to ensure that the patient is not injured during the procedure. After the roll is completed, the clutch is reengaged, so that the patient positioning support system 5 can mechanically perform additional movement and positioning of the patient.

Yaw Axes

Each of the vertical translation subassemblies 20 includes a yaw axis Yn. For example, in the embodiments shown in FIGS. 2, 37 and 38, the vertical translation subassemblies 20 include the yaw axes Y1 and Y2, respectively. When the patient support structure 15#, such as but not limited to a prone patient support structure 15, is substantially parallel with the floor F, and not rolled about the roll axis R, such as is shown in FIG. 4, the yaw axes Y1 and Y2 are substantially perpendicular to the floor F and substantially parallel with the vertical axes V1 and V2. However, when the patient support structure 15‡ is and rolled about the roll axis R, so as to be non-parallel with the floor F, such as is shown in FIGS. 50-54, the yaw axes Y1 and Y2 are not perpendicular to the floor F or with the vertical axes V1 and V2.
The yaw axes Yn enable rotational movement thereabout of at least a portion of the patient positioning support system 5. Such rotational movement prevents buckling or collapse of the patient positioning support system 5 when the patient support structure 15t, such as but not limited to a prone or supine patient support structure 15, 15', is placed in certain positions, such as but not limited to a Trendelenburg or a reverse Trendelenburg position, in conjunction with rotation about the roll axis R, such as is described in greater detail below.
As described below, the rotation block 57 (Fig. 15) is sized, shaped and arranged to as to rotate or pivot about the associated yaw axis Yn. As the connection block 57 pivots about the yaw axis Yn, the rear face 110 does not substantially contact either the housing front 61 (Fig. 13) or the rotation plate 65. In some embodiments, the rotation block 57 is spaced a sufficient distance from the rotation plate 65 and additionally or alternatively the housing front 61 so as to substantially prevent such contact therebetween from happening.
In alternative or additional embodiments, the rotation block 57 and the rotation subassembly 50 are sized, shaped and configured to allow or enable the rotation block 57 to be rotated a small angle about the yaw axis Yn, so as to prevent the patient positioning support system 5 from collapsing during certain positioning and rolling of the patient support structure 15#, such as described elsewhere herein, and-also such that the distance of rotation about the yaw axis Yn is not sufficient for the rear face 110 of the rotation block 57 to contact the housing front 61 of the rotation plate 65.

Movement of the Patient Positioning Support Structure With Respect to the Roll, Yaw and Vertical Translation Axes; Active versus Passive Movement; Simultaneous Versus Sequential Movement

The patient positioning support system 5 is adapted for movement with respect to the roll, yaw and vertical translation axes R, Yn and Vn, respectively. With respect to two or more of these axes, such movement may occur simultaneously or sequentially, or occurs at substantially the same time.
In an exemplary embodiment of simultaneous movement with respect to two or more of roll, yaw and vertical translation axes R, Yn and Vn, one of the vertical translation subassemblies 20 may telescope upwardly, so as to lift the attached end of the patient support structure 15‡, such as but not limited to a prone or supine patient support structure 15 or 15', while the rotation subassembly 50 simultaneously or concurrently rolls the patient support structure 15‡ a distance of between about 5° and about 25° toward the left-hand side of the patient positioning support system 5.
In other embodiments, movement with respect to two or more of these axes is sequential. The rotation subassembly 50 is movably attached to the connection subassembly 75 so as to enable both rotational movement of at least a portion of the connection subassembly 75 about the roll axis R and also rotational movement of at least a portion of the connection subassembly 75 about an associated yaw axis Yn. In particular, the rotation subassembly 50 is attached to the respective rotation block 57 by an attachment that allows that rotation block 57 to pivot about the yaw axis Yn. It is foreseen that the connection subassembly 75 can be joined or attached to the rotation subassembly 50 using a variety structures or mechanisms known in the art, so long as rotation of the connection subassembly 75 with respect to the roll and yaw axes R, Yn is maintained.
Preferably, such rotation about both the roll and yaw axes R, Yn is smooth and non-incremental. However, in certain embodiments, rotation about the roll axis R is incremental, including a plurality of selectable incremental stops. Further, rotation about the roll axis R may be active, such as mechanically actuated or driven, or rotation about the roll axis R may be passive, such as manually rolling the patient support structure 15‡ about the roll axis R.
In the illustrated embodiment, such as is shown in FIG. 14, the rotation shaft outer portion 71 extends into and optionally through the rotation block through-bore or through-channel 140, and is attached, joined or fixed thereto. Rolling or rotation of the rotation shaft 56, due to actuation of the rotation subassembly 50, causes rotation of the rotation block 57 about the roll axis R, in either a clockwise or a counterclockwise direction. Rolling of the rotation shaft 56 can rotate the rotation block 57 a distance of between about 1° and about 360° in either a clockwise or a counter clockwise direction, such that a patient on the patient support structure 15‡ can be rolled over or tilted, such as is described elsewhere herein.

Patient Support Structure Components and Operation

As described above, the patient positioning support system 5 includes at least one patient support structure 15‡, such as but not limited to prone and supine patient support structures 15, 15'. In some embodiments, the patient positioning support system 5 includes one or more additional patient support structures, such as but not limited to a patient support structure adapted to hold a patient of a different size, such as but not limited to a pediatric patient, an extra-tall adult patient, and an obese patient. In some embodiments, the patient positioning support system 5 includes one or more additional patient support structures 15‡, such as but not limited to a patient support structure adapted for a specific medical procedure, some of which are described in greater detail below. It is foreseen that a patient support structure 15‡ may be configured and arranged to include one or more modular or interchangeable portions.
The patient support structure 15‡ is suspended above the floor F. In a further embodiment, the patient support structure 15‡ is attached to and supported by or suspended by the base 10.
Each patient support structure 15‡, such as but not limited to the prone and supine patient support structures 15, 15' described below, includes a plurality of pitch axes, which are denoted by Pn, wherein n is an integer that indicates or denotes a specific or particular pitch axis. For example, as shown in FIGS. 3 and 103, the prone and supine patient support structures 15, 15' each include first, second and third pitch axes, which are denoted by P1, P2 and P3, respectively. The first pitch axis P1 is located between and spaced from the second and third pitch axes P2 and P3. All three pitch axes P1, P2 and P3 run substantially perpendicular to a longitudinal axis of the respective patient support structure 15‡ as well as substantially parallel with one another. Depending upon the position of the patient support structure 15‡ relative to the floor F, the pitch axes P1, P2 and P3 may be either parallel with the floor F or intersect the floor F.
The patient support structure 15# is adapted, configured and arranged for rotational movement about each of the pitch axes P1, P2 and P3. In general, the first pitch axis P1 is located so as to be associated with rotational movement at or near a patient's hips. The first pitch axis P1 enables positioning of a patient in a prone position such that the hips are flexed or extended. In contrast, the second and third pitch P2 and P3 axes are associated with rotational movement of the patient support structure 15‡ about the respective axis relative to the base 10, and wherein the second pitch axis P2 is associated with head-end of the patient support structure 15‡ and P3 is associated with the foot-end of the patient support structure 15‡. This enables placing the patient in either a Trendelenburg position or a reverse Trendelenburg position, such as is described in greater detail below.

