Applicator for applying pasty transplants in surgery, and applicator set with associated instruments

Abstract

An applicator (10) for pasty surgical transplants comprises a cylinder (14) which delimits a transplant receptacle region (22) around a longitudinal axis (20) and which has front and back openings (24), a plunger (16) which is insertable into the receptacle region through the back opening and displaceable along the longitudinal axis and which serves to displace the transplant through the front opening, a nozzle (12) with a connection portion (28) for coupling, on the front opening side, to the cylinder and an administering portion (30), by means of the administering opening (32) of which the displaced transplant is applicable, and a rotary handle (18) operatively connected to the plunger. To convert a rotary movement of the rotary handle into a plunger longitudinal movement, provision is made of a gearing mechanism having a first threaded portion (36) stationary with respect to the cylinder and, cooperating therewith, a second threaded portion (38) stationary with respect to the rotary handle. In this case, the first threaded portion is formed on the outer circumference (40) of the cylinder while the second threaded portion is provided on the inner circumference (42) of the rotary handle that is substantially in the form of a sleeve and has a pickup portion for transferring the longitudinal movement to the plunger.

Description

[0001] APPLICATOR FOR APPLYING PASTE-LIKE TRANSPLANTS IN SURGERY AND APPLICATOR SET WITH ASSOCIATED INSTRUMENTS TECHNICAL FIELD The present invention relates generally to an applicator for applying paste-like transplants in surgery, according to the preamble of claim 1, as well as to an applicator set comprising such an applicator. In particular, the invention relates to an applicator for applying autologous, allogeneic, xenogeneic, or alloplastic, paste-like bone transplants. Such applicators are used extensively in surgery when it comes to placing bone or bone replacement materials in or on a bone. PRIOR ART The reconstruction of bony defects is becoming increasingly important for patients with severe bone injuries, after the removal of bone cysts or tumors, in oral and maxillofacial surgery,In sports medicine, for example, in cruciate ligament revisions, in hand and foot surgery, in spinal surgery, or for relatively young patients with a prosthesis, such as an artificial hip joint, which will likely need to be replaced after some time, this is becoming increasingly important. In such a prosthesis replacement, for example, every revision procedure is accompanied by a loss of bone substance; in particular, the removal of the bone cement anchoring the prosthesis (usually plastic-based) often leads to significant bone defects. The same applies to the loss of bone substance, on a smaller scale, for example, in cruciate ligament revisions. Various bone replacement materials are now available as transplants for the revision of such bony defects.which differ in the starting materials used and in the processes for obtaining the respective bone substitute material. In addition to the patient's own bone tissue (autologous transplants), allogeneic transplants from human bone, xenogeneic transplants of animal origin, and synthetically produced bone substitute materials (alloplastic material) are used. Commercially available materials include, for example, sawn bone chips, bone granules, cancellous bone blocks and cancellous bone cylinders, secondary bone cement-like, i.e., UV-curing pastes, fiber-disintegrated transplants, or ready-to-use pastes made from demineralized bone matrix with a suitable carrier (e.g., hyaluronic acid), which can be used directly to fill smaller bone cavities. In the context of the present invention, the focus is exclusively on such transplants.which are in pasty form. When filling bone defects, the pasty transplants must also be placed in / at the bone defects in a controlled manner. Applicators are used for this purpose, into which the material to be applied must first be filled before it is then pushed toward the defect by a piston or plunger through an outlet opening of the applicator. Although the transplants are usually available as ready-to-use, commercially available – i.e., allogeneic, xenogeneic, or alloplastic – transplant pastes, this does not excludethat transplant pastes obtained / produced from autologous bone material - during or before surgery - can also be used. At least the ready-to-use transplant pastes are usually kept in glass syringes and can be filled directly into the applicator from the front or back. Due to their gas-tightness, glass syringes offer advantages, particularly over plastic syringes, regarding stable storage and a longer shelf life of the contained transplant. Interactions with the bone or bone substitute materials, as well as the release of chemicals that could potentially disrupt the healing process, are not to be expected with glass syringes. However, due to the risk of breakage, increased care is required during handling of the glass syringes. In particular, care must be taken to ensure thatthat the graft is not contaminated with glass splinters during the applicator filling process, which could, for example, be caused by the syringe hitting the applicator. When withdrawing the syringe after the filling process, it must also be ensured that the pasty graft remains in the applicator and is not partially pulled out of the applicator while adhering to the syringe. There is no shortage of proposals in the prior art for loading an applicator with the graft. For example, US 2018 / 0008746 A1 discloses an applicator to which a syringe can be connected via a thread for filling with the graft. In this prior art, the graft components to be mixed are first premixed and compacted in the syringe and then filled into the applicator from behind via a rear opening using the syringe. Applicators,Applicators that can be loaded from the front or back without a syringe can also be found, for example, in the publications DE 10 2009 012 437 A1 and US 2010 / 0198140 A1. However, these applicators are primarily intended for use with non-paste-like grafts. When applying the pasty graft using the applicator, the surgeon must simultaneously position and guide the applicator's exit opening with the greatest possible precision relative to the defect in / on the bone, and dose the amount of material to be applied as sensitively as possible. Depending on the consistency of the graft and the size of the applicator's dispensing opening, considerable forces must be applied to displace the graft.which must be simultaneously generated and supported / countered by the surgeon on the applicator. This can make both the exact positioning of the applicator relative to the defect in / on the bone and the sensitive dosing of the transplant considerably more difficult. In order for the surgeon to position the applicator's delivery opening with the required precision and to be able to dose the transplant mass accurately using the applicator with only moderate force, a force transmission on the applicator is desirable. In this context, rack and pinion drives for conveying bone and bone substitute materials are known, for example from the documents US 2018 / 0177609 A1, US 2018 / 0049890 A1, US 2004 / 0215201 A1, EP 3 305 252 B1 and US 5,925,051, in which the force is introduced and transmitted by means of a hand lever mechanism. Such drives are known from cartridge presses,such as those used in the trade for the creation of silicone joints. However, these mechanisms are relatively complex, usually difficult to clean, and can cause problems with the precise positioning of the dispensing opening during use of the applicator equipped with them, because operating the hand lever inevitably applies a counter-holding torque to the applicator, with the risk of undesired deflection of the dispensing opening. Another drive or force transmission concept for dispensing a pasty graft from an applicator can be found, for example, in US 2010 / 0094307 A1 and EP 0955 022 B1, which forms the preamble of patent claim 1. In this prior art, the force required to expel the graft is introduced via a manually driven threaded spindle.which, like a screw press, is screwed into a fixed or fixable thread with respect to the applicator, so that the rotary movement introduced into the threaded spindle by the surgeon is translated into a linear movement of the piston / ram in contact with the threaded spindle in the applicator. In other words, the document EP 0 955 022 B1, which forms the preamble of patent claim 1, discloses an applicator for applying pasty transplants, comprising a hollow cylinder that defines a receiving area for the transplant around a longitudinal axis, which has a front opening and a rear opening leading to the receiving area. The applicator further comprises a piston that can be inserted into the receiving area of ​​the cylinder via the rear opening and can be displaced along the longitudinal axis in the receiving area.to displace the transplant from the receiving area via the front opening of the cylinder. Furthermore, the applicator comprises a nozzle having a connecting section for coupling to the cylinder in the area of ​​the front opening and a dispensing section with a dispensing opening through which the transplant displaced through the front opening of the cylinder via the nozzle can be applied. For manual force application, as shown in particular in Fig. 2 of this publication, a rotary handle in the form of a toggle grip is provided, which is operatively connected to the piston via a threaded spindle and is attached to the end of the threaded spindle facing away from the piston. To convert a rotary movement of the toggle handle about a longitudinal axis of the threaded spindle into a longitudinal movement of the piston in