DE202022002294U1 - Applicator for applying pasty transplants in surgery and applicator set with associated instruments - Google Patents

Abstract

Applicator (10) for applying pasty transplants (T) in surgery, in particular autologous, allogeneic, xenogeneic or alloplastic bone transplants, with a cylinder ( 14) which has a bow opening (24) and a stern opening (26) towards the receiving area (22), a piston (16) which can be inserted via the stern opening (26) into the receiving area (22) of the cylinder (14) and which in the receiving area (22) is displaceable along the longitudinal axis (20) in order to displace the graft (T) from the receiving area (22) via the nose opening (24) of the cylinder (14), a nozzle (12) which has a connection section (28) for coupling to the cylinder (14) in the area 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 is, and one with the piston (16) operative andthe rotary handle (18), wherein a gear mechanism (34) is provided in the cylinder (14) to convert a rotary movement of the rotary handle (18) into a longitudinal movement of the piston (16), which has a cylinder-fixed first threaded section (36) and a first threaded section (36) connected to the first Threaded section (36) has a cooperating second threaded section (38) fixed to the rotary handle, characterized in that the first threaded section (36) is formed on the outer circumference (40) of the cylinder (14), while the second threaded section (38) is formed on the inner circumference (42) of the essentially sleeve-shaped rotary handle (18) is provided, which has a driving section (44) for transmitting the longitudinal movement to the piston (16).

Description

TECHNICAL AREA

The present invention generally relates to an applicator for the application of pasty grafts in surgery, according to the preamble of claim 1, and an applicator set comprising such an applicator. In particular, the invention relates to an applicator for applying autologous, allogeneic, xenogeneic or alloplastic, pasty bone transplants. Applicators of this type are used en masse in surgery when it comes to placing bone or bone replacement materials in or on a bone.

STATE OF THE ART

The reconstruction of bony defects wins 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 the revision of cruciate ligaments, in hand and foot surgery, in spinal surgery or e.g. for relatively young patients with a prosthesis, such as an artificial hip joint, which is very likely to have to be changed after a long time, is becoming increasingly important. With such a prosthesis change, 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 based on plastic) often leads to considerable bony defects. The same applies to the loss of bone substance, on a smaller scale, for example for cruciate ligament revisions.

For the revision (also) of such bony defects, various bone replacement materials are available as transplants today, which differ in the starting materials used and in the methods of obtaining the respective bone replacement material. In addition to the patient's own bone tissue (autologous transplants), allogeneic transplants from human foreign bones, xenogeneic transplants of animal origin and synthetically manufactured bone replacement materials (alloplastic material) are used. Commercially available are, for example, sawn bone chips, bone granules, spongiosa blocks and spongiosa cylinders, similar to bone cement secondary, i.e. pastes that harden under UV light, transplants opened up as fibers or ready-to-use pastes made of demineralized bone matrix with a suitable carrier (e.g. hyaluronic acid) that can be applied directly to fill smaller bone cavities. In the context of the present invention, it is exclusively about transplants that are present in pasty form.

When filling the bone defects, the pasty grafts 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 displaced by means of a piston or ram via an outlet opening of the applicator in the direction of the defect. Even if the transplants are mostly available as ready-to-use, commercially available - i.e. allogeneic, xenogeneic or alloplastic - transplant pastes, this does not exclude the possibility that transplant pastes obtained/manufactured from autologous bone material - during or before the operation - are also used be able.

At least the ready-to-use transplant pastes are usually kept in glass syringes and can be filled into the applicator directly from the front or the back. Due to their gas-tightness, glass syringes have advantages in terms of stable storage and a longer shelf life of the transplant contained, in particular compared to syringes made of plastic. Glass syringes are not to be expected to have any interactions with the bone or bone replacement materials or to release chemicals that might interfere with the healing process. However, due to the risk of breakage of the glass syringes, increased care is required during handling. In particular, it must be ensured that the transplant is not contaminated with glass splinters during the filling process of the applicator, which could occur, for example, if the syringe hits the applicator.

When removing the syringe after the filling process, it must also be ensured that the pasty transplant remains in the applicator and does not stick to the syringe and is partially pulled out of the applicator together with it.

In the prior art there is no lack of proposals as to how an applicator is to be loaded with the transplant. So is about from the pamphlet US 2018/0008746 A1 an applicator known to which a syringe can be connected via a thread for filling with the transplant. In this prior art, the components of the transplant to be mixed are first premixed and compacted in the syringe and then filled into the applicator from the rear via a rear opening by means of the syringe. Also included are applicators that can be front-loaded or rear-loaded without a syringe for example the publications DE 10 2009 012 437 A1 and U.S. 2010/0198140 A1 , but these applicators are primarily intended for use with non-pasty grafts.

When applying the pasty transplant using the applicator, the surgeon must at the same time position and guide the outlet opening of the applicator as precisely as possible with regard 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 transplant and the size of the delivery opening of the applicator, not inconsiderable forces have to be applied to displace the transplant, which the surgeon must simultaneously generate and support/counteract on the applicator. This can make both an exact positioning of the applicator with regard to the defect in/on the bone and a sensitive dosage of the transplant considerably more difficult. In order for the surgeon to position the dispensing opening of the applicator with the required precision and to be able to dose the transplant mass well using the applicator with only moderate effort, a power transmission on the applicator is desirable.

In this context, for example, from the publications U.S. 2018/0177609 A1 , US 2018/0049890 A1 , US 2004/0215201 A1 , EP 3 305 252 B1 and U.S. 5,925,051 Rack and pinion drives for conveying bone and bone substitute materials are known, in which the force is introduced and the force is transmitted by means of a hand lever mechanism. Such drives are known from cartridge presses, such as those used in the trade when creating silicone joints. However, these mechanisms are relatively complex, usually difficult to clean and can cause problems when using the applicator equipped in this way with the exact positioning of the dispensing opening, because the actuation of the hand lever forces a counteracting torque to be applied to the applicator, with the risk of an undesirable Discharge opening deflection.

Another drive or power transmission concept for deploying a pasty transplant from an applicator is, for example, the publication U.S. 2010/0094307 A1 and the publication forming the preamble of claim 1 EP 0 955 022 B1 refer to. In this state of the art, the force required to expel the transplant is introduced via a manually drivable threaded spindle which, like in a screw press, is screwed into a thread that is fixed or fixable 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 the applicator, which is in contact with the threaded spindle.

In other words, the publication forming the preamble of claim 1 discloses EP 0 955 022 B1 an applicator for the application of pasty transplants, with a hollow cylinder which delimits a receiving area for the transplant about a longitudinal axis and has a front opening and a rear opening towards the receiving area. The applicator also has a piston which can be inserted into the receiving area of the cylinder via the rear opening and which can be displaced 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. Furthermore, the applicator includes a nozzle that has a connection section for coupling to the cylinder in the area of the bow opening and a delivery section with a delivery opening through which the transplant displaced through the cylinder's bow opening can be applied via the nozzle.

For the manual introduction of force, according to in particular 2 This publication provides a rotary handle in the form of a toggle handle 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. This applicator has a gear mechanism for converting 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. The latter has a cylinder-fixed, first threaded section, namely an internal thread on a coupling sleeve attached to the cylinder, and a cooperating with the first threaded section, T-handle fixed second threaded section, namely the external thread attached to the threaded spindle. To convert the movement, the T-handle-fixed external thread of the threaded spindle is screwed into the cylinder-fixed internal thread on the coupling sleeve. A rotation of the threaded spindle in the coupling sleeve thus leads to a longitudinal displacement of the threaded spindle with respect to the coupling sleeve. Since the end of the threaded spindle remote from the toggle handle is in contact with the piston in the cylinder, the piston also experiences a longitudinal displacement with respect to the cylinder in order to act on the transplant in the cylinder.

