Calcium phosphate cements (CPCs) have been used to treat bone defects and support bone regeneration because of their good biocompatibility and osteointegrative behavior. Since their introduction in the 1980s, remarkable clinical success has been achieved with these biomaterials, because they offer the unique feature of being moldable and even injectable into implant sites, where they harden through a low-temperature setting reaction. However, despite decades of research efforts, two major limitations concerning their biological and mechanical performance hamper a broader clinical use. Firstly, achieving a degradation rate that is well adjusted to the dynamics of bone formation remains a challenging issue. While apatite-forming CPCs frequently remain for years at the implant site without major signs of degradation, brushite-forming CPCs are considered to degrade to a greater extent. However, the latter tend to convert into lower soluble phases under physiological conditions, which makes their degradation behavior rather unpredictable. Secondly, CPCs exhibit insufficient mechanical properties for load bearing applications because of their inherent brittleness. This review places an emphasis on these limitations and provides an overview of studies that have investigated the biological and biomechanical performance as well as the degradation characteristics of different CPCs after implantation into trabecular bone. We reviewed studies performed in large animals, because they mimic human bone physiology more closely in terms of bone metabolism and mechanical loading conditions compared with small laboratory animals. We compared the results of these studies with clinical trials that have dealt with the degradation behavior of CPCs after vertebroplasty and kyphoplasty.

磷酸钙水泥（CPC）具有良好的生物相容性和骨整合性能，已被用于治疗骨缺损和支持骨再生。自1980年代问世以来，这些生物材料在临床上取得了巨大的成功，因为它们具有可模塑甚至可注射到植入部位的独特功能，这些部位通过低温固化反应而变硬。然而，尽管进行了数十年的研究努力，但有关它们的生物学和机械性能的两个主要限制却阻碍了更广泛的临床应用。首先，实现对骨形成动力学进行适当调整的降解速度仍然是一个具有挑战性的问题。虽然形成磷灰石的CPC经常在植入部位保留数年，而没有明显的降解迹象，形成透钙磷石的CPCs降解程度更大。然而，后者在生理条件下倾向于转化为较低的可溶相，这使其降解行为相当不可预测。其次，CPC由于其固有的脆性而不能在承重应用中显示出足够的机械性能。这篇综述着重于这些局限性，并提供了研究的概况，这些研究调查了植入小梁骨后不同CPC的生物学和生物力学性能以及降解特性。我们回顾了在大型动物中进行的研究，因为与小型实验动物相比，它们在骨骼代谢和机械负荷条件方面更接近人类骨骼生理。