The present invention relates to a surgical frame for supporting a patient during surgery. The surgical frame includes components that can be adjusted to facilitate positioning and repositioning of a patient during surgery and/or to accommodate differently sized patients. The components of the surgical frame are configured to afford supported movement of a patient during surgery. Preferred components of the surgical frame afford adjustment of the position of the upper body (including the head, shoulders, arms, and chest), and the lower body (including the hips, legs, and feet) of a patient. Additionally, the surgical frame includes components that afford movement of the entirety of the surgical frame. In doing so, the entirety of the surgical frame can be pivoted to further adjust the position of a patient during surgery including between a prone position and a lateral position. In a preferred embodiment of the surgical frame the patient can be positioned in a prone position, a lateral position, or an angled position therebetween, by way of example, at a 45 degree angle.
Traditionally, it has been difficult to articulate the bodies of patients during surgery. It is inherently difficult to position and reposition a patient under general anesthesia. To illustrate, multiple operating room personnel may be required for positioning a patient to afford a first surgical approach, and repositioning the patient to afford a second surgical approach may again require multiple operating room personnel.
Given the inherent difficulty in moving a patient during surgery, there exists a need for a surgical frame for supporting a patient thereon that affords positioning and repositioning of the patient to afford multiple surgical approaches.
The present invention in one preferred embodiment contemplates a positioning frame for supporting a patient, the positioning frame including at least one main beam having a first end, a second end, and a length extending between the first and second end, the at least one main beam defining an axis of rotation relative to at least a first support structure and a second support structure, the at least one main being rotatable about the axis of rotation between at least a first position and a second position, the axis of rotation substantially corresponding to a cranial-caudal axis of the patient when the patient is supported on the positioning frame; the first and second support structures supporting the at least one main beam, the first and second support structure spacing the at least one main beam from the ground; a torso-lift support attached to the at least one main beam, the torso-lift support including a chest support plate being configured to support the chest of the patient, the torso-lift support being pivotally connected to the at least one main beam, the torso-lift support being configured to pivot the chest support plate between at least a first position and a second position to move the torso of the patient between an unlifted position and a lifted position; and a pelvic-tilt support attached to the at least one main beam, the pelvic-tilt support including a thigh cradle and a lower leg cradle, the thigh support being configured to support the thighs of the patient, and the lower leg cradle being configured to support the lower legs of the patient, the thigh cradle and the lower leg cradle being pivotal with respect to one another to facilitate adjustment of the hips of the patient.
The present invention in another preferred embodiment contemplates A positioning frame for supporting a patient, the positioning frame including at least one main beam having a first end, a second end, and a length extending between the first and second end, the at least one main beam defining an axis of rotation relative to at least a first support structure and a second support structure, the at least one main being rotatable about the axis of rotation between at least a first position and a second position, the axis of rotation substantially corresponding to a cranial-caudal axis of the patient when the patient is supported on the positioning frame; the first and second support structures supporting the at least one main beam, the first and second support structure spacing the at least one main beam from the ground; a torso-lift support attached to the at least one main beam, the torso-lift support including a chest support plate being configured to support the chest of the patient, the torso-lift support being pivotally connected to the at least one main beam, the torso-lift support being configured to pivot the chest support plate between at least a first position and a second position to move the torso of the patient between an unlifted position and a lifted position; a pelvic-tilt support attached to the at least one main beam, the pelvic-tilt support including a thigh cradle and a lower leg cradle, the thigh support being configured to support the thighs of the patient, and the lower leg cradle being configured to support the lower legs of the patient, the thigh cradle and the lower leg cradle being pivotal with respect to one another to facilitate adjustment of the hips of the patient; a coronal adjustment assembly attached to the at least one main beam, the coronal adjustment assembly being configured to move at least a portion of the torso of the patient away from a portion of the at least one main beam; and at least one actuator for articulating at least one of the at least one main beam, the torso-lift support, the pelvic-tilt support, and the coronal adjustment assembly.
The present invention in yet another preferred embodiment contemplates a method of performing surgical using a positioning frame to position portions of the body of a patient, the method including positioning the patient on the positioning frame by approximately aligning the cranial-caudal axis of the body of the patient with an axis of rotation of a main support beam; supporting the torso of the patient on a torso-lift support, the torso-lift support being attached to the main support beam; supporting the thighs and lower legs of the patient on a pelvic-tilt support; the pelvic-tilt support being attached to the main support beam; and rotating the main support being about the axis of rotation there to move the patient between a first position and a second position, the patient being in a prone position in the first position and in a lateral position in the second position.