the cylinder, this applicator has a gear mechanism. The latter has a first threaded section fixed to the cylinder, namely an internal thread on a coupling sleeve attached to the cylinder.and a second threaded section, which interacts with the first threaded section and is fixed to the toggle handle, namely the external thread attached to the threaded spindle. To implement movement, the external thread of the threaded spindle, which is fixed to the toggle handle, is screwed into the internal thread on the coupling sleeve, which is fixed to the cylinder. Turning the threaded spindle in the coupling sleeve therefore leads to a longitudinal displacement of the threaded spindle relative to the coupling sleeve. Since the end of the threaded spindle facing away from the toggle handle is in contact with the piston in the cylinder, the piston also experiences a longitudinal displacement relative to the cylinder in order to act on the transplant in the cylinder. The toggle handle, which is firmly connected to the threaded spindle, also has several arms that extend outward in a radial direction relative to the axis of rotation and through which the surgeon applies the forces required to expel the transplant with one hand on the applicator.While the surgeon holds the applicator in the area of ​​the cylinder with his other hand, i.e., the guiding hand, and positions the nozzle, or more precisely its discharge opening, relative to the defect in / on the bone in order to apply the transplant. With this design, the force introduction point on the toggle handle is located at the end of the threaded spindle facing away from the cylinder and thus as far away as possible from the discharge opening of the applicator nozzle. If the surgeon applies a torque to the threaded spindle via the toggle handle with this design, there is a risk that transverse forces will also be introduced into the threaded spindle. Even the smallest transverse forces on the toggle handle, due to the large lever length between the toggle handle and the surgeon's guiding hand holding the cylinder, generate considerable moments on the wrist of the guiding hand, which, if the surgeon cannot counteract them,This could result in an undesirable displacement of the nozzle's discharge opening relative to the bone defect to be filled. To make matters worse, most operators intuitively tend to stiffen the wrist of the hand gripping the toggle handle when operating such toggle handles and use their forearm as a lever, whereby the upper arm is lowered toward the upper body with a rotating movement in the shoulder joint, or raised away from the upper body when operated in the opposite direction. When the toggle handle is rotated in this way, the transverse forces also introduced into the threaded spindle via the toggle handle occur in an amplified form, so that the aforementioned tilting or torque forces, which the surgeon must simultaneously counteract, are even greater. A problem with previously known applicator designs that operate with a gear mechanism,The aim of the invention, which converts the rotary movement of a rotary handle into a longitudinal movement of the applicator piston, is to apply the force required for the desired dosage of the transplant to the applicator and, at the same time, to position the discharge opening of the applicator nozzle as precisely as possible on the bone defect to be filled. Against this background, an applicator design that enables improved, particularly more precise, handling during surgery would be desirable. Finally, the publication US 5,160,327 discloses a rotary pressure drive for a medical syringe for inflating balloons, which serves to build up or maintain fluid pressure in the syringe in a controlled manner. As can be seen in particular from Fig. 5 of this publication,The rotary pressure drive comprises a hollow cylindrical chamber with an open distal end for receiving the syringe plunger. Within the chamber, a stop for the syringe plunger and internal threads for receiving radially projecting flanges of the syringe barrel are provided. By rotating the rotary pressure drive relative to the syringe barrel, the stop for the syringe plunger is displaced toward the flanges of the syringe barrel. However, this previously known rotary pressure drive in combination with a commercially available syringe is not suitable or even intended for the precise dosing of pasty transplants, as this is already prevented by the very loose connection between the syringe barrel and the rotary pressure drive, which is limited only to the flanges. OBJECTIVE Based on the above-described prior art, the invention is based on the object ofTo provide an applicator designed as simply as possible for applying pasty transplants in surgery, in particular autologous, allogeneic, xenogeneic, or alloplastic pasty bone transplants, as well as an applicator set with such an applicator, which generally avoids the disadvantages described above and specifically enables improved handling of the applicator compared to the prior art, which is particularly optimized with regard to more precisely positioned application of pasty transplants with reduced force. SUMMARY OF THE INVENTION This object is achieved by an applicator having the features of patent claim 1 and an applicator set having the features of patent claim 12, respectively. Advantageous or expedient developments of the invention are the subject of patent claims 2 to 11 and 13 to 15, respectively. In an applicator for applying pasty transplants in surgery,in particular of autologous, allogeneic, xenogeneic, or alloplastic bone transplants, comprising a cylinder defining a hollow receiving area for the transplant around a longitudinal axis, which cylinder has a front opening and a rear opening towards the receiving area, a piston insertable into the receiving area of ​​the cylinder via the rear opening, which piston is displaceable along the longitudinal axis in the receiving area in order to displace the transplant from the receiving area via the front opening of the cylinder, a nozzle having a connecting section for coupling to the cylinder in the region of the front opening and a dispensing section with a dispensing opening, via which the transplant displaced through the front opening via the nozzle can be applied, and a rotary handle operatively connected to the piston, wherein a gear mechanism is provided in the cylinder to convert a rotary movement of the rotary handle into a longitudinal movement of the piston,which has a first threaded section fixed to the cylinder and a second threaded section fixed to the rotary handle, which cooperates with the first threaded section; according to the invention, the first threaded section is formed on the outer circumference of the cylinder, while the second threaded section is provided on the inner circumference of the essentially sleeve-shaped rotary handle, which has a driving section for transmitting the longitudinal movement to the piston. Thus, according to the invention, similar to the prior art described at the beginning, a gear mechanism is used which uses a thread transmission to expel the transplant from the applicator using moderate actuating forces by the surgeon. However, compared to the generic prior art, the invention reverses the situation.regarding the position of the cylinder-fixed threaded section and the position of the rotary handle-fixed threaded section. The cylinder-fixed threaded section is provided on the outer circumference of the cylinder, while the rotary handle-fixed threaded section is formed on the inner circumference of the sleeve-shaped rotary handle, which in turn, via a driving section, transmits the displacement of the rotary handle along the longitudinal axis caused by a rotation of the rotary handle about the longitudinal axis of the applicator relative to the cylinder to the piston accommodated in the cylinder. According to the invention, the force introduction point on the rotary handle is located above or very close to the cylinder of the applicator, so that only a very short or minimal lever results between the force introduction point on the rotary handle and the holding point of the applicator on the cylinder. This results inthat any transverse forces applied by the surgeon when turning the rotary handle on the cylinder cannot generate large moments at the cylinder's holding point, which the surgeon would have to counteract with his or her guiding hand holding the cylinder. Accordingly, it is easier for the surgeon to keep the nozzle of the applicator with its discharge opening well positioned, i.e., as precisely as possible, at the defect on / in the bone to be filled with the transplant during an operation. Furthermore, the sleeve-shaped design of the rotary handle surrounding the cylinder not only advantageously results in a very compact design of the applicator according to the invention, which is particularly positive when using the applicator in a spatially confined surgical environment,It also allows the surgeon to engage the rotary handle over a large area - as opposed to a more point-like approach - over a significantly greater length than the state of the art, allowing the rotary handle to be operated more sensitively. Finally, it is worth mentioning in this context that the axial extension of the sleeve-shaped rotary handle also advantageously provides the surgeon with a high degree of variability in terms of the options for gripping the sleeve-shaped rotary handle to apply the actuating forces. This also contributes to the applicator being very easy to handle during surgery. In principle, the rotary handle can be formed integrally with the piston or as a single component. However, particularly with regard to better cleaning options and simpler manufacturing, a design of the applicator is preferred.in which the piston and the rotary handle are two separate components. A