Prone Patient Support Structure

The prone patient support structure 15 is sized, shaped, configured and arranged, or otherwise adapted, for supporting a patient (not shown) in a prone, or face-down, position during a medical procedure, such as but not limited to imaging and surgical procedures. FIGS. 1, 3-9, and 23-100 illustrate exemplary embodiments of the prone patient support structure 15. Alternatively sized, shaped, configured and arranged, or otherwise adapted prone patient support structures 15 are foreseen.
As is most easily seen in FIG. 3, the prone patient support structure 15 of the present invention includes a first pitch or pivot axis P1 that is associated with virtual pivot points 248. In some embodiments, the virtual pivot points 248 are a pair of virtual pivot points, which may be located so as to be spaced and opposed to one another. The first pitch axis P1 intersects the virtual pivot points 248. At least a portion of the prone patient support structure 15 is rotatable about the first pitch axis P1 wherein such rotational movement is indicated by the double-headed directional arrow 284.
In the exemplary embodiment of FIG. 3, the virtual pivot points 248 are each located at a point of contact between the patient's skin and a surface of a hip-thigh pad 286, also referred to as pelvic pads or pelvic support pads. The hip-thigh pads 286 are sized, shaped and located so as to hold, support and pad the hips or pelvis of a prone patient (not shown) supported on the prone patient support structure 15.
In other embodiments, the virtual pivot points 248 and the associated first pitch axis P1 are located above or below the exemplary virtual pivot points 248 and first pitch axis P1 depicted in FIG. 3. Additionally or alternatively, in some embodiments, the virtual pivot points 248 and the associated first pitch axis P1 are located more toward the head-end 288 or more toward the foot-end 290 of the patient positioning support structure 15, than the exemplary virtual pivot points 248 and first pitch axis P1 depicted in FIG. 3.
The prone patient support structure 15 includes second and third pitch or pivot axes P2 and P3 that are associated with its head and foot-ends, and which are generally denoted by the numerals 288 and 290 respectively. The prone patient support structure 15 is sized, shaped and arranged to provide for rotation of the prone patient support structure 15 about the second pitch axis P2, such as is indicated by the double-headed directional arrow 292. For example, the prone patient support structure 15 is adapted to rotate about the second pitch axis P2 relative to the floor F. Similarly, the prone patient support structure 15 is sized, shaped and arranged to provide for rotation of the prone patient support structure 15 about the third pitch axis P3, such as is indicated by the double-headed directional arrow 294. For example, the prone patient support structure 15 is adapted to rotate about the third pitch axis P3 relative to the floor F.
The maximum amounts of rotation at P2 and P3 is determined by, or dependent upon, the minimum and maximum heights of the vertical translator upper ends, such as but not limited to the minimum and maximum heights of the connection subassembly connection to the rotation subassembly.
The prone patient support structure 15 is adapted to pivot, rotate or move about P2 and P3 when reversibly placed in and moved between numerous positions relative to the floor F. For example, in a first position, or orientation, the patient support structure 15 is positioned such that an upper body portion 288, 306A, 308A thereof, or the torso of a patient supported thereon is substantially parallel with the floor F. In a second position, the upper body portion of the prone patient support structure 15, or the torso of a patient supported thereon, is substantially non-parallel with the floor F. The patient support structure 15 is movable between the first and second positions. For example the prone patient support structure 15 may be moved to and placed in Trendelenburg and reverse Trendelenburg positions, such as a shown in FIGS. 31 and 23, respectively. When moving the prone patient support structure 15 between the first and second positions, the prone patient support structure 15 must rotate about both P2 and P3. Generally, this pivoting movement about P2 and P3 is simultaneous, though not necessarily at the same rate. It is foreseen that such movement may be incremental or non-incremental, such as but not limited to between maximally angled Trendelenburg and reverse Trendelenburg positions relative to the floor F. Rotation about the second and third pitch axes P2 and P3 is discussed in greater detail below. It is noted that an infinite number of non-incremental positions may exist between the minimum and maximum positions. It is also noted that a finite number of incremental positions may exist between the minimum and maximum positions. It is noted that in some embodiments the supine patient support structure 15' is movable in a substantially similar manner to that of the prone patient support structure 15.