The present invention in yet another preferred embodiment contemplates an adjustable surgical frame for supporting a patient to facilitate different surgical approaches to the spine of the patient, the adjustable surgical frame including a first end, an opposite second end, and a length extending between the first and second ends thereof, the surgical frame having a longitudinal axis extending between the first and second ends along the length thereof, the surgical frame being moveable between a first position, a second position, and a third position, the surgical frame being supported by a first support surface in the first position, a second support surface in the second position, and a third support surface in the third position, a chest support being configured to support the chest of the patient on the surgical frame, at least a portion of the chest support being movable in a direction transverse to the longitudinal axis of the surgical frame to facilitate positioning and repositioning of the chest of the patient thereon, a hip and upper leg support being configured to support the hips and upper legs of the patient on the surgical frame, at least a portion of the hip and upper leg support being pivotally adjustable to facilitate positioning and repositioning of the hips and upper legs of the patient, and a feet and lower leg support being configured to support the feet and the lower legs of the patient on the surgical frame, at least a portion of the feet and lower leg support being moveable in a direction aligned with the longitudinal axis of the surgical frame to facilitate positioning and repositioning of the feet and lower legs of the patient, where the coronal plane of the patient is oriented approximately horizontal when the surgical frame is in the first position, the coronal plane of the patient is oriented approximately 45° with respect to horizontal and vertical when the surgical frame is in the second position, the coronal plane of the patient is oriented approximately vertical when the surgical frame is in the third position.
The present invention in yet another preferred embodiment contemplates a method including providing the surgical frame having a first end, an opposite second end, and a length extending between the first and second ends, the surgical frame having a longitudinal axis extending between the first and second ends along the length thereof, the surgical frame including at least a chest support, a hip and upper leg support, and a feet and lower leg support, adjusting the chest support, the hip and upper leg support, and the feet and lower leg support to accommodate the size of the patient, positioning the patient on the surgical frame by contacting portions the chest of the patient with the chest support, contacting portions of the hips and upper legs of the patient with the hip and upper leg support, and contacting at least the feet of the patient with the feet and lower leg support, moving the surgical frame between a first position, a second position, and a third position, and performing surgery on the patient when the surgical frame is disposed in the first, second, and third positions, where the coronal plane of the patient is oriented approximately horizontal when the surgical frame is in the first position and the patient is supported thereby, the coronal plane of the patient is oriented approximately 45° with respect to horizontal and vertical when the surgical frame is in the second position and the patient is supported thereby, and the coronal plane of the patient is oriented approximately vertical when the surgical frame is in the third position and the patient is supported thereby.
The present invention in yet another preferred embodiment contemplates an adjustable surgical frame for supporting a patient to facilitate different surgical approaches to the spine of the patient, the adjustable surgical frame having a first end, an opposite second end, and a length extending between the first and second ends thereof, the surgical frame having a longitudinal axis extending between the first and second ends along the length thereof, the surgical frame having a first support surface, a second support surface, and a third support surface, a chest support, at least a portion of the chest support being movable in a direction transverse to the longitudinal axis of the surgical frame to facilitate positioning and repositioning of the chest of the patient thereon, a hip and upper leg support, at least a portion of the hip and upper leg support being pivotally adjustable to facilitate positioning and repositioning of the hips and upper legs of the patient, a feet and lower leg support, at least a portion of the feet and lower leg support being moveable in a direction aligned with the longitudinal axis of the surgical frame to facilitate positioning and repositioning of the feet and lower legs of the patient, where a first plane extends through the surgical frame, and the surgical frame is moveable between and supports the patient in a first position, a second position, and a third position, the surgical frame being supported by the first support surface in the first position, the second support surface in the second position, and the third support surface in the third position, the first plane being oriented approximately horizontal when the surgical frame is in the first position, the first plane being oriented approximately 45° with respect to horizontal and vertical when the surgical frame is in the second position, and the first plane being oriented approximately vertical when the surgical frame is in the third position.
These and other objects of the present invention will be apparent from review of the following specification and the accompanying drawings.
The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate preferred embodiments of the invention and, together with the description, serve to explain the objects, advantages, and principles of the invention. In the drawings:
The following description is intended to be representative only and not limiting. Many variations, therefore, can be anticipated according to these teachings. For example, a dynamic surgical table system is disclosed in U.S. Pat. No. 7,234,180, the contents of which are incorporated herein by reference. Reference will now be made in detail to the preferred embodiments of this invention, examples of which are illustrated in the accompanying drawings.
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The first portion 12 includes various frame members. The first portion 12 includes a first frame member 28, a second frame member 30, a third frame member 32 (
The second frame member 30 supports first and second chest support mechanisms 40 and 42. Each of the first and second chest support mechanisms 40 and 42 include a collar portion 44, an upright portion 46, an extension portion 48, and a chest pad 50. As discussed below, components of the first and second chest support mechanisms 40 and 42 can be adjusted to position and reposition the upper body (including the chest) of the patient P during surgery and/or to accommodate differently sized patients.
The collar portions 44 of the first and second chest support mechanisms 40 and 42 are moveable with respect to the second frame member 30, and the extension portions 48 are moveable with respect to the upright portions 46. Furthermore, the chest pads 50 are attached to the extension portions 48. Movement of the collar portions 44 with respect to the second frame member 30, and movement of the extension portions 48 with respect to the upright portions 46 serves in facilitating positioning and repositioning of the chest pads 50.