further advantage of a separate design of the piston and rotary handle is that when the rotary movement is initiated in the rotary handle, the piston is not necessarily rotated, so that the transplant to be delivered, which is present at the piston, is not exposed to any shear forces. This also has an advantageous effect in terms of minimizing the forces required to rotate the rotary handle. In principle, it is possible to provide the sleeve-shaped rotary handle at one end with radially inward-running projections or a circumferential, radially inward-pointing annular collar for axial contact with the piston.in order to transmit the axial displacement of the rotary handle relative to the cylinder, caused by the gear mechanism, to the piston in the cylinder when the rotary handle is rotated about the longitudinal axis of the applicator. The projections could also be bent at their free ends, or the annular collar could be provided with an annular ridge extending in the axial direction on the inner circumference in order to come into axial contact with the piston accommodated in the cylinder. However, particularly with a view to achieving the simplest and most compact design possible for the applicator, it is preferred for the rotary handle to be cup-shaped, with a base region which, as the driving section of the rotary handle, can be brought into contact with an end of the piston protruding from the receiving area of ​​the cylinder. The cup-shaped design of the rotary handle with the base region also has the advantage that the applicator can be moved backwards at this point,i.e., it is closed at its end facing away from the nozzle and consequently cannot become contaminated from this side. In principle, the base area of ​​the cup-shaped rotary handle as well as the end of the piston protruding from the cylinder can have flat contact surfaces for each other. In an advantageous development of the applicator with the cup-shaped rotary handle, however, it is preferably provided that the piston, on its side facing away from the front opening of the cylinder, has a dome-shaped or spherical projection at a substantially central location, against which the base area of ​​the rotary handle can be brought into contact. A particular advantage of such an applicator design is that only very low frictional forces occur at the thus very small, almost point-like contact surface between the piston projection and the substantially flat base area of ​​the rotary handle, which is also located in the area of ​​the rotation axis.which facilitates manual rotation of the rotary handle relative to the cylinder. The same effect could, of course, be achieved if the base region of the cup-like rotary handle had a dome-shaped or spherical projection at a substantially central location, which abuts against a flat or level end of the piston, or if the base region of the rotary handle and the piston end had corresponding axial projections that abut against one another. For improved handling, particularly when withdrawing the piston from the cylinder after applying the transplant, it is further preferred if the piston is provided with at least one recess on its outer circumference, forming an undercut, at its end protruding from the receiving area of ​​the cylinder. Compared to a similarly conceivable design of the applicator with a piston end without an undercut,Where the force required to pull the piston out of the cylinder can be transmitted solely by means of a frictional connection between the piston and the surgeon's gloved hand, the preferred design here enables the piston to be pulled out with reduced force, which can be attributed to the positive connection achievable between the hand and the piston. The risk of the surgeon slipping off the piston while wearing a glove that may be soiled from the operation is also significantly reduced. For proper functioning of the gear mechanism, the first threaded section provided on the outer circumference of the cylinder can, in principle, be designed to be completely circumferential. In contrast, however, a design of the applicator is preferred in which the cylinder has a recess or flattened area extending along the longitudinal axis of the cylinder on at least one outer longitudinal side.which interrupts the first threaded section on the outer circumference of the cylinder. Particularly preferably, the cylinder can even be provided with a recess or flattened portion on each of its outer longitudinal sides opposite its longitudinal axis, which interrupts the first threaded section on the outer circumference of the cylinder. This recess(es) or flattened portion(s) can be advantageously used to easily apply a marking or label to a flat, i.e., non-curved, surface of the cylinder.e.g., by means of laser marking in the case of a metallic material for the cylinder. The interruption of the first threaded section on the outer circumference of the cylinder caused by such a recess or flattening of the cylinder also offers advantages when cleaning the cylinder after surgery. Thus, the partial thread(s) of the first threaded section of the cylinder, delimited by the recess(es), can be cleaned particularly easily and quickly using a brush guided transversely to the longitudinal axis and parallel to the threads of the first threaded section. In contrast to a continuous thread contaminated with transplant and / or tissue residue from the operation, in which the contaminants are only displaced around the cylinder in the thread base with a brush guided in this way,The contaminants can be easily brushed or swept out of the partial threads running towards the recess(es) using a brush. A further advantage of the recesses or flattened areas on the cylinder described above is that the flat surfaces created on the cylinder also improve the handling of the applicator for the surgeon because they offer a good grip for the surgeon, similar to wrench surfaces. For example, the surgeon can hold the applicator on the cylinder with the thumb and index finger of one hand, with the thumb and index finger gripping the opposing recesses or flattened areas of the cylinder like a pair of pliers. Particularly with regard to the most precise dosing of the transplant, it is also preferred if a scale is attached to the cylinder in the area of ​​the recess, which interacts with an edge area of ​​the rotary handle.to provide at least a relative measure of the graft displaced from the receiving area via the front opening of the cylinder during the application of the graft. The scale can also be designed so that, for example, adjacent lines and / or numbers on the scale provide an absolute measure of the displaced volume of graft, taking into account the clear cross-section of the receiving area in the cylinder. In principle, it is possible to provide, for example, a snap connection for the detachable attachment of the nozzle to the cylinder of the applicator, which is formed between the connecting section of the nozzle and the cylinder near the front opening of the cylinder. A frictional connection would also be conceivable here to detachably attach the nozzle to the cylinder. In contrast, particularly with regard to the security of the connection against unintentional loosening as well as the possibility of intentionally releasing the connection as easily as possible,A preferred embodiment of the applicator is one in which the nozzle connection section is sleeve-shaped and has an internal thread as a third threaded section for coupling to the cylinder, which cooperates with an external thread attached to the cylinder near the front opening of the cylinder as a fourth threaded section to releasably fasten the nozzle to the cylinder. With such a configuration of the connection between nozzle and cylinder, it is further preferred if the third and fourth threaded sections have a different thread pitch than the first and second threaded sections of the gear mechanism. The nozzle or the rotary handle can thus only be mounted on the side of the cylinder provided with the corresponding counter-thread, which prevents incorrect assembly of the applicator. Furthermore, the respective thread pairing can be optimized with regard to its function - the most reliable possible hold on the nozzle,The simplest possible rotation of the rotary handle should be optimized. Furthermore, with regard to the aforementioned thread pairings on the applicator, it is preferably provided that the third and fourth threaded sections for nozzle attachment have the same direction of rotation as the first and second threaded sections of the gear mechanism for generating the piston movement in the cylinder. In principle, different directions of rotation of the thread pairings in question would also be conceivable, for example, as an additional measure to prevent incorrect assembly of the applicator. However, such a design is less preferred with regard to proper function of the applicator because it entails the risk that when the rotary handle is rotated relative to the cylinder to deliver the transplant via the nozzle, the nozzle will also be unscrewed from the cylinder at the same time.if it was not screwed onto the cylinder tightly enough beforehand. In principle, it is possible to provide the rotary handle and the nozzle connection section with a smooth surface on the outer circumference. However, particularly with regard to better force transmission for actuating the screw connections, it is preferred if the essentially sleeve-shaped rotary handle and / or the sleeve-shaped nozzle connection section are provided with a plurality of grip recesses on the outer circumference, which are distributed over the outer circumference. As an alternative to grip recesses, knurling or embossing on the outer circumference of these parts would also be conceivable in order to increase their grip.However, this is less preferred due to the resulting poorer