Amid global climate change, freeze-thaw cycles in cold regions have intensified, reducing the stability of infrastructures and significantly increasing the demand for grouting reinforcement. However, the deterioration in the durability of existing grouting materials under the combined effects of freeze-thaw cycles and low temperatures has become a major technical bottleneck restricting their application in cold regions. This paper focuses on polyurethane (PU) grouting materials with foaming and lifting characteristics, systematically reviewing the research progress and technical challenges associated with their engineering applications in cold regions. First, in terms of material composition and preparation, the core components and modified additives are detailed to establish a theoretical foundation for performance regulation. Second, addressing the application requirements in cold regions, standardized testing methods and comprehensive evaluation systems are summarized based on key indicators such as heat release temperature, impermeability, diffusion properties, mechanical strength, and expansion properties. Combined with microstructural characteristics, the deformation behavior and failure mechanisms of PU grouting materials under freeze-thaw cycles and salt-freezing environments are revealed. At the engineering application level, the challenges faced by PU grouting materials in cold regions-such as inhibited low-temperature reactivity and insufficient long-term durability-are highlighted. Finally, considering current research gaps, including the unclear mechanisms of microscopic dynamic evolution and the lack of studies on the combined effects of complex environments, future research directions are proposed. This paper aims to provide theoretical support for the development and application of PU grouting materials in cold-region geotechnical engineering.