Each of the collar portions 44 include an aperture 52 for receiving the second frame member 30 therethrough to facilitate slidable movement of the first and second chest support mechanisms 40 and 42 on the second frame member 30.
The first and second chest support mechanisms 40 and 42 each include a pin 54, and the collar portions 44 each include apertures 56 through opposed sides thereof for receiving one of the pins 54. Furthermore, the second frame member 30 includes various sets of apertures 58 along and through opposed sides thereof for receiving the pins 54. When the apertures 56 are aligned with one of the sets of apertures 58, insertion of one of the pins 54 through the apertures 56 and one of the sets of apertures 58 serves to hold the first and second chest support mechanisms 40 and 42 in position with respect to the second frame member 30. As such, the first and second chest support mechanisms 40 and 42 can be positioned and repositioned along the second frame member 30.
The extension portion 48 is partially received within the upright portion 46, and is moveable outwardly and inwardly with respect to the upright portion 46. Each of the first and second chest support mechanisms 40 and 42 include a pin 60, and the upright portions 46 each include apertures 62 through opposed sides thereof for receiving one of the pins 60. Furthermore, each of the extension portions 48 include various sets of apertures (not shown) along and through opposed sides thereof for receiving one of the pins 60. When the apertures 62 are aligned with one of the sets of apertures in one of the extension portions 48, insertion of one of the pins 60 through the apertures 62 and one of the sets of apertures in one of the extension portions 48 serves to hold the extension portion 48 (and the chest pad 50 attached thereto) in position with respect to the corresponding upright portion 46. As such, the chest pads 50 of the first and second chest support mechanisms 40 and 42 can be positioned and repositioned with respect to the upright portions 46 (and the remainder of the first and second chest support mechanisms 40 and 42).
The third and fourth frame members 32 and 34 support hip and upper leg support mechanism 70 and feet support mechanism 72. As discussed below, components of the hip and upper leg support mechanism 70 and the feet support mechanism 72 can be adjusted to position and reposition the lower body (including the hips, legs, and feet) of the patient P during surgery and/or to accommodate differently sized patients. In situations where the patient P is being positioned for back surgery, hip and upper leg support mechanism 70 offers a significant advantage to the surgeon by permitting the positioning of the patient's back into a preferred position for access to the surgical site. By way of example, during posterior lumbar surgery, the patient's back can by curved via movement of the hip and upper leg support mechanism 70 to a more distracted/open orientation on the posterior side between adjacent vertebrae so as to facilitate removal of the disc therebetween and/or subsequent insertion of a spinal implant therein.
As depicted in
The first and second collar members 76 and 78 are hollow. As such, the first and second collar members 76 and 78 include cavities 84 and 85, respectively, extending therethrough from one end to the other end thereof. The third frame member 32 is received through the first collar member 76, and the fourth frame member 34 is received through the second collar member 78. As such, the first and second collar members 76 and 78 are moveable along the third and fourth frame members 32 and 34, respectively. The movement of the first and second collar members 76 and 78 along the third and fourth frame members 32 and 34, respectively, facilitates movement of the sub-frame 74 (and hence, the hip and upper leg support mechanism 70 and the feet support mechanism 72) relative to the remainder of the surgical frame 10. As discussed above, the moveable frame member 36 also affords repositioning of the third and fourth frame members 32 and 34 (and the sub-frame 74, and the hip and upper leg support mechanism 70 and the feet support mechanism 72 supported by the sub-frame 74) along the first frame member 28. As such, the positions of the hip and upper leg support mechanism 70 and the feet support mechanism 72 can be changed by moving the moveable frame member 36 along the first frame member 28, and by moving the sub-frame 74 along the third and fourth frame members 32 and 34.
The sub-frame includes a pin 86, and the second collar member 78 includes apertures 87 through opposed sides thereof for receiving the pin 86. Furthermore, the fourth frame member 34 includes various sets of apertures 88 along and through opposed sides thereof for receiving the pin 86. When the apertures 87 are aligned with one of the sets of apertures 88, insertion of the pin 86 through the apertures 87 and the sets of apertures 88 serves to hold the second collar member 78 (and hence, the sub-frame 74) in position relative to the fourth frame member 34.
As discussed above, the first and second collar members 76 and 78 of the sub-frame 74 are moveable along the third and fourth frame members 32 and 34, respectively. To facilitate such movement (especially when the patient P is positioned on the surgical frame 10), the third frame member 32 and the first collar member 76 include an internal mechanism (not shown) that translates rotational movement of a shaft 90 extending through the third frame member 32 into movement of the sub-frame 74 (and the hip and upper leg support mechanism 70 and the feet support mechanism 72 attached thereto). Rotation of the shaft 90 in one direction moves the sub-frame 74 (and the hip and upper leg support mechanism 70 and the feet support mechanism 72 attached thereto) toward the first frame member 28, and rotation of the shaft 90 in the other direction moves the sub-frame 74 (and the hip and upper leg support mechanism 70 and the feet support mechanism 72 attached thereto) away from the first frame member 28. Thus, via movement of the sub-frame 74, the hip and upper leg support mechanism 70 and the feet support mechanism 72 can be moved toward and away from the first frame member 28 to position and reposition the lower body of the patient P during surgery and/or to accommodate differently sized patients.