cleaning options and the risk of damaging the disposable gloves that are mandatory during such operations. Furthermore, in a suitable design of the applicator in the dispensing section of the nozzle, the dispensing opening for applying the transplant can be aligned with the longitudinal axis or run transversely to the longitudinal axis, depending on the specific surgical requirements. Depending on the location and accessibility of the bone defect, a correspondingly suitable nozzle can be provided for the surgeon in order to achieve the best possible application result. Furthermore, the present invention provides an applicator set for applying pasty transplants in surgery, in particular autologous, allogeneic, xenogeneic, or alloplastic bone transplants.which, in addition to the applicator described above, has at least one further component from an associated instrumentation, which comprises the following components: a rear filling sleeve, which is adapted for detachable attachment to the cylinder of the applicator in the region of the rear opening of the cylinder; a filling aid for shearing off the pasty graft when filling the receiving area in the cylinder via its rear opening; at least one further nozzle, which, like the aforementioned nozzle of the applicator, has a connection section for coupling to the cylinder in the region of the bow opening and a discharge section with a discharge opening, through which the graft displaced through the bow opening via the further nozzle can be applied,wherein the further nozzle differs from the aforementioned nozzle with regard to the length and / or cross-section of the dispensing section and / or the position and / or shape of the dispensing opening; at least one plunger with a grip section and an adjoining expulsion section, which is adapted in terms of length and cross-section to the nozzle of the applicator and / or the further nozzle of the applicator set in order to displace the residual graft remaining in the nozzle and / or the further nozzle after emptying the cylinder from the nozzle or the further nozzle; and a conditioning aid with a base having a central blind bore,whose cross-section is adapted to the outer diameter of the applicator nozzle and / or the other nozzle of the applicator set. Regarding these optional additions to the applicator described above, the following should be noted at this point: The use of a rear filling sleeve for filling the applicator via the rear opening in the cylinder is particularly useful when the applicator is to be loaded with pasty transplants, which are stored ready for use in glass syringes, for example. Damage to the delicate glass syringes due to careless / uncontrolled impact on the - preferably metallic - cylinder of the applicator must be avoided at all costs. In this context, it is advantageous if the rear filling sleeve has a stop, which can be brought into contact with the cylinder with a first end face in the area of ​​the rear opening and has a second end face facing away from the first end face.which forms a contact surface for a syringe for filling the receiving area in the cylinder with the pasty graft. The stop on the rear filling sleeve, which is preferably made of plastic, ensures a forced separation or spacing between the (glass) syringe and the cylinder of the applicator to prevent damage to the syringe. Preferably, the rear filling sleeve further comprises a longitudinally slotted sleeve section for tightly receiving a syringe for filling the receiving area in the cylinder with the pasty graft. This creates a simple clamp connection for the syringe, which can advantageously also compensate for diameter tolerances on the glass syringe and ensures a secure, centered hold of the syringe relative to the applicator during the actual filling process. Regarding the filling aid of the instrumentation for the applicator described above, it is preferably providedthat the rear filling sleeve, viewed along the longitudinal axis, has, between the first end face and the second end face, an opening extending transversely to the longitudinal axis, which opens into a graft passage of the rear filling sleeve and has a predetermined cross-section, wherein the filling aid is formed by a pin having a cross-section complementary to the cross-section of the opening in the rear filling sleeve. If the applicator is filled with the pasty graft via the rear opening using, for example, a syringe, the pin can be inserted into the lateral opening of the rear filling sleeve at the end of the filling process in order to pierce or puncture the graft. The syringe can then be withdrawn from the applicator—possibly after rotating around its longitudinal axis—without the graft being pulled out of the receiving area of ​​the cylinder while adhering to the syringe. The following must be taken into account here:that the pasty graft is not compressed when filling the receiving area via the rear opening in the cylinder due to a lack of sufficient counterpressure – for example, because a smaller volume of graft is dispensed via the syringe than the receiving area in the applicator can hold – and should not be compressed for conditioning purposes, so that ultimately no frictional connection occurs between the graft and the inner wall of the cylinder bordering the receiving area, which would prevent the graft from being pulled out with the syringe. In this situation, the filling aid enables a clean separation of the syringe from the applicator. Regarding the possible additional nozzles in the instrumentation for the applicator described above, it should first be noted that these are fully compatible with the first-mentioned (main) nozzle of the applicator in terms of their attachment to the cylinder.i.e., in particular, the connecting section for coupling to the cylinder can be designed identically for all nozzles. Furthermore, since the possible additional nozzle(s) differ from the first-mentioned (main) nozzle of the applicator in terms of a) length – longer or shorter, in order to better reach the defect in / on the bone to be filled or with a smaller dead volume in the nozzle – and / or b) the cross-section of the delivery section – thinner or thicker, depending on the desired delivery cross-section of the graft to be delivered or, in turn, the dead volume of graft accepted in the nozzle – and / or c) the position of the delivery opening – aligned with the longitudinal axis of the nozzle or applicator, or obliquely or transversely to it – and / or d) the shape of the delivery opening – round, oval, etc. – it is advantageously possible to select the nozzle(s) according to the requirements of the respective operation.with which the defect in / on the bone to be treated can be best filled with the pasty graft in terms of volume (partially or completely) and / or time course (faster or slower) and / or with regard to a specific, defined placement of the graft in the defect. This can then be done in several steps and / or with different nozzles if necessary. Analogously, other nozzles are also conceivable in the instrumentation for the previously described applicator, whose discharge section, for example, has a curved or angled profile. Furthermore, the use of the plunger of the instrumentation for the previously described applicator is particularly useful when working with pasty grafts.which harden or solidify relatively quickly. Thus, during the course of an operation, immediately following an application procedure with the applicator described above, the used nozzle can be removed from the applicator's cylinder. With the aid of the plunger, which is inserted with its expulsion section from the front over the discharge opening - only in the case of a discharge opening aligned with the discharge section of the nozzle - but otherwise from the rear, starting from the connection section of the nozzle into the discharge section of the nozzle, the residual graft remaining in the discharge section of the nozzle can be pushed out and the nozzle cleaned for possible reuse, which is preferred. Accordingly, the nozzle can of course also be cleaned at a later time with the aid of the plunger. However, it is also quite possible to hold the nozzle, for example, by its connection section during an operation using the plunger of the applicator set.so that the nozzle's discharge opening remains at the possibly partially filled defect in / on the bone. Then, the applicator cylinder is separated from the nozzle. The plunger, with its expulsion section, is inserted over the nozzle's connecting section into the nozzle's discharge section. Subsequently, by pressing the handle portion of the plunger toward the nozzle's connecting section, the residual graft remaining in the discharge section is manually expelled through the nozzle's discharge opening to the defect in / on the bone. This approach is useful, for example, when it is necessary to ensure that no graft remains during application, either to avoid wasting material or because only a limited amount of graft is available. With a suitable design of the plunger with a handle portion that is longer than the cylinder's receiving area, a corresponding procedure can also be used.by not separating the cylinder from the nozzle, but rather unscrewing the rotary handle from the cylinder and pulling the piston out of the cylinder before inserting the expulsion section of the plunger through the receiving area of ​​the cylinder into the discharge section of the nozzle to expel the residual graft from the nozzle via its discharge opening. In this variant, the nozzle can advantageously be held (further) over the cylinder with its discharge opening at the defect in / on the bone, so that during the surgical workflow, there is no need to switch from the cylinder to the connecting section of the nozzle. Instead, the cylinder can be held with one hand while the rotary handle and piston