To systematically evaluate the effect of tizanidine hydrochloride combined with rehabilitation training in the treatment of muscle spasm after stroke. Methods: Randomized controlled trials of tizanidine hydrochloride in the treatment of muscle spasm after stroke were searched from China National Knowledge Intemet(CNKI), Wanfang Data medicalinformation system(WF), VIP database, Pubmed, Web of Science, Embase and Cochrane Library databases from the establishment to September 2022. Meta-analysis of the studies that met the inclusion criteria was performed using RevMan 5.4. Results: Nine studies involving 683 patients were included. The results of Meta-analysis showed that the modified Ashworth Scale(MAS) score (WMD=－0.22, 95% CI －0.29～－0.14, P<0.00001) and modified Barthel Index(MBI) score (WMD=2.68, 95%CI 0.10～5.27, P=0.04) in the treatment group were better than those in the control group, but there was no difference in the Fugl-Meyer assessment(FMA) score [WMD=2.14, 95% CI － 0.33～4.61, P=0.09]. In subgroup analysis of different control interventions, compared with rehabilitation training alone, tizanidine can effectively relieve muscle spasm (MAS score: WMD=－0.38, 95%CI －0.48～－0.27, P<0.00001；CSI score: WMD=－2.61, 95%CI －3.30～－1.92, P<0.00001) after stroke and improve the activies of daily living(ADL) (MBI score：WMD=10.48, 95% CI 8.20～12.75, P<0.00001), but has no obvious advantage in improving movement disorders (FMA score：WMD=4.55，95% CI －1.03～10.13, P=0.11). There was no difference in MAS score[WMD=－0.06，95%CI －0.16～0.05, P=0.31), FMA score[WMD=0.82，95%CI (－0.31, 1.96), P= 0.16], MBI score[WMD=0.27，95%CI －0.77～1.32, P=0.61) and clinical effective rate[WMD=2.07, 95%CI 0.97～4.43, P=0.06) between the treatment group(Tizanidine) and the control drug group(Baclofen and Eperisone).The incidence of adverse reactions of tizanidine was lower than that of Baclofen(WMD=0.51，95% CI 0.30～0.88, P=0.02), but not different from eperisone (WMD=1.37, 95% CI 0.52～3.57, P=0.53). Conclusion: Compared with rehabilitation training alone, tizanidine combined with rehabilitation training can effectively reduce muscle tone and improve daily living ability of patients after stroke, while the efficacy is comparable to other oral antispasticity drugs, and the safety is better.