As depicted in
The flange portion 96 attaches the feet support mechanism 72 to the second cross member 82 using bolts 104 attached to a truck 106 moveable within the second cross member 82. The bolts 104 are attached to the truck 106 through a slot 110 formed in the second cross member 82. The truck 106 is confined within the interior of the second cross member 82, and the slot 110 affords movement of both the truck 106 and the feet support mechanism 72 attached thereto relative to the second cross member 82. To facilitate such movement (especially when the patient P is positioned on the surgical frame 10), the second cross member 82 includes an internal mechanism (not shown) that translates rotational movement of a shaft 112 extending through the second cross member 82 into movement of the truck 106 (and the feet support mechanism 72 attached thereto). Rotation of the shaft 112 in one direction moves the truck 106 (and the feet support mechanism 72 attached thereto) toward the fourth frame member 34, and rotation of the shaft 112 in the other direction moves the truck 106 (and the feet support mechanism 72 attached thereto) away from the fourth frame member 34. As such, movement of the feet support mechanism 72 toward and away from the fourth frame member 34 serves to position and reposition the legs of the patient P during surgery and/or to accommodate differently sized patients.
The first and second foot supports 100 and 102 are provided on opposed sides of the upright portion 98. The first and second foot supports 100 and 102 each include an arm portion 116 and an extension portion 118. The arm portions 116 of the first and second foot supports 100 and 102 are attached to either side of the upright portion 98 using a pin 120, and washers 122 received on the pin 120 are positioned between the arm portions 116 and the upright member 98. The pin 120 allows the first and second foot supports 100 and 102 to pivot. The extension portions 118 support the feet of the patient thereon, and, as the patient is positioned and repositioned, the extension portions 118 move via pivotal movement of the first and second foot supports 100 and 102 to accommodate such positioning.
As depicted in
The patient support platform 130 includes a body portion 132, a first leg portion 134, and a second leg portion 136. A slot 138 separates the first and second leg portions 134 and 136 from one another. The body portion 132 serves in supporting the hips of the patient P, the first and second leg portions 134 and 136 serves in supporting the upper legs of the patient, and the slot 138 serves to limit contact of the support platform 130 with the groin area of the patient.
As depicted in
The first and second angled portions 140 and 142 are attached to the first collar member 76 of the sub-frame 74, and the first and second extension portions 144 and 146 are partially received within the first and second angled portions 140 and 142, respectively. As seen in
End portions 154 and 156 of the first and second extension portions 144 and 146, respectively, are attached to the plate 148. The plate 148 is attached to the patient support platform 130, and the plate 148 includes a top surface 160 and a bottom surface 162. The top surface 160 contacts the patient support platform 130, and the bottom surface 162 includes a first clevis 164 and a second clevis 166 facilitating attachment of the first and second extension portions 144 and 146 to the plate 148. Attachment of the end portions 154 and 156 to plate 148 allows for pivotal movement of the plate 148 (and the patient support platform 130 attached thereto) with respect to the first and second extension portions 144 and 146. Furthermore, movement of the first and second extension portions 144 and 146 with respect to the first and second angled portions 140 and 142 allows for outward and inward movement of plate 148 (and the patient support platform 130 attached thereto). As such, the angle and location of the patient support platform 130 can be adjusted to position and reposition the hips and the upper legs of the patient during surgery and/or to accommodate differently sized patients.
The first and second clevises 164 and 166 can be integrally formed with the plate 148. The end portion 154 is received in the first clevis 164 and the second end portion 156 is received in the second clevis 166. Each of the first and second clevises 164 and 166 include apertures 170 therethrough, and each of the end portions 154 and 156 include apertures (not shown) therethrough on opposed sides of the first and second extension portions 144 and 146. Fixed pins 172 can be received through the apertures 170 and the apertures to pivotally attach the end portions 154 and 156 to the first and second clevises 164 and 166, respectively. Furthermore, each of the fixed pins 172 includes a handle 174 that can be tightened onto the fixed pins 172 to hold the first and second clevises 164 and 166 in position relative to the end portions 154 and 156.
As discussed above, given that the plate 148 is attached to the patient support platform 130, the pivotal movement of the plate 148 affords corresponding pivotal movement of the patient support platform 130 attached thereto. Thus, tightening of the handles 174 onto the fixed pins 172 serves to hold the plate 148 and the patient support platform 130 attached thereto in position relative to the first and second extension portions 144 and 146. Furthermore, as discussed above, given that the plate 148 is attached to the first and second extension portions 144 and 146, movement of the first and second extension portions 144 and 146 outwardly and inwardly affords corresponding outward and inward movement of the plate 148 and the patient support platform 130 attached thereto. Thus, insertion of the pins 152 through one of the sets of apertures in each of the first and second extension portions 144 and 146 serves to hold the first and second extension portions 144 and 146, the plate 148 attached to the first and second extension portions 144 and 146, and the patient support platform 130 attached to the plate 148 in position relative to the first and second angled portions 140 and 142.
