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

Abstract

An applicator (10) for surgical grafts has a grip piece (12) which delimits a receiving region (26) for the graft about a longitudinal axis (24) and which at its ends has, in alignment with the longitudinal axis, nose and tail openings (28, 30) towards the receiving region, and it has a window opening (32) which, extending transverse to the longitudinal axis, likewise opens into the receiving region. A plunger (14), insertable into the receiving region via the tail opening and protruding with a plunger end (34) from the grip piece, is movable along the longitudinal axis in the receiving region, in order to drive the graft out of the receiving region through the nose opening and thus apply it. Finally, a closure device (16) for selectively closing the window opening is provided which, by means of a holding mechanism (36) interacting with the grip piece, is able to be secured on the grip piece in a position covering the window opening, in such a way that during the application no graft can emerge through the window opening securely closed by the holding mechanism.

Description

[0001] APPLICATOR FOR APPLYING TRANSPLANTS IN SURGERY AND APPLICATOR SET WITH ASSOCIATED INSTRUMENTS TECHNICAL FIELD The present invention generally relates to an applicator for applying transplants in surgery, according to the preamble of claim 1, and to an applicator set comprising such an applicator. In particular, the invention relates to an applicator for applying autologous, allogeneic, xenogeneic, or alloplastic bone transplants. Such applicators are used extensively in surgery, for example, when it comes to placing bone or bone replacement materials in or on a patient's bone.STATE OF THE ART The reconstruction of bone 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 example, for relatively young patients with a prosthesis, such as an artificial hip joint, which will most likely need to be replaced after some time. With such a prosthesis replacement, every revision procedure is associated with 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.To repair such bone defects, various bone replacement materials are currently available as transplants. These differ in the starting materials used and the methods used to obtain the respective bone replacement 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 replacement materials (alloplastic material) are used. Commercially available materials include sawn bone chips, bone granules, cancellous bone blocks, and cancellous bone cylinders; secondary bone cement, i.e., UV-curing pastes; fiber-reinforced transplants; and ready-to-use pastes made from demineralized bone matrix with a suitable carrier (e.g., hyaluronic acid), which can be used directly to fill small bone cavities.For larger, extensive defects, the bone substitute material is processed in block form or as granules. Smaller bone chips or swarf can be used for all other indications. Depending on the application and the required properties of the bone or bone substitute material, individual transplant mixtures are produced from pastes, blocks or cylinders, prepared chips or granules and, if necessary, conditioned with blood plasma, growth factors, antibiotics, and / or the patient's own blood. For simplicity, the transplant mixtures will be referred to generally as transplants. An ideal transplant is still malleable, allowing it to be optimally adapted to the bone defect. When filling bone defects, the transplants must be carefully placed in / at the defective areas of the bone.Applicators are used for this purpose. The material to be applied must first be filled into them. It is then compressed into a cohesive, injectable mass using a piston or plunger and then pushed out towards the defect via an outlet opening in the applicator. The force required for the displacement can be applied by the surgeon, for example, by manually pressing the piston or plunger and / or hitting it with a hammer. 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 have advantages over plastic syringes in terms of stable storage and a longer shelf life for the transplant they contain. Interactions with the bone or bone replacement materials and the release of anyChemicals that disrupt the healing process are not to be expected with glass syringes. However, due to the risk of glass syringes breaking, increased care must be taken during handling. In particular, care must be taken to ensure that 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 together with the syringe while adhering to the syringe. The prior art does not lack suggestions for how to load an applicator with the graft. For example, the document US 2018 / 0008746 A1 describes an applicator to which a syringe can be connected via a thread for filling with the graft.In this state of the art, the transplant components to be mixed are first premixed and compacted in the syringe and then filled into the applicator from the rear via a rear opening using the syringe. Applicators that can be loaded from the front or rear without a syringe can also be found, for example, in the publications DE 102009 012 437 A1 and US 2010 / 0198140 A1. A "cancellous bone applicator for filling bone defects" with the features of the preamble of patent claim 1 is available from Karl Storz SE & Co. KG, 78532 Tuttlingen, Germany (ENDOWORLD). ®ART 512.0 06 / 2015-D). This applicator has a handle that defines a hollow receiving area for the transplant around a longitudinal axis. The handle has a front opening and a rear opening at opposite ends, which are aligned with the longitudinal axis. Furthermore, the handle is provided with an oval window opening, which runs transversely to the longitudinal axis and also opens into the receiving area. Through this window, the components of the transplant can be introduced individually or mixed into the receiving area. A plunger, which can be inserted into the receiving area of ​​the handle via the rear opening, protrudes from the handle with one end and can be moved along the longitudinal axis in the receiving area by hand or using a hammer.to displace the transplant from the receiving area through the front opening of the handle and apply it. To optionally close the window opening in the handle, this previously known applicator also has a closure device in the form of a plug for the window opening, which, when precisely inserted into the window opening, protrudes radially into the receiving area of ​​the handle. When this applicator is used in accordance with the manufacturer's specifications, i.e., as intended, a closure cap is first placed on the applicator before filling, closing the front opening. The transplant is then inserted, for example, into the side window opening of the applicator. Since protruding portions of the transplant can hinder the advancement of the transplant by means of the plunger in the receiving area, the plug is inserted precisely into the window opening.so that the plug presses the portions of the graft that protrude radially relative to the longitudinal axis just below the diameter of the applicator's receiving area. The graft can now be moved using the plunger into the area between the window opening and the bow opening of the applicator, so that the plug in the window opening is no longer needed during application. According to the manufacturer's instructions, filling the applicator with a length of more than 4 cm should be avoided, as this would make applying the graft more difficult. To achieve controlled and measured filling of the bone defect, the manufacturer initially recommends using an applicator.whose receiving area has a smaller diameter than the defect diameter. For the next filling of the bone defect, another applicator with a larger diameter of the receiving area - depending on the defect size - should then be used. The graft to be applied should therefore be prepared and processed in different tranches. In everyday clinical practice, however, it sometimes happens that the surgeon, contrary to the manufacturer's specifications, fills the applicator with a filling of significantly more than 4 cm in length in order to fill the bone defect with a uniform graft and in a single operation. In this case, the applicator is filled either via the side window opening or - in the case of ready-to-use, pasty grafts and only with a plug inserted - via the stern or bow opening. The aforementioned "overfilling" of the applicator then results inThe graft is also under pressure in the area of ​​the lateral window opening when compacted or applied via the plunger, so the surgeon must manually secure the plug in its position closing the window opening. This can cause liquid or pasty components of the graft to leak out of the lateral window opening under the plug, which is slightly raised due to the dynamic pressure – or by the plunger itself – making it difficult to hold the applicator during application. Furthermore, the need to manually hold the plug of the "overfilled" applicator in place in the lateral window opening of the handle hinders or prevents precise guidance or positioning of the applicator with its bow opening on the bone defect during application of the graft. Finally, the publication WO 2016 / 164189 A1 discloses a pellet feeder.by means of which, for example, slowly dissolving pellets for the release of hormones such as testosterone or estrogen can be inserted under the skin of a patient. In the event that multiple pellets are to be held and placed, this state of the art provides a pellet cartridge that can be connected to a trocar of the pellet delivery device. A trocar is defined as a puncture instrument that is used, for example, in minimally invasive surgery to gain access to a body cavity or to drain fluids from body cavities. The pellet cartridge contains a plurality of pellets that can be inserted into the trocar via a medial opening, whereby the pellet cartridge can be connected to the trocar via a retaining element. The retaining element shown in Fig. 6 of this publication is configured such thatthat it can snap elastically around the body of the trocar to connect the inner cavity of the pellet cartridge with the medial opening of the trocar. A tight closure of the medial