Prone Patient Support Structure: Frame

The prone patient support structure 15 includes an open fixed frame 296 (Fig. 3) that is suspended above the floor F. The frame 296 is substantially rigid and strong, and able to withstand substantial forces applied thereto. Additionally, as much of the frame 296 as possible is radiolucent, so as to not interfere with imaging.
In the illustrated embodiment, the frame 296 is attachable to the base 10, such that the base 10 holds or suspends the frame 296 above the floor F. However, it is foreseen that the frame 296 can also be suspended above the floor F using any other useful structure known in the art, such as but not limited to an attachment structure that connects the frame 296 with the ceiling, with a wall, or with a combination thereof. In some embodiments, the frame 296 is suspended or held above the floor F using another base known in the art. Numerous configurations are foreseen. Further, the illustrated base 10, or any other useful base known in the art, can also suspend either the prone patient support 15 alone or both the prone and supine patient supports 15 and 15' together above the floor F. As described below, the prone and supine patient support structures 15, 15' can both be connected to and disconnected from the base 10.
The prone patient support structure frame 296 includes left-hand and right-hand sides, generally 298 and 300 respectively, a head-end 302 and a foot-end 304. When a prone patient is supported on the prone patient support structure 15, the left side of the patient is near or at the frame left-hand side 298. Similarly, the patient's right side of the patient is located near or at the frame right-hand side 300.
The frame 296 also includes left-hand and right- hand frame portions 306 and 308, respectively, which are spaced apart and opposed to or opposite one another, and extend longitudinally with respect to the prone patient support structure 15. The left-hand and right- hand frame portions 306, 308 are substantially parallel with one another. At the frame head-end 302, the left-hand and right- hand frame portions 306, 308 are joined by a head-end frame member 310. Similarly, at the frame foot-end 304, the left-hand and right- hand frame portions 306, 308 are joined by a foot-end frame member 312. Accordingly, the frame head-end and foot- end frame members 310 and 312 hold or maintain the left-hand and right- hand frame portions 306, 308 in spaced relation to one another.
Each of the head-end and foot- end frame members 310, 312 includes an attachment structure 314 structure adapted for attachment to the base 10 and also to enable angulation of the patient support structure 15 relative to the base 5 at the second and third pivot axes P2 and P3. Attachment of the patient support structure 15 head-end 302 to a vertical translation subassembly 20 using a T-pin 101 (Fig. 11) and the like is described below. When installed, the T-pin 101 associated with the frame head-end 310 is substantially coaxial with the second pitch axis P2. Similarly, when installed, the T-pin 101 associated with the frame foot-end 312 is substantially coaxial with the third pitch axis P3.
The head-end frame member 310 includes an attachment structure 314 that includes a T-pin engaging member 316 with a through-bore 318 extending therethrough. The through-bore 318 is sized and shaped to reversibly slidingly receive a T-pin 101 therethrough. In the illustrated embodiment, the T-pin engaging member 316 is a substantially cylindrical tube-like member. However, it is foreseen that the T-pin engaging member 316 may have any other useful shape known in the art. In the illustrated embodiment, the head-end attachment structure 314 is attached to a ladder 100 or 100' by aligning the T-pin engaging member through-bore 318 with a pair of ladder through-bores 270 (Fig. 10), such as through-bores 275 and 280, such that the through-bore 318 is located between the through-bores 275 and 280 and the three through- bores 275, 280 and 318 are substantially coaxial. Then, a T-pin 101 is inserted into and through the three through- bores 275, 280 and 318 so as to be engaged thereby. With respect to the head-end 302 of the frame 296, when the T-pin 101 and through- bores 275, 280 and 318 are engaged, they are also coaxial with the second pitch axis P2.
The frame foot-end 304 is connected or attached to a second or foot-end vertical translator 20 in a substantially similar manner to the frame head-end 302. Namely, the foot-end frame member 312 includes another attachment structure 314 that also includes a T-pin engaging member 316 with a through-bore 318 extending therethrough. The through-bore 318 is sized and shaped to reversibly slidingly receive a T-pin 101 therethrough. In the illustrated embodiment, the T-pin engaging member 316 is a substantially cylindrical tube-like member. However, it is foreseen that the T-pin engaging member 316 may have any other useful shape known in the art. In the illustrated embodiment, the foot-end attachment structure 314 is attached to a ladder 100 or 100' by aligning the T-pin engaging member through-bore 318 with a pair of ladder through-bores 270, such as through-bores 275 and 280, such that the through-bore 318 is located between the through-bores 275 and 280 and the three through- bores 275, 280 and 318 are substantially coaxial. Then, a T-pin 101 is inserted into and through the three through- bores 275, 280 and 318 so as to be engaged thereby. With respect to the foot-end 304 of the frame 296, when the T-pin 101 and through- bores 275, 280 and 318 are engaged, they are also coaxial with the third pitch axis P3.
Referring to FIGS. 23-38, the T-pin engaging members 316 are sized, shaped and configured to pivot or rotate about an engaged T-pin 101, so as to rotate, pivot, angulate or articulate about the associated pitch axis P2 or P3. For example, with reference to FIG. 29, the head-end T-pin engaging member 316 pivots counter-clockwise about the engaged T-pin 101, as indicated by the arrow 292. In another example, with reference to FIG. 30, the foot-end T-pin engaging member 316 pivots counter clockwise about another T-pin 101, as indicated by the arrow 294. In yet another example, with reference to FIG. 37, the head-end T-pin engaging member 316 pivots clockwise about the engaged T-pin 100, as indicated by the arrow 292. In still another example, with reference to FIG. 38, the foot-end T-pin engaging member 316 pivots clockwise about the T-pin 101, as indicated by the arrow 294.
An exemplary T-pin 101 is shown in FIGS. 11 and 11a. It is noted that T-pins 101 are used to connect both of the head- and foot-ends 302, 304 of both the prone and supine patient support structures 15, 15' to the vertical translation subassemblies 20 using the ladders 100 and optionally the ladders 100', but such T-pins 101 are not shown in many of the attached figures. Each T-pin 101 includes a shaft 102, a T-shaped handle 103 and a locking member 104. As shown in FIG. 11a, the locking member is positionable in a locking position, shown in phantom, and a non-locking position. The locking member 104 may be positively held in the locking or non-locking positions by a mechanism (not shown) such as a detent mechanism. It is foreseen that the patient support structures 15, 15' may include alternatively configured attachment structures 314 and T-pins 101. Additional information about T-pins can be found in co-pending U.S. Patent Application No. 13/507,618, filed June 18, 2012 .

Translation Compensation Subassembly

As noted above, the patient support structure 15° can be moved to numerous positions wherein said structure is or is not parallel with the floor F. Since the illustrated base 10 is fixed in position by the cross-bar 25, such that the vertical translation subassemblies 20 cannot move relative to one another, a change in the height of one or both of the vertical translation subassemblies 20 changes the distance between the rotation subassemblies 50, such as the rotation blocks 57, the yaw pins 79, and the like. Accordingly, when this distance increases or decreases, the length of the patient support structure 15° must change a similar or complementary amount. The patient support structure 15° changes its length and therefore includes a translation compensation subassembly 320 (FIG. 3), described below.
Referring now to FIGS. 63 through 66, at their foot-ends 304, the illustrated left-hand and right- hand frame portions 306, 308 include an in-frame or in-line embodiment of a translation compensation subassembly, generally 320, also referred to as a lateral translation compensation subassembly. In an exemplary embodiment, each translation compensation subassembly 320 includes a translation rod 322 that joins the foot-end 290 of the associated frame portion 306 or 308 with the foot-end frame member 312. The translation rods 322 are adapted to telescope outwardly and inwardly from the associated frame portions 306, 308, so as to effectively lengthen and shorten the foot-end 304 of the frame 296 when the frame 296 is moved from an orientation generally parallel with the floor F and to Trendelenburg and reverse Trendelenburg positions, or when the frame 296 is moved such that the roll axis R moves between orientations that are parallel and non-parallel with the floor F. The translation compensation subassembly 320 also includes a translation driver 324 located within the frame portions 306 or 308 that actuates the telescoping of the translation rod 322.
The frame 296 of the present invention may be adapted to be used with a variety of translation compensation subassemblies, such as but not limited to those described in U.S. Patent No. 7,565,708 , U.S. Patent No. 8,060,960 , or U.S. Patent Application No. 60/798,288 , U.S. Patent Application No. 12/803,173 , U.S. Patent Application No. 12/803,192 , or U.S. Patent Application No. 13/317,012 , instead of the illustrated translation compensation subassembly 320. However, the in-frame compensation subassembly 320 of the present invention provides the advantage of a low profile.
The translation compensation subassembly 320 of the present invention is actively driven and infinitely adjustable between a maximally outwardly telescoped configuration and a closed configuration. Passive translation compensation mechanisms are also foreseen. Translation compensation mechanisms that are not in-line with the frame 296 are also foreseen. It is noted that the supine patient support structure 15' may include a similar translation compensation subassembly 320.