As depicted in
The extension portion 184 is moveable outwardly and inwardly with respect to the base portion 182. Moving the extension portion 184 outward lengthens the telescoping mechanism 180, and moving the extension portion 184 inward shortens the telescoping mechanism 180. The base portion 182 includes apertures 192 in opposed sides thereof, and the extension portion 184 includes sets of apertures 194 along and through opposed sides thereof. When the apertures 192 are aligned with one of the sets of apertures 194, insertion of a pin 196 through the apertures 192 and one of the sets of apertures 194 serves to hold the base portion 182 and the extension portion 184 in position with respect to one another. As such, the extension portion 184 can be positioned and repositioned with respect to the base portion 182.
The clevis 186 is attached to an extension arm 190 depending downwardly from the plate 148. The clevis 186 can be integrally formed with the extension portion 184, and the extension arm 190 can be integrally formed with plate 148. The extension arm 190 is received within the clevis 186. As depicted in
The lengthening or shortening of the telescoping mechanism 180 can be used to adjust the angle of the patient support platform 130. As discussed above, the plate 148 is pivotally attached to the first and second extension portions 144 and 146 via the first and second clevises 164 and 166. The extension arm 190 attached to the plate 148 serves as a moment arm to facilitate pivotal movement of the plate 148 on the first and second clevises 164 and 166. Movement of the extension arm 190 toward the first and second chest support mechanisms 40 and 42 serves to move the body portion 132 of the patient support platform 130 downwardly, and movement of the extension arm 190 toward the feet support mechanism 72 serves to move the body portion 132 of the patient support platform 130 upwardly. Lengthening of the telescoping mechanism 180 moves the extension arm 190 toward the first and second chest support mechanisms 40 and 42, and shortening of the telescoping mechanism 180 moves the extension arm 190 toward the feet support mechanism 72. As such, by adjusting the telescoping mechanism 180, the angle of the plate 148 and the patient support platform 130 attached thereto can be adjusted to position and reposition the hips and the upper legs of the patient P during surgery and/or to accommodate differently sized patients.
As depicted in
A portion of the third portion 16 can be separable from the remainder of the surgical frame 10. As depicted in
In addition to the first and second chest support mechanisms 40 and 42, the hip and upper leg support mechanism 70, and the feet support mechanism 72, the surgical frame 10 includes a lateral shoulder/upper torso mechanism 250 and a lateral hip support mechanism 252. As discussed below, components of the lateral shoulder/upper torso mechanism 250 and the lateral hip support mechanism 252 can be adjusted to position and reposition the upper body (including the chest) and the hips of the patient P during surgery and/or to accommodate differently sized patients.
As depicted in
The collar portion 260 includes an aperture 268 for receiving the second portion 232 of the ninth frame member 222 therethrough to facilitate slidable movement of the lateral shoulder/upper torso mechanism 250 on the ninth frame member 222. The lateral shoulder/upper torso mechanism 250 includes a pin 270, the collar portion 260 includes apertures 272 through opposed sides thereof for receiving the pin 270, and the second portion 232 of the ninth frame member 222 includes various sets of apertures 274 along and through opposed sides thereof for receiving the pin 270. When the apertures 272 are aligned with one of the sets of apertures 274, insertion of the pin 270 through the apertures 272 and one of the sets of apertures 274 serves to hold the lateral shoulder/upper torso mechanism 250 in position with respect to the ninth frame member 222. As such, the lateral shoulder/upper torso mechanism 250 can be positioned and repositioned along the ninth frame member 222.
The extension portion 264 is partially received within the base portion 262, and is moveable outwardly and inwardly with respect to the base portion 262. The lateral shoulder/upper torso mechanism 250 includes a pin 280, the base portion 262 includes apertures (not shown) through opposed sides thereof for receiving the pin 280, and the extension portion 264 includes various sets of apertures (not shown) along and through opposed sides thereof for receiving the pin 280. When the apertures in the base portion 262 are aligned with one of the sets of apertures in the extension portion 264, insertion of the pin 280 through the apertures in the base portion 262 and one of the sets of apertures in the extension portion 264 serves to hold the position of the extension portion 264 (and the shoulder/upper torso contacting portion 266 attached thereto) in position with respect to the base portion 262. As such, the shoulder/upper torso contacting portion 266 of the lateral shoulder/upper torso support mechanism 250 can be positioned and repositioned with respect to the base portion 262 (and the remainder of the lateral shoulder/upper torso mechanism 250).