are removed from the cylinder with the other hand before the plunger is used as described. Furthermore, the optional conditioning aid of the applicator set serves - as the name suggests - toThis is particularly helpful in conditioning the pasty graft in the applicator. If, for example, the hollow receiving area in the applicator's cylinder was only partially filled with the pasty graft from a syringe, as described above, essentially without pressure, then, in addition to the loosely held graft, there will also be air in the cylinder's receiving area. This is where the conditioning aid comes into play. Its base is placed on a surface, such as a table, so that the central blind hole in the base is accessible from above. The applicator is then inserted, with the nozzle's discharge opening facing forward, into the blind hole of the conditioning aid, so that the conditioning aid temporarily closes the nozzle's discharge opening, but is not airtight.which can subsequently escape. Subsequently, to condition the transplant, a fluid such as blood can be injected into the receiving area of ​​the cylinder using a syringe, depending on the requirements of the respective operation. The fluid at least partially fills the cavities between the pasty transplant and the cylinder wall. With or after inserting the piston through the rear opening of the cylinder into the receiving area of ​​the applicator, the air can now be displaced via the nozzle of the applicator, the fluid can be further distributed around the pasty, essentially incompressible transplant, and the resultingThe mixed mass is then moved through the cylinder towards the nozzle. The filling of the applicator is moved either by manually pushing it in or – preferably – by moving the piston using the rotary handle screwed onto the cylinder in the direction of the nozzle's dispensing opening, until the conditioned graft is present at the nozzle's dispensing opening. The surgeon can recognize the applicator's finished or ready state for graft application visually by the fact that the fluid used for conditioning, e.g., blood, rises in a ring-like manner around the dispensing section of the nozzle in the blind bore of the conditioning aid, and also haptically by the fact thatthat the resistance increases noticeably when turning the rotary handle out of the cylinder. The applicator is now ready for use and can be used to apply the transplant. Of course, the conditioning aid for preparing or preparing the applicator for use during surgery could also be omitted. Instead of the conditioning aid, a smooth table surface could be used to temporarily close the nozzle's discharge opening, for example, on which the applicator is placed with the nozzle's discharge opening. However, this is less preferred because the conditioning fluid would then escape from the nozzle more or less uncontrolled. Furthermore, it is not possible to determine in a well-reproducible manner whether the applicator is ready for use. Especially with regard to the reusability, durability, and wear resistance of the applicator, it is ultimately preferable toif at least the cylinder and / or the nozzle of the applicator are made of a titanium alloy. Such a material is not only easy to clean and sterilize, but also has a low weight and very good corrosion resistance for a metallic material, in addition to the chemically inert properties of this material, which are positive for the intended use. BRIEF DESCRIPTION OF THE DRAWINGS The invention is explained in more detail below using preferred embodiments with reference to the attached, partially schematic or simplified drawings. The drawings show: Fig. 1A is a perspective exploded view of an applicator for applying pasty bone transplants according to a preferred embodiment of the invention, comprising, from left to right in Fig. 1A, a nozzle for dispensing the transplant,a cylinder with a bow opening and a rear opening, a piston that can be inserted into the cylinder via the rear opening for displacing the transplant via the bow opening, and a rotary handle, wherein the nozzle and rotary handle are designed to be screwed onto the cylinder, and a thread between the cylinder and rotary handle is part of a gear mechanism that can convert a rotary movement of the rotary handle into a longitudinal movement of the piston in the cylinder; Fig. 1B is a perspective exploded view of an applicator set for applying pasty bone transplants, here comprising the applicator according to Fig. 1A, which is shown in a filling configuration without the piston and rotary handle; in Fig. 1B, to the right of the cylinder, a rear filling sleeve for filling the applicator via the rear opening in the cylinder; above the nozzle and cylinder in Fig. 1B, various additional nozzles that can be optionally screwed onto the cylinder of the applicator;Below the cylinder in Fig. 1B, tappets adapted to the nozzle or other nozzles for completely emptying the nozzles, bottom left in Fig. 1B, a conditioning aid, and below the rear filling sleeve in Fig. 1B, a filling aid for shearing off the pasty graft when filling the cylinder via its rear opening; Fig. 2 is a side view of the applicator according to Fig. 1A with the nozzle screwed on to illustrate the assembly of the piston and the rotary handle after filling the applicator with the graft; Fig. 3 is a sectional view of the applicator according to Fig. 1A along the section line III-III in Fig. 2 - without a graft in the cylinder - in particular to illustrate a first threaded section fixed to the cylinder and a second threaded section of the gear mechanism fixed to the rotary handle; Fig. 4 is a side view of the applicator according to Fig. 1A, in which the rotary handle is at its maximum,ie is screwed onto the cylinder as far as possible; Fig. 5 is a sectional view of the applicator according to Fig. 1A along the section line VV in Fig. 4; Fig. 6 is a sectional view of the applicator according to Fig. 1A along the section line VI-VI in Fig. 4, enlarged in scale compared to the illustration in Fig. 4; Fig. 7 is an enlarged view of detail VII in Fig. 5, particularly to illustrate how an end of the piston protruding from a receiving area of ​​the cylinder bears against a bottom area of ​​the cup-shaped rotary handle; Fig. 8 is a perspective view of the cylinder of the applicator according to Fig. 1A, enlarged in scale compared to the illustration in Fig. 1A; Fig. 9 is a plan view of the cylinder according to Fig. 8, with a view of a recess or flattening interrupting the first threaded section on the outer circumference of the cylinder,on which a scale is attached; Fig. 10 is a sectional view of the cylinder according to Fig. 8 along section line XX in Fig. 9; Fig. 11 is a side view, enlarged in scale compared to the illustration in Fig. 1B, of a further nozzle of the applicator set according to Fig. 1B, in which the dispensing opening for applying the transplant runs transversely to the longitudinal axis; Fig. 12 is a sectional view of the further nozzle according to Fig. 11 along section line XII-XII in Fig. 11; Fig. 13 is an enlarged illustration of detail XIII in Fig. 12; Fig. 14 is a perspective view of the rear filling sleeve of the applicator set according to Fig. 1B, enlarged in scale compared to the illustration in Fig. 1B; Fig. 15 is a front view of the rear filling sleeve according to Fig. 14; Fig. 16 is a sectional view of the rear filling sleeve according to Fig. 14 along the section line XVI-XVI in Fig. 15; Fig. 17 is a reduced-scale view of the rear filling sleeve according to Fig. 1A,Perspective view of the applicator according to Fig. 1A without piston and rotary handle, but with a syringe and the rear filling sleeve of the applicator set according to Fig. 1B placed on the cylinder in the area of ​​the rear opening, in which the syringe with its syringe cylinder is inserted to fill the applicator with the transplant, as well as the pin-shaped filling aid of the applicator set according to Fig. 1B inserted into a lateral opening of the rear filling sleeve; Fig. 18 is a side view of the applicator according to Fig. 1A, broken off at the top in the area of ​​the filling aid and enlarged compared to the illustration in Fig. 17, in the filling configuration according to Fig. 17 with syringe and filling aid; Fig. 19 is a sectional view of the applicator according to Fig. 1A in the filling configuration of Fig. 17 according to the section line XIX-XIX in Fig. 18; Fig. 20 is an enlarged view of detail XX in Fig. 19, for illustration,how the rear filling sleeve separates the syringe from the cylinder when filling the applicator by means of a stop for both parts; Fig. 21 is a sectional view of the rear filling sleeve and the filling aid of the applicator set according to Fig. 1B, enlarged compared to the illustration in Fig. 19 and broken off to the left in the area of ​​the filling aid, corresponding to the section line XXI-XXI in Fig. 19; and Fig. 22 is a perspective view of the applicator according to Fig. 1A during its handling by a surgeon to dispense the pasty transplant via the nozzle - here, for example, into a bowl - with the surgeon holding the applicator on the nozzle side of the cylinder with one hand, while the surgeon delicately turns the rotary handle with the other hand,to actuate the piston for expelling the transplant via the nozzle by means of the gear mechanism of the applicator. DETAILED DESCRIPTION OF THE EMBODIMENTS In Figs. 1A to 7, reference numeral 10 generally designates an applicator for applying pasty transplants T (see Fig. 22) in surgery, such as autologous, allogenic, xenogenic, or alloplastic pasty bone transplants. In the illustrated embodiment, the applicator 10 comprises only four components, namely, from left to right in Fig. 1A, a nozzle 12, a cylinder 14, a piston 16, and a rotary handle 18. In this embodiment, the piston 16 and the rotary handle 18 are therefore two separate