The T-handle, which is firmly connected to the threaded spindle, also has several arms which extend outwards in the radial direction with respect to the axis of rotation and via which the surgeon applies the forces required to expel the transplant with one hand on the applicator, while the The operator with the other hand, ie the guide hand, holds the applicator in the area of the cylinder and positions its nozzle, more precisely its discharge opening, with respect to the defect in/on the bone in order to apply the transplant. With this design, the force application point on the toggle handle is at the end of the threaded spindle facing away from the cylinder and is therefore at a maximum distance from the dispensing opening of the applicator nozzle.

If the operator applies a torque to the threaded spindle with this design using the locking handle, there is a risk that lateral forces will also be introduced into the threaded spindle, with even the smallest lateral forces on the locking handle due to the large lever length between the locking handle and the guide hand holding the cylinder of the operator generate significant moments on the wrist of the guide hand which, if they are not (or cannot) be held against by the operator, result in an undesirable displacement of the discharge opening of the nozzle with respect to the defect in the bone to be filled.

This is made more difficult by the fact that when operating such toggle handles, most operators intuitively tend to stiffen the wrist of the hand gripping the toggle handle and use their forearm as a lever, with the upper arm being lowered or raised in the direction of the upper body with a rotary movement in the shoulder joint an operation in the opposite direction is lifted away from the upper body. With such a rotary actuation of the T-handle, the lateral forces also introduced into the threaded spindle via the T-handle occur in an increased form, so that the above-mentioned tilting or torques which the operator must counter at the same time are even greater.

A problem with the previously known applicator designs that work with a gear mechanism that converts the rotary movement of a rotary handle into a longitudinal movement of the applicator piston is that of applying the force required for the desired dosage of the transplant to the applicator and at the same time positioning the dispensing opening of the applicator nozzle as precisely as possible to position the bone defect to be filled. Against this background, it would be desirable to have an applicator design that enables improved, in particular more precise, handling during an operation.

TASK

Based on the prior art described above, the invention is based on the object of providing an applicator of the simplest possible design for the application of paste-like transplants in surgery, in particular autologous, allogeneic, xenogeneic or alloplastic, paste-like bone transplants, as well as an applicator set with such an applicator provide that generally avoids the disadvantages described above and specifically allows improved handling of the applicator compared to the prior art, which is optimized in particular with regard to a more precisely positioned application of pasty transplants with reduced effort.

PRESENTATION OF THE INVENTION

This object is achieved by an applicator having the features of claim 1 or an applicator set having the features of claim 12 . Advantageous and expedient developments of the invention are the subject of claims 2 to 11 and 13 to 15.

In an applicator for applying pasty transplants in surgery, in particular autologous, allogeneic, xenogeneic or alloplastic bone transplants, comprising a cylinder which delimits a hollow receiving area for the transplant about a longitudinal axis and has a front opening and a rear opening towards the receiving area, a piston which can be inserted into the receiving area of the cylinder via the rear opening and which can be displaced along the longitudinal axis in the receiving area in order to displace the transplant from the receiving area via the bow opening of the cylinder, a nozzle which has a connecting section for coupling to the cylinder in the area of the bow opening and has a delivery section with a delivery opening, via which the transplant displaced through the bow opening via the nozzle can be applied, and a rotary handle operatively connected to the piston, wherein to convert a rotary movement of the rotary handle into a longitudinal movement of the piston in the cylinder ei n gear mechanism is provided which has a cylinder-fixed first threaded section and a rotating handle-fixed second threaded section cooperating 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.

According to the invention, similar to the prior art described at the outset, a gear mechanism is used which uses a thread transmission in order to drive the transplant out of the applicator using moderate actuating forces by the operator. Compared to the generic state of the art According to the invention, however, a reversal of the situation takes place as far as the position of the cylinder-fixed threaded section and the position of the rotary handle-fixed threaded section is concerned. 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, compensates the displacement of the rotary handle along the longitudinal axis to the im Cylinder recorded piston transmits.

According to the invention, the force application point is on the rotary handle above or very close to the cylinder of the applicator, so that there is only a very short or minimal lever between the force application point on the rotary handle and the stopping point of the applicator on the cylinder. The result of this is that the operator, when turning the rotary handle on the cylinder, cannot generate large moments that the operator would have to counter with his guide hand holding the cylinder. Accordingly, it is easier for the surgeon during an operation to keep the nozzle of the applicator with its delivery opening well positioned, i.e. as precisely as possible, at the defect on/in the bone to be filled with the transplant.

The sleeve-shaped design of the rotary handle surrounding the cylinder not only leads to a very compact design of the applicator according to the invention, which is particularly positive when using the applicator in a spatially cramped operating environment, but also allows the surgeon to use a flat surface - in contrast to a more punctiform attack on the rotary handle over a significantly greater length on the rotary handle compared to the prior art, so that the rotary handle can be operated more sensitively by the operator.

Finally, it is also worth mentioning in this context that, due to the axial extension of the sleeve-shaped rotary handle, there is also a high degree of variability, which is advantageous for the surgeon, in terms of the possibilities of grasping the sleeve-shaped rotary handle to introduce the actuating forces. This is also conducive to very good handling of the applicator during an operation.

In principle, the rotary handle can be designed in one piece with the piston or as one component. In contrast, however, a design of the applicator in which the piston and the rotary handle are two separate components is preferred, particularly with regard to better cleaning options and the simplest possible manufacture. 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 does not necessarily have to be rotated as well, so that the transplant to be conveyed that is on the piston is not exposed to any shearing forces, which is also advantageous in terms of possible lower forces to be applied to turn the twist grip.

In principle, it is possible to provide the sleeve-shaped rotary handle at one end with projections running radially inwards or a circumferential annular collar pointing radially inwards for axial contact with the piston, in order to Transmission mechanism caused to transfer axial displacement of the turning handle relative to the cylinder to the piston in the cylinder. The projections could also be bent at their free ends or the annular collar could be provided on the inner circumference with an annular web extending in the axial direction in order to come into axial contact with the piston accommodated in the cylinder. However, in particular with regard to the simplest and most compact design of the applicator, it is preferred if the rotary handle is designed in the manner of a cup, with a base area which, as a 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-like design of the rotary handle with the bottom area also has the advantage that the applicator is closed at this point to the rear, i.e. at its end facing away from the nozzle, and consequently cannot get dirty on the inside from this side.

In principle, the base area of the cup-shaped rotary handle and the end of the piston protruding out of the cylinder can have flat contact surfaces for one another. In an advantageous further development of the applicator with the cup-like twist grip, however, it is preferably provided that the piston has a dome-shaped or convex projection at a substantially central point on the side facing away from the bow opening of the cylinder, against which the base area of the twist grip can be brought into contact. A particular advantage of such a design of the applicator is that only very low frictional forces occur on the very small, almost punctiform contact surface between the piston projection and the essentially flat bottom area of the rotary handle, which is also in the area of the axis of rotation, which means that the manual Easier to rotate the rotary handle with respect to the cylinder. The same effect could of course be created This would be the case if the base area of the cup-like twist grip had a dome-shaped or convex protrusion at an essentially central point, which abuts against a flat or planar end of the piston, or if the base area of the twist grip and the piston end had corresponding axial protrusions that touch each other.

For improved handling, in particular when withdrawing the piston from the cylinder after the transplant has been applied, it is also preferred if the piston is provided with at least one recess on the outer circumference at its end protruding from the receiving area of the cylinder, which forms an undercut. In contrast to a likewise conceivable design of the applicator with a piston end without an undercut, in which the force required to pull the piston out of the cylinder can only be transmitted by means of a frictional connection between the piston and the gloved hand of the surgeon, the preferred design here enables the piston with a reduced effort, which can be attributed to the form fit that can be achieved between the hand and the piston. The risk of the operator slipping off the plunger with a glove that may have been soiled from the operation is also significantly reduced.