As depicted in
The first portion 290 of the lateral hip support mechanism 252 includes a collar portion 300, a base portion 302, and a slidable portion 304. The collar portion 300 is moveable with respect to the eighth frame member 220, and the slidable portion 304 is moveable with respect to the fifth frame member 210. The collar portion 300 includes an aperture 306 for receiving the eighth frame member 220 therethrough to facilitate slidable movement of the first portion 290 on the eighth frame member 220. Furthermore, the slidable portion 304 is configured to rest on the fifth frame member 210 to facilitate slidable movement thereon. The first portion 290 includes a pin 310, the collar portion 300 includes apertures 312 through opposed sides thereof for receiving the pin 310, and the eighth frame member 220 includes various sets of apertures 314 along and through opposed sides thereof for receiving the pin 310. When the apertures 312 are aligned with one set of the apertures in the eighth frame member 220, insertion of the pin 310 through the apertures 312 and one of the sets of apertures 314 in the eighth frame member 220 serves to hold the position of the first portion of the lateral hip support mechanism 252 relative to the fifth frame member 210 and the eighth frame member 220. As such, the first portion 290 (and the second portion 292 attached thereto) of the lateral hip support mechanism 252 can be positioned and repositioned with respect to the fifth frame member 210 and the eighth frame member 220.
The second portion 292 of the lateral hip support mechanism 252 includes a collar portion 320, a base portion 322, an extension portion 324 (
To facilitate movement of the second portion 292 relative to the first portion 290, the lateral hip support mechanism 252 includes a pin 330, the collar portion 320 includes apertures 332 through opposed sides thereof for receiving the pin 330 therethrough, and the base portion 302 of the first portion 290 includes various sets of apertures 334 along and through opposed sides thereof for receiving the pin 330 therethrough. When the apertures 332 are aligned with one of the sets of apertures 334, insertion of the pin 330 through the apertures 332 and one of the sets of apertures 334 serves to hold the second portion 292 in position with respect to the base portion 302 of the first portion 290. As such, the second portion 292 of the hip support mechanism 252 can be positioned and repositioned along the base portion 302 of the first portion 290.
Additionally, to facilitate movement of the extension portion 324 relative to the base portion 322, the lateral hip support mechanism 252 includes a pin 340, the base portion 322 includes apertures 342 through opposed sides thereof for receiving the pin 340, and the extension portion 324 includes various sets of apertures (not shown) along and through opposed sides thereof for receiving the pin 340. When the apertures 342 are aligned with one of the sets of apertures, insertion of the pin 340 through the apertures 342 and one of the sets of apertures serves to hold the extension portion 324 (and the hip-contacting portion 326 attached thereto) in position with respect to the base portion 322. As such, the hip-contacting portion 326 of the lateral hip support mechanism 252 can be positioned and repositioned with respect to the base portion 322 (and the remainder of the lateral hip support mechanism 252).
As discussed above, the surgical frame 10 affords positioning and repositioning of the upper body (including the chest), hips, legs, and feet of the patient P during surgery and/or to accommodate differently sized patients. In summary, the locations of chest support pads 50 of the first and second chest support mechanisms 40 and 42 can be adjusted to position and reposition the upper body (including the chest) of the patient P. The angle and location of the patient support platform 130 of the hip and upper leg support mechanism 70 can be adjusted to position and reposition the hips and upper legs of the patient P. The location of the feet support mechanism 72 can be adjusted to position and reposition the legs of the patient P. The positions of the hip and upper leg support mechanism 70 and the feet support mechanism 72 (and the patient P received thereon) also can be changed by moving the moveable frame member 36 along the first frame member 28, and by moving the sub-frame 74 along the first and second frame members 32 and 34. Furthermore, the location of the shoulder/upper torso contacting portion 266 of the lateral shoulder/upper torso mechanism 250, and the location of the hip-contacting portion 326 of the lateral hip support mechanism 252 can be adjusted to position and reposition the shoulders and hips of the patient P. The movement afforded by the various mechanisms of the surgical frame 10 affords articulation of portions of the body of the patient P to change the degree of surgical access to the body during surgery. The movement afforded by the various mechanisms of the surgical frame 10 also affords the accommodation of differently sized patients.
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In addition to the articulation afforded by the various mechanisms of the surgical frame 10, the orientation of the surgical frame 10 can also be changed during surgery. As depicted in
The surgical frame 10′ is configured to provide a relatively minimal amount of structure adjacent the patient's spine to facilitate access thereto and to improve the quality of imaging available before and during surgery. Thus, the surgeon's workspace and imaging access are thereby increased. Furthermore, radio-lucent or low magnetic susceptibility materials can be used in constructing the structural components adjacent the patient's spine in order to further enhance imaging quality.
The surgical frame 10′ has a longitudinal axis and a length therealong. As shown in
The offset main beam 600 is used to facilitate rotation of the patient P. The offset main beam 600 can be rotated a full 360° before and during surgery to facilitate various positions of the patient to afford various surgical pathways to the patient's spine depending on the surgery to be performed. For example, the offset main beam 600 can be positioned to place the patient P in a prone position (e.g.,
As depicted in
The vertical support posts 612 can be adjustable to facilitate expansion and contraction of the heights thereof. Expansion and contraction of the vertical support posts 612 facilitates raising and lowering, respectively, of the offset main beam 600. As such, the vertical support posts 612 can be adjusted to have equal or different heights. For example, the vertical support posts 612 can be adjusted such that the vertical support post 612 of the second support portion 606 is raised 12 inches higher than the vertical support post 612 of the first support portion 604 to place the patient P in a reverse Trendelenburg position.