components, which, however, could in principle also be combined into one component, as already discussed at the beginning, so that the applicator 10 would then comprise only three components. The applicator shown individually in Figs. 8 to 10,The cylinder 14, formed from a titanium alloy, defines a hollow receiving area 22 for the transplant T around a longitudinal axis 20 of the applicator 10 and has a bow opening 24 and a rear opening 26 towards the receiving area 22. The piston 16, formed here from a plastic material such as polyetheretherketone (PEEK), can be inserted into the receiving area 22 of the cylinder 14 via the rear opening 26, as can be seen in particular in Figs. 3 and 5 to 7, and can be displaced in the receiving area 22 along the longitudinal axis 20.to displace the transplant T from the receiving area 22 in the manner of a plunger via the bow opening 24 of the cylinder 14. The nozzle 12, which is also made of a titanium alloy, has, as shown in particular in Figs. 1A to 5, a connecting section 28 for coupling to the cylinder 14 in the area of ​​the bow opening 24 of the cylinder 14. Adjoining the connecting section 28 of the nozzle 12 is a smaller diameter discharge section 30 with a discharge opening 32, through which the transplant T displaced through the bow opening 24 of the cylinder 14 via the nozzle 12 can be applied. The nozzle 12, shown in sectional views in Figs. 3 and 5 to 7,The rotary handle 18, here made of a plastic material such as polyetheretherketone (PEEK), is further operatively connected to the piston 16 in relation to the cylinder 14. More precisely, to convert a rotary movement of the rotary handle 18 into a longitudinal movement of the piston 16 in the cylinder 14, a gear mechanism 34 (see in particular Figs. 5 to 7) is provided, which has a first threaded portion 36 fixed to the cylinder and a second threaded portion 38 fixed to the rotary handle, which interacts with the first threaded portion 36. A special feature of the applicator 10 is that the first threaded portion 36 is formed on the outer circumference 40 of the cylinder 14, while the second threaded portion 38 is provided on the inner circumference 42 of the essentially sleeve-shaped rotary handle 18. The rotary handle 18 also has a driving portion 44 (cf. Figs. 3,5 and 7) for transmitting the longitudinal movement of the rotary handle 18 relative to the cylinder 14, caused by the gear mechanism 34 as a result of rotation of the rotary handle 18 about the longitudinal axis 20 of the applicator 10, to the piston 16, as will also be explained in more detail below. According in particular to Figs. 3, 5 and 7, the rotary handle 18 is cup-shaped, with a closed, here flat, base region 46, which can be brought into contact as a driving section 44 of the rotary handle 18 against an end 48 of the piston 16, which protrudes from the receiving region 22 of the cylinder 14. In the illustrated embodiment, the piston 16 is dimensioned in relation to the receiving area 22 of the cylinder 14 in such a way that the end 48 of the piston 16 facing away from the nozzle 12 protrudes from the receiving area 22 in every actuating position of the piston 16 in the cylinder 14, i.e. even when the piston 16 is moved to its maximum extent according to Fig. 5,ie, it has been pushed into the cylinder 14 until it stops, so that the substantially flat, other end 50 of the piston 16, facing the nozzle 12, rests against the connecting section 28 of the nozzle 12, as shown in Fig. 5. As can also best be seen in Fig. 7, the piston 16 has, on its side facing away from the bow opening 24 of the cylinder 14, a dome-shaped or spherical projection 52 at a substantially central location, i.e. in the region of the longitudinal axis 20, against which the base region 46 of the rotary handle 18 can be brought into contact. It is evident,that as a result of the protrusion 52 on the piston 16 bulging towards the flat base region 46 of the rotary handle 18 in the region of the longitudinal axis 20, only essentially point-like contact is possible between the rotary handle 18 and the piston 16. The bearing point created in this extremely simple manner facilitates rotation of the rotary handle 18 relative to the piston 16. Furthermore, Fig. 7 best shows that the otherwise essentially cylindrical piston 16 is provided on its outer circumference with a circumferential recess 54 at its end 48 protruding from the receiving region 22 of the cylinder 14, which recess forms an undercut 56. This recess 54 is easily accessible to the operator even when the piston 16 is pushed into the cylinder 14 as far as possible according to Fig. 5, when the rotary handle 18 is or has been unscrewed from the cylinder 14, and serves with its undercut 56 as a handle,via which the operator can manually pull the piston 16 out of the cylinder 14. With regard to the cup-shaped rotary handle 18, it should also be noted in connection with Figs. 2 to 7 that in the illustrated embodiment, the second threaded section 38 of the gear mechanism 34, which is provided on the inner circumference 42 of the rotary handle 18 and runs completely, ie continuously, extends to near the bottom region 46 of the rotary handle 18. A shorter design of the second threaded section 38, which starts running near the open end of the rotary handle 18, would also be conceivable here. Due to the long length of the second threaded section 38 chosen in the exemplary embodiment, the rotary handle 18 experiences better guidance on the cylinder 14 or the first threaded section 36 of the gear mechanism 34 formed thereon, against tilting with respect to the longitudinal axis 20 of the applicator 10. In addition, Figs. 1A, 2, 4 and 6 show the rotary handle 18,that the rotary handle 18 is provided on the outer circumference in a section close to the base region 46 with a plurality of grip recesses 58, which are evenly distributed over the outer circumference. The grip recesses 58, which in the illustrated embodiment extend parallel to the longitudinal axis 20 over almost half the length of the rotary handle 18, significantly improve the grip of the applicator 10, especially in a moist or greasy surgical environment. Further details on the cylinder 14 can be found in particular in Figs. 8 to 10. Accordingly, the cylinder 14 has on at least one outer longitudinal side(s) (each) - in the illustrated embodiment, on opposite sides with respect to its longitudinal axis 20, i.e., two - a recess 60 or flattening extending along the longitudinal axis 20 of the cylinder 14, which interrupts the first threaded portion 36 on the outer circumference 40 of the cylinder 14. As already mentioned at the beginning,These recesses 60, each forming a flat surface on the cylinder 14, can be used for labeling the cylinder 14, and they also allow easy cleaning of the cylinder 14 due to the interruption of the first threaded section 36 on the outer circumference 40 of the cylinder 14. Furthermore, the recesses 60 offer the surgeon a good point of contact for holding the applicator 10 in use during an operation. According in particular to Figs. 1A, 8 and 9, in the illustrated embodiment, a scale 62 is attached to the cylinder 14 in the region of the or each recess 60, which scale cooperates with an edge region 64 of the rotary handle 18 in order to provide at least a relative measure of the transplant T displaced from the receiving area 22 via the bow opening 24 of the cylinder 14 during application of the transplant T. For example, this scale 62 may be designed to indicate during an operation,how much graft T has already been delivered by the applicator 10 or how much graft T is still present in the applicator 10. The distance between two adjacent scale marks, in the example "10", multiplied by a device constant that takes into account the diameter of the receiving area 22 of the cylinder 14 or its clear cross-section, can then also provide an absolute measure of the volume of dispensed graft T. As can be seen in particular from Figs. 3 and 5, the connecting section 28 of the nozzle 12 is also sleeve-shaped and, for coupling to the cylinder 14, has a fully circumferential internal thread as a third threaded section 66, which cooperates with a likewise fully circumferential external thread attached to the cylinder 14 as a fourth threaded section 68, as shown in Figs. 8 to 10, near the nose opening 24 of the cylinder 14.to releasably attach the nozzle 12 to the cylinder 14. As can be clearly seen in particular in Figs. 8 and 9, the thread pairing of the third and fourth threaded sections 66, 68 (fastening thread) has a different thread pitch than the thread pairing of the first and second threaded sections 36, 38 (movement thread). In Figs. 1A, 1B, 8 and 9, it is also clearly visible that the third and fourth threaded sections 66, 68 have the same direction of rotation as the first and second threaded sections 36, 38. As a result, when the applicator 10 is actuated, there is no risk that the nozzle 12 will be unscrewed from the cylinder 14 as a result of a clockwise rotation of the rotary handle 18 with respect to the cylinder 14 about the longitudinal axis 20 in order to displace the transplant T from the receiving area 22 of the cylinder 14 by means of the piston 16. As shown in particular in Figs. 1A, 2 and 4,The sleeve-shaped connecting section 28 of the nozzle 12 is also provided on the outer circumference with a plurality of grip recesses 70, which are distributed over the outer circumference. These grip recesses 70 also serve to improve the grip for the operator when the nozzle 12 is screwed onto the cylinder 14, but also when the applicator 10 is held in use on the connecting section 28 of the nozzle 12, as shown in Fig. 22. Finally, with regard to the nozzle 12, it should be noted that in the illustrated embodiment, according to Figs. 3 and 5 in particular, the dispensing opening 32 for applying the transplant