In order for the gear mechanism to function properly, the first threaded section provided on the outer circumference of the cylinder can, in principle, be designed to be completely circumferential. In contrast, however, an embodiment of the applicator is preferred in which the cylinder has a recess or flattening on at least one outer longitudinal side that extends along the longitudinal axis of the cylinder and 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 area on opposite outer longitudinal sides with respect to its longitudinal axis, which cutout interrupts the first threaded section on the outer circumference of the cylinder. This recess(es) or flattening(s) can be advantageously used to attach a label or marking to the cylinder in a simple manner on a flat, i.e. non-curved surface, e.g. by means of laser inscription in the case of a metallic material for the cylinder.

However, 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 an operation. 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 residues from the operation, where the contamination is only moved around the cylinder at the base of the thread with a brush guided in this way, the contamination can simply be removed with the brush from the direction Brush out or sweep out partial thread turns running out of the recess(es).

A further advantage of the above-described recesses or flat areas on the cylinder is that the flat surfaces created on the cylinder in this way also improve the operator's handling of the applicator because they offer the operator a good grip in the form of key surfaces. For example, the operator can hold the applicator on the cylinder with the thumb and forefinger of one hand, with the thumb and forefinger gripping the opposing recesses or flat areas of the cylinder like pliers.

In particular with regard to the most exact dosing of the transplant possible, it is also preferred if a scale is attached to the cylinder in the area of the recess, which scale interacts with an edge area of the rotary handle in order to at least give a relative measure for the from the receiving area when applying the transplant the bow opening of the cylinder to give displaced graft. The scale can also be designed in such a way that e.g. adjacent lines and/or numbers on the scale provide an absolute measure of the displaced volume of transplant, 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 connection section of the nozzle and the cylinder near the bow opening of the cylinder. A frictional connection would also be conceivable here in order to detachably fix the nozzle on the cylinder. In contrast, particularly with regard to the security of the connection against unintentional detachment and the possibility of being able to detach the connection as easily as possible at will, an embodiment of the applicator is preferred in which the connection section of the nozzle is designed in the form of a sleeve and is used for coupling to the cylinder third threaded portion has an internal thread that is attached to the cylinder with an external thread attached near the bow opening of the cylinder as fourth threaded portion cooperates to releasably secure the nozzle to the barrel.

With such an embodiment of the connection between the nozzle and the cylinder, it is furthermore preferred if the third and fourth threaded section have a different thread pitch than the first and second threaded section of the gear mechanism. The nozzle or the rotary handle can therefore only be mounted on the side of the cylinder provided with the corresponding counter-thread, which prevents incorrect assembly of the applicator. In addition, the respective pairing of threads can be optimized in terms of their function - holding the nozzle as reliably as possible, turning the rotary handle as easily as possible.

Furthermore, with regard to the above-mentioned thread pairings on the applicator, it is preferably provided that the third and fourth thread section for fastening the nozzle have the same direction of rotation as the first and second thread section 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 here, for example as a possibly additional measure to prevent incorrect assembly of the applicator. However, such a configuration is less preferred with regard to the proper functioning of the applicator, because it entails the risk that when the rotary handle is rotated in relation to the cylinder for dispensing the transplant via the nozzle, the nozzle will also be unscrewed from the cylinder at the same time if it was previously not screwed tightly enough onto the cylinder.

In principle, it is possible to provide the rotary handle and the connection section of the nozzle with a smooth surface on the outer circumference. In contrast, it is preferred, especially with regard to a better introduction of force for actuating the screw connections, if the essentially sleeve-shaped rotary handle and/or the sleeve-shaped connection section of the nozzle is provided with a plurality of recessed grips on the outer circumference, which are distributed over the outer circumference. As an alternative to recessed grips, knurling or embossing on the outer circumference of these parts would of course also be conceivable in order to increase their grip, which is less preferable in view of the poorer cleaning options and the risk of damaging the disposable gloves that are mandatory for such operations.

Furthermore, in accordance with the respective operation requirements, in an expedient embodiment 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 location and accessibility of the bone defect, a correspondingly suitable nozzle can therefore be provided for the operator 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 set of instruments, which includes the following components : a rear filler sleeve adapted for releasable attachment to the barrel of the applicator in the area of the rear opening of the barrel; a filling aid for shearing off the pasty transplant when filling the receiving area in the cylinder via its rear opening; at least one additional nozzle which, like the aforementioned nozzle of the applicator, has a connection section for coupling to the cylinder in the area of the bow opening and a delivery section with a delivery opening through which the transplant displaced through the bow opening via the additional nozzle can be applied, with the additional nozzle differs from the aforementioned nozzle with regard to the length and/or the cross-section of the discharge section and/or the position and/or the shape of the discharge 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 additional nozzle of the applicator set in order to prevent the in the nozzle and/or the additional nozzle after the cylinder has been emptied to displace the remaining residual transplant from the nozzle or the further nozzle; and a conditioning aid with a base which has a central blind bore which is adapted in terms of its cross-section to the outer diameter of the nozzle of the applicator and/or the further nozzle of the applicator set. At this point, the following should be said about these optional additions to the applicator described above:

The use of a rear filling sleeve for filling the applicator via the rear opening in the cylinder is particularly useful if the applicator is to be loaded with pasty transplants that are kept ready-to-use in glass syringes, for example. Damage to the sensitive glass syringes caused by thoughtless/uncontrolled hitting 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 a first face in the area of the rear opening on the cylinder and has a second face, remote from the first face, which has a contact face for a syringe for filling of the receiving area in the cylinder with the pasty graft. Here, 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 in order to counteract damage to the syringe.

Preferably, the tail filler sleeve further includes a longitudinally split sleeve portion for closely receiving a syringe for filling the receiving area in the barrel with the pasty graft. A clamp connection for the syringe is thus created in a simple manner, which is advantageously also able to compensate for diameter tolerances on the glass syringe and ensures that the syringe is held securely and centered with respect to the applicator during the actual filling process.

As far as the filling aid of the instrument set for the above-described applicator is concerned, it is preferably provided that the rear filling sleeve, viewed along the longitudinal axis, has an opening between the first end face and the second end face that runs transversely with respect to the longitudinal axis, which opens into a transplant passage of the rear filling sleeve and has a predetermined cross section, the filling aid being formed by a pin which has a cross section complementary to the cross section of the opening in the rear filling sleeve. If the applicator is filled with the pasty transplant via the rear opening using a syringe, for example, the pen can be inserted into the side opening of the rear filling sleeve at the end of the filling process in order to pierce or pierce the transplant. Now the syringe can be pulled away from the applicator--possibly after rotating it about its longitudinal axis--without the transplant being pulled out of the receiving area of the cylinder again while adhering to the syringe.

It must be taken into account here that the pasty transplant is not compressed when filling the receiving area via the rear opening in the cylinder in the absence of sufficient counter-pressure - for example because a smaller volume of transplant is released via the syringe than the receiving area in the applicator can accommodate - and for conditioning purposes nor should it be, so that ultimately there is no frictional connection between the transplant and the inner wall of the cylinder delimiting the receiving area, which would counteract the transplant being pulled out with the syringe. In this situation, the filling aid allows for a clean separation of the syringe from the applicator.

With regard to the possible additional nozzles of the instruments for the applicator described above, it should first be said that these are fully compatible with the first-mentioned (main) nozzle of the applicator with regard to their attachment to the cylinder, i.e. in particular the connection section for coupling to the cylinder can be used with all nozzles be identical in design.