Pivot-Shift Mechanism

Referring again to FIG. 3, as well as FIGS. 65-84, the prone patient support structure 15 includes a pair of spaced opposed angularly turning or gliding joints, generally 326, that provide a pivot-shift mechanism for moving the pelvic pads 286.
The joints 326 are generally centrally located along a length of the frame 296 and cooperate with the frame 296 of the prone patient support structure 15. For example, in the embodiment shown in FIG. 3, the joints 326 are located along the length of the frame 296 so as to be associated with the first pitch axis P1. The joints 326 are spaced apart and opposed to one another, so as to allow a portion of a patient's body to hang downwardly therebetween. For example, a patent's belly may hang downwardly between the joints 326 when the patient is positioned in a prone position on the prone patient support structure 15. Further, the joints 326 are longitudinally aligned with one another.
Referring to FIG. 72 each joint 326 includes a point 248 that is intersected by the first pitch axis P1 and an arc of motion, denoted by AOM, that is spaced a distance, or radius r, from the virtual pivot axis 248. Since the points 248 may be spaced from the associated joint 326 (described below), they may be referred to as a virtual pivot points 248 or as a virtual pivot axis 248. Further, the virtual pivot axis defined by points 248 may be synonymous with the first pitch axis P1. The radius r of the arc of motion AOM extends from the virtual pivot axis 248 to the arc of motion AOM in a plane that is substantially perpendicular to the first pitch axis P1. The radius r defines at least a portion of the arc of motion AOM.
Each joint 326 includes a first joint component 328, a second joint component 330, and a third joint component 332. In the illustrated embodiment, the first and third joint components 328, 332 each include a plurality of teeth that are adapted such that the rack teeth 328 of the first joint component 328 cooperatively engage the teeth 332 of the third joint component 332. The third joint component 322 is connected to a motor 333 (FIG. 75) that actively drives clockwise and counterclockwise rotation of the third joint component or pinion gear 332, whereby the third joint component of drive gear 332 actuates rotary movement of the first joint component 328 with respect to the second joint component 330. It is noted that the first and second joint components 328 and 330 each include a guide track component with a weight-bearing gliding surface, 328a and 330a (FIG. 75) respectively, wherein the guide track components cooperatively slidingly mate to enable the first joint component 328 to glide or slide, and therefore rotate, with respect to the second joint component 330 and also about the respective virtual pivot axis 248. Alternative joint configurations and components are foreseen so long as the function of moving the joint 326 with respect to the virtual pivot axis 248 in maintained.
The joints 326 are movable along the arc of motion AOM. Since each hip-thigh pad 286 (FIG. 3) is attached to the first joint components 328, movement of the first joint component 328 associated with a hip-thigh pad 286, with respect to the virtual pivot axis 248 and the arc of motion AOM glidingly or slidingly moves, pivots or rotates the hip-thigh pad 286 about the virtual pivot axis 248 and also a portion of the hip-thigh pad 286 along the arc of motion AOM, such as is described in greater detail below.
Still referring to FIG. 72, it is noted that a joint 326 can be configured such that the virtual pivot axis 248 is located higher or lower, or more to the left-hand or the right-hand side of the page, than depicted, such as but not limited to exemplary alternative virtual pivot axes 248a, 248b and 248c. Additionally, the arc of motion AOM include alternative sizes and locations than depicted, such as but not limited to exemplary arcs of motion denoted by ACA2, AOM3 and AOM4, respectively. Accordingly, the radius r of each arc of motion AOM is different.
In some circumstances, components of the joint 326 are sized, shaped and configured to move the attached hip-thigh pad 286 so as to follow an alternative arc of motion AOM, such as by including at least one of an alternatively located virtual pivot axes 248 or an alternative length radius r. For example, the prone patient support structure 15 may include joints 326 adapted for use with a pediatric patient, a very tall patient, or a patient with certain spinal anomalies. In some embodiments, the patient positioning support system 5 is provided with at least two prone patient support structures 15, wherein a first of the prone patient support structures 15 includes "standard" joints 326 that are useable with most patients, and a second of the prone patient support structures 15 includes non-standard or alternatively configures joints 326 for use with pediatric patients, very tall patients, patients with certain spinal anomalies, and the like. In some embodiments, the prone patient support structure 15 includes modular joints 326 that are interchangeable or adjustable to provide the ability to use a single prone patient support structure 15 with adult and pediatric patients, short, medium and tall patients, and the like.
The joints 326 are movable between a first position and a second position with respect to the virtual pivot axis 248, the arc of motion AOM and the floor F. The first and second positions are selected by an operator, so as to move the patient's hips between flexed positions, extended positions and a "neutral" position wherein the hips are neither flexed nor extended. For example, in FIG. 70, the first and second joint components 328 and 330 are located and oriented so as to position a patient's hips in a neutral position. In another example, in FIG. 71, the first and second joint components 328 and 330 are located and oriented so as to position a patient's hips in an extended position. In yet another example, in FIG. 72, the first and second joint components 328 and 330 are located and oriented so as to position a patient's hips in a flexed position.
It is noted that the first joint component 328 may be moved with respect to the second joint component 330, so as to be moved from the orientation or configuration shown in FIG. 70 to the orientation shown in FIG. 71, wherein such movement or motion is indicated by arrow 334. Similarly, the first joint component 328 may be moved with respect to the second joint component 330, so as to be moved from the orientation shown in FIG. 70 to the orientation shown in FIG. 72, wherein such movement or motion is indicated by arrow 336.
The first joint component 328 includes maximum positions, with respect to the second joint component 330 wherein the patient's hips are maximally flexed and maximally extended. The maximum positions are selected so as to cooperate with the patient's biomechanics, such that the patient's spine and additionally or alternatively hips can be flexed and extended a maximum amount. These maximum amounts of flexion and selections are selected so as not to injure the patient, but also to provide a desirable amount of lordosis for a given spinal surgery, such as is known in the art.
In some embodiments, the virtual pivot axis 248 is located within a patient supported on the prone patient support structure 15. For example, the joints 326 may be sized, shaped and configured to align the virtual pivot axis 248 within the patient, such as near the lumbar spine or on or near the pelvis. Accordingly, in this embodiment, the first pitch axis P1 passes through the patient. For example, in some embodiments, the virtual pivot axis 248 is located adjacent to the spine of a patient supported on the patient positioning support system 5.
In some embodiments, the virtual pivot axis 248 is located at a contact point between a patient supported on the prone patient support structure 15 and a hip-thigh pad 286. For example, the virtual pivot axis 248 may be located where the patient's skin contacts the surface of the hip-thigh pad 286. Since the hip-thigh pads 286 are moldable or compressible, the weight of the patient can cause the hip-thigh pads to be compressed, thereby effectively moving the virtual pivot axis 248 above the hip-thigh pads 286 and into the patient's body, in some embodiments. Further, since the patient's belly hangs downward between the hip-thigh pads 286, a virtual pivot axis 248 located at a contact point between the patient's skin and a surface of the hip-thigh pad 286 is associated with a first pitch axis P1 that passes through the patient's body.
As discussed above, and with reference to FIGS. 73-84, the hip-thigh pads 286 are joined with the associated joints 326. In particular, the hip-thigh pads 286 are attached to pad mounts 338 (FIG. 78) of the first joint components 328. It is noted that when the joint is assembled with the frame 296, the pad attachment surfaces 340, of the pad mounts 338, face generally toward, or are oriented toward, the roll axis R, also referred to as being oriented in an inwardly or central direction. The pad attachment surfaces 340 are attached to the undersides 342 of the pads 286. The hip pad undersides 342 are contoured so as to not obstruct movement of the joints 326 or to undesirably contact the frame 296, which could disrupt operation of the joints 326.