opening of the trocar by means of the pellet cartridge is, of course, neither intended nor possible with this prior art. OBJECTIVE Based on the prior art described above, the invention is based on the object of providing an applicator for applying transplants in surgery, in particular autologous, allogeneic, xenogeneic, or alloplastic bone transplants, as well as an applicator set with such an applicator, which generally avoids the disadvantages described above and specifically allows the application of even larger,This object is achieved by an applicator having the features of patent claim 1 and an applicator set having the features of patent claim 10, respectively. Advantageous and expedient developments of the invention are the subject of patent claims 2 to 9 and 11 to 15, respectively. In an applicator for applying transplants in surgery, in particular autologous, allogeneic, xenogeneic, or alloplastic bone transplants, comprising a handle defining a hollow receiving area for the transplant around a longitudinal axis, which has, at opposite ends, a front opening and a rear opening toward the receiving area, which are aligned with the longitudinal axis, and a window opening,which runs in a direction transverse to the longitudinal axis and also opens into the receiving area, a plunger insertable via the rear opening into the receiving area of ​​the handle, which plunger protrudes from the handle with one end of the plunger and 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 handle and to apply it, and a closure device for selectively closing the window opening in the handle; according to the invention, the closure device can be secured on the handle by means of a holding mechanism cooperating with the handle in a position covering or covering the window opening of the handle such that when the transplant is applied, no transplant escapes via the window opening in the handle, which is securely closed by means of the holding mechanism.Since the closure device for the lateral window opening in the handle can be secured according to the invention by means of the holding mechanism in its position covering or covering the lateral window opening, i.e., in its position closing the window opening of the handle, the surgeon is relieved of such a task. There is then no longer any need for the surgeon to grasp the handle of the applicator in a specific position securing or holding the closure device on the handle, since this securing is provided by the holding mechanism. The surgeon can therefore hold the handle in any position according to the respective surgical requirements, which significantly improves the handling of the applicator, particularly during the application of the transplant in hard-to-reach areas. The fact thatThe fact that the surgeon does not have to worry about holding his instruments during the application of the transplant also has a positive effect on the application result because, when this considerable distraction is completely eliminated, the surgeon can devote himself entirely to his actual task, namely the precise placement of the applicator and the controlled delivery of the transplant. Since no transplant can escape through the window opening of the applicator, whose window opening in the handle is closed with the locking device secured according to the invention, during application, even if the receiving area in the handle is filled to the point of or beyond the window opening, as viewed along the longitudinal axis,The quantity restrictions for the graft provided for in the above prior art for the intended use of the applicator are eliminated. The applicator can thus advantageously be completely loaded with a uniform graft in a first step, in order to safely and cleanly apply larger graft quantities tailored to the respective bone defect in a second step. Filling the bone defect in several steps with different applicators is therefore advantageously not necessary in many cases. Last but not least, the fact that during application of the graft, no graft escapes through the window opening in the handle, which is securely closed by the holding mechanism according to the invention,This improves the grip of the applicator compared to the above-mentioned prior art, as well as promoting the cleanest possible operating environment. In a preferred embodiment of the applicator, its closure device can comprise, in a first, particularly simple and easy-to-clean variant, a sleeve that is adapted to cover the window opening of the handle when pushed onto the handle. If the holding mechanism is not simply formed by a correspondingly tight fit of the sleeve on the inner diameter and the handle on the outer diameter, so that the sleeve can only be pushed onto the handle by applying a predetermined force,The holding mechanism can also have a collar formed on the sleeve as a stop for the handle and / or an O-ring attached to an inner peripheral surface of the sleeve for frictional engagement with an outer peripheral surface of the handle. Such a sleeve of the locking device, which encloses the handle in the assembled state, can be brought into its functional position particularly easily by sliding it onto the handle. The collar formed on the sleeve, if any, can advantageously ensure a defined end position of the sleeve on the handle. When the sleeve is joined to the handle, this results in a stable end position for the sleeve, which gives the surgeon a tactile impression that the lateral window opening in the handle is closed. Alternatively or additionally, the sleeve can be secured against slipping by means of the O-ring on the handle. If the sleeve is to be used "on both sides",i.e., are held securely on the handle in the assembly and disassembly directions, a sleeve design with a collar and O-ring is recommended. In this variant of the closure device with a sleeve, the closure device can optionally comprise a closure plug for selectively closing the lateral window opening, which has a base body that is complementarily shaped to ensure a precise closure of the window opening in the handle. This advantageously avoids - in addition to the receiving area for the plunger - cavities in the applicator into which transplant material could flow during filling or application. As a result of this simple reduction in dead space in the applicator, fewer transplant losses occur compared to an applicator design without a closure plug, thereby improving the material yield. In a particularly preferred,In an alternative embodiment of the applicator, its closure device can be designed in a second variant with a closure plug for selectively closing the lateral window opening in the handle such that a holding section of the holding mechanism is provided on the base body of the closure plug, which cooperates with the handle and by means of which the closure plug can be secured to the handle in the position closing the window opening. Compared to the first-mentioned variant of the closure device with a sleeve, which can include a closure plug for the window opening in addition to the sleeve, the above-described second variant of the closure device with a holding section on the base body of the closure plug offers the advantage of improved handling.Because the dead-space-reducing closure of the window opening in the handle and the securing of this closure do not require different handling steps with / on the closure device. Rather, when mounting the closure plug, which has the base body and the holding section, on the handle, the dead-space-reducing closure of the window opening and the securing of this closure advantageously take place simultaneously in one process or with one movement of the operator. In this variant of the closure device with the holding section of the holding mechanism on the base body of the closure plug, the holding section and the base body can essentially be two different parts - for example, a base body made of plastic and a metallic holding section - which are connected to one another in a suitable manner, detachably or permanently, but in any case captively (positively, force-fitting, or materially bonded,Depending on the materials used and the strength requirements). However, particularly with a view to achieving the most cost-effective production possible, a design of the applicator is preferred in which the holding section of the holding mechanism is formed integrally with the base body of the closure plug. Regarding the currently preferred materials for the holding section and base body, the holding section and the base body of the closure plug can be formed from a single plastic material, for example, polyoxymethylene (POM). A one-piece design of the holding section and base body can thus be realized cost-effectively using injection molding technology, whereby the produced injection-molded part is advantageously easy to disinfect because it has no joint gaps. In a structurally particularly simple design of the applicator, it is further preferredif, in the variant of the closure device with the holding section of the holding mechanism on the base body of the closure plug, the holding section of the holding mechanism has at least one leg that is resilient and capable of encompassing an outer peripheral surface of the handle in order to secure the closure plug, which is received with its base body in the window opening of the handle, to the handle in a clamp-like or clasp-like manner. In this case, the at least one leg of the holding section can have a contact surface shaped complementarily to the outer peripheral surface of the handle, which, when the closure plug is mounted on the window opening of the handle, rests flatly against the outer peripheral surface of the handle. Compared to a likewise conceivable linear contact between a free end of the leg of the holding section and the outer peripheral surface of the handle, the previously described flat contact is preferred.because it promises less mobility in the connection of the components involved, as well as less wear on the components. In principle, it is possible for the above-described holding section of the holding mechanism to have only one spring-elastic leg encompassing the outer peripheral surface of the handle, which, for example, is bent into a