1. a) der Länge - länger oder kürzer, um besser bzw. mit einem geringeren Totvolumen in der Düse an die aufzufüllende Fehlstelle im/am Knochen zu gelangen - und/oder
2. b) des Querschnitts des Abgabeabschnitts - dünner oder dicker, je nach dem gewünschten Abgabequerschnitt des auszutragenden Transplantats bzw. wiederum dem in der Düse akzeptierten Totvolumen an Transplantat - und/oder
3. c) der Lage der Abgabeöffnung - mit der Längsachse der Düse bzw. des Applikators ausgefluchtet oder schräg oder quer dazu

und/oder

1. d) der Form der Abgabeöffnung - rund, oval, etc.

unterscheidet, besteht vorteilhaft die Möglichkeit, den Erfordernissen der jeweiligen Operation entsprechend diejenige(n) Düse(n) auszuwählen, mit der/denen die zu behandelnde Fehlstelle im/am Knochen im Volumen (teilweise oder vollständig) und/oder zeitlichen Verlauf (schneller oder langsamer) und/oder hinsichtlich einer bestimmten, definierten Platzierung des Transplantats in der Fehlstelle am besten mit dem pastösen Transplantat aufgefüllt werden kann. Dies kann dann ggf. auch in mehreren Schritten und/oder mit verschiedenen Düsen erfolgen. In analoger Weise sind im Instrumentarium zum vorbeschriebenen Applikator natürlich auch weitere Düsen denkbar, deren Abgabeabschnitt z.B. einen gekrümmten oder abgewinkelten Verlauf aufweist.The fact that further possible (s) further (s) nozzle (s) from the former (main) nozzle of the applicator with regard

1. a) the length - longer or shorter, in order to reach the defect in/on the bone to be filled better or with a smaller dead volume in the nozzle - and/or
2. b) the cross section of the delivery section - thinner or thicker, depending on the desired delivery cross section of the transplant to be discharged or again the dead volume of transplant accepted in the nozzle - and/or
3. c) the location of the dispensing orifice - aligned with, or oblique or transverse to, the longitudinal axis of the nozzle or applicator

and or

1. d) the shape of the dispensing opening - round, oval, etc.

differs, there is the advantageous possibility of selecting the nozzle(s) according to the requirements of the respective operation, with which the defect to be treated in/on the bone can be treated in volume (partially or completely) and/or over time (rapidly or slower) and/or can best be filled with the pasty transplant in terms of a specific, defined placement of the transplant in the defect. If necessary, this can then also take place in several steps and/or with different nozzles. In a manner analogous to the above-described applicator, other nozzles are of course also conceivable in the set of instruments, the discharge section of which has a curved or angled course, for example.

Furthermore, using the plunger of the instrument set for the applicator described above is particularly useful when working with pasty transplants that harden or solidify relatively quickly. Thus, in the course of an operation, immediately following an application process with the applicator described above, the nozzle used can be removed from the cylinder of the applicator and under With the help of the ram, which is pushed with its expulsion section from the front via the discharge opening - only in the case of a discharge opening aligned with the discharge section of the nozzle - but otherwise from behind, starting from the connection section of the nozzle and into the discharge section of the nozzle, which remained in the discharge section of the nozzle Residual graft pushed out and the nozzle cleaned for reuse if necessary, which is preferred. Accordingly, the nozzle can of course also be cleaned at a later point in time with the help of the plunger.

With the plunger of the applicator set, however, it is also possible to hold the nozzle, for example by its connection section, during an operation, so that the discharge opening of the nozzle remains at the possibly only partially filled defect in/on the bone, and then remove the cylinder of the applicator from the To separate the nozzle, to introduce the ram with its expulsion section via the connection section of the nozzle into the discharge section and then, by pressing the handle section of the ram in the direction of the connection section of the nozzle, the residual transplant remaining in the discharge section via the discharge opening of the nozzle to the defect in / to displace by hand on the bone. Such a procedure is useful, for example, when it is necessary to ensure that no transplant is left over during application, either to avoid wasting material or because only a limited amount of transplant is available.

If the tappet is suitably designed with a grip section that is longer than the receiving area of the cylinder, the corresponding procedure can also be followed by not separating the cylinder from the nozzle, but instead unscrewing the turning handle from the cylinder and pulling the piston out of the cylinder before the expulsion portion of the plunger is inserted through the receiving portion of the barrel and into the dispensing portion of the nozzle to expel the residual graft from the nozzle through its dispensing opening. In this variant, the nozzle can advantageously (further) be held via the cylinder with its delivery opening at the defect in/on the bone, so that in the work flow of the operation there is no need to reach around from the cylinder to the connection section of the nozzle, but rather continue to hold the cylinder with one hand can be held while the other hand is used to remove the twist grip and piston from the cylinder before using the ram as described.

Furthermore, the optional conditioning aid of the applicator set serves - as the name suggests - to help in particular with the conditioning of the pasty graft in the applicator. If, for example, the hollow receiving area in the cylinder of the applicator was only partially filled with the pasty transplant from a syringe essentially without pressure, as described above, there is also air in the receiving area of the cylinder in addition to the "loosely" received transplant. Now the conditioning aid is used, which is placed with its base on a surface, e.g. a table, so that the central blind hole in the base is accessible from above.

The applicator is now inserted with the discharge opening of its nozzle first into the blind bore of the conditioning aid, so that the conditioning aid temporarily closes the discharge opening of the nozzle, but not tightly for air, which can consequently escape. Subsequently, to condition the transplant, a liquid such as blood can be injected with a syringe into the receiving area of the cylinder according to the requirements of the respective operation, with the liquid at least partially filling the cavities between the pasty transplant and the cylinder wall. With or after pushing in the piston via 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 liquid can be further distributed around the pasty, essentially incompressible transplant and the resulting mass, which has been mixed to a certain extent the cylinder to be shifted in the direction of the nozzle.

The applicator is filled either by manually pressing it in or—preferably—by moving the piston in the direction of the discharge opening of the nozzle using the rotary handle that has been screwed onto the cylinder in the meantime, until the conditioned transplant is present at the discharge opening of the nozzle. The surgeon can see that the applicator is ready for the application of the transplant by the fact that the liquid used for conditioning, e.g. blood, rises in the blind bore of the conditioning aid, distributed in a ring around the dispensing section of the nozzle, and by touch that the resistance increases noticeably when turning the twist grip out of the cylinder. Now the applicator is ready and can be used to apply the graft.

Of course, the conditioning aid for preparing or preparing the applicator for its use in an operation could also be omitted, in which case a smooth table surface could be used instead of the conditioning aid for temporarily closing the discharge opening of the nozzle, on which the applicator with the discharge opening of the nozzle could be placed will. However, this is less preferred because the liquid for conditioning would escape from the nozzle in a more or less uncontrolled manner. In addition, it cannot be determined in a well reproducible manner whether the applicator is ready for use.

In particular with regard to the reusability, longevity and wear resistance of the applicator, it is finally preferred if at least the cylinder and/or the nozzle of the applicator is/are made of a titanium alloy. Such a material is not only easy to clean and sterilize, but for a metallic material it also has a low weight and very good corrosion resistance, in addition to the other positive chemically inert properties of this material for the intended use here.