Furthermore, cross member 608 can be adjustable to facilitate expansion and contraction of the length thereof. Expansion and contraction of the cross member 608 facilitates lengthening and shortening, respectively, of the distance between the first and second support portions 604 and 606.
The vertical support post 612 of the first and second support portions 604 and 606 have heights at least affording rotation of the offset main beam 600 and the patient P positioned thereon. Each of the vertical support posts 612 include a clevis 620, a support block 622 positioned in the clevis 620, and a pin 624 pinning the clevis 620 to the support block 622. The support blocks 622 are capable of pivotal movement relative to the clevises 620 to accommodate different heights of the vertical support posts 612. Furthermore, axles 626 extending outwardly from the offset main beam 600 are received in apertures 628 formed the support blocks 622. The axles 626 define an axis of rotation of the offset main beam 600, and the interaction of the axles 626 with the support blocks 622 facilitate rotation of the offset main beam 600.
Furthermore, a servomotor 630 can be interconnected with the axle 626 received in the support block 622 of the first support portion 604. The servomotor 630 can be computer controlled and/or operated by the operator of the surgical frame 10′ to facilitate controlled rotation of the offset main beam 600. Thus, by controlling actuation of the servomotor 630, the offset main beam 600 and the patient P supported thereon can be rotated to afford the various surgical pathways to the patient's spine.
As depicted in
The axles 626 are attached to the first portion 650 of the forward portion 640 and to the third portion 664 of the rear portion 642. The lengths of the first portion 650 of the forward portion 640 and the second portion 662 of the rear portion 642 serve in offsetting portions of the forward and rear portion 640 and 642 from the axis of rotation of the offset main beam 600. This offset affords positioning of the cranial-caudal axis of patient P approximately aligned with the axis of rotation of the offset main beam 600.
Programmable settings controlled by a computer controller (not shown) can be used to maintain an ideal patient height for a working position of the surgical frame at a near-constant position through rotation cycles, for example, between the patient positions depicted in
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As depicted in
An alternative preferred embodiment of a torso-lift support is generally indicated by the numeral 700 in
As discussed below, the torso-lift support 700 depicted in
As discussed above, the chest support lift mechanism 706 includes actuators 708 to position and reposition the support plate 704 (and hence, the chest support plate 368). As depicted in
The second actuator 708B is interconnected with the support plate 704 via first links 730, and the third actuator 708C is interconnected with the support plate 704 via second links 732. First ends 734 of the first links 730 are pinned to the second actuator 708B and elongated slots 735 formed in the offset main beam 702 using a pin 736, and first ends 738 of the second links 732 are pinned to the third actuator 708C and elongated slots 739 formed in the offset main beam 702 using a pin 740. The pins 736 and 740 are moveable within the elongated slots 735 and 739. Furthermore, second ends 742 of the first links 730 are pinned to the support plate 704 using the pin 724, and second ends 744 of the second links 732 are pinned to the support plate 704 using a pin 746. To limit interference therebetween, as depicted in
Actuation of the actuators 708A, 708B, and 708C facilitates movement of the support plate 704. Furthermore, the amount of actuation of the actuators 708A, 708B, and 708C can be varied to affect different positions of the support plate 704. As such, by varying the amount of actuation of the actuators 708A, 708B, and 708C, the COR 710 thereof can be controlled. As discussed above, the COR 710 can be predetermined, and can be either fixed or varied. Furthermore, the actuation of the actuators 708A, 708B, and 708C can be computer controlled and/or operated by the operator of the surgical frame 10′, such that the COR 710 can be programmed by the operator'. As such, an algorithm can be used to determine the rates of extension of the actuators 708A, 708B, and 708C to control the COR 710, and the computer controls can handle implementation of the algorithm to provide the predetermined COR. A safety feature can be provided, enabling the operator to read and limit a lifting force applied by the actuators 708A, 708B, and 708C in order to prevent injury to the patient P. Moreover, the torso-lift support 700 can also include safety stops (not shown) to prevent over-extension or compression of the patient P, and sensors (not shown) programmed to send patient position feedback to the safety stops.
As depicted in
As depicted in
To accommodate patients with different torso lengths, the position of the thigh cradle 800 can be adjustable by moving the plate 810 along the offset main beam 600. Furthermore, to accommodate patients with different thigh and lower leg lengths, the lengths of the second and third support struts 806 and 808 can be adjusted.