T in the dispensing section 30 of the nozzle 12 is aligned with the longitudinal axis 20. The discharge opening 32' can also be arranged or aligned transversely to the longitudinal axis 20, as shown in Figs. 11 to 13 for another nozzle 12'. As already discussed at the beginning,The applicator 10 described above can be a component of an applicator set 80 illustrated in Fig. 1B for applying pasty transplants in surgery, in particular autologous, allogeneic, xenogeneic, or alloplastic bone transplants. In Fig. 1B, as an example of such an applicator set 80, in addition to the applicator 10, which is shown here in a filling configuration without piston 16 and rotary handle 18, an associated instrumentation with several different nozzles 12' above the applicator 10, a rear filling sleeve 82 to the right behind the applicator 10, a filling aid 84, two different plungers 86, and a conditioning aid 88 below the applicator 10 as further components is shown. These components will only be described briefly below, after the structure, function and use of these components have already been described in more detail at the beginning,This should be mentioned again at this point. Regarding the other nozzles 12', these, like the aforementioned nozzle 12 of the applicator 10, have a connecting section 28' for coupling to the cylinder 14 in the area of ​​the nose opening 24 of the cylinder 14 and an adjoining discharge section 30' with a discharge opening 32'.via which the transplant T displaced through the bow opening 24 via the additional nozzle 12' can be applied. These and other details are shown in more detail in Figs. 11 to 13 for the additional nozzle 12' on the right in Fig. 1B. The grip recesses 70' formed on the outer circumference of the connecting section 28' are also clearly visible here. Depending on the respective application requirements, the additional nozzles 12' can differ from the previously described nozzle 12 with regard to the length and / or cross-section of the discharge section 30' - Fig. 1B illustrates additional nozzles 12' of different lengths as an example - and / or the position and / or shape of the discharge opening 32' - in the example in Fig. 1B, different positions of the discharge opening 32' are also illustrated (aligned with the longitudinal axis 20 or transverse thereto,(according to Figs. 11 and 12). Matching the nozzle 12 and the further nozzles 12', the applicator set 80 in the example comprises the two plungers 86. Each plunger 86, preferably made of a metallic material, such as a titanium alloy, has a gripping portion 90 and an adjoining expulsion portion 92, which is adapted in terms of length and cross-section to the nozzle 12 of the applicator 10 and / or the further nozzles 12' of the applicator set 80 in order to displace the residual transplant T remaining in the nozzle 12 and / or the respective further nozzle 12' after emptying the cylinder 14 from the nozzle 12 or the further nozzle 12'. The gripping portions 90 of both plungers 86 are equally dimensioned such thatthat the cross-section of the respective handle section 90 is smaller than the cross-section of the receiving area 22 in the cylinder 14 and the length of the respective handle section 90 is longer than the length of the receiving area 22 in the cylinder 14. This enables the respective nozzle 12, 12' to be emptied with the respective plunger 86 when mounted on the cylinder 14, as already described above. Further details on the rear filling sleeve 82 made of a plastic, such as polyetheretherketone (PEEK), can be found in the separate illustration according to Figs. 14 to 16 and Figs. 17 to 21, which illustrate the use of the rear filling sleeve 82 and the preferably metallic filling aid 84 when filling the applicator 10 with the transplant T using a syringe 94, here in the form of a known glass syringe. First of all, the following should be said about the rear filling sleeve 82:that it is adapted for releasable attachment to the cylinder 14 of the applicator 10 in the region of the rear opening 26 of the cylinder 14. In the illustrated embodiment, the inner diameter of the rear filling sleeve 82 is larger than the outer diameter of the cylinder 14, wherein a threaded portion 96 matching the first threaded portion 36 on the cylinder 14 is formed on the inner circumference of the rear filling sleeve 82 for releasable attachment to the cylinder 14. The rear filling sleeve 82 can thus be screwed onto the cylinder 14 for the filling process, as shown in Figs. 17 to 20. Furthermore, the rear filling sleeve 82 has a stop 98 on the inner circumference, which in the illustrated embodiment is formed by an annular collar stepped on the inner diameter, can be brought into contact with the cylinder 14 with a first end face 100 in the region of the rear opening 26 (cf. Fig. 20) and has a second end face 102 facing away from the first end face 100,which forms a contact surface for the syringe 94 for filling the receiving area 22 in the cylinder 14 with the pasty transplant T, as also shown in Figs. 19 and 20. It can be seen that the rear filling sleeve 82 with its stop 98 thus separates the syringe 94, more precisely its glass cylinder, from the cylinder 14 of the applicator 10 when filling the applicator 10, so that the syringe 94 cannot strike the cylinder 14. As can be clearly seen in particular in Figs. 14 to 16 and 20, the rear filling sleeve 82 further has a longitudinally slotted sleeve section 104 for closely receiving the syringe 94 for filling the receiving area 22 in the cylinder 14 with the pasty transplant T. Due to the longitudinal slots, the sleeve section 104 of the rear filling sleeve 82 can spring back slightly to keep the syringe 94 centered during the filling process and also to compensate for diameter tolerances on the glass cylinders of the syringes 94. As already described at the beginning,Furthermore, the filling aid 84 is provided for shearing off the pasty transplant T when filling the receiving area 22 in the cylinder 14 via its rear opening 26. For this purpose, the rear filling sleeve 82, viewed along the longitudinal axis 20, has, between the first end face 100 and the second end face 102, an opening 106 extending transversely with respect to the longitudinal axis 20, which, as shown in Fig. 16, opens into a transplant passage 108 of the rear filling sleeve 82 and has a predetermined cross-section. Furthermore, the filling aid 84 is formed by a pin 110, which has a cross-section complementary to the cross-section of the opening 106 in the rear filling sleeve 82. In particular, it can be seen from Figs. 17, 18, and 21 that the pin-shaped filling aid 84 can thus be inserted into the opening 106 in the rear filling sleeve 82.to shear off the graft T in the area of ​​the graft passage 108 of the rear filling sleeve 82. Finally, with regard to the conditioning aid 88, it can be seen from Fig. 1B that the conditioning aid 88 has a base 112 with a central blind bore 114 and can be placed, for example, on a table in the orientation shown. The cross-section of the blind bore 114 in the base 112 is adapted to the outer diameter of the nozzle 12 of the applicator 10 or the other nozzles 12' of the applicator set 80, so that the conditioning aid 88 can be used as already discussed above. In brief, an applicator 10 for applying pasty transplants T comprises a cylinder 14 in which a piston 16, which can be inserted via a rear opening 26, is guided in a longitudinally displaceable manner in order to displace the transplant T from a receiving area 22 of the cylinder 14 via its bow opening 24. There, a nozzle 12 is coupled to the cylinder 14,which has a discharge opening 32 for applying the displaced transplant T. To convert a rotary movement of a rotary handle 18 operatively connected to the piston 16 into a longitudinal movement of the piston 16 in the cylinder 14, a gear mechanism 34 is provided, with a first threaded portion 36 fixed to the cylinder and a cooperating second threaded portion 38 fixed to the rotary handle. A special feature here is that the first threaded portion 36 is formed on the outer circumference 40 of the cylinder 14, while the second threaded portion 38 is provided on the inner circumference 42 of the essentially sleeve-shaped rotary handle 18, which in turn has a driving portion 44 for transmitting the longitudinal movement to the piston 16. As a result, improved handling of the applicator 10 is enabled compared to the prior art.which is optimized in particular with regard to the more precisely positioned application of a pasty transplant T with reduced force. Figure 22 illustrates in this context how sensitively the transplant T can be applied by rotating the rotary handle 18 with one hand around the cylinder 14 of the applicator 10 held with the other hand. An applicator for pasty surgical transplants comprises a cylinder defining a transplant receiving area around a longitudinal axis, which cylinder has front and rear openings, a piston insertable into the receiving area via the rear opening and displaceable along the longitudinal axis for displacing the transplant via the front opening, a nozzle with a connecting section for coupling to the cylinder on the front opening side, and a dispensing section, via whose dispensing opening the displaced transplant can be applied.and a rotary handle operatively connected to the piston. To convert a rotary movement of the rotary handle into a longitudinal piston movement, a gear mechanism is provided, which has a first threaded section fixed to the cylinder and a cooperating second threaded section fixed to the rotary handle. The first threaded section is formed on the outer circumference of the cylinder, while the second threaded section is provided on the inner circumference of the essentially sleeve-shaped rotary handle, which has a drive section for transmitting the longitudinal movement to the piston.