C-shape and connected at one leg end to the base body of the closure plug. However, particularly with regard to the most uniform contact pressure for the closure plug and the smallest possible required spring-back or deformation capacity of the leg, a design of the applicator in which the holding section of the holding mechanism has two legs is preferred.which extend away from the base body in bilateral symmetry with respect to the base body of the closure plug. With such a design of the holding section, the closure plug can also be mounted more easily, namely by a mere linear movement in / on the window opening in the handle. In an advantageous design of the applicator, it can further be provided that the closure plug, on its side facing away from the receiving area for the transplant when mounted on the handle, is provided with a central marking recess in which a marking lens or disc for identifying the applicator is firmly received. This can, for example, easily address the problem that the attachment of a permanent,Delicate marking on components made of certain plastics is often difficult. However, if a metallic marking lens or disc is used in the marking recess of the closure plug, this can be advantageously used for laser marking, for example. Individual marking of the applicators by using colored marking lenses or discs in the marking recesses of the closure plug is of course also conceivable. Furthermore, in a preferred embodiment, the applicator can have a closure cap for optionally closing the bow opening in the handle, which is primarily used when filling the receiving area in the handle with the transplant, wherein the closure cap can be detachably attached to the handle, in particular by means of a locking device engaging in a groove on the handle. In principle, it is also possibleto fill the applicator's rear and / or window with the graft without the aforementioned closure cap located at the handle's nose opening. The nose opening can be closed manually, for example, or temporarily sealed by placing it on a support surface, such as a table. However, filling the applicator is easier if the nose opening does not need to be closed manually, nor does the applicator need to be positioned in a specific position and orientation during filling to close the nose opening. Furthermore, the optional closure cap is advantageous for transporting the filled applicator. For example, the applicator equipped with the closure cap can be prepared at another location during surgery, i.e., filled with the graft, and the latter can be conditioned and compacted if necessary.before the appropriately prepared applicator is passed on to the surgeon. The closure cap prevents both accidental discharge of the graft from the applicator and contamination of the graft via the bow opening in the handle. Before applying the graft, the surgeon then only has to remove the closure cap from the applicator and position the applicator relative to the defect on the bone. Instead of a locking device for holding the closure cap to the applicator, another connection can of course be provided, e.g. a screw connection or a frictional connection, which, however, is less preferred with regard to the security of the connection and the ease of handling of the applicator. Furthermore, the present invention provides an applicator set for applying grafts in surgery, in particular autologous, allogeneic,xenogeneic or alloplastic bone transplants, which, in addition to the applicator described above, also has at least one further component from an associated instrumentation, which comprises the following components: a front filling sleeve adapted for releasable attachment to the front opening in the handle of the applicator; a rear filling sleeve adapted for releasable attachment to the rear opening in the handle of the applicator; a filling aid for shearing off a pasty transplant when filling the receiving area in the handle via its rear opening; and an application aid that can be placed on an extension of the handle, on which the front opening of the handle is formed, in a position in which the application aid protrudes beyond the extension of the handle,The applicator has an exit opening for the transplant. Regarding these optional additions to the applicator described above, the following should be noted: The use of a front filling sleeve for filling the applicator via the front opening in the handle, as well as the use of a rear filling sleeve for filling the applicator via the rear opening in the handle, is particularly useful if the applicator is to be loaded, for example, with pasty transplants stored ready for use in glass syringes. Damage to the delicate glass syringes due to careless / uncontrolled impact on the – preferably metallic – handle of the applicator must be avoided at all costs. In this context, it is advantageous if the front filling sleeve has a stop.which can be brought into contact with the handle with a first end face in the region of the front 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 handle with the pasty transplant. Accordingly, the rear filling sleeve can have a stop, which can be brought into contact with the handle with a first end face in the region 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 handle with the pasty transplant. In both cases, the stop on the filling sleeve, which is preferably made of plastic, ensures a forced separation or spacing between the (glass) syringe and the handle of the applicator.to prevent damage to the syringe. Preferably, the front filling sleeve and / or the rear filling sleeve further comprises a longitudinally slotted sleeve section for tightly receiving the syringe for filling the receiving area in the handle with the pasty graft. This creates a simple clamping 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 with respect to the applicator during the actual filling process. Regarding the filling aid of the instrumentation for the applicator described above, it is preferably provided that the handle of the applicator has an opening extending transversely to the longitudinal axis between the rear opening and the window opening, viewed along the longitudinal axis, which opens into the receiving area of ​​the handle and has a predetermined cross-section, wherein the filling aid is formed by a pin.which has a cross-section complementary to the opening in the handle. 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 side opening of the handle at the end of the filling process to pierce or puncture the graft. The syringe can now be withdrawn from the applicator – possibly after rotating it around its longitudinal axis – without the graft adhering to the syringe being pulled out of the handle's receiving area. The following must be taken into account here:that the pasty graft may not be able to be compressed when filling the receiving area via the rear opening in the handle due to a lack of sufficient counterpressure – e.g., because the syringe has a smaller receiving volume for the graft than the receiving area in the applicator – so that no frictional connection is created between the graft and the inner wall of the handle that defines the receiving area, which would prevent the graft from being pulled out with the syringe. In this case, the filling aid enables a clean separation of the syringe from the applicator. When filling the receiving area in the applicator via the front opening of the handle, however, the counterpressure required to create the aforementioned frictional connection between the graft and the handle can be applied by the plunger inserted into the applicator via the rear opening.So, such a filling aid is not needed here. Regarding the application aid of the instrumentation for the applicator described above, it should first be noted that the outlet opening of the application aid can have a cross-section that differs from the cross-section of the bow opening on the extension of the handle, e.g., smaller in the manner of a nozzle. By selecting an application aid with a specific cross-section, it can be easily adapted to the respective defect in the bone, specifically in the sense of optimally filling or covering the defect with the transplant, without having to use a different or differently sized applicator. Furthermore, the application aid can be sleeve-shaped, with a first end facing the handle when the application aid is placed on the extension of the handle, and a second end facing away from the first end.which is beveled with respect to its longitudinal axis to form an inclined exit opening for the transplant. This allows, for example, in cases of restricted access to the bone defect to be filled, an easy oblique application or placement of the applicator with the application aid on the bone. Due to its bevel, the exit opening of the application aid can be placed largely tightly against the bone defect, so that the transplant enters the bone defect as completely as possible. Furthermore, the sleeve-shaped application aid can be provided with a ring collar on an outer peripheral surface as a handle, via which the application aid can be safely moved, for example, from a use position in which it protrudes over the extension of the handle to a non-use position on the extension retracted with respect to the extension - and vice versa.This also contributes to improved handling of the applicator, allowing the surgeon to move the applicator aid appropriately with respect to the applicator without having to set it down, which advantageously ensures an uninterrupted workflow. Last but not least, the sleeve-shaped applicator aid can have resilient locking lugs on an inner peripheral surface that can be brought into engagement with a groove formed on an outer peripheral surface of the handle extension in order to hold the applicator aid in the correct length on the handle. With such an applicator design, manual holding of the applicator aid, for example, in its use position, is advantageously not necessary. If necessary, several axially spaced-apart grooves can also be provided on the handle extension.to define different use and non-use positions of the application aid on the applicator for the surgeon. Finally, particularly with regard to the reusability, durability, and