To control the pivotal angle between the second and third struts 806 and 808 (and hence, the pivotal angle between the thigh cradle 800 and lower leg support 802), a link 820 is pivotally connected to a captured rack 822 via a pin 823. The captured rack 822 includes an elongated slot 824, through which is inserted a worm gear shaft 826 of a worm gear assembly 828. The worm gear shaft 826 is attached to a gear 830 provided on the interior of the captured rack 822. The gear 830 contacts teeth 832 provided inside the captured rack 822, and rotation of the gear 830 (via contact with the teeth 832) causes motion of the captured rack 822 upwardly and downwardly. The worm gear assembly 828, as depicted in
The worm gear assembly 828 also is configured to function as a brake, which prevents unintentional movement of the sagittal adjustment assembly 370. Rotation of the drive shaft 836 causes rotation of the worm gears 834, thereby causing reciprocal vertical motion of the captured rack 822. The vertical reciprocal motion of the captured rack 822 causes corresponding motion of the link 820, which in turn pivots the second and third support struts 806 and 808 to correspondingly pivot the thigh cradle 800 and lower leg cradle 802. A servomotor (not shown) interconnected with the drive shaft 836 can be computer controlled and/or operated by the operator of the surgical frame 10′ to facilitate controlled reciprocal motion of the captured rack 822.
The sagittal adjustment assembly 370 also includes the leg adjustment mechanism 373 facilitating articulation of the thigh cradle 800 and the lower leg cradle 802 with respect to one another. In doing so, the leg adjustment mechanism 373 accommodates the lengthening and shortening of the patient's legs during bending thereof. As depicted in
The pelvic-tilt mechanism 372 is movable between a flexed position and a fully extended position. As depicted in
The sagittal adjustment assembly 370, having the configuration described above, further includes an ability to compress and distract the spine dynamically while in the lordosed or flexed positions. The sagittal adjustment assembly 370 also includes safety stops (not shown) to prevent over-extension or compression of the patient, and sensors (not shown) programmed to send patient position feedback to the safety stops.
As depicted in
As depicted in
Preferably the surgical frames further can be used in association with a traditional surgical table by placing the surgical frames on top of the surgical table. The surgical frames preferably could be secured to the surgical table via straps, clamps, or other fastening device to ensure the surgical frames do not inadvertently move relative to the surgical table.
Other embodiments of the invention will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein.
In one embodiment, external tooling devices can be provided, adapted either to be hand-held by a surgeon or to be applied from an external frame not connected to the surgical frames, for the purpose of a combination of surgical frame position, dual or simultaneous access, and applying controlled forces to specific aspects of instrumentation or inserted tools during a surgery. The surgical frames can change the 360° of global body position and can add vectors of forces with the head support, arm supports, the torso-lift supports, the sagittal adjustment assembly, and the coronal adjustment assembly. For example, during application of the sagittal adjustment assembly for performance of an osteotomy on a patient, constraint of fixation points on one side of the osteotomy by the external frame, or by hand by the surgeon, results in the vectors of forces acting together to reduce the osteotomy, to improve the sagittal plane, to reduce risk to the patient, and to maximize corrections. Through the use of live imaging, such as OKI live imaging, which is well known in the art, the change of angulation, pelvic parameters, and global alignment can be seen in real time while the vectors of forces are applied for reduction of the osteotomy.
In one embodiment, the surgeon can hold tools that modulate instrumentation in concert with actions of the surgical frames, and in concert with real-time computer-generated data of sagittal balance. Movement of the surgical frames can be controlled by robotic arms, combined with computer oversight, rather than being controlled directly by the surgeon. In this embodiment, the surgical frame movement, the movement of the robotic arms, and the input by the surgeon, together create a real-time dynamic sagittal plane correction that is predetermined by preoperative measurements.
For example, if it is determined that a 30° correction of lumbar lordosis is required, after the surgeon has made approaches connecting the robotic arms to a simultaneous access, a feedback loop between the surgical frames and the robotic arms gives the surgeon an ability to “dial-in” 30° of lordosis at the L4-L5 lumbar spine vertebrae, and the computer drives the surgical frames and the robotic arms in harmony to make this exact change, under the observation and guidance of the surgeon.
In one embodiment, the surgical table provides an option for the surgeon to perform separate surgeries on a single patient at the same time, rather than performing the surgeries at different times.
For example, in a case of a patient having a cervical degenerative disc disease (“DDD”) or deformity, and a lumbar DDD or deformity, such patient often elects two separate surgeries. The surgical frames enable the surgeon to operate initially, for example, on the cervical DDD or deformity, flip the patient, and next operate on the lumbar DDD or deformity, or else to operate initially on the lumbar DDD or deformity, flip the patient, and next operate on the cervical DDD or deformity. Alternately, the surgical frames enable the surgeon to rotate the patient to a single position, and perform surgery on both the lumbar DDD or deformity, and the cervical DDD or deformity, via the same point of access.
It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the invention being indicated by the following claims.
The present application is a continuation of U.S. application Ser. No. 15/239,256, filed Aug. 17, 2016; and claims benefit of U.S. Provisional Application No. 62/206,064, filed Aug. 17, 2015, and of U.S. Provisional Application No. 62/314,950, filed Mar. 29, 2016; all of which are incorporated by reference herein.
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Number | Date | Country | |
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Child | 17103431 | US |