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

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

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Publication number
EP2890351B1
EP2890351B1 EP13833588.0A EP13833588A EP2890351B1 EP 2890351 B1 EP2890351 B1 EP 2890351B1 EP 13833588 A EP13833588 A EP 13833588A EP 2890351 B1 EP2890351 B1 EP 2890351B1
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EP
European Patent Office
Prior art keywords
patient
support structure
patient support
joints
prone
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Active
Application number
EP13833588.0A
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German (de)
French (fr)
Other versions
EP2890351A1 (en
EP2890351A4 (en
Inventor
Lawrence E. Guerra
Trevor A. WAGGONER
Steven R. Walton
Michael A. HERRON
Roger P. Jackson
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Warsaw Orthopedic Inc
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Warsaw Orthopedic Inc
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Filing date
Publication date
Priority to US201261743240P priority Critical
Priority to US201261795649P priority
Priority to US201361849035P priority
Priority to US201361849016P priority
Priority to US201361852199P priority
Priority to PCT/US2013/000199 priority patent/WO2014035460A1/en
Application filed by Warsaw Orthopedic Inc filed Critical Warsaw Orthopedic Inc
Publication of EP2890351A1 publication Critical patent/EP2890351A1/en
Publication of EP2890351A4 publication Critical patent/EP2890351A4/en
Application granted granted Critical
Publication of EP2890351B1 publication Critical patent/EP2890351B1/en
Application status is Active legal-status Critical
Anticipated expiration legal-status Critical

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61GTRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00Operating tables; Auxiliary appliances therefor
    • A61G13/02Adjustable operating tables; Controls therefor
    • A61G13/08Adjustable operating tables; Controls therefor the table being divided into different adjustable sections
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61GTRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00Operating tables; Auxiliary appliances therefor
    • A61G13/0036Orthopaedic operating tables
    • A61G13/0054Orthopaedic operating tables specially adapted for back or spinal surgeries
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61GTRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00Operating tables; Auxiliary appliances therefor
    • A61G13/02Adjustable operating tables; Controls therefor
    • A61G13/04Adjustable operating tables; Controls therefor tiltable around transverse or longitudinal axis
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61GTRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00Operating tables; Auxiliary appliances therefor
    • A61G13/10Parts, details or accessories
    • A61G13/101Clamping means for connecting accessories to the operating table
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61GTRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00Operating tables; Auxiliary appliances therefor
    • A61G13/10Parts, details or accessories
    • A61G13/104Adaptations for table mobility, e.g. arrangement of wheels
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61GTRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00Operating tables; Auxiliary appliances therefor
    • A61G13/10Parts, details or accessories
    • A61G13/12Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A61G13/1205Rests specially adapted therefor; Arrangements of patient-supporting surfaces for specific parts of the body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61GTRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00Operating tables; Auxiliary appliances therefor
    • A61G13/10Parts, details or accessories
    • A61G13/12Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A61G13/1205Rests specially adapted therefor; Arrangements of patient-supporting surfaces for specific parts of the body
    • A61G13/121Head or neck
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61GTRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00Operating tables; Auxiliary appliances therefor
    • A61G13/10Parts, details or accessories
    • A61G13/12Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A61G13/1205Rests specially adapted therefor; Arrangements of patient-supporting surfaces for specific parts of the body
    • A61G13/122Upper body, e.g. chest
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61GTRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00Operating tables; Auxiliary appliances therefor
    • A61G13/10Parts, details or accessories
    • A61G13/12Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A61G13/1205Rests specially adapted therefor; Arrangements of patient-supporting surfaces for specific parts of the body
    • A61G13/123Lower body, e.g. pelvis, hip, buttocks
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61GTRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00Operating tables; Auxiliary appliances therefor
    • A61G13/10Parts, details or accessories
    • A61G13/12Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A61G13/1205Rests specially adapted therefor; Arrangements of patient-supporting surfaces for specific parts of the body
    • A61G13/1235Arms
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61GTRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
    • A61G13/00Operating tables; Auxiliary appliances therefor
    • A61G13/10Parts, details or accessories
    • A61G13/12Rests specially adapted therefor; Arrangements of patient-supporting surfaces
    • A61G13/128Rests specially adapted therefor; Arrangements of patient-supporting surfaces with mechanical surface adaptations
    • A61G13/1285Rests specially adapted therefor; Arrangements of patient-supporting surfaces with mechanical surface adaptations having modular surface parts, e.g. being replaceable or turnable

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