wear resistance of the applicator, it is preferred if at least the handle and / or the plunger 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 further chemically inert properties of this material, which are positive for the intended use. BRIEF DESCRIPTION OF THE DRAWINGS The invention is described below using preferred embodiments with reference to the attached,explained in more detail in partially schematic or simplified drawings. The drawings show: Fig. 1A is a perspective exploded view of an applicator for applying bone transplants according to a first embodiment of the invention, comprising a handle with a front opening, a rear opening, and a side window opening, a plunger insertable into the rear opening of the handle for displacing the transplant through the front opening, a closure device for the window opening, which can be secured to the handle by means of a special holding mechanism, which in this case has a closure plug insertable into the window opening, and an optional closure cap for closing the front opening in the handle; Fig. 1B is a perspective exploded view of an applicator set for applying bone transplants, here comprising the applicator according to Fig. 1A.which is shown in a filling configuration with the closure plug inserted into the window opening, secured there by the holding mechanism, and without a plunger, a front filling sleeve for optionally filling the applicator via the front opening in the handle, a rear filling sleeve for optionally filling the applicator via the rear opening in the handle, an application aid that can be placed on a front-side extension of the applicator's handle, and a filling aid for shearing off a pasty graft when filling the handle via its rear opening; Fig. 2 is a side view of the applicator prepared for applying the graft according to Fig. 1A, interrupted in the area of ​​the plunger.in which the bow opening in the handle is closed by means of the closure cap and the window opening in the handle is closed by means of the closure plug of the closure device secured by the holding mechanism; Fig. 3 is a plan view of the applicator according to Fig. 1A, in which the bow opening and the window opening in the handle are closed according to Fig. 2 and the plunger is shown fully inserted into the handle to illustrate the relative dimensions of the plunger in relation to the handle; Fig. 4 is a sectional view of the applicator according to Fig. 1A, enlarged in scale compared to the illustration in Fig. 2, along the section line IV-IV in Fig. 2, wherein the transplant in the handle is not shown; Fig. 5 is a sectional view of the applicator according to Fig. 1A, along the section line VV in Fig. 3; Fig. 6 is a sectional view of the applicator according to Fig. 1A, enlarged in scale compared to the illustration in Fig. 1A,Perspective view of the closure plug of the closure device of the applicator according to Fig. 1A, which has a base body shaped complementarily to the window opening, on which a holding section of the holding mechanism is provided; Fig. 7 is a side view of the closure plug according to Fig. 6; Fig. 8 is a front view of the closure plug according to Fig. 6 from the left in Fig. 7; Fig. 9 is a bottom view of the closure plug according to Fig. 6 from below in Fig. 7; Fig. 10 is a sectional view of the closure plug according to Fig. 6 according to the section line XX in Fig. 7; Fig. 11 is an enlarged view of the detail XI in Fig. 10; Fig. 12 is an enlarged perspective exploded view of the optional closure cap of the applicator according to Fig. 1A, with - in Fig. 12 from left to right - a housing, a spring element,a locking ring and a closure piece; Fig. 13 is a front view of the assembled closure cap according to Fig. 12, looking at the closure piece surrounded by the locking ring; Fig. 14 is a sectional view of the closure cap according to Fig. 12 along section line XIV-XIV in Fig. 13; Fig. 15 is a side view of the handle of the applicator according to Fig. 1A; Fig. 16 is a plan view of the handle according to Fig. 15 from above in Fig. 15; Fig. 17 is a sectional view of the handle according to Fig. 15, enlarged in scale compared to the illustration in Fig. 15, along section line XVII-XVII in Fig. 15; Fig. 18 is a plan view of the plunger of the applicator according to Fig. 1A; Fig. 19 is an enlarged view of detail XIX in Fig. 18, illustrating details of the end of the plunger facing away from the handle; Fig. 20 is a perspective view of the applicator according to Fig. 1A without the plunger,but with a syringe and the bow filling sleeve of the applicator set placed in the area of ​​the bow opening on the handle according to Fig. 1B, in which the syringe with its syringe cylinder is inserted for filling the applicator with the transplant; Fig. 21 a plan view of the applicator with syringe and bow filling sleeve, broken off to the right, as shown in Fig. 20; Fig. 22 a sectional view of the applicator with syringe and bow filling sleeve, broken off to the right, according to Fig. 20, along section line XXII-XXII in Fig. 21; Fig. 23 an enlarged view of detail XXIII in Fig. 22, to illustrate how the bow filling sleeve separates the syringe from the handle by means of a stop for both parts when filling the applicator; Fig. 24 is a perspective view of a bow filling sleeve, enlarged compared to the illustration in Fig. 1B,which is designed as an alternative to the front filling sleeve shown in the applicator set according to Fig. 1B, matching a different diameter ratio between the syringe barrel and the extension on the handle of the applicator; Fig. 25 is a front view of the front filling sleeve according to Fig. 24 with a view of a second end face forming a contact surface for the syringe at the stop of the front filling sleeve; Fig. 26 is a sectional view of the front filling sleeve according to Fig. 24 along section line XXVI-XXVI in Fig. 25; Fig. 27 is a perspective view of the applicator according to Fig. 1A without a plunger, but with the rear filling sleeve of the applicator set according to Fig. 1B placed in the area of ​​the rear opening on the handle and thepen-shaped filling aid; Fig. 28 is a plan view, broken off to the left, of the applicator with rear filling sleeve and filling aid, as shown in Fig. 27; Fig. 29 is a sectional view, broken off to the left, of the applicator with rear filling sleeve and filling aid according to Fig. 27, according to the section line XXIX-XXIX in Fig. 28; Fig. 30 is an enlarged view of detail XXX in Fig. 29, for better illustration of how the pen-shaped filling aid, received in the transverse opening of the handle, projects into a hollow receiving area of ​​the handle in order to shear off a pasty transplant at the end of a filling process; Fig. 31 is a perspective view, enlarged compared to the view in Fig. 1B, of the rear filling sleeve of the applicator set according to Fig. 1B; Fig. 32 a rear view of the rear filling sleeve according to Fig. 31 with a view of a contact surface for the syringe,second end face at a stop of the rear filling sleeve; Fig. 33 a sectional view of the rear filling sleeve according to Fig. 31 corresponding to the section line XXXIII-XXXIII in Fig. 32; Fig. 34 a side view of the sleeve-shaped application aid of the applicator set according to Fig. 1B, with an annular collar as a handle at a first end and an oblique outlet opening for the transplant at a second end facing away from the first end; Fig. 35 a rear view of the application aid according to Fig. 34 from the right in Fig. 34, looking at the annular collar; Fig. 36 a sectional view of the application aid according to Fig. 34 corresponding to the section line XXXVI-XXXVI in Fig. 35; Fig. 37 is a reduced-scale bottom view of the application aid according to Fig. 34 in a state placed on the extension of the handle of the applicator according to Fig. 1A, shown broken off to the right,in which the oblique exit opening for the transplant protrudes beyond the extension of the handle; Fig. 38 is a sectional view of the application aid of Fig. 34 placed on the extension of the handle according to Fig. 37, corresponding to the section line XXXVIII-XXXVIII in Fig. 37; Fig. 39 is a sectional view, corresponding to the section line of Fig. 38, of the application aid of Fig. 34 placed on the extension of the handle in a non-use position, in which the application aid rests with its first end at the entrance to the extension on the handle; Fig. 40 is a side view of an application aid for the applicator set according to Fig. 1B in a first variant of the application aid shown in Fig. 34, which has resilient locking lugs on an inner circumferential surface; Fig. 41 a rear view of the application aid according to Fig. 40 from the right in Fig. 40,with a view of the annular collar; Fig. 42 is a sectional view of the application aid according to Fig. 40 along the section line XLII-XLII in Fig. 41; Fig. 43 is a sectional view of the application aid according to Fig. 40, reduced in scale compared to the illustration in Fig. 40 and corresponding to the section line in Fig. 38, in a state placed on the extension of the handle of the applicator according to Fig. 1A, shown broken off to the right, to illustrate how the resilient locking lugs formed on the inner circumferential surface engage with a groove formed on an outer circumferential surface of the extension of the handle; Fig. 44 is a side view of an application aid for the applicator set according to Fig. 1B in a further variant of the application aids shown in Figs. 34 and 40, significantly shorter than the other two application aids, without their annular collar as a handle and with spring-loaded locking lugs on the inner circumferential surface,similar to the application aid of Fig. 40; Fig. 45 a rear view of the application aid according to Fig. 44 from the right in Fig. 44; Fig. 46 a sectional view of the application aid according to Fig. 44 corresponding to the section line XLVI-XLVI in Fig. 45; Fig. 47 a sectional view of the application aid according to Fig. 44, reduced in scale compared to the illustration in Fig. 44, but again corresponding to Fig. 38 with regard to the section line, in a state placed on the extension of the handle of the applicator according to Fig. 1A, shown broken off