character list

• 1A eine perspektivische Explosionsdarstellung eines Applikators für das Applizieren von pastösen Knochentransplantaten nach einem bevorzugten Ausführungsbeispiel der Erfindung, umfassend von links nach rechts in 1A eine Düse zur Abgabe des Transplantats, einen Zylinder mit einer Bugöffnung und einer Hecköffnung, einen über die Hecköffnung in den Zylinder einführbaren Kolben zum Verdrängen des Transplantats über die Bugöffnung sowie einen Drehgriff, wobei Düse und Drehgriff auf den Zylinder aufschraubbar ausgestaltet sind und ein Gewinde zwischen Zylinder und Drehgriff Bestandteil eines Getriebemechanismus ist, der eine Drehbewegung des Drehgriffs in eine Längsbewegung des Kolbens im Zylinder umzusetzen vermag;
• 1B eine perspektivische Explosionsdarstellung eines Applikatorsatzes für das Applizieren von pastösen Knochentransplantaten, hier umfassend den Applikator gemäß 1A, der in einer Befüllkonfiguration ohne Kolben und Drehgriff dargestellt ist, in 1B rechts vom Zylinder eine Heck-Füllhülse zum Befüllen des Applikators über die Hecköffnung im Zylinder, oberhalb von Düse und Zylinder in 1B verschiedene, wahlweise auf den Zylinder des Applikators aufschraubbare, weitere Düsen, unterhalb des Zylinders in 1B an die Düse bzw. weiteren Düsen angepasste Stößel zum restlosen Entleeren der Düsen, unten links in 1B eine Konditionierhilfe sowie unterhalb der Heck-Füllhülse in 1B eine Füllhilfe zum Abscheren des pastösen Transplantats beim Befüllen des Zylinders über dessen Hecköffnung;
• 2 eine Seitenansicht des Applikators gemäß 1A mit aufgeschraubter Düse zur Veranschaulichung der Montage des Kolbens sowie des Drehgriffs nach einer Befüllung des Applikators mit dem Transplantat;
• 3 eine Schnittansicht des Applikators gemäß 1A entsprechend der Schnittverlaufslinie III-III in 2 - ohne Transplantat im Zylinder - insbesondere zur Illustration eines zylinderfesten ersten Gewindeabschnitts und eines drehgrifffesten zweiten Gewindeabschnitts des Getriebemechanismus;
• 4 eine Seitenansicht des Applikators gemäß 1A, bei dem der Drehgriff maximal, d.h. so weit wie möglich auf den Zylinder aufgeschraubt ist;
• 5 eine Schnittansicht des Applikators gemäß 1A entsprechend der Schnittverlaufslinie V-V in 4;
• 6 eine im Maßstab gegenüber der Darstellung in 4 vergrößerte Schnittansicht des Applikators gemäß 1A entsprechend der Schnittverlaufslinie VI-VI in 4;
• 7 eine vergrößerte Darstellung des Details VII in 5, insbesondere zur Veranschaulichung, wie ein aus einem Aufnahmebereich des Zylinders vorstehendes Ende des Kolbens gegen einen Bodenbereich des becherartig ausgebildeten Drehgriffs ansteht;
• 8 eine im Maßstab gegenüber der Darstellung in 1A vergrößerte, perspektivische Ansicht des Zylinders des Applikators gemäß 1A;
• 9 eine Draufsicht auf den Zylinder gemäß 8, mit Blick auf eine den ersten Gewindeabschnitt am Außenumfang des Zylinders unterbrechende Aussparung oder Abflachung, an der eine Skala angebracht ist;
• 10 eine Schnittansicht des Zylinders gemäß 8 entsprechend der Schnittverlaufslinie X-X in 9;
• 11 eine im Maßstab gegenüber der Darstellung in 1B vergrößerte Seitenansicht einer weiteren Düse des Applikatorsatzes gemäß 1B, bei der die Abgabeöffnung zum Applizieren des Transplantats quer zur Längsachse verläuft;
• 12 eine Schnittansicht der weiteren Düse gemäß 11 entsprechend der Schnittverlaufslinie XII-XII in 11;
• 13 eine vergrößerte Darstellung des Details XIII in 12;
• 14 eine im Maßstab gegenüber der Darstellung in 1B vergrößerte, perspektivische Ansicht der Heck-Füllhülse des Applikatorsatzes gemäß 1B;
• 15 eine Vorderansicht der Heck-Füllhülse gemäß 14;
• 16 eine Schnittansicht der Heck-Füllhülse gemäß 14 entsprechend der Schnittverlaufslinie XVI-XVI in 15;
• 17 eine im Maßstab gegenüber der Darstellung in 1A verkleinerte, perspektivische Ansicht des Applikators gemäß 1A ohne Kolben und Drehgriff, aber mit einer Spritze und der im Bereich der Hecköffnung auf dem Zylinder platzierten Heck-Füllhülse des Applikatorsatzes gemäß 1B, in der die Spritze mit ihrem Spritzenzylinder zum Befüllen des Applikators mit dem Transplantat eingesetzt ist, sowie der in einer seitlichen Öffnung der Heck-Füllhülse eingeführten, stiftförmigen Füllhilfe des Applikatorsatzes gemäß 1B;
• 18 eine nach oben im Bereich der Füllhilfe abgebrochene, gegenüber der Darstellung in 17 vergrößerte Seitenansicht des Applikators gemäß 1A in der Befüllkonfiguration entsprechend der 17 mit Spritze und Füllhilfe;
• 19 eine Schnittansicht des Applikators gemäß 1A in der Befüllkonfiguration von 17 entsprechend der Schnittverlaufslinie XIX-XIX in 18;
• 20 eine vergrößerte Darstellung des Details XX in 19, zur Veranschaulichung, wie die Heck-Füllhülse beim Befüllen des Applikators die Spritze vom Zylinder vermittels eines Anschlags für beide Teile trennt;
• 21 eine gegenüber der Darstellung in 19 vergrößerte, im Bereich der Füllhilfe nach links abgebrochene Schnittansicht der Heck-Füllhülse und der Füllhilfe des Applikatorsatzes gemäß 1B, entsprechend der Schnittverlaufslinie XXI-XXI in 19; und
• 22 eine perspektivische Ansicht des Applikators gemäß 1A während dessen Handhabung durch einen Operateur zum Ausbringen des pastösen Transplantats über die Düse - hier beispielhaft in eine Schüssel - wobei der Operateur mit einer Hand den Applikator düsenseitig am Zylinder hält, während der Operateur mit der anderen Hand feinfühlig am Drehgriff dreht, um vermittels des Getriebemechanismus des Applikators den Kolben zum Austreiben des Transplantats über die Düse zu betätigen.

The invention is explained in more detail below on the basis of preferred exemplary embodiments with reference to the attached, partially schematic or simplified drawings. In the drawings show:

• 1A an exploded perspective view of an applicator for the application of pasty bone grafts according to a preferred embodiment of the invention, comprising from left to right in 1A a nozzle for dispensing the transplant, a cylinder with a bow opening and a stern opening, a piston that can be inserted into the cylinder via the stern opening for displacing the transplant via the bow opening, and a rotary handle, the nozzle and rotary handle being designed to be screwed onto the cylinder and a thread between Cylinder and rotary handle is part of a gear mechanism which is able to convert a rotary movement of the rotary handle into a longitudinal movement of the piston in the cylinder;
• 1B a perspective exploded view of an applicator set for the application of pasty bone grafts, here comprising the applicator according to 1A , which is shown in a filling configuration without a piston and rotary handle, in 1B a rear filling sleeve to the right of the cylinder for filling the applicator via the rear opening in the cylinder, above the nozzle and cylinder in 1B Various additional nozzles that can optionally be screwed onto the cylinder of the applicator, below the cylinder in 1B Tappet adapted to the nozzle or other nozzles for complete emptying of the nozzles, bottom left in 1B a conditioning aid and below the rear filler sleeve in 1B a filling aid for shearing off the pasty transplant when filling the cylinder via its rear opening;
• 2 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 the applicator has been filled with the transplant;
• 3 a sectional view of the applicator according to FIG 1A according to section line III-III in 2 - without a transplant in the cylinder - in particular to illustrate a cylinder-fixed first threaded section and a rotary handle-fixed second threaded section of the gear mechanism;
• 4 a side view of the applicator according to FIG 1A , in which the rotary handle is screwed onto the cylinder as far as possible, ie as far as possible;
• 5 a sectional view of the applicator according to FIG 1A according to the section line VV in 4 ;
• 6 one on a scale relative to that shown in 4 enlarged sectional view of the applicator according to FIG 1A according to the line of intersection VI-VI in 4 ;
• 7 an enlarged view of detail VII in 5 , in particular to illustrate how an end of the piston protruding from a receiving area of the cylinder rests against a bottom area of the rotary handle designed like a cup;
• 8th one on a scale relative to that shown in 1A enlarged perspective view of the cylinder of the applicator according to FIG 1A ;
• 9 a top view of the cylinder according to FIG 8th , with a view of a recess or flattened area which interrupts the first threaded section on the outer circumference of the cylinder and to which a scale is attached;
• 10 a sectional view of the cylinder according to FIG 8th according to the section line XX in 9 ;
• 11 one on a scale relative to that shown in 1B enlarged side view of another nozzle of the applicator set according to FIG 1B wherein the delivery port for applying the graft is transverse to the longitudinal axis;
• 12 a sectional view of the further nozzle according to FIG 11 according to section line XII-XII in 11 ;
• 13 an enlarged view of detail XIII in 12 ;
• 14 one on a scale relative to that shown in 1B 12 is an enlarged perspective view of the applicator set's rear filler sleeve 1B ;
• 15 FIG. 12 is a front view of the rear filler sleeve according to FIG 14 ;
• 16 a sectional view of the rear filler sleeve according to FIG 14 according to section line XVI-XVI in 15 ;
• 17 one on a scale relative to that shown in 1A reduced, perspective view of the applicator according to FIG 1A without piston and turning handle, but with a syringe and the rear filling sleeve placed on the cylinder in the area of the rear opening according to the applicator set 1B , in which the syringe is used with its syringe cylinder for filling the applicator with the transplant, as well as the pen-shaped filling aid of the applicator set according to FIG 1B ;
• 18 one broken off at the top in the area of the filling aid, compared to the representation in 17 enlarged side view of the applicator according to FIG 1A in the filling configuration according to the 17 with syringe and filling aid;
• 19 a sectional view of the applicator according to FIG 1A in the filling configuration of 17 according to the section line XIX-XIX in 18 ;
• 20 an enlarged view of the detail XX in 19 , to illustrate how the rear filling sleeve separates the syringe from the barrel by means of a stop for both parts when filling the applicator;
• 21 one opposite the representation in 19 enlarged sectional view of the rear filling sleeve and the filling aid of the applicator set, broken off to the left in the area of the filling aid 1B , according to the section line XXI-XXI in 19 ; and
• 22 a perspective view of the applicator according to FIG 1A while it is being handled by an operator to apply the pasty transplant via the nozzle - here, for example, into a bowl - the operator holding the applicator on the cylinder on the nozzle side with one hand, while the operator sensitively turns the rotary handle with the other hand in order to use the gear mechanism of the applicator to actuate the plunger to expel the graft through the nozzle.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS

In the 1A until 7 reference numeral 10 generally designates an applicator for the application of pasty grafts T (see Fig 22 ) in surgery, such as autologous, allogeneic, xenogeneic or alloplastic, pasty bone grafts. In the exemplary embodiment shown, the applicator 10 comprises only four components, namely from left to right in 1A a nozzle 12, a cylinder 14, a piston 16 and a rotary handle 18. In this exemplary embodiment, the piston 16 and the rotary handle 18 are two separate components, which in principle could also be combined into one component, as already mentioned discussed, so that the applicator 10 would then only comprise three components.

The in the 8th until 10 The cylinder 14 shown individually and made of a titanium alloy delimits 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 here from a plastic material such as polyether ether ketone (PEEK) trained piston 16, such as in particular 3 and 5 until 7 can be seen, introduced into the receiving area 22 of the cylinder 14 via the rear opening 26 and displaced in the receiving area 22 along the longitudinal axis 20 in order 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 in accordance with, in particular, 1A until 5 a connection section 28 for coupling to the cylinder 14 in the area of the front opening 24 of the cylinder 14. The connection section 28 of the nozzle 12 is followed by a delivery section 30 with a smaller diameter and a delivery opening 32, through which the through the front opening 24 of the cylinder 14 the nozzle 12 displaced transplant T can be applied.

The in the 3 and 5 until 7 The rotary handle 18 shown in sectional views, here made of a plastic material such as polyetheretherketone (PEEK), is also operatively connected to the piston 16 in relation to the cylinder 14 . More specifically, for converting rotational movement of rotary handle 18 into longitudinal movement of piston 16 in cylinder 14, a gear mechanism 34 (see in particular Figs 5 until 7 ) provided which has a cylinder-fixed first threaded portion 36 and one with the first thread section 36 cooperating, rotary handle-fixed second threaded portion 38 has.

A special feature of the applicator 10 is that the first threaded section 36 is formed on the outer circumference 40 of the cylinder 14 , while the second threaded section 38 is provided on the inner circumference 42 of the turning handle 18 , which is essentially sleeve-shaped. The rotary handle 18 also has a driving section 44 (cf 3 , 5 and 7 ) for transmitting the longitudinal movement of the rotary handle 18 with respect to the cylinder 14 to the piston 16 caused by the gear mechanism 34 as a result of a rotation of the rotary handle 18 about the longitudinal axis 20 of the applicator 10, as will also be explained in more detail below.

According to in particular the 3 , 5 and 7 the rotary handle 18 is cup-shaped, with a closed, here flat bottom area 46, which as a driving section 44 of the rotary handle 18 can be brought into contact with one end 48 of the piston 16, which protrudes from the receiving area 22 of the cylinder 14. In the exemplary embodiment shown, the length of the piston 16 is dimensioned in relation to the receiving area 22 of the cylinder 14 such that the end 48 of the piston 16 facing away from the nozzle 12 protrudes out of the receiving area 22 of the piston 16 in the cylinder 14, i.e. also then even if the piston 16 according to the 5 has been pushed as far as possible, ie as far as it will go into the cylinder 14, so that the essentially flat other end 50 of the piston 16 facing the nozzle 12 rests against the connection section 28 of the nozzle 12, as in FIG 5 shown.

As well as the best 7 As can be seen, on the side facing away from the front opening 24 of the cylinder 14, the piston 16 has a dome-shaped or crowned overhang 52 at a substantially central point, i.e. in the area of the longitudinal axis 20, on which the base area 46 of the rotary handle 18 is brought to rest can be. It can be seen that as a result of the protrusion of the projection 52 on the piston 16 in the direction of the flat bottom area 46 of the rotary handle 18 in the area of the longitudinal axis 20, only essentially punctiform contact between the rotary handle 18 and the piston 16 is possible. The bearing point created in the simplest way possible makes it easier to turn the rotary handle 18 with respect to the piston 16.

In the 7 It is also best to see that the—otherwise essentially cylindrical—piston 16 is provided with a circumferential recess 54 on its outer circumference at its end 48 protruding from the receiving area 22 of the cylinder 14, which forms an undercut 56. This recess 54 is also in accordance with the 5 The piston 16 inserted at most into the cylinder 14 is easily accessible to the operator when the rotary handle 18 is or has been unscrewed from the cylinder 14, and its undercut 56 serves as a handle with which the operator can manually pull the piston 16 out of the cylinder 14 can.

For cup-like rotary handle 18 is related to the 2 until 7 It should also be noted that in the exemplary embodiment shown, the second threaded section 38 of the gear mechanism 34 which is provided on the inner circumference 42 of the rotary handle 18 and extends completely, ie uninterruptedly, to near the bottom area 46 of the rotary handle 18 . A shorter design of the second threaded section 38, which starts near the open end of the rotary handle 18, would also be conceivable. Due to the long length of the second threaded section 38 selected in the exemplary embodiment, the rotary handle 18 experiences the cylinder 14 or the first threaded section 36 formed thereon Gear mechanism 34 provides better guidance against tilting with respect to the longitudinal axis 20 of the applicator 10.

In addition, the 1A , 2 , 4 and 6 Regarding the rotary handle 18, the rotary handle 18 is provided on the outer circumference in a section close to the bottom area 46 with a plurality of recessed grips 58, which here are evenly distributed over the outer circumference. The recessed grips 58, which in the exemplary embodiment shown 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, particularly in a moist or greasy surgical environment.

More details about the cylinder 14 are in particular the 8th until 10 refer to. Accordingly, the cylinder 14 has on at least one outer longitudinal side(s) (in each case)—in the illustrated exemplary embodiment on opposite sides with respect to its longitudinal axis 20, i.e. two—a cutout 60 or flattening extending along the longitudinal axis 20 of the cylinder 14, which forms the first threaded section 36 on the outer circumference 40 of the cylinder 14 interrupts. As already mentioned, these recesses 60, each forming a flat surface on the cylinder 14, can be used for inscribing the cylinder 14, and they also allow easy cleaning as a result of the interruption of the first threaded section 36 on the outer circumference 40 of the cylinder 14 of the cylinder 14. In addition, the recesses 60 for the Ope rateur a good vulnerability to keep the applicator 10 deployed during an operation.