[0002] LIST OF REFERENCE SYMBOLS Applicator Nozzle ' Additional nozzle Cylinder Piston Rotary handle Longitudinal axis Pick-up area Bow opening Rear opening , 28' Connection section , 30' Discharge section , 32' Discharge opening Gear mechanism First threaded section Second threaded section Outer circumference Inner circumference Driving section Base area End End Projection Recess Undercut Grip recesses Cutout / flattening Scale Edge area , 66' Third threaded section Fourth threaded section, 70' Grip recesses Applicator set Rear filling sleeve Filling aid Tappet Conditioning aid Grip section Expulsion section Syringe Threaded section Stop First end face Second end face Longitudinally slotted sleeve section Opening Graft passage Pin Base Blind hole Graft

Claims

PATENT CLAIMS:

1. Applicator (10) for applying pasty transplants (T) in surgery, in particular autologous, allogeneic, xenogeneic or alloplastic bone transplants, comprising a cylinder (14) which defines a hollow receiving area (22) for the transplant (T) around a longitudinal axis (20), which cylinder has a bow opening (24) and a rear opening (26) towards the receiving area (22), a piston (16) which can be inserted into the receiving area (22) of the cylinder (14) via the rear opening (26) and which is displaceable in the receiving area (22) along the longitudinal axis (20) in order to displace the transplant (T) from the receiving area (22) via the bow opening (24) of the cylinder (14), a nozzle (12) which has a connecting section (28) for coupling to the cylinder (14) in the region of the bow opening (24) and a dispensing section (30) with a dispensing opening (32) through which the transplant (T) displaced through the bow opening (24) via the nozzle (12) can be applied,and a rotary handle (18) operatively connected to the piston (16), wherein a gear mechanism (34) is provided for converting a rotary movement of the rotary handle (18) into a longitudinal movement of the piston (16) in the cylinder (14), said gear mechanism having a first threaded portion (36) fixed to the cylinder and a second threaded portion (38) fixed to the rotary handle, said second threaded portion cooperating with the first threaded portion (36), characterized in that the first threaded portion (36) is formed on the outer circumference (40) of the cylinder (14), while the second threaded portion (38) is provided on the inner circumference (42) of the substantially sleeve-shaped rotary handle (18), which has a driving portion (44) for transmitting the longitudinal movement to the piston (16).

2. Applicator (10) according to claim 1, characterized in that the piston (16) and the rotary handle (18) are two separate components.

3. Applicator (10) according to claim 1 or 2, characterized in that the rotary handle (18) is cup-shaped, with a bottom region (46) that can be brought into contact with an end (48) of the piston (16) protruding from the receiving region (22) of the cylinder (14) as a driving section (44) of the rotary handle (18).Applicator (10) according to claim 3, characterized in that the piston (16) has, on its side facing away from the bow opening (24) of the cylinder (14), a dome-shaped or spherical projection (52) at a substantially central location, against which the base region (46) of the rotary handle (18) can be brought into contact, and / or that the piston (16) is provided on its end (48) projecting from the receiving region (22) of the cylinder (14) on the outer circumference side with at least one recess (54) which forms an undercut (56).

5. Applicator (10) according to one of the preceding claims, characterized in that the cylinder (14) has, on at least one outer longitudinal side, a recess (60) or flattening extending along the longitudinal axis (20) of the cylinder (14), which interrupts the first threaded portion (36) on the outer circumference (40) of the cylinder (14).Applicator (10) according to one of the preceding claims, characterized in that the cylinder (14) has outer longitudinal sides opposite one another with respect to its longitudinal axis (20). each provided with a recess (60) which interrupts the first threaded portion (36) on the outer circumference (40) of the cylinder (14).

7. Applicator (10) according to claim 5 or 6, characterized in that a scale (62) is attached to the cylinder (14) in the region of the recess (60), which scale cooperates with an edge region (64) of the rotary handle (18) to provide at least a relative measure for the transplant (T) displaced from the receiving region (22) via the bow opening (24) of the cylinder (14) during application of the transplant (T).Applicator (10) according to one of the preceding claims, characterized in that the connecting section (28) of the nozzle (12) is sleeve-shaped and, for coupling to the cylinder (14), has an internal thread as a third threaded section (66), which cooperates with an external thread attached to the cylinder (14) near the bow opening (24) of the cylinder (14), as a fourth threaded section (68), in order to releasably fasten the nozzle (12) to the cylinder (14).

9. Applicator (10) according to claim 8, characterized in that the third and fourth threaded sections (66, 68) have a different thread pitch than the first and second threaded sections (36, 38) and / or that the third and fourth threaded sections (66, 68) have the same direction of rotation as the first and second threaded sections (36, 38). 10.Applicator (10) according to one of the preceding claims, characterized in that the substantially sleeve-shaped rotary handle (18) and / or the sleeve-shaped connecting section (28) of the nozzle (12) on the outer circumference. is provided with a plurality of grip recesses (58, ) distributed over the outer circumference.

11. Applicator (10) according to one of the preceding claims, characterized in that in the dispensing section (30) of the nozzle (12), the dispensing opening (32) for applying the transplant (T) is aligned with the longitudinal axis (20) or extends transversely to the longitudinal axis (20).

12. Applicator set (80) for applying pasty transplants (T) in surgery, in particular autologous, allogeneic, xenogeneic or alloplastic bone transplants, with an applicator (10) according to one of the preceding claims and at least one further component from an associated instrumentation, comprising a rear filling sleeve (82) adapted for releasable attachment to the cylinder (14) of the applicator (10) in the region of the rear opening (26) of the cylinder (14),a filling aid (84) for shearing off the pasty graft (T) when filling the receiving area (22) in the cylinder (14) via its rear opening (26), at least one further nozzle (12') which, like the aforementioned nozzle (12) of the applicator (10), has a connecting section (28) for coupling to the cylinder (14) in the region of the bow opening (24) and a dispensing section (30) with a dispensing opening (32) through which the graft (T) displaced through the bow opening (24) via the further nozzle (12') can be applied, wherein the further nozzle (12') differs from the aforementioned nozzle (12) with regard to the length and / or cross-section of the dispensing section (30) and / or the position and / or shape of the dispensing opening (32), at least one plunger (86) with a grip portion (90) and an adjoining expulsion portion (92), which is adapted in terms of length and cross-section to the nozzle (12) of the applicator (10) and / or the further nozzle (12') of the applicator set (80) in order to displace the residual transplant (T) remaining in the nozzle (12) and / or the further nozzle (12') after emptying the cylinder (14) from the nozzle (12) or the further nozzle (12'), and a conditioning aid (88) with a base (112) having a central blind bore (114), the cross-section of which is adapted to the outer diameter of the nozzle (12) of the applicator (10) and / or the further nozzle (12') of the applicator set (80). 13.Applicator set (80) according to claim 12, characterized in that the rear filling sleeve (82) has a stop (98) which can be brought into contact with the cylinder (14) with a first end face (100) in the region of the rear opening (26) and has a second end face (102) facing away from the first end face (100), which forms a contact surface for a syringe (94) for filling the receiving area (22) in the cylinder (14) with the pasty transplant (T), and / or that the rear filling sleeve (82) has a longitudinally slotted sleeve section (104) for tightly receiving a syringe (94) for filling the receiving area (22) in the cylinder (14) with the pasty transplant (T).

14. Applicator set (80) according to claim 13, characterized in that the rear filling sleeve (82) has, viewed along the longitudinal axis (20), between the first end face (100) and the second end face (102), an opening (106) which runs transversely with respect to the longitudinal axis (20) and which can be used in a transplant. passage (108) of the rear filler sleeve (82) and has a predetermined cross-section, wherein the filling aid (84) is formed by a pin (110) which has a cross-section complementary to the cross-section of the opening (106) in the rear filler sleeve (82).

15. Applicator (10) or applicator set (80) according to one of the preceding claims, characterized in that at least the cylinder (14) and / or the nozzle (12) of the applicator (10) is / are made of a titanium alloy.

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