to the right, again to illustrate how the resilient locking lugs of the application aid formed on the inner circumferential surface engage with the groove formed on the outer circumferential surface of the extension of the handle; Fig. 48 is a perspective exploded view of an applicator for applying bone transplants according to a second embodiment of the invention,again comprising a handle, a plunger and an optional closure cap for the bow opening, analogous to the first embodiment, as well as a closure device for the window opening in the handle, which is different from the first embodiment and can be secured to the handle by means of a different holding mechanism and has a sleeve that can be pushed onto the handle and covers the window opening, as well as optionally a closure plug that can be inserted into the window opening; Fig. 49 is a plan view, cut away to the left, of the applicator according to Fig. 48, with the plunger completely pushed into the handle, according to the illustration in Fig. 3, and the sleeve of the closure device pushed onto the handle; Fig. 50 is a sectional view of the applicator according to Fig. 48 according to the section line LL in Fig. 49, with the inserted in the window opening,in this embodiment, optional closure plug; Fig. 51 is a sectional view of the applicator according to Fig. 48, enlarged in scale compared to the illustration in Fig. 49, along the section line LI-LI in Fig. 49, which illustrates how the sleeve of the closure device pushed onto the handle of the applicator positively secures the closure plug inserted in the window opening; and Fig. 52 is a longitudinal sectional view of the sleeve of the closure device of the applicator according to Fig. 48 to further illustrate the holding mechanism of this closure device, with a collar formed on the sleeve and an O-ring attached to an inner circumferential surface of the sleeve. DETAILED DESCRIPTION OF THE EMBODIMENTS In Figs. 1A to 5, 20 to 23 and 27 to 30, the reference numeral 10 generally designates an applicator according to a first embodiment, which is intended for applying transplants in surgery,such as autologous, allogeneic, xenogeneic, or alloplastic bone transplants (not shown in the figures). These transplants can be pasty, but do not have to be; rather, as described above, they can also be in the form of chips or granules, as small cancellous blocks or cylinders, as fiber-disintegrated transplants, or the like. In the first embodiment shown here, the applicator 10 comprises only three components, namely, as a central component, a handle 12, a plunger 14, and a closure device 16 for the handle 12. Optionally, the applicator 10 can further comprise a closure cap 18, also shown in Fig. 1A. The applicator 10 shown individually in Figs. 15 to 17The handle 12, made of a titanium alloy, initially has, when viewed from the outside, a base 20 (on the right in Figs. 15 and 16) and an adjoining extension 22 (on the left in Figs. 15 and 16). Around a longitudinal axis 24, the handle 12 defines a hollow, more precisely hollow-cylindrical receiving area 26 (cf. the sectional views according to Figs. 5 and 17) for the transplant, which extends through the base 20 and the extension 22. At opposite ends, the handle 12 also has a bow opening 28, namely on the extension 22, and a rear opening 30, specifically on the base 20, which are aligned with the longitudinal axis 24 and at which the receiving area 26 opens at both ends of the handle 12. In addition, the handle 12 has a lateral window opening 32, which runs in a direction transverse to the longitudinal axis 24 and also opens into the receiving area 26. As will be explained in more detail below,The applicator 10 can be loaded with the transplant via the front opening 28, the rear opening 30 and / or the lateral window opening 32 in the handle 12. The lateral window opening 32 of the handle 12 is primarily suitable for loading the applicator 10 with non-pasty transplants, while loading with pasty transplants can primarily take place via the front opening 28 or the rear opening 30 of the handle 12. The plunger 14, shown individually in Figs. 18 and 19 and also made of a titanium alloy, can be inserted into the receiving area 26 of the handle 12 via the rear opening 30. The plunger 14 is dimensioned in relation to the handle 12 in terms of length, as shown in particular in Fig. 5, such thatthat even when maximally inserted into the handle 12, it still protrudes from the handle 12 with a plunger end 34 shown enlarged in Fig. 19. The sealless plunger 14 can also be displaced in the receiving area 26 of the handle 12 along the longitudinal axis 24 in order to displace the transplant from the receiving area 26 in the manner of a plunger via the bow opening 28 of the handle 12 and to apply it. The closure device, initially only generally numbered with the reference numeral 16 and described in more detail below, serves to selectively close the window opening 32 in the handle 12, as can be seen from a comparison of Fig. 1A on the one hand and Figs. 1B to 5 on the other hand. A special feature of the applicator 10 is that, as will also be explained in more detail below,The closure device 16 can be secured to the handle 12 by means of a holding mechanism 36 cooperating with the handle 12 in a position closing the window opening 32 of the handle 12, so that the lateral window opening 32 in the handle 12 does not have to be manually closed by the operator for and during use of the applicator 10. In the first embodiment of the applicator 10, the closure device 16 comprises a closure plug 38 for selectively closing the window opening 32, which is shown individually in Figs. 6 to 11. The closure plug 38 initially has a base body 40, which is complementarily shaped to the window opening 32 for a precise closure of the window opening 32 in the handle 12. In the top and bottom views according to Figs. 3, 9,16 and 28, for example, the elongated oval shape of the base body 40 essentially corresponds to the elongated oval shape of the window opening 32. Circumferential bevels 42, 44 on the window opening 32 and the base body 40 are also designed to match one another, as the sectional views according to Figs. 5 and 29 show. As can also be seen in particular from the sectional view according to Fig. 4, the base body 40 is designed on its underside 46 facing the receiving area 26 of the handle 12 in such a way that it complements the circular cross-section of the receiving area 26 in the area of ​​the window opening 32, without projecting radially into the circular cross-section of the receiving area 26 with respect to the longitudinal axis 24. According in particular to Figs. 1A to 4, in the first embodiment of the applicator 10, on the base body 40 of the closure plug 38 there is further provided aA holding section of the holding mechanism 36, generally designated by reference numeral 48, is provided, by means of which the closure plug 38 can be secured to the handle 12 in the position closing the window opening 32. As further shown specifically in Figs. 6 to 11, the holding section 48 is formed integrally with the base body 40 of the closure plug 38. In particular, the holding section 48 and the base body 40 of the closure plug 38 can be formed from a single plastic material, such as polyoxymethylene (POM), according to the illustrated embodiment, for example, as an injection-molded part. As can be seen in particular from Figs. 4, 8, and 10, the holding section 48 has at least one, in the illustrated embodiment even two, legs 50.which extend away from the base body 40 with bilateral symmetry with respect to the base body 40 of the closure plug 38. In other words, the holding section 48 with its legs 50 is mirror-symmetrical with respect to an imaginary plane that runs perpendicular to the drawing plane of Figs. 4, 8, and 10. Each leg 50 is resilient and is capable of gripping an outer peripheral surface 52 of the handle 12 in order to secure the closure plug 38, which is received with its base body 40 in the window opening 32 of the handle 12, to the handle 12 in a clamp-like or clasp-like manner, as shown in Fig. 4. Accordingly, the legs 50 are designed so long that they extend beyond an imaginary center plane of the handle 12 containing the longitudinal axis 24, as can best be seen in Fig. 4,in order to form an undercut for the handle 12 there as a result of its bend pointing radially inward with respect to the longitudinal axis 24. In particular, Fig. 4 also shows that each leg 50 of the holding section 48 has a contact surface 54 which is shaped or curved in a complementary manner to the essentially cylindrical outer peripheral surface 52 of the handle 12 in the region of the base 20 and which, when the closure plug 38 is mounted on the window opening 32 of the handle 12, rests flatly against the outer peripheral surface 52 of the handle 12. Further details regarding the closure plug 38 can be seen in particular in Figs. 4, 9, 10 and 11, according to which rounded recesses 56 are provided on the base body 40 of the closure plug 38, which is shaped complementarily to the window opening 32 in the handle 12, in the (inner) attachment areas of the two legs 50 on the base body 40, both in the longitudinal direction and in the transverse direction.which virtually "free" the legs 50 from the base body 40. By providing these recesses 56, the legs 50 are, in a sense, "extended" in the direction of the base body 40, thereby improving their resilient properties. Furthermore, the soft rounding of the recesses 56 reduces the stresses that occur during spring-back at the transitions from the legs 50 to the base body 40 of the closure plug 38. Finally, with regard to the closure plug 38, in particular, Figs. 4, 5, and 10 show that, on its side facing away from the receiving area 26 for the transplant when mounted on the handle 12, the closure plug 38 is provided with a central marking recess 58, in which a marking lens or disc 60 for identifying the applicator 10 is firmly received, e.g., pressed in. The marking disc 60 can be metallic, for example,so that it can be easily laser engraved. Further details on the handle 12 can be found in particular in Figs. 4, 5 and 15 to 17. Accordingly, the handle 12 is initially provided