According to in particular the 1A , 8th and 9 In the exemplary embodiment shown, a scale 62 is attached to the cylinder 14 in the area of the or each recess 60, which scale interacts with an edge area 64 of the rotary handle 18 in order, when the transplant T is being applied, to determine at least one relative measure for the amount of material from the receiving area 22 via the bow opening 24 of the Cylinder 14 displaced graft T to give. For example, this scale 62 can be designed in such a way that during an operation it shows how much transplant T has already been delivered by means of the applicator 10 or how much transplant T is still in the applicator 10 . The distance between two adjacent tick marks, “10” in the example, 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 for the volume of the transplant T that has been delivered.

As can be seen in particular from the 3 and 5 results, the connecting portion 28 of the nozzle 12 is also sleeve-shaped and has for coupling to the cylinder 14 as a third threaded portion 66 a completely circumferential internal thread, which is provided with a according to the 8th until 10 near the nose opening 24 of the cylinder 14 as a fourth threaded section 68 attached to the cylinder 14, also completely circumferential external threads, cooperates in order to attach the nozzle 12 to the cylinder 14 in a detachable manner. As in particular in the 8th and 9 is clearly visible, the thread pairing from the third and fourth thread section 66, 68 (fastening thread) has a different thread pitch than the thread pairing from the first and second thread section 36, 38 (moving thread). In the 1A , 1B , 8th and 9 It is also easy to see that the third and fourth threaded section 66, 68 have the same direction of rotation as the first and second threaded section 36, 38. As a result, when the applicator 10 is actuated, there is no risk that rotation of the rotary handle 18 with respect to the Cylinder 14 in a clockwise direction about the longitudinal axis 20 in order to displace the graft T from the receiving area 22 of the cylinder 14 by means of the piston 16, the nozzle 12 is unscrewed from the cylinder 14.

Like those in particular 1A , 2 and 4 show, the sleeve-shaped connection section 28 of the nozzle 12 is also provided on the outer circumference with a plurality of recessed grips 70 which are distributed over the outer circumference. These recessed grips 70 also serve to improve the operator's grip when the nozzle 12 is screwed onto the cylinder 14, but also when the applicator 10 is held at the connection section 28 of the nozzle 12 during use, as in FIG 22 shown.

The nozzle 12 is finally to be noted that in the illustrated embodiment, in particular according to 3 and 5 in the delivery section 30 of the nozzle 12 the delivery opening 32 for application of the graft T is aligned with the longitudinal axis 20 . However, the dispensing opening 32' can also run or be aligned transversely to the longitudinal axis 20, as is shown in FIGS 11 until 13 for a further nozzle 12' is shown.

As already discussed at the beginning, the applicator 10 described above can be part of an in 1B illustrated applicator set 80 for the application of pasty transplants in surgery, in particular autologous, allogeneic, xenogeneic or alloplastic bone transplants. In 1B is 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 set of instruments with several, different, additional nozzles 12' above the applicator 10, a rear filling sleeve 82 on the right behind the applicator 10, a filling aid 84, two different tappets 86 and a conditioning aid 88 shown below the applicator 10 as further components. 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, to which reference is once again made at this point.

As far as the other nozzles 12' are concerned, like the aforementioned nozzle 12 of the applicator 10, these have a connection section 28' for coupling to the cylinder 14 in the area of the bow opening 24 of the cylinder 14 and an adjoining delivery section 30' with a delivery opening 32'. , via which the transplant T displaced through the bow opening 24 via the further nozzle 12' can be applied. These and other details are in the 11 until 13 for the inside 1B right additional nozzle 12 'shown again in more detail. The recessed grips 70', which are again formed on the outer circumference of the connection section 28', can also be clearly seen here.

According to the respective application requirements, the further nozzles 12' can differ from the nozzle 12 described above with regard to the length and/or the cross section of the discharge section 30' - in 1B Illustrated by way of example are further nozzles 12' of different lengths - and/or the position and/or the shape of the dispensing opening 32' - in the example in FIG 1B are also different positions of the dispensing opening 32' (aligned with or transverse to the longitudinal axis 20, corresponding to Figs 11 and 12 ).

Matching the nozzle 12 and the other 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 handle section 90 and an adjoining expulsion section 92, which is adapted in terms of length and cross section to the nozzle 12 of the applicator 10 and/or the additional nozzles 12' of the applicator set 80, in order to prevent the pressure in the nozzle 12 and/or the respective additional nozzle 12' after the cylinder 14 has been emptied to displace the remaining residual transplant T from the nozzle 12 or the further nozzle 12'. The handle sections 90 of both plungers 86 are equally dimensioned such that 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 tappet 86 in its mounted state on the cylinder 14, as already described at the outset.

Further details on the rear filling sleeve 82, which is made of a plastic such as polyetheretherketone (PEEK), are shown in the separate representation according to FIGS 14 until 16 as well as the 17 until 21 can be seen, which illustrate the use of the Heck filling sleeve 82 and the preferably metallic filling aid 84 when filling the applicator 10 with the transplant T by means of a syringe 94, here in the form of a glass syringe known per se.

The first thing to be said about the rear filling sleeve 82 is that it is adapted for detachable attachment to the cylinder 14 of the applicator 10 in the area 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, a threaded portion 96 matching the first threaded portion 36 on the cylinder 14 being formed on the inner circumference of the rear filling sleeve 82 for detachable 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 until 20 shown.

Furthermore, the rear filler sleeve 82 has a stop 98 on the inner circumference, which in the exemplary embodiment shown is formed by an annular collar with a stepped inner diameter and can be brought into contact with the cylinder 14 with a first end face 100 in the region of the rear opening 26 (cf 20 ) and 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 in FIGS 19 and 20 shown. It can be seen that the rear filling sleeve 82 with its stop 98 separates the syringe 94, more precisely its glass cylinder, from the cylinder 14 of the applicator 10 when the applicator 10 is being filled, so that the syringe 94 cannot strike the cylinder 14.

As in particular in the 14 until 16 and 20 As can be clearly seen, the tail filling sleeve 82 further includes a longitudinally slotted sleeve portion 104 for closely receiving the syringe 94 for filling the receiving area 22 in the barrel 14 with the paste graft T. As a result of the longitudinal slots, the sleeve section 104 of the rear filling sleeve 82 is able to spring up slightly in order 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 above, the filling aid 84 is also 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 has, viewed along the longitudinal axis 20, between the first end face 100 and the second end face 102, an opening 106 running transversely with respect to the longitudinal axis 20, which according to FIG 16 opens into a graft passage 108 of the tail packing sleeve 82 and has a predetermined cross-section. Furthermore, the filling aid 84 is formed by a pin 110 which has a cross section that is complementary to the cross section of the opening 106 in the rear filling sleeve 82 . In particular from the 17 , 18 and 21 It can be seen that the pen-shaped filling aid 84 can thus be inserted into the opening 106 in the tail filling sleeve 82 in order to shear the graft T in the region of the graft passage 108 of the tail filling sleeve 82 .