The virtual pivot axis 248 is positioned at a height or distance, denoted by D1, above the floor F, such as is shown in FIGS. 4, 24, 32, 40, 56, 65-67, 69. The height D1 is substantially constant during, or throughout, movement of the joint 326 with respect to the virtual pivot axis 248. In an exemplary embodiment, with reference to FIGS. 4 and 40, the patient positioning support structure 5 is positioned such that the joints 326 are in a neutral position (FIG 4), such that a patient's hips and spine are neither flexed or extended, and the virtual pivot axis 248 is spaced a distance D1 above the floor F. The operator adjusts the patient positioning support system 5 such that the virtual pivot axis 248 is located at a selected height D1 above the floor F, such as but not limited to 48-inches (122 cm), for example. The selected height D1 is a convenient and additionally or alternatively comfortable working height for the surgeon to perform the surgery. D1 can be other heights, such as but not limited to a height D1 between minimum and maximum distances above the floor F, wherein the minimum and maximum distances provide a range of selectable infinitely adjustable heights D1. The height D1 is associated with the locations of the upper portions 35 of the vertical translation subassembly 20. Accordingly, the minimum and maximum heights D1 are associated with the vertical translation subassemblies 20 being closed and maximally outwardly telescoped, respectively.
Continuing with the exemplary embodiment above, when the joints 326 are actuated and moved from the neutral position of FIG. 4 to the position shown in FIG. 40, wherein the hips and knees of the patient would be flexed, the height D1 of the virtual pivot axis 248 remains unchanged, or stays 48-inches (122 cm) from the floor F. Similarly, if the joints 326 are actuated and moved from the neutral position of FIG. 4 to the position shown in FIG. 56, wherein the hips and knees of the patient would be extended, the height D1 of the virtual pivot axis 248 still remains substantially unchanged, or 48-inches (122 cm) from the floor F.
The patient positioning support structure 5 is also configured such that the patient's hips and knees can be kept in the neutral position described above, and also the patient's body can be positioned in either a Trendelenburg position, such as is shown in FIG. 32, or a reverse Trendelenburg position, such as is shown in FIG. 24. When prone patient support structure 15 is moved to the Trendelenburg and reverse Trendeleburg positions, the height D1 remains unchanged, or 48-inches from the floor F.
FIG. 65 depicts the prone patient support structure 15 including joints 326 positioned so as to maximally extend the patient's hips and knees, and the virtual pivot axis 248 is located a distance D1 above the floor F. In comparison, FIG. 66 depicts the prone patient support structure 15 including joints 326 positioned so as to maintain the patient's hips and knees in a neutral position, or not flexed or extended, and the virtual pivot axis 248 is also located a distance D1 above the floor F, wherein the distance D1 of FIG. 65 is substantially equal to the distance D1 of FIG. 66. In a further comparison, FIG. 67 depicts the prone patient support structure 15 including joints 326 positioned so as to maximally flex the patient's hips and knees, wherein the virtual pivot axis 248 is also located a distance D1 above the floor F, and wherein the distance D1 of FIG. 67 is substantially equal to the distances D1 of FIGS. 65 and 66. Thus, as the joints 326 are actuated, they are movable between a plurality of selectable positions, the plurality of selectable positions being between and including the positions shown in FIGS. 70-72 and FIGS. 65-67, without substantially changing the heights D1 of the virtual pivot axis 248 of the joints 326.
As noted above, the height D1 of the virtual pivot axis 248 is adjustable. The height D1 can be adjusted by actuating one or both of the vertical translation subassemblies 20, so as to move the upper portions 35 upwardly or downwardly with respect to the associated vertical translation axis V1 and V2. Such vertical translation of the upper portions 35 causes vertical translation of the associated connection assembly 75, which in turn is connected with the head-end or foot- end frame members 310 and 312, respectively. At least a portion of each the hip-thigh pad 286 glides along the associated arc of motion AOM, such as, for example, when the associated joint moves to and between the positions shown in FIGS. 70-72 and FIGS. 65-67.
The prone patient support structure 15 includes a lower extremity support structure 344. The lower extremity support structure 344 is adapted to support the legs of the patient on the prone patient support structure 15. The lower extremity support structure 344 is also adapted to move the patient's legs between the neutral, flexed and extended positions, and to support the legs when the legs are in those positions. For example, in FIG. 39, the lower extremity support structure 344 is rotated downwardly by the joints 326, such that the hips would be flexed. In another example, in FIG. 55, the lower extremity support structure 344 is rotated upwardly by the joints 326, such that the hips would be extended.
The lower extremity support structure 344 includes an upper leg support portion or femoral support 346 (FIG. 3), and a lower leg support portion or lower leg cradle 348 that are joined or pivotably connected by a pair of knee hinges 350, so as to be movable between a first position and a second position; and wherein when in the first position, the femoral support 346 and the lower leg cradle 348 are in a neutral position; and when in the second position, the femoral support 346 and the lower leg cradle 348 are in a flexed position. In some embodiments, the lower leg cradle 348 is continuously adjustable with respect to the femoral support 346 and between the neutral position and a maximally flexed position. In other embodiments, the lower leg cradle 348 is continuously adjustable with respect to the femoral support 346 and between the neutral position and a maximally flexed position. Additionally, in some embodiments, the lower leg cradle 348 is incrementally adjustable with respect to the femoral support 346. In other embodiments, the lower leg cradle 348 is continuously adjustable with respect to the femoral support 346.
The knee hinges 350, also referred to as lower leg hinges, are spaced from and opposed to one another, and also enable flexion and extension of the patient's knees between the first and second positions. The knee hinges 350 may be active, or powered, or the knee hinges 350 may be passive, or unpowered, such as but not limited to spring hinges. The upper leg support portion 346 includes a pair of spaced opposed rails 352 with a thigh support sling 354 suspended therebetween. In some embodiments, the thigh support sling 354 is adjustable, such that the height of the thighs is adjustable. In some embodiments, the thigh support sling 354 is removable, such as for cleaning, replacement and additionally or alternatively adjustment. The thigh support sling 354, like other components of the patient positioning support structure, such as but not limited to the frame 396, the hip-thigh pads 286, and the joints 326 may be covered with a disposable, or washable, covering or drape provided as part of a draping kit (not shown), such as is known in the surgical arts. The draping kit may also include one or more pillow structures, for filling the thigh support sling 354, so as to support the thighs in a more preferred orientation.
The spaced opposed rails 352 are fixedly joined with the joint first components 328, such as is shown in FIGS. 65¬67. And accordingly, in addition to glidingly moving the hip-thigh pads 286 with respect to the arc of motion AOM, the joints 326 also move, pivot or rotate the rails 352, and therefore the lower extremity support structure 344-, about the first pitch axis P1. Accordingly, as the joints 326 move, or are selectively moved, from a neutral position, such as is shown in FIG. 66, to the maximally extended position, and such as is shown in FIG. 65, the patient's hips become progressively more extended, until the maximum extended position is reached. The operator can adjust the amount of hip extension, by selecting an extended position of the joints 326. Further, as the joints 326 move, or are selectively moved, from the neutral position, shown in FIG. 66, to the maximally flexed position, such as is shown in FIG. 67, the patient's hips become progressively more flexed, until the maximum flexed position is reached. It is noted that, due to the provision of knee hinges 350, the knees may also be flexed and extended together with the flexion and extension of the hips. However, it is foreseen that the lower extremity support structure 344 may be configured without knee hinges 350, such that the knees do not flex or extend.
In the illustrated embodiment, the lower leg support portion 348 is a frame adapted for supporting the lower legs of the patient. The lower leg support portion 348 may include one or more cross-pieces 356 adapted for holding pillows or pads (not shown) or for attachment of the patient's lower legs thereto. Further, in some embodiments, the lower leg support portion 348 may include one or more guide members 358 adapted to guide movement of the lower leg support portion 348 and additionally or alternatively actuation of passive knee hinges 350. In some embodiments, such guide members 358 contact and slide along a guide track 360 of the foot-end portions of the frame 296, or the foot ends 304 of the left-hand and right- hand frame portions 306, 308, such as is shown in FIGS. 44-54. It is foreseen that in some embodiments the frame 296 may not include guide tracks 360. In some embodiments, the knee hinges 350 may be actively driven, or powered, such that the knee hinges 350 operate without the need to guide tracks 360 or guide members 358.
In some embodiments, the lower extremity support structure 344 is joined with the joints 326 such that the lower extremity support structure 344 is movable with respect to the virtual pivot axis 248 and between the first and second positions, such as described above.