with a flat flattened portion 62 on its outer circumferential surface 52 on the side of the base 20 facing away from the window opening 32. This flattened portion 62 prevents the handle 12 from rolling away about its longitudinal axis 24 by means of a positive fit when it is placed on a smooth, flat surface such as a table. On the inner circumferential side, Figs. 5, 29 and 30 show a radial groove 64 near the rear opening 30 of the handle 12, in which an O-ring 66 is inserted, which protrudes slightly radially inward from the radial groove 64 with respect to the longitudinal axis 24. This O-ring 66 serves, when using the applicator 10, in particular toto center the plunger 14 in the handle 12 and to secure it against falling out of the handle 12. It can also be seen in particular from Figs. 4 and 17 that recesses 68 are provided in the handle 12 on the lateral edges, parallel to the longitudinal axis 24, of the window opening 32 opening into the receiving area 26, which recesses extend to an imaginary plane containing the longitudinal axis 24. These recesses 68 widen the window opening 32 in this area to a width corresponding to the diameter of the receiving area 26 for the transplant. By widening the window opening 32 in this way, the receiving area 26 of the applicator 10 can be loaded, for example, with one (or more) bone cylinders as a transplant, the outer diameter of which approximately corresponds to the inner diameter of the receiving area 26 in the handle 12. Finally, the handle 12 can be clearly seen, particularly in Figs. 1A, 1B and 3,that a scale 70 is attached to the outer circumference of the extension 22 of the handle 12 in a position aligned with the window opening 32 in the base 20. This scale 70 serves to indicate to the surgeon during a surgical procedure how far or deep he has penetrated, for example, into a bone with the applicator 10. According to Figs. 1A and 18, the plunger 14 is also provided on the outer circumference with a scale 72, which, in the illustrated embodiment, provides a measure of how much or what quantity of transplant is still contained in the applicator 10 during an application process. Further details regarding the plunger 14 can be seen specifically in Figs. 5, 18 and 19, according to which the plunger 14 in the illustrated embodiment is formed from two parts, namely a substantially cylindrical plunger shaft 74, which carries the scale 72,and a plunger head 76 attached thereto, e.g., by means of a welded connection, at the plunger end 34. Alternatively, the plunger 14 can of course also be formed in one piece, e.g., as a turned part made of the same material. The plunger head 76 forms a force introduction section with a diameter that is larger than the plunger shaft 74, on which an annular stop surface 78 pointing in the direction of the handle 12 is provided. With the stop surface 78, the plunger 14 can be brought into contact with the handle 12 in the area of ​​the rear opening 30, as shown in particular in Fig. 5. It can also be seen from Fig. 5 that the plunger shaft 74, when the stop surface 78 of the plunger head 76 bears against the handle 12,with its end facing away from the ram head 76 flush with the extension 22 of the handle 12 at its bow opening 28. For force introduction, a spherically shaped force introduction surface 80 is further provided at the end of the ram head 76 facing away from the handle 12, via which the forces for driving the ram 14 into the receiving area 26 of the handle 12 can be applied manually or by means of a hammer - the latter in particular when the transplant loaded into the receiving area 26 of the handle 12 still needs to be compacted. In addition, on the outer circumference of the end of the plunger head 76 facing away from the handle 12, a circumferential collar 82 is formed, projecting radially relative to the longitudinal axis 24, which facilitates the handling of the plunger 14 - especially when the plunger 14 is to be pulled out of the handle 12. As already mentioned above,The applicator 10 can also optionally include a closure cap 18 for selectively closing the bow opening 28 in the handle 12, which can be used in particular when filling the receiving area 26 in the handle 12 with the transplant. The closure cap 18 can be releasably attached to the handle 12. More precisely, in the illustrated embodiment, the closure cap 18 can be locked by means of a locking device 86 engaging in a groove 84 on the handle 12 or its extension 22, which will be described in more detail below with reference to Figs. 12 to 14. As can be seen from the exploded view according to Fig. 12 and in the sectional view according to Fig. 14, the closure cap 18 of the applicator 10 comprises four components from left to right in Fig. 12, namely a metallic housing 88, a helical compression spring 90 made of spring steel,a metallic locking ring 92 and a closure piece 94 made of a plastic material, such as polyetheretherketone (PEEK). The housing 88 of the closure cap 18 is rotationally symmetrical and provided with a stepped blind bore 96, which is open to the right in Fig. 14 and extends along the longitudinal axis 24 of the housing 88. The blind bore 96 has a holding section 98 with a first, smaller bore diameter and a guide section 100 with a second, larger bore diameter. Furthermore, the closure piece 94 of the closure cap 18 has a cylindrical bearing pin 102, at one end of which a cup-shaped and longitudinally slotted clamping section 104 is provided. The clamping section 104 comprises a plurality of locks 106,which are each provided with a locking lug 108 extending radially inward relative to the longitudinal axis 24 and can spring in the radial direction relative to the longitudinal axis 24. In the assembled state of the closure cap 18, the bearing pin 102 of the closure piece 94 is firmly received by means of a press fit in the holding section 98 of the blind bore 96, as shown in Fig. 14. The end of the bearing pin 102 with the clamping section 104 protrudes from the housing 88, leaving an actuating space 110 extending annularly around the bearing pin 102 between the housing 88 and the clamping section 104. The release or locking of the latch 106 of the clamping section 104 is effected by displacing the sleeve-shaped locking ring 92 along the longitudinal axis 24.which has a guide section 112 and a locking section 114. The locking ring 92 is guided with its guide section 112 on a circumferential surface 116 of the housing 88 and with its locking section 114 on a circumferential surface 118 of the cup-shaped clamping section 104 of the closure piece 94. On the inner circumference of the locking ring 92, an annular shoulder 120 is formed, extending radially inward between the guide section 112 and the locking section 114 into the annular actuating space 110. In an unactuated locking position of the locking ring 92 according to Fig. 14, in which the locking section 114 of the locking ring 92 encompasses or covers the locks 106 of the clamping section 104 on the closure piece 94 and thus prevents the locks 106 from springing open,The annular shoulder 120 rests against the clamping section 104. Axially between the holding section 98 of the blind bore 96 in the housing 88 and the annular shoulder 120 of the locking ring 92, the helical compression spring 90 is guided on the bearing pin 102 of the locking piece 94 in the guide section 100 of the housing 88, which preloads the locking ring 92 into the locked position via its annular shoulder 120. For release, the locking ring 92 is retracted against the preload of the helical compression spring 90 in the direction of the housing 88 into a release position, in which the locking section 114 of the locking ring 92 no longer covers the locks 106 on the locking piece 94, so that the latter can spring open radially outwards. It is clear to the person skilled in the art that by this design of the locking device 86 on the closure cap 18, the locking lugs 108 of the closure piece 94 can be held in positive engagement with the groove 84 on the extension 22 of the handle 12,when the locking ring 92 is in its unactuated, spring-loaded locking position according to Fig. 14. In this state, the bottom of the cup-shaped clamping section 104 covers the bow opening 28 of the handle 12, as shown in Fig. 5, so that the receiving area 26 for the transplant in the handle 12 is closed at the bow opening 28 by the closure cap 18. To remove the closure cap 18 from the handle 12 and release the bow opening 28 in the handle 12, the locking ring 92 simply needs to be retracted against the spring force of the helical compression spring 90 relative to the housing 88, whereupon the latches 106 of the closure piece 94 are released by the locking portion 114 of the locking ring 92, allowing them to spring open and consequently the locking lugs 108 to be released from the groove 84 in the extension 22 of the handle 12. As already discussed at the beginning,The applicator 10 described above can be part of an applicator set 130 illustrated in Fig. 1B for applying transplants in surgery, in particular autologous, allogeneic, xenogeneic or alloplastic bone transplants. In Fig. 1B, as an example of such an applicator set 130, in addition to the applicator 10, which is shown here in a filling configuration without the plunger 14 and with the closure plug 38 inserted in the window opening 32 of the handle 12, an associated instrumentation with a bow filling sleeve 132 to the left in front of the applicator 10, a rear filling sleeve 134 to the right behind the applicator 10, a filling aid 136 above the applicator 10, and an application aid 138 above the bow filling sleeve 132 as further components is shown. These components will only be briefly described below, after the structure, function, and use of these components have already been described in more detail at the beginning.which should be referred to again at this point. Further details on the bow filling sleeve 132 made of a plastic, such as polyetheretherketone (PEEK), can be found in the separate illustration of a diameter variant of the bow filling sleeve 132' according to Figs. 24 to 26 and Figs. 20 to 23, which illustrate the use of the bow filling sleeve 132 when filling the applicator 10 with the