Finally, there is the conditioning aid 88 1B it can be seen that the conditioning aid 88 has a base 112 which has a central blind hole 114 and can be placed on a table, for example, in the orientation shown. The cross section of the blind hole 114 in the base 112 is adapted to the outside 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 short, an applicator 10 for applying pasty transplants T has a Cylinder 14, in which a piston 16 that 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 and has a delivery opening 32 for applying the displaced graft T. FIG. A gear mechanism 34 is provided for converting a rotary movement of a rotary handle 18, which is operatively connected to the piston 16, into a longitudinal movement of the piston 16 in the cylinder 14, with a cylinder-fixed first threaded section 36 and a cooperating, rotary-grip-fixed second threaded section 38. A special feature here is that the first threaded section 36 is formed on the outer circumference 40 of the cylinder 14, while the second threaded section 38 is provided on the inner circumference 42 of the essentially sleeve-shaped rotary handle 18, which in turn has a driver section 44 for transmitting the longitudinal movement to the piston 16. As a result, improved handling of the applicator 10 compared to the prior art is made possible, which is optimized in particular with regard to a more precisely positioned application of a pasty transplant T with reduced effort. the 22 illustrates in this context how sensitively the transplant T can be deployed by rotating the rotary handle 18 with one hand around the cylinder 14 of the applicator 10 held with the other hand.

reference list

10

applicator

12

jet

12'

another nozzle

14

cylinder

16

Pistons

18

rotary handle

20

longitudinal axis

22

recording area

24

bow opening

26

stern opening

28, 28'

connector section

30, 30'

delivery section

32, 32'

dispensing opening

34

gear mechanism

36

first thread section

38

second thread section

40

outer perimeter

42

inner circumference

44

takeaway section

46

floor area

48

End

50

End

52

Got over

54

recess

56

undercut

58

recessed grips

60

Recess/Flat

62

scale

64

edge area

66, 66'

third thread section

68

fourth thread section

70, 70'

recessed grips

80

applicator set

82

rear filler sleeve

84

filling aid

86

pestle

88

conditioning aid

90

handle section

92

expulsion section

94

Injection

96

threaded section

98

attack

100

first face

102

second face

104

longitudinally slit sleeve section

106

opening

108

graft passage

110

Pen

112

Base

114

blind hole

T

graft

QUOTES INCLUDED IN DESCRIPTION

This list of documents cited by the applicant was generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Patent Literature Cited

• US20180008746A1 [0007]
• DE 102009012437 A1 [0007]
• US 2010/0198140 A1 [0007]
• US20180177609A1 [0009]
• US20180049890A1 [0009]
• US20040215201A1 [0009]
• EP 3305252 B1 [0009]
• US5925051 [0009]
• US20100094307 A1 [0010]
• EP 0955022 B1 [0010, 0011]

Claims (15)

Applicator (10) for applying pasty transplants (T) in surgery, in particular autologous, allogeneic, xenogeneic or alloplastic bone transplants, with a cylinder delimiting a hollow receiving area (22) for the transplant (T) about a longitudinal axis (20). (14) which has a bow opening (24) and a stern opening (26) towards the receiving area (22), a piston (16) which can be inserted via the stern opening (26) into the receiving area (22) of the cylinder (14) and which in The receiving area (22) can be displaced 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 area of the bow opening (24) and has a delivery section (30) with a delivery opening (32) through which the graft (T) displaced through the bow opening (24) via the nozzle (12) can be applied, and one with the piston (16). connected rotary handle (18), wherein a gear mechanism (34) is provided to convert a rotary movement of the rotary handle (18) into a longitudinal movement of the piston (16) in the cylinder (14), which has a cylinder-fixed first threaded section (36) and a first threaded section (36) connected to the first Threaded section (36) has a cooperating second threaded section (38) which is fixed to the rotary handle, characterized in that the first threaded section (36) is formed on the outer circumference (40) of the cylinder (14), while the second threaded section (38) is formed on the inner circumference (42) of the essentially sleeve-shaped rotary handle (18) is provided, which has a driving section (44) for transmitting the longitudinal movement to the piston (16). Applicator (10) after claim 1 , characterized in that the piston (16) and the rotary handle (18) are two separate components. Applicator (10) after claim 1 or 2 , characterized in that the rotary handle (18) is constructed like a cup, with a base area (46) which acts as a driving section (44) of the rotary handle (18) at an end (48) protruding from the receiving area (22) of the cylinder (14). of the piston (16) can be brought into contact. Applicator (10) after claim 3 , characterized in that the piston (16) has on its side facing away from the bow opening (24) of the cylinder (14) at a substantially central point a dome-shaped or crowned overhang (52) on which the base area (46) of the rotary handle ( 18). ) forms. 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 flattened area which extends along the longitudinal axis (20) of the cylinder (14) and which the first threaded section (36) on the outer circumference (40) of the cylinder (14) interrupts. Applicator (10) according to one of the preceding claims, characterized in that the cylinder (14) is provided with a recess (60) on opposite outer longitudinal sides with respect to its longitudinal axis (20), which recess the first threaded section (36) on the outer circumference (40 ) of the cylinder (14) interrupts. Applicator (10) after claim 5 or 6 , characterized in that in the area of the recess (60) a scale (62) is attached to the cylinder (14) which interacts with an edge area (64) of the rotary handle (18) to at least a relative when applying the transplant (T). measure for the graft (T) displaced from the receiving area (22) via the bow opening (24) of the cylinder (14). Applicator (10) according to one of the preceding claims, characterized in that the connection section (28) of the nozzle (12) is sleeve-shaped and for coupling to the cylinder (14) has an internal thread as the third threaded section (66) which is connected to a close male threads attached to the cylinder (14) at the nose opening (24) of the cylinder (14) cooperate as a fourth threaded portion (68) to releasably secure the nozzle (12) to the cylinder (14). Applicator (10) after claim 8 , characterized in that the third and fourth thread section (66, 68) have a different thread pitch than the first and second thread section (36, 38) and/or that the third and fourth thread section (66, 68) have the same direction of rotation as the first and second threaded sections (36, 38). Applicator (10) according to any one of the preceding claims, characterized in that the essentially sleeve-shaped turning handle (18) and/or the sleeve-shaped dete connection section (28) of the nozzle (12) is provided on the outer circumference with a plurality of recessed grips (58) which are distributed over the outer circumference. 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 is transverse to the longitudinal axis (20 ) runs. Applicator set (80) for applying pasty transplants (T) in surgery, in particular autologous, allogeneic, xenogeneic or alloplastic bone transplants comprising an applicator (10) according to any one of the preceding claims and at least one further component from an associated set of instruments a rear filler sleeve (82) adapted for releasable attachment to the barrel (14) of the applicator (10) in the region of the rear opening (26) of the barrel (14), a filling aid (84) for shearing off the pasty transplant (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 connection section (28) for coupling to the cylinder (14) in the area of the bow opening (24) and a delivery section (30) with a discharge opening (32) via which the transplant (T) displaced through the bow opening (24) via the further nozzle (12') can be applied, the further nozzle (12') differing from the aforementioned nozzle (12) in terms of length and/or the cross section of the dispensing section (30) and/or the position and/or the shape of the dispensing opening (32), at least one plunger (86) with a grip section (90) and an adjoining expulsion section (92) which, in terms of length and cross section, matches the nozzle (12) of the applicator (10) and/or the additional nozzle (12') of the applicator set (80) is adapted to remove the residual transplant (T) remaining in the nozzle (12) and/or the additional nozzle (12') after the cylinder (14) has been emptied from the nozzle (12) or the additional nozzle (12 ') to displace, and a conditioning aid (88) with a base (112) which has a central blind bore (114) which, in terms of its cross section, matches the outside diameter of the nozzle (12) of the applicator (10) and/or the additional nozzle (12') of the applicator set (80) is adjusted. applicator set (80) after claim 12 , characterized in that the rear filling sleeve (82) has a stop (98) which can be brought into contact with a first end face (100) in the region of the rear opening (26) on the cylinder (14) and one of the first end face ( 100) has a second end face (102) facing away, 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 ) a longitudinally slotted sleeve portion (104) for closely receiving a syringe (94) for filling the receiving area (22) in the barrel (14) with the pasty graft (T). applicator set (80) after Claim 13 , characterized in that the rear filling sleeve (82), viewed along the longitudinal axis (20), has an opening (106) running transversely with respect to the longitudinal axis (20) between the first end face (100) and the second end face (102) and which in a graft passage (108) of the tail filling sleeve (82) and has a predetermined cross-section, the filling aid (84) being formed by a pin (110) having a cross-section of the opening (106) in the tail filling sleeve (82 ) has a complementary cross-section. 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) are/is formed from a titanium alloy.

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