Torso Support Structure

The patient positioning support structure 5 of the present invention includes a torso support structure 362 that is received on and attachable to a head-end portion 302 of the frame 296 of the prone patient support structure 15, so as to support the head and torso of a patient thereon. As shown in FIG. 12, the torso support structure 362 includes a support body or frame 364 with a substantially transparent or radio-transparent face shield 366, a chest pad 368 attached to the support body 364 and a plurality of lockable brackets 370 that are adapted for releasable connection to the frame 296. A pair of adjustable arm support boards 372, such as are known in the art, is attachable either to the support body 364 or optionally to the frame 296 of the patient support structure 15. A ring-shaped pillow or similar structure (not shown) may be placed on the face shield 366 so as to support the patient's head while simultaneously providing clearance for anesthesia tubing or other equipment. The chest pad 368 is somewhat compressible and substantially radiolucent. In some embodiments, the chest pad 368 includes two or more chest pads 368. The chest pad 368 may be covered with a cover or drape (not shown), such as is described elsewhere herein. The position of the chest pad 368 is slidably adjustable along a length of the head-end portion 302 of the frame 296.
Accordingly, the torso support structure 362 can be slid or moved along the frame head-end portions 302, or along a length thereof, so as to position the chest pad 368 in a suitable location with respect to the patient's body and biomechanics. Once the chest pad 368 is in a suitable position along the frame 296, the torso support structure 362 can be locked into place on the frame 296, such as by actuating reversibly lockable brackets 370.
When the patient positioning support system 5 is being assembled for a sandwich-and-roll procedure, the patient is face up on the supine support structure 15', described below, and the prone patient support structure 15 is positioned over or on top of the patient, such that the patient is sandwiched between the two structures 15 and 15'. Then, the torso support structure 362 is placed onto the frame 296, such that the chest pad 368 is located between the sides of the frame 296, or between the left-hand and right- hand frame portions 306, 308, and against the patient's chest. The location of the chest pad 368 is adjusted by sliding it along the length of the frame 296 upper portion 302. When the desired location of the chest pad 368 is reached, achieved or selected, the brackets 370 are locked or otherwise engaged so as to fix the position of the torso support structure 362 with respect to the frame 296. The patient's arms are positioned and removably attached or strapped onto adjustable arm boards 372 of the torso support structure 362, and then the sandwiched patient can be rolled over about the roll axis R.
Referring to FIGS. 65-68, the hip-thigh pads 286 are associated with a lower-body side of the joints 326 and the chest pad 368 is associated with an upper-body side of the joints 326. Accordingly, the hip-thigh pads 286 are opposed to and spaced a distance from the chest pad 368. In particular, the virtual pivot axis 248 of each hip-thigh pad 286, or of each joint 326, is spaced a distance D2 from the chest pad 368. As shown in FIG. 68, as the hip-thigh pads 286 are rotated about the pivot axis 248, the distance D2 between the pivot axis 248 and the chest pad 368 is substantially constant. Additionally, when the joints 326 are moved to an extended or flexed position, even though the distance D2 between the pivot axis 248 and the chest pad 368 remains substantially constant, the hip pads 286 may translate longitudinally a distance D3 toward the head-end of the patient positioning support system 5. Generally, the distance D3 is relatively small. When the joints 326 return to the neutral position, the hip pads 286 move back to the starting position, such as by longitudinally translating a distance D3 toward the foot-end of the system 5 such as toward the foot end 16' of the base 10 or toward the foot end 19 of the prone patient support structure 15.
Accordingly, in some embodiments, the distance D2 between the chest pad 368 and the hip-thigh pads 286 is substantially constant during movement of the joints 326 between a first position and a second position, or toward and away from the head-end 16 of the base 10 when moving between neutral and angulated positions. In other embodiments, the distance D2 between the chest pad 368 and the hip-thigh pads 286 is slightly variable during movement of the joints 326.