transplant via the bow opening 28 in the handle 12 using a syringe 140, here in the form of a known glass syringe. First of all, it should be said about the bow filling sleeve 132 that it is adapted for detachable attachment to the bow opening 28 in the handle 12 of the applicator 10. In the illustrated embodiment, the bow filling sleeve 132 has a sleeve section 142, the inner diameter of which is selected to match the outer diameter of the extension 22 of the handle 12,that the bow filling sleeve 132 with the sleeve section 142 can be pushed tightly onto the extension 22 of the handle 12, as shown in Figs. 20 to 23. Furthermore, the bow filling sleeve 132 has a stop 144 on its inner circumference, which in the illustrated embodiment is formed by an annular collar, with a first end face 146 in the region of the bow opening 28 on the handle 12, more precisely its extension 22, and has a second end face 148 facing away from the first end face 146, which forms a contact surface for the syringe 140 for filling the receiving area 26 in the handle 12 with a pasty transplant, as also shown in Figs. 22 and 23. It is evident that the bow filling sleeve 132 with its stop 144 thus separates the syringe 140, more precisely its glass cylinder, from the handle 12 of the applicator 10 when filling the applicator 10.so that the syringe 140 cannot strike the handle 12. As shown in particular in Figs. 20 and 21, the front filling sleeve 132 further comprises a longitudinally slotted sleeve section 150 for tightly receiving the syringe 140 for filling the receiving area 26 in the handle 12 with the pasty graft. Due to the longitudinal slots, the sleeve section 150 of the front filling sleeve 132 can spring back slightly in order to keep the syringe 140 centered during the filling process and also to compensate for diameter tolerances on the glass cylinders of the syringes 140. Further details of the rear filling sleeve 134, which is also made of a plastic, such as polyetheretherketone (PEEK), can be found in the separate illustration according to Figs. 31 to 33 and Figs. 27 to 30.which illustrate the rear filling sleeve 134 prepared for use in filling the applicator 10 with a pasty transplant via the rear opening 30 in the handle 12 using a syringe (not shown here). First, the rear filling sleeve 134 is adapted for releasable attachment to the rear opening 30 in the handle 12 of the applicator 10. In the illustrated embodiment, this is achieved by an annular recess 152 in the rear filling sleeve 134, the inner diameter of which is matched to the inner diameter of the receiving area 26 in the handle 12, so that the aforementioned O-ring 66 in the radial groove 64 of the handle 12 is able to hold the rear filling sleeve 134 in a state when plugged onto the handle 12 at the rear. Here, the outer diameter of the annular recess 152 is of course matched to the diameter of the outer peripheral surface 52 of the base 20 of the handle 12,so that the rear filling sleeve 134 can cover the handle 12 on the outer circumference. Analogous to the bow filling sleeve 132, the rear filling sleeve 134 also has a stop 154 ​​formed by an annular collar, which can be brought into contact with the handle 12 with a first end face 156 in the recess 152 in the region of the rear opening 30, as shown in Figs. 29 and 30, and has a second end face 158 facing away from the first end face 156, which forms a contact surface for the syringe (not shown) for filling the receiving area 26 in the handle 12 with the pasty transplant. In further analogy to the bow filling sleeve 132, the stern filling sleeve 134 also has a longitudinally slotted sleeve section 160 for tightly receiving the syringe for filling the receiving area 26 in the handle 12 with the pasty transplant via the stern opening 30 in the handle 12. The associated effects have already been described above. As already discussed at the beginning,Furthermore, the filling aid 136 is provided for shearing off the pasty transplant when filling the receiving area 26 in the handle 12 via its rear opening 30. For this purpose, the handle 12 of the applicator 10, more precisely its base 20 as seen along the longitudinal axis 24, has an opening 162 extending transversely with respect to the longitudinal axis 24 between the rear opening 30 and the window opening 32, which, as shown in particular in Figs. 5, 29, and 30, opens into the receiving area 26 of the handle 12 and has a predetermined cross-section. Furthermore, the filling aid 136 in the illustrated embodiment is formed by a cylindrical pin 164, which has a cross-section complementary to the cross-section of the opening 162 in the handle 12. In particular, it can be seen from Figs. 29 and 30 that the pin-shaped filling aid 136 can thus be inserted into the opening 162 in the base 20 of the handle 12,to shear off the transplant in the receiving area 26 of the handle 12. Figs. 34 to 39, 40 to 43 and 44 to 47 also show various possible variants of the application aid 138, 138' or 138''. In the figures, the various variants are identified by no line, one line or two lines next to the respective reference symbol. For better reading flow, these lines will be omitted in the further text. The various application aids 138 have in common that they can be placed on the extension 22 of the handle 12, on which the bow opening 28 of the handle 12 is formed, in a position in which the application aid 138 protrudes beyond the extension 22 of the handle 12, wherein the application aid 138 has an exit opening 166 for the transplant. This is illustrated in Figs. 37, 38, 43 and 47. In principle, the outlet opening 166 of the application aid 138 can have a cross-section,which is different from the cross-section of the bow opening 28 on the extension 22 of the handle 12. For example, a nozzle-like tapered design of the application aid 138 is also conceivable, although not shown in Figs. 34 to 47. The application aids 138 shown in Figs. 34 to 47 also have in common that the application aids 138 are sleeve-shaped, each with a first end 168 which, when the application aid 138 is placed on the extension 22 of the handle 12, faces the handle 12, and a second end 170 facing away from the first end 168, which is beveled with respect to the longitudinal axis 24 in order to form an oblique outlet opening 166 for the transplant. In the two variants of the sleeve-shaped application aid 138 shown in Figs. 34 to 39 and 40 to 43, the application aid 138 is further provided on an outer circumferential surface 172 with an annular collar 174 as a handle,via which the respective application aid 138 can be easily moved on the extension 22 of the handle 12. The variant of the application aid 138 shown in Figs. 44 to 47, on the other hand, has a smooth outer circumferential surface 172, without an annular collar. Furthermore, the variants according to Figs. 40 to 43 and 44 to 47 illustrate that the sleeve-shaped application aid 138 can also have resilient locking lugs 178 on an inner circumferential surface 176, which can be brought into engagement with the previously described groove 84 formed on the outer circumferential surface of the extension 22 of the handle 12 - or a groove formed here at a different axial location (not shown) - in order to hold the application aid 138 longitudinally positioned on the handle 12. Finally, with reference to Fig. 48 to Fig. 52, a second embodiment of the applicator 10' will be briefly described, but only insofar asthan it differs significantly from the previously described first embodiment of the applicator 10. In the second embodiment of the applicator 10', the closure device 16' for temporarily closing the lateral window opening 32 in the handle 12 is designed differently than in the first embodiment. Thus, the closure device 16' here comprises a sleeve 180', also shown separately in Fig. 52, which is adapted to cover the window opening 32 of the handle 12 when pushed onto the handle 12. In this context, "adapted" means that the sleeve 180' has an inner diameter that is slightly larger than the outer diameter of the handle 12 at its outer circumferential surface 52, so that the sleeve 180' can be pushed onto the handle 12. In the second embodiment, a closure plug 38' can, but need not, be provided.whose base body 40' is designed to complement the window opening 32 in the handle 12 in order to cover the window opening 32 analogously to the first embodiment. If no closure plug 38' is provided, the sleeve 180' is to be dimensioned lengthwise such that the sleeve 180' also covers the window opening 32 in the axial direction of the applicator 10'. If the sleeve 180' does not form its own holding mechanism on the outer circumferential surface 52 of the handle 12 due to correspondingly tight diameter tolerances, as shown in Figs. 50 and 52,the holding mechanism 36' for the closure device 16' has a collar 182' formed on the sleeve 180' as a stop for the handle 12 (see Fig. 50) and / or an O-ring 186' attached to an inner circumferential surface 184' of the sleeve 180' - which in the illustrated embodiment is received in a groove formed on the inner circumferential surface 184' of the sleeve 180' - for frictional engagement with the outer circumferential surface 52 of the handle 12. An applicator for surgical transplants has a handle which defines a receiving area for the transplant around a longitudinal axis and which has front and rear openings aligned with the longitudinal axis at each end towards the receiving area and has a window opening which also opens into the receiving area and runs transversely to the longitudinal axis. A device that can be inserted into the receiving area via the rear opening,A plunger, with a plunger end protruding from the handle, is movable along the longitudinal axis in the receiving area to displace the transplant from the receiving area through the bow opening and apply it. Finally, a closure device is provided for selectively closing the window opening. This closure device can be secured to the handle by means of a holding mechanism that cooperates with the handle in a position that covers or covers the window opening, so that no transplant can escape through the window opening, which is securely closed by the holding mechanism, during application.

