Global warming and extreme climate events (ECEs) have grown more frequent, and it is essential to investigate the influences of ECEs on vegetation in the Yellow River Basin (YRB) and other environmentally fragile areas. This study was based on data from 86 meteorological stations in the YRB for the period 2000–2020. Twenty-five extreme climate indices (ECIs) were chosen, encompassing four dimensions: extreme value, intensity, duration, and frequency. The trend analysis approach was used to examine the spatiotemporal characteristics of extreme climate conditions. Additionally, geographical detectors and Pearson correlation analysis methods were employed to quantitatively assess the influence of ECEs on the Normalized Difference Vegetation Index (NDVI). The Multiscale Geographically Weighted Regression (MGWR) method was adopted to analyze the regression of twenty-five ECIs. The findings revealed the following: (1) Over the last 21 years, there has been a distinct rise in both the extreme precipitation indices (EPIs) and the extreme temperature indices (ETIs). (2) The spatial distribution of the NDVI throughout the year displayed the characteristic of being high in the south and low in the north. The annual NDVI demonstrated a noteworthy increase at a rate of 0.055/decade, with the enhancement encompassing an extensive area of 87.33%. (3) The investigation revealed that EPIs, including PRCPTOT, R10mm, CWD, R95p, and CDD, had explanatory values surpassing 0.4. This implied that the intensity, frequency, and duration of extreme precipitation played pivotal roles in steering vegetation alterations in the YRB. (4) The correlation between the EPIs and vegetation was greater than the ETIs. Grassland meadows exhibited greater sensitivity to precipitation than woody plants. The EPIs (excluding CDD and SDII) and the ETIs (TXn) displayed a substantial positive correlation with the NDVI in regions hosting grasslands, broadleaf forests, and shrubs. Desert vegetation and cultivated plants were less affected by ECEs. This study underscores the importance of the interplay between extreme climate and vegetation in the YRB. Additionally, it provides a scientific basis for formulating environmental safeguarding strategies.