Supine Patient Support Structure

In some embodiments, the present invention includes a supine patient support structure 15' that is suspended above the floor F, such as is illustrated in FIGS. 102-116. In particular, the patient positioning support structure 5 of the present invention includes a base 10 that supports or suspends the supine patient support structure 15' above the floor F. The supine patient support structure 15' is removably attachable to the base 10 using a pair of ladders 100, 100', such as with a pair of standard-length ladders 100 or a pair of extended-length ladders 100', such as is described above with respect to attaching the prone patient support structure 15 to the base 10 using a pair of standard-length ladders 100.
In some embodiments, the supine patient support structure 15' includes an open frame 374 that is articulatable or breakable at a pair of spaced opposed hinges 376, and at least one of a set of body support pads (not shown), such as is known in the art, and a closed table-top 378 (FIG. 102). The supine patient support structure 15' also includes head-and foot-ends 288', 290', and left-hand and right-hand sides 298', 300'. The closed table-top 378 includes a head portion 380 and a foot portion 382, and may be covered by one or more flat pads 384. In some embodiments, the body support pads, the elongate table pad 384 and the table-top 378 are substantially radiolucent.
The supine patient support structure 15' includes head-end and foot-end ladder connection subassemblies 190'. In some embodiments, the ladder connection subassemblies 190' are configured and arranged so as to be substantially the same in structure and function as the ladder connection subassemblies 190 of the prone patient support structure 15. In other embodiments, other ladder connection subassemblies 190' are used. The ladder subassemblies 190' are attached to the rotation blocks 57 by either a pair of standard length ladders 100 (FIG. 10) or a pair of extended length ladders 100' (FIG. 101) using a pair of T-pins 101 (FIG. 11), such as is described with respect to the ladder connection subassemblies 190 of the prone patient positioning structure 15. It is noted that the T -pins 101 are coaxial with second and third pitch axes P2 and P3 of the supine patient support structure 15', similar to that described above with respect to the prone patient support structure 15, whereby the supine patient support structure 15' can rotate or pivot about the second and third pitch axes P2 and P3.
The spaced opposed hinges 376 of the supine patient support structure 15' pivot about a first pivot axis P1. As shown in FIGS. 116-120, each hinge 376 includes pivotably connected first and second hinge members 388 and 390, respectively, and a worm drive, generally 392. A shroud or housing 394 covers and protects the worm drive 392. The worm drive 392 is also partially covered by a frame portion 396 that joins the second hinge member 390 with the frame 374 of the supine patient support structure 15'. In some embodiments, the frame 374 includes one or more of the first and second hinge members 388, 390, and the frame portion 396. However, it is foreseen that the hinges 376 may be entirely separate from but connected to the frame 374.
The worm drive 392 is a gear arrangement in which a worm 398, which is a gear in the form of a screw or helical thread, meshes with a worm gear 400. Like other gear arrangements, a worm drive 392 can reduce rotational speed or allow higher torque to be transmitted. Additionally, a worm gear drive is a one-way mechanism in that the work 398 can turn the worm gear 400, but usually not vice versa. In the illustrated embodiments, the worm drive 392 is actuated by a motor 402 and the amount of pivot about the first pitch axis P1 is selectable by controlling the amount of rotation of the work 398.
In some embodiments, the supine patient support structure 15' is reversibly positionable in a lateral-decubitus position, such as is shown in FIGS. 112-113. In a lateral-decubitus position, the patient may be positioned on their side, such that the patient is bent at the waist, with the head and feet lower than the hips. A lateral-decubitus position is essential for certain spinal surgeries, such as is known in the art. When in a lateral-decubitus position, the supine patient support structure 15' is typically joined with the base 10 using the extended-length ladders 100'. The extended-length ladders 100' are useful for positioning the patient in a lateral-decubitus position while spacing the surgical site, and therefore spacing the first pitch axis P1 and the hinges 376, a suitable distance D4 from the floor F, such that the surgeon can perform the surgery comfortably.
In some embodiments, the patient positioning support system 5 includes a supine patient support structure 15', such as is shown in FIGS. 102-108, that is used for positioning a patient (not shown) in a supine or lateral position, such as is described elsewhere herein.
In another exemplary embodiment of the supine patient support structure 15' shown in FIG. 105, a first pitch axis P1 is associated with the pair of spaced opposed hinges 376. The supine patient support structure 15' also includes second and third pitch axes P2 and P3 that are associated with its head and foot-ends, which are generally denoted by the numerals 18' and 19' (FIG. 104) respectively.
For convenience, the left and right-hand sides of the supine patient support structure 15' are designated 298' and 300', and are also associated with the left and right sides, respectively of the patient in a supine position. Accordingly, when the patient positioning support structure 5 is configured for a sandwich-and-roll procedure, the two left-hand sides 298 and 298' of the prone and supine patient support structures 15 and 15' are spaced from each other, on the front and back sides of the patient, such as is shown in FIGS. 92a through 98. Additionally, the two right-hand sides 300 and 300' of the prone and supine patient support structures 15 and 15' are also spaced from each other, on the front and back sides of the patient.
With reference to FIGS. 112 and 114, the vertical translation subassemblies 20 can be raised or upwardly telescoped, such as to raise the ends 18', 19' of the supine patient support structure 15'. While moving to the position shown in FIG. 114, the height of the surgical site D4 is maintainable by pivoting the hinges 376 downwardly.
Still referring to FIGS. 112 and 114, in some embodiments, the supine patient support structure 15' includes an in-frame translation compensation subassembly 320' that is substantially similar to the translation compensation subassembly 320 of the prone patient support structure 15. The in-frame translation compensation subassembly 320' includes a translation rod 322', which is most easily seen in FIG. 112, that is actively extended and retracted, or telescoped at the foot-end 304' of the frame 374. It is foreseen that in some embodiments the supine patient support structure 15' includes a translation compensation subassembly 320' that is located outside of the frame 374. It is foreseen that in some embodiments, the supine patient support structure 15' includes a translation compensation subassembly 320' similar to but not limited to translation compensation structures and mechanisms described in U.S. Patent No. 7,152,261 , U.S. Patent No. 7,343,635 , U.S. Patent No. 7,565,708 , U.S. Patent No. 8,060,960 , or U.S. Patent Application No. 60/798,288 , U.S. Patent Application No. 12/803,173 , U.S. Patent Application No. 12/803,192 , or U.S. Patent Application No. 13/317,012 .