[0002] LIST OF REFERENCE SYMBOLS , 10' applicator handle plunger , 16' locking device closure cap base extension longitudinal axis receiving area bow opening stern opening window opening plunger end , 36' holding mechanism , 38' closure plug , 40' base body bevel , 44' bevel , 46' underside holding section leg outer peripheral surface contact surface recess marking recess marking disc flattening radial groove O-ring recess scale scale plunger shaft plunger head stop surface force introduction surface collar groove locking device housing helical compression spring locking ring locking piece blind bore holding section guide section bearing pin clamping section latch locking lug actuating area guide section locking section peripheral surface peripheral surface annular shoulder applicator set , 132' bow filling sleeve stern filling sleeve filling aid , 138', 138'' application aid syringe , 142' sleeve section, 144' stop, 146' first end face, 148' second end face,150' sleeve section annular recess stop first end face second end face sleeve section opening pin , 166', 166'' outlet opening , 168', 168'' first end , 170', 170'' second end , 172', 172'' outer peripheral surface , 174' annular collar , 176', 176'' inner peripheral surface 178', 178'' locking lug ' sleeve ' collar ' inner peripheral surface ' O-ring,

Claims

PATENT CLAIMS:

1. Applicator (10, 10') for applying transplants in surgery, in particular autologous, allogeneic, xenogeneic or alloplastic bone transplants, with a handle (12) which defines a hollow receiving area (26) for the transplant around a longitudinal axis (24), which has, at opposite ends, a bow opening (28) and a rear opening (30) towards the receiving area (26), which are aligned with the longitudinal axis (24), and a window opening (32) which runs in a direction transverse to the longitudinal axis (24) and also opens into the receiving area (26), a plunger (14) which can be inserted into the receiving area (26) of the handle (12) via the rear opening (30), which plunger protrudes from the handle (12) with a plunger end (34) and extends along the Longitudinal axis (24) is displaceable in the receiving area (26),in order to displace the transplant from the receiving area (26) via the bow opening (28) of the handle (12) and to apply it, and a closure device (16, 16') for selectively closing the window opening (32) in the handle (12), characterized in that the closure device (16, 16') can be secured on the handle (12) by means of a holding mechanism (36, 36') cooperating with the handle (12) in a position covering or covering the window opening (32) of the handle (12) such that when the transplant is applied, no transplant emerges via the window opening (32) in the handle (12) which is securely closed by means of the holding mechanism (36, 36').

2. Applicator (10, 10') according to claim 1, characterized in that the closure device (16, 16') has a closure plug (38, 38') for selectively closing the, Window opening (32) comprising a base body (40, 40') which is shaped complementarily to the window opening (32) for a precise closure of the window opening (32) in the handle (12).

3. Applicator (10) according to claim 2, characterized in that a holding section (48) of the holding mechanism (36) is provided on the base body (40) of the closure plug (38), which cooperates with the handle (12), and by means of which holding section the closure plug (38) can be secured on the handle (12) in the position closing the window opening (32).

4. Applicator (10) according to claim 3, characterized in that the holding portion (48) is formed integrally with the base body (40) of the closure plug (38) and / or that the holding portion (48) and the base body (40) of the closure plug (38) are formed of a single plastic material, preferably polyoxymethylene (POM).Applicator (10) according to claim 3 or 4, characterized in that the holding section (48) has at least one leg (50) which is designed to be spring-elastic and is able to engage around an outer circumferential surface (52) of the handle (12) in order to secure the closure plug (38), which is received with its base body (40) in the window opening (32) of the handle (12), to the handle (12) in a clamp-like or clasp-like manner.

6. Applicator (10) according to claim 5, characterized in that the at least one leg (50) of the holding section (48) has a contact surface (54) which is shaped complementarily to the outer circumferential surface (52) of the handle (12) and which, in the accessory mounted on the window opening (32) of the handle (12), the position of the closure plug (38) lies flat against the outer peripheral surface (52) of the handle (12), and / or that the holding section (48) has two legs (50) which extend away from the base body (40) in bilateral symmetry with respect to the base body (40) of the closure plug (38).

7. Applicator (10) according to one of claims 2 to 6, characterized in that the closure plug (38), on its side facing away from the receiving area (26) for the transplant when mounted on the handle (12), is provided with a central marking recess (58), in which a marking lens or disc (60) for identifying the applicator (10) is firmly received.Applicator (10') according to claim 1 or 2, characterized in that the closure device (16') comprises a sleeve (180') which is adapted to cover the window opening (32) of the handle (12) when pushed onto the handle (12), wherein the holding mechanism (36') preferably has a collar (182') formed on the sleeve (180') as a stop for the handle (12) and / or an O-ring (186') attached to an inner circumferential surface (184') of the sleeve (180') for frictional engagement with an outer circumferential surface (52) of the handle (12).

9. Applicator (10, 10') according to one of the preceding claims, characterized by a closure cap (18) for selectively closing the bow opening (28) in the handle (12), in particular when filling the receiving area (26) in the handle (12) with the transplant, wherein the closure cap (18) can be detachably fastened to the handle (12), in particular. can be locked by means of a locking device (86) engaging in a groove (84) on the handle (12).

10. Applicator set (130) for applying transplants in surgery, in particular autologous, allogeneic, xenogeneic or alloplastic bone transplants, with an applicator (10, 10') according to one of the preceding claims and at least one further component from an associated instrumentation, comprising a bow filling sleeve (132, 132') adapted for releasable attachment to the bow opening (28) in the handle (12) of the applicator (10, 10'), a rear filling sleeve (134) adapted for releasable attachment to the rear opening (30) in the handle (12) of the applicator (10, 10'), a filling aid (136) for shearing off a pasty transplant when filling the receiving area (26) in the handle (12) via its rear opening (30) and a Application aid (138, 138', 138'') which is mounted on an extension (22) of the handle (12),on which the bow opening (28) of the handle (12) is formed, can be placed in a position in which the application aid (138, 138', 138'') projects beyond the extension (22) of the handle (12), wherein the application aid (138, 138', 138'') has an exit opening (166, 166', 166'') for the transplant.

11. Applicator set (130) according to claim 10, characterized in that the bow filling sleeve (132, 132') has a stop (144, 144') which can be brought into contact with the handle (12) with a first end face (146, 146') in the region of the bow opening (28) and has a second end face (148, 148') facing away from the first end face (146, 146'), which has an on, forming a support surface for a syringe (140) for filling the receiving area (26) in the handle (12) with the pasty transplant, and / or that the bow filling sleeve (132, 132') has a longitudinally slotted sleeve section (150, 150') for tightly receiving a syringe (140) for filling the receiving area (26) in the handle (12) with the pasty transplant. 12.Applicator set (130) according to claim 10 or 11, characterized in that the rear filling sleeve (134) has a stop (154) which can be brought into contact with the handle (12) with a first end face (156) in the region of the rear opening (30) and has a second end face (158) facing away from the first end face (156), which forms a contact surface for a syringe (140) for filling the receiving area (26) in the handle (12) with the pasty transplant, and / or that the rear filling sleeve (134) has a longitudinally slotted sleeve section (160) for tightly receiving a syringe (140) for filling the receiving area (26) in the handle (12) with the pasty transplant. 13.Applicator set (130) according to one of claims 10 to 12, characterized in that the handle (12) of the applicator (10, 10'), viewed along the longitudinal axis (24), has, between the rear opening (30) and the window opening (32), an opening (162) which runs transversely with respect to the longitudinal axis (24), which opens into the receiving area (26) of the handle (12) and has a predetermined cross-section, wherein the filling aid (136) is formed by a pin (164) which has a cross-section complementary to the cross-section of the opening (162) in the handle (12).

14. Applicator set (130) according to one of claims 10 to 13, characterized in that the outlet opening (166, 166', 166'') of the application aid (138, 138', 138'') has a cross-section which is different from the cross-section of the bow opening (28) on the extension (22) of the handle (12), and / or that the application aid (138, 138', 138'') is sleeve-shaped, with a first end (168, 168', 168'') which, in the state of the application aid (138, 138', 138'') placed on the extension (22) of the handle (12), faces the handle (12), and a remote second end (170, 170', 170''), which is bevelled with respect to the longitudinal axis (24) in order to form an oblique exit opening (166, 166', 166'') for the transplant, and / or that the sleeve-shaped application aid (138, 138') is provided on an outer circumferential surface (172, 172') with an annular collar (174,174') is provided as a handle and / or that the sleeve-shaped application aid (138', 138'') has resilient locking lugs (178', 178'') on an inner peripheral surface (176', 176'') that can be brought into engagement with a groove (84) formed on an outer peripheral surface of the extension (22) of the handle (12) in order to hold the application aid (138', 138'') longitudinally positioned on the handle (12).

15. Applicator (10, 10') or applicator set (130) according to one of the preceding claims, characterized in that at least the handle (12) and / or the plunger (14) of the applicator (10, 10') are / is formed from a titanium alloy.

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