Sandwich-And-Roll Procedure

In some embodiments, such as but not limited to when performing various steps of a sandwich-and-roll procedure, such as is illustrated in FIGS. 85-100, the supine patient support structure 15' is spaced from and opposed to the frame 296 of the prone patient support structure 15. In these embodiments, both the prone and supine patient support structures 15 and 15' are attached to the base 10. When both the prone and supine patient support structures 15 and 15' are attached to the base 10, a patient can be sandwiched between the structures 15 and 15'. A space S (FIG. 100) between the prone 'and supine patient support structures 15 and 15' is adjustable. For example, in some embodiments, the space S can be modified by moving one of the patient support structures 15 or 15' away from, or toward, the opposed patient support structure. For example, a first T-pin 101 (FIG. 11) associated with a first end of the patient support structure 15 or 15' to be adjusted can be disconnected, such as described elsewhere herein, followed by moving the associated end of the patient support structure upwardly or downwardly a distance along the associated ladder 100, 100', and reconnecting the first T-pin 101; followed by disconnecting a second T-pin 101 associated with the second end of the patient support structure 15 or 15', adjusting the second end of the patient support structure the same distance along the ladder 100, 100' as the first end, and then reconnecting the second T-pin 101.
Referring now to FIGS. 4-7, and as noted above, the patient positioning support structure 5 of the present invention includes a base 10 with a pair of spaced opposed vertical translation subassemblies 20 that are optionally joined by a cross-bar 25. The patient positioning support structure 5 is adapted such that the vertical translation subassemblies 20 are not substantially laterally movable with respect to one another during operation of the patient positioning support structure 5. The patient positioning support structure 5 also includes a prone patient support structure 15 removably attached to the base 10 by connection subassemblies 75 located at the head- and foot-ends 18, 19 of the prone patient support structure 15. The patient positioning support structure 15 includes a pair of spaced opposed gliding or sliding joints 326. The joints 326 each include a virtual pivot axis 248, and arc of motion AOM (FIG. 72) attached thereto and a radius r. The joints 326 are attached to hip-thigh pads 286 and are sized, shaped, configured and arranged to slidingly rotate at least a portion of the hip-thigh pads 286 about or around the virtual pivot axis 248 and along the arc of motion AOM. Accordingly, the hips of a patient on the prone patient support structure 15 can be flexed and extended about the virtual pivot axis 248, thereby enabling flexion and translation of the hips substantially without lateral translation of the patient's torso. The virtual pivot axis 248 is associated with a selectable location or height for the surgical site, wherein the height of virtual pivot axis 248 is spaced a first distance D1 above the floor F. As the prone patient support structure 15 is manipulated to place the patient in various positions, such as but not limited to flexed or articulated positions and additionally or alternatively Trendelenburg or reverse Trendelenburg positions, the patient positioning support structure 5 is adapted to substantially maintain the first distance D1.
Still referring to FIGS. 4-7, the patient positioning support system 5 includes a roll axis R, about which the prone patient support structure 15 can be tilted or rotated. When the supine patient support structure 15' is attached to the base 10, the supine patient support structure 15' can also be tilted or rotated about the roll axis R. The patient positioning support system 5 includes a pair of vertical translation axes V1 and V2 (FIG. 2), wherein each of the vertical translation axes V1 and V2 is associated with one of the vertical translation subassemblies 20. Additionally, the patient positioning support system 5 includes a pair of yaw axes Y1 and Y2 associated with the connection subassemblies 75. The yaw axes Y1 and Y2 allow for generally small amounts of rotation of the patient support structure 15 or 15' thereabout when the patient support structure 15 or 15' is placed in a Trendelenburg or reverse Trendelenburg position and also tilted about the roll axis R.
The prone patient support structure 15 includes the releasably attachable and lockable torso support structure 362 with a chest pad 368. The location of the chest pad 368 is slidably adjustable along a length of the prone patient support structure 15, as indicated by the straight double-headed arrow (FIG. 4) above the torso support 362 that is generally parallel with the roll axis R.
As shown in FIGS. 23-30, the patient positioning support system 5 is configured and arranged to move and place .the patient support structure 15 or 15' in a reverse Trendelenburg position, such as but not limited to by outwardly telescoping the head-end vertical translation subassembly 20 and alternatively or additionally inwardly telescoping the foot-end vertical translation subassembly 20, such as is indicated by the upward and downward arrows, respectively in FIG. 23. It is noted that D1 in FIG. 24 is substantially equal to D1 in FIG. 4. In FIG. 4, the roll axis R is substantially parallel with the floor F. However, in FIG. 24, the roll axis R sloped upwardly from the floor F from the foot-end 19 to the head-end 18, moving from left to right across the page. It is noted that when the patient support structure 15 is moved from the position of Fig. 4 to the position shown in FIG. 24, the distance between the virtual pivot axis 248 and a point of the chest pad 368 does not change substantially. Also, in the configuration of FIG. 24, the patient support structure 15 had not substantially pivoted about either of the yaw axes Y1 or Y2. In the position shown in FIG. 24, the patient support structure 15 does pivot about the second and third pivot axes P2 and P3, which is most easily seen in FIGS. 24, 29 and 30, and is indicated by arrows 292 and 294.
FIGS. 31-38 show the patient positioning support structure in a Trendelenburg position. This positioning is achieved by telescoping the vertical translation subassemblies 20 in opposite directions from those associated with placing the patient positioning support structure in a reverse Trendelenburg position. It is noted that D1 of FIG. 32 is substantially equal to D1 of FIGS. 4 and 24.
Figs. 39-47 illustrate the configuration of the patient positioning support structure 5 with the patient support structure 15 in a neutral position and the joints 326 rotated such that the lower extremity support structure 344, or lower body support structure, is adjusted so as to flex the hips and knees of a patient thereon. Again, D1 of FIG. 40 is substantially equal to D1 of FIGS. 4, 24 and 32.
FIGS. 48-54 illustrate the patient positioning support structure 5 with the patient support structure 15 in a neutral position and the joints 326 rotated such that the lower body support structure 344 is adjusted so as to flex the hips and knees of a patient thereon and also such that the patient support structure 15 is rolled or tilted about, or approximately, 25° about, or around, the roll axis R. Such tilting can proved improved access to the surgical site. The patient support structure 15 can also be tilted when the legs are extended, such as is described elsewhere herein.
Figs. 55-65 illustrate the patient positioning support structure 5 in a reverse Trendelenburg position and with the joints 326 rotated such that the lower body support structure 344 is adjusted so as to extend the hips and knees of a patient thereon. It is noted that the distance D1 of FIGS. 56 is substantially equal to the distance D1 of FIGS. 4, 24, 32 and 40. To maintain the height D1 while extending the hips, the head-end vertical translator 20 is telescoped upwardly, so as to raise the head-end 18 of the patient support structure 15, and the foot-end vertical translator 20 is telescoped downwardly, so as to lower the foot-end 19 of the prone patient support structure 15. This changes the roll axis R to a position sloping upwardly from the foot end 19 to the head end 18, as viewed from the left to the right of the page. Additionally, articulation or rotation occurs about all three pitch axes, P1 (FIG. 55), P2 and P3 (FIG. 57).

Claims

A patient support apparatus (5) for supporting a patient during a surgical procedure, the apparatus comprising:
a) an open fixed frame (296) suspended above a floor (F);

b) a lower body support structure (344) joined with the open fixed frame (296) by a pair of spaced opposed joints (326), the joints (326) including a first pivot axis (PI) about which the lower body support structure (344) is configured to pivot relative to the open fixed frame (296), the lower body support structure (344) and the open fixed frame (296) being movable between a neutral position, a flexed position and an extended position with respect to the floor (F);

c) a chest pad (368) associated with an upper-body side of the joints (326) and being in a fixed position relative to the open fixed frame (296);

d) a hip-thigh pad (286) associated with a lower-body side of the joints (326) and being opposed to and spaced a distance from the chest pad (368); and

e) wherein a distance (D2) between the chest pad (368) and the hip-thigh pad (286) is substantially constant during movement of the joints (326); characterised in that

f) the lower body support structure (344) includes a femoral support structure (346) and a lower leg cradle (348); and

g) the femoral support structure (346) and the lower leg cradle (348) are pivotably connected by a pair of knee hinges (350) so as to be movable between a neutral position and a flexed position.
The apparatus of claim 1, wherein the first pivot axis (PI) intersects a virtual pivot point (248) associated with each of the pair of spaced opposed joints (326).
The apparatus of claim 2, wherein the first pivot axis (PI) intersects the hip-thigh pads (286).
The apparatus of claim 2, wherein the virtual pivot points (248) are located on or above the hip-thigh pads (286).
The apparatus according to claim 1, wherein the hip-thigh pad (286) translates a distance (D3) away from the chest pad (368) during certain movements of the joint (326).
The apparatus of claim 1, wherein the joints (326) are movable along an arc of motion (AOM) so as to rotate the hip-thigh pads (286) about the first pivot axis (PI).
The apparatus of claim 1, wherein the joints (326) comprise a first joint component (328) comprising a rack of teeth (328) adapted to cooperatively engage teeth (332) of a third joint component (332) comprising a pinion gear that is coupled with a motor (333) that